As reported in News Analysis in the January edition of Tobacco Control, the Dortmund city-owned company Westfalenhallen Dortmund GmbH (Germany) is organising Inter-tabac Asia, a trade fair for the tobacco industry, to be held on the Indonesian island of Bali on 27 & 28 February. An international campaign against the event has attracted support from around the world, and a petition on change.org has been signed by more than 11,5000 people. The Dortmund mayor has indicated he will refuse to receive the petition. Meanwhile, the Bali Governor Made Mangku Pastika has reportedly blocked the fair, drawing praise from the Southeast Asia Tobacco Control Alliance (SEATCA).

On January 10, Pascal Diethelm, President of Swiss NGO OxyRomandie, joined nearly 18 international health organisations and German politicians in sending an open letter to the mayor of Dortmund, the Honourable Ullrich Sierau, urging the cancellation of Inter-tabac Asia 2014. On 23 January, he received a reply from Dr Andreas Weber, from the Marketing and Corporate Communications Department at Messe Westfalenhallen Dortmund GmbH. In it, Dr Weber advises that the trade fair is directed at professional visitiors, and that children and young people are not permitted. He goes on to state: “Tobacco is a legal product in Indonesia, as it is in Germany. Economic stakeholders therefore have a right to a trading platform of this kind, as in any other industry. Messe Westfalenhallen Dortmund GmbH respects all political laws and regulations in countries where it organises trade fairs and will of course continue to do so in the future.”

Mr Diethelm’s response, reproduced in full below, outlines how Messe Westfalenhallen Dortmund Gmbh’s organisation of Inter-tabac likely breaches Germany’s legal obligations under the WHO Framework Convention on Tobacco or Health, as well as the moral and ethical implications of its involvement:

Dear Mr Dr Weber,

Thank you for communicating to us the position of Messe Westfalenhallen Dortmund GmbH concerning the organization of Inter-tabac ASIA 2014 by the city of Dortmund.

Unfortunately, I have to say that your company’s statement misses our point entirely.

The official implication of the municipality of Dortmund in such an event, even indirectly through your company, of which the city of Dortmund is the sole shareholder, clearly violates Germany’s legal obligations emanating from article 5.3 of the Framework Convention on Tobacco Control (FCTC), an international treaty ratified by your country on 16 December 2004. The treaty was also ratified by the European Union on 30 June 2005 and all EU Member States are now Parties to the treaty, which could therefore be also considered as providing a European  legal framework for tobacco control.

The Guidelines on Article 5.3 of the treaty (see attached German translation) indicate to parties how to fulfill their obligations emanating from the Convention. The city of Dortmund breaches several key dispositions of these Guidelines:

–      It violates point 2.1 which states that “Parties should interact with the tobacco industry only when and to the extent strictly necessary to enable them to effectively regulate  the tobacco industry and tobacco products.” The organization of Inter-tabac ASIA by the city of Dortmund can hardly be described as “strictly necessary.”

–      It violates point 3.1, which states that “Parties should not accept, support or endorse partnerships and non-binding or non-enforceable agreements as well as any voluntary arrangement with the tobacco industry or any entity or person working to further its interests.” The organization of Inter-tabac ASIA will inevitably lead the city of Dortmund, via Messe Westfalenhallen Dortmund GmbH, to conclude multiples agreements with the tobacco companies who are exhibitors in the tobacco trade fair.

–      It violates point 4.7, which states that “Government institutions and their bodies should not have any financial interest in the tobacco industry.” By organizing Inter-tabac ASIA, the city of Dortmund has a vested interest in the tobacco industry. The return on its investment is directly linked to the commercial success of its exhibitors, the tobacco companies.

–      It violates point 7.1, which states that “Parties should not grant incentives, privileges or benefits to the tobacco industry to establish or run their businesses.” By facilitating their business in Asia, the city of Dortmund grants privilege and benefits to the tobacco industry.

Your company’s statement misses the point in even a more worrying way. You company does not seem to understand, or even have minimal appreciation, of the ethical and moral implications of the decision of the city of Dortmund to organize a trade fair in Bali aimed at promoting tobacco in Indonesia and Asia.

Currently, tobacco kills 6 million people per year and this toll continues to rise while it is at the same time shifting from the highly developed world to lower income countries. In the 20^th Century, tobacco was responsible for 100 million deaths. If nothing is done to change the course of the tobacco epidemic, the World Health Organization and all public health authorities predict that the number of tobacco deaths will reach 1 billion in the 21th Century.

In Indonesia, where over two-thirds of the men smoke and where the age of initiation of smoking is commonly below 10, the toll caused by tobacco is taking genocidal proportions. Tobacco kills 260’000 Indonesians each year and this number is rising rapidly. Nowhere in the world can we witness a more striking manifestation of what professor Robert Proctor, historian of science at the University of Stanford, calls the Golden Holocaust.⁽¹⁾

In such a context, we were stupefied when we read that your company, Messe Westfalenhallen Dortmund GmbH, and therefore the city of Dortmund, feel comfortable with having contributed to this Golden Holocaust for 30 years, as it claims to have done it “with integrity”. This line of defense evokes some of the darkest memories, having connotations of what Hannah Arendt calls “the banality of evil.”

Fortunately, there are people in this world with a conscience, a high sense of morality and who are prepared to act in conformance with their values. This is the case of our tobacco control colleagues in Indonesia, who, with insignificant means compared to the financial power of the tobacco industry, are fighting with courage and determination to reduce the tobacco epidemic in their country and eliminate the grip tobacco multinationals have on it. Over the recent days, they scored a major victory by rallying the support of the Governor of Mali, Made Mangku Pastika. The Governor has publicly announced his commitment to prevent Inter-tabac ASIA from taking place in his province. He has issued orders that no permit be granted to the tobacco trade fair.

This decision of a man with real integrity sends a clear signal to the city of Dortmund, whose reputation is being tarnished in this affair. Let us hope Mr. Ullrich Sierau listens and learns the lesson and does not miss this opportunity to get better educated in the ethical and moral implications of the tobacco trade.⁽²⁾

The ties between Dortmund and the tobacco industry are indeed highly detrimental to the city’s reputation: a lot of people in the world now know Dortmund mainly through the slogan “Dortmund Kills.” Your company and the mayor should realize that the city’s involvement in Inter-tabac is irremediably doomed – soon or later, Dortmund will have to give up all activities linked – directly or indirectly – to the tobacco industry and comply with the legal requirements of the FCTC. The tobacco issue is not going to fade away – on the contrary, it is now considered a priority risk factor in the global fight against non-communicable diseases.

Today, the FCTC has 177 Parties, covering 90% of the population of the world. Situations where a public institution is in bed with the tobacco industry are no longer acceptable and will be increasingly targeted as aberrations to eliminate. It is illusory to think that Dortmund’s Inter-tabac will escape this worldwide phenomenon. The sooner Messe Westfalenhallen Dortmund GmbH will cut all links with the tobacco industry, the better and less painful the process will be. On behalf of my association, I urge your company and the mayor of Dortmund to do it without delay.

Yours sincerely,

Pascal Diethelm

(1)   Proctor, Robert N. (2012). Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition. Berkeley: University of California Press.ISBN 9780520270169

(2)   For example, see : Deutsches Krebsforschungszentrum (2005). Die Tabakindustriedokumente I: Chemische eränderungen an Zigaretten und Tabakabhängigkeit, Heidelberg (https://www.dkfz.de/…/Tabakindustriedokumente_I.pdf)

Simon Chapman writes for the BMJ blog about the forthcoming advertisements from the US tobacco industry where they must admit to deceiving the public about addiction and health harms.

But as snakes shed their skins only to replace them with more of the same, the global tobacco industry continues its business as usual. A friend teaching in Myanmar emailed me last week describing sales promotion staff for foreign brands openly handing out free cigarettes to children. Indonesia, the world’s fourth largest nation, where smoking by men is almost compulsory and tobacco control policies almost non-existent, is a transnational tobacco industry paradise wallpapered with tobacco advertising by BAT, Philip Morris, and local companies. The industry says ad nauseam that it supports “effective” tobacco control, while continuing to lobby—as if its economic life depended on it—against any law or policy like plain packaging that threatens its bottom line.

Simon Chapman is a Professor of Public Health at the University of Sydney and Editor Emeritus of Tobacco Control. Twitter: @simonchapman6

This video outlines the history of tobacco industry marketing in the US

This story should be required reading for anyone who works for a tobacco company or denies that tobacco causes horrific suffering. The editorial team at Tobacco Control thanks Karen for her bravery and honesty in sharing her very personal story.

Beyond statistics: the hidden face of smoking-related cancer

By Simon Chapman, University of Sydney

The Russian dictator Joseph Stalin infamously said that a single death is a tragedy, a million deaths a statistic. And in tobacco control, there are statistics to die for. Tobacco caused about 100 million deaths last century. But a projected one billion people will die from tobacco-caused disease this century if present trends continue.

The average smoker takes 12.7 puffs per cigarette. A person who starts smoking at age 15, and smokes 20 cigarettes a day for 40 years, will baste the delicate pink linings of their mouth, throat and lungs with a cocktail of 69 carcinogens 3,710,940 times by the time they reach just 55.

Half of long-term smokers die early from a tobacco caused disease, taking an average of ten years off the normal life expectancy. A cigarette takes about six minutes to smoke. So for every cigarette that a person like former Beatle George Harrison – who died from lung cancer at 58 – smoked, they lost more than five times the time it took to smoke them, off the end of their life.

On and on it goes, but statistics on tobacco deaths have become banal for many. People rationalise that life’s a jungle of risks, that feeling fine or seeing longevity in a smoking relative means that they are bullet-proof, and cling to self-exempting beliefs like air pollution causes most lung cancer or that putting on some weight if they quit is more dangerous than smoking.

What is so often missing from these reflections about smoking is any real appreciation of the suffering and greatly diminished quality of life or the years that people can spend living with smoking caused disease.

On many occasions across my career I’ve received unsolicited letters, calls and email from people living with tobacco caused disease. Two in particular stand out.

An articulate 52 year old woman called me a few years ago. Give the “smoking kills” line a rest, she urged:

I’ve smoked for thirty years. I have emphysema. I am virtually housebound. I get exhausted walking more than a few metres. I have urinary incontinence, and because I can’t move quickly to the toilet, I wet myself and smell.

I can’t bear the embarrassment, so I stay isolated at home. Smoking has ruined my life. You should start telling people about the living hell smoking causes while you’re still alive, not just that it kills you.

Then last week, amid publicity on the 50th anniversary of the first historic United States Surgeon General’s report on smoking, an amazingly brave woman, Karen Daniels, wrote to me. Her words moved me to tears and with her permission, you can read them below.

Smoking tobacco causes around 70% of oral and pharyngeal cancers in men, and around 55% in women. In Australia in 2009, 3031 Australian were diagnosed with various head and neck cancers, and in 2010, 1,045 died.

Karen’s story

This cancer is brutal! Treatments are cruel! Daily for six to eight weeks during radiotherapy treatments our head and face is covered with a tight mask and bolted to a slab while radiotherapy is blasted at our mouth teeth jaw face and neck. Damage during and after this treatment is horrendous. Many of us will never speak clearly, swallow or function normally again.

Patients endure tracheotomies inserted in their wind pipe because we cannot breath naturally through our mouth and nose due to swelling and other side effects.

Many people are left with PEG feeding tubes shoved in their stomach for the rest of their lives because they will never swallow normal food via their mouth again. I had a PEG tube for three and a half years. A tube hanging from our stomach is sickening and depressing. Think about never eating another meal or swallowing again! You can’t imagine the never ending physical and emotional hell this particular disease causes.

I was diagnosed in 2007 at 46 years of age. Yes, I smoked for several years. I have endured 12 surgeries since 2007 trying to improve my quality of life.

Almost all my entire tongue, lower jaw, gums and beautiful teeth have been removed and reconstructed because of treatments to remove cancer. Bone was taken from my hip to reconstruct my jaw. Normal function is gone… Permanently. My perfect face is now disfigured.

I have not sat down to a normal meal with friends or family in almost seven years. Those pleasures of socialising, eating at restaurants and dinner parties that everyone regularly attends are history for us. I struggle to control saliva because of oral cavity nerve damage and facial trauma. Sometimes I dribble when I try to speak. I will never kiss again.

My life has been destroyed by this cancer, as has many other wonderful people around Australia. We lose our careers. Relationships fall apart.

We can’t make appointments over the telephone or ask for something over a counter. No one can understand us! We write down questions during appointments because we can’t speak and Doctors don’t understand what we’re saying. That doesn’t work! This is frustrating, humiliating and extremely upsetting.

The aftermath from this disease is debilitating and permanent. Dental issues are painful and relentless, yet the previous Federal Government abolished the Enhanced Care Dental Scheme. This is shameful!

We can’t just pick-up from where we left off. We can’t “do coffee” with friends and chat about our issues like most other cancer patients because we can’t speak or drink as normal. We can’t cover our mouth with a piece of clothing and get on with it. Our face is our identity!

Many smokers say things like “oh well, I’m going to die anyway” or “I could get hit by a bus tomorrow”. Well, from my experience I can honestly say dying immediately would be much easier than the long slow suffering this disease puts patients through. In 2007 while in hospital I had a cardiac arrest because the tracheotomy blocked. Once resuscitated, little did I know I had years and years of pain, ongoing treatments and loss of normal function ahead of me! It’s devastating!

My lower face and mouth has been cut and shut many times. My neck/throat has been dissected twice ear to ear. It’s been a long difficult road! I’ve undergone six surgeries in the past three years trying to improve mouth function and facial appearance. More than likely there’s a few more down the track. I have a wonderful plastic surgeon who genuinely cares!

Karen’s hopes are for more resources to be given to care and support for people like herself. I hope her story stimulates far greater attention to some of the cancers like hers that do not enjoy the publicity of some of the higher profile cancers.

But with so much potential for head and neck cancers to be prevented, I hope too that her unforgettable words will be passed along to anyone still smoking.

Simon Chapman does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

This article was originally published at The Conversation.
Read the original article.