Monthly Archives: March 2012

France: Plain packaging?

March 12, 2012

The French government has been given a 10 point plan to tackle the country’s high prevalence of smoking, which at 29% is the highest in Europe. The aim is to halve tobacco consumption by 2025.

A report commissioned by the Ministry of Health and delivered to parliament on 1 March calls for a cross department policy to reduce dependence on tobacco in France, to be led by the prime minister. It recommends a new tax on tobacco companies, according to their volume of sales, and ringfencing a portion of tobacco sales taxes to pay for preventive and treatment strategies.

The report also calls for price rises and plain packaging for all tobacco products. The French policy of compensating tobacco retailers for falls in sales should also be abandoned, says the report.

The report is in line with an opinion paper from the French High Council for Public Health, released on 25 January, which recommended increasing taxes on tobacco by at least 10% instead of the average 6% during recent years.

Yves Bur, an MP for Bas-Rhin in Alsace, who wrote the report, told the BMJ that the government’s tobacco strategy over the past decade has been “disappointing,” littered with “contradictory policies.” An antitobacco hardliner, Mr Bur is a member of the Union pour un Mouvement Populaire (UMP), the right wing party of Nicolas Sarkozy.

Despite key measures in recent years, such as a 40% rise in the prices of cigarettes in 2003-4 and a ban on smoking in public places in 2008, smoking among the French population has been rising since 2003 after 20 years of falling prevalence. It rose by 2% between 2005 and 2010 to 29%. In the UK about 22% of adults smoke.

Smoking peaks among 20-25 years olds, with rates of 43% in men in this group and 39% in women. The rates among 15-19 years olds are 27% and 21%, respectively.

“Tobacco kills 60 000 people each year in France, three times more than road accidents. However, fighting tobacco has never been a public health priority,” said Mr Bur.

He added, “The tobacco industry always intervenes to delay measures and decisions. It interferes through politicians and by claiming that tobacco retailers are part of local business which should be protected. Yet tobacco retailers have seen their turnover increase by 35% since 2002 [because of price increases], and since 2003 the state has paid them a total of €1.1bn [£0.9bn; $1.5bn] as compensation for the increase in the price of tobacco. So the state spends money to maintain a pool of smokers.”

Responding to the report, the health minister, Xavier Bertrand, said that he was “more determined than ever” to reduce tobacco dependence.

However, with a presidential election looming on 22 April to 6 May, followed by general elections in June, some politicians may be reluctant to confront the powerful tobacco lobby. On 2 March the French Society of Public Health called for all presidential candidates to take a stand on tobacco control.

Source: BMJ 2012;344:e1647 (March 6, 2012)

Sri Lanka: Pictorial Warnings

March 7, 2012

The government is planning to bring in two important pieces of legislation which when implemented, could result in a significant reduction in tobacco smoking in the country. “The government will bring in laws which would require the industry to include pictorial health warnings on all tobacco packaging and also to ban smoking in all public and work places,” Health Deputy Minister Lalith Dissanayake said during a media workshop organized by the Jeevaka Foundation.

The organizations involved in the fight against tobacco have been urging the authorities to implement the two smoke-free laws, to make the public aware of it’s toll on health and protect non-smokers from second hand smoke.

According to the World Health Organisation (WHO), tobacco use kills one person in every six seconds.

The deputy minister said that amendments to the National Authority on Tobacco and Alcohol Act has been sent to the legal draftsman and was been translated into all three languages.

Dissanayake said that the Health Ministry was expecting the finished document within the next two – three months and then forward it to the perusal of its health committee before presenting it in Parliament for approval.

The deputy minister also noted that Health Minister Maithripala Sirisena was making special efforts to realize this at the earliest.

He said that the government led by President Mahinda Rajapaksa always stood for progressive legislation of this kind, which has the good health of the people at heart, through initiatives such as Mathata Thitha, which aims at weaning the public away from the imbibing of death-inviting intoxicants and other harmful substances.

It is expected that the pictorial warnings would come first which when implemented would require the industry to include graphic warning labels such as deceased lungs, oral cancer, wasted gums, children afflicted due to second-hand smoke etc covering at least 50 percent of the pack, according to NATA chairman Prof Carlo Fonseka.

It would come into effect with the empowerment of Article 11 of the WHO sponsored Framework Convention on Tobacco Control which Sri Lanka has agreed to enact as a party to the FCTC.

Cancer Care Association chairman and National Cancer Institute, Maharagama medical officer Dr Samadi Rajapaksa said that pictorial warnings on packaging’s was one of the most influential modes in communicating risks of tobacco use to users. “Graphic pictorial warnings can be very helpful in decreasing tobacco use by increasing public awareness of its dangers,” he added.

Dr Rajapaksa also pointed out that studies carried out after the implementation of pictorial package warnings in many countries reveal remarkably consistent findings on the positive impact of the warnings in reducing tobacco use.

While welcoming moves to ban smoking in all public places, Dr Rajapaksa said that Public Health authorities worldwide have concluded that there is no safe level to secondhand smoke exposure.

Secondhand smoke has proved to cause lung cancer, heart disease, sudden infant death syndrome, low birth weight and serious respiratory conditions, he said.

He also said that a cigarette contains 4,000 harmful substances with 40 of them having a direct impact on cancer. In Sri Lanka, the doctor says that over 40 percent of cancers are directly related to tobacco use.

Dr Rajapaksa said that he had informed the President on the importance of enacting the above laws and he had received a reply saying that it had been referred to the health minister.

Meanwhile, actor Roshan Ranawana speaking at the workshop attended by journalists representing nearly 40 electronic and print media organisations, said that Sri Lanka had lost many talented artistes prematurely due to tobacco use and alcohol abuse. He urged the young generation to stay away from both.

According to WHO, the leading preventable cause of death, tobacco kills more than five million people every year. One tobacco death occurs every six seconds. Tobacco killed 100 million in the 20th century and if preventable measures are not taken it could kill one billion in the 21st century.

Source: Daily News (March 6, 2012)

US: Judge blocks FDA’s plan for graphic labels on cigarette packs

March 5, 2012

A federal judge has blocked the Food and Drug Administration’s attempt to introduce graphic labels covering half of a cigarette pack. The nine labels – including graphic images of a cadaver with a sewn-up chest, diseased lungs and gums, and cigarette smoke drifting around an infant – were chosen by the FDA in June.

U.S. District Judge Richard Leon ruled Wednesday that the labels violate free-speech rights under the First Amendment. The labels were slated to debut Sept. 22.

“While the line between the constitutionally permissible dissemination of factual information and the impermissible expropriation of a company’s advertising space for government advocacy can be frustratingly blurry, here the line seems quite clear,” Leon wrote.

R.J. Reynolds Tobacco Co. and Lorillard Inc. were among five tobacco manufacturers that filed a lawsuit against the FDA in August challenging the constitutionality of the mandated labels, which also had to cover the top 20 percent of any advertisement.

The FDA has claimed their attempt to change the labels would be the most significant change to cigarette packaging in 25 years.

The opinion follows a Nov. 7 decision by Leon in which he granted the manufacturers’ request for a preliminary injunction in a strongly worded rebuttal of the FDA’s initiative.

The U.S. Justice Department has appealed the preliminary injunction.

“As a matter of general policy, the FDA does not comment on possible, pending or ongoing litigation,” spokeswoman Michelle Bolek said Wednesday.

Leon wrote in November “it is abundantly clear from viewing these images that the emotional response they were crafted to induce is calculated to provoke the viewer to quit, or never to start smoking – an objective wholly apart from disseminating purely factual and uncontroversial information.”

In Wednesday’s 19-page opinion, Leon wrote “the government has failed to carry both its burden of demonstrating a compelling interest and its burden of demonstrating that the rule is narrowly tailored to achieve a constitutionally permissible form of compelled commercial speech.

“The graphic images are neither factual nor accurate.”

Leon said, as an example, the image of the cadaver “suggests that smoking leads to autopsies, but the government provides no support to show that autopsies are a common consequence of smoking. Indeed, it makes no attempt to do so.”

“Instead, it contends that the image symbolizes that smoking kills 443,000 Americans each year. The image, however, does not provide that factual information.”

Matthew Myers, president of the Campaign for Tobacco-Free Kids, said Leon’s ruling “is again wrong on the science and the law.”

“It is incomprehensible that Judge Leon would conclude that the warnings are neither factual nor accurate when they unequivocally tell the truth about cigarette smoking – that it is addictive, harms children, causes fatal lung disease, cancer, strokes and heart disease, and can kill you,” Myers said.

“If allowed to stand, Judge Leon’s rulings would make it impossible to implement any effective warning labels.”

Reynolds said it was pleased with Leon’s ruling.

“We believe governments, public health officials, tobacco manufacturers and others share a responsibility to provide tobacco consumers with accurate information about the various health risks associated with smoking,” said Martin Holton III, executive vice president and general counsel for Reynolds. “However, the goal of informing the public about the risks of tobacco use can and should be accomplished consistent with the U.S. Constitution.”

Leon wrote the FDA has chosen not to use several alternatives offered by the manufacturers “that are easily less restrictive and burdensome for plaintiffs, yet would still allow the government to educate the public on the health risks of smoking without unconstitutionally compelling speech.”

Those include: the FDA increasing its own anti-smoking advertisements beyond the $600 million already committed to a multimedia campaign; and the FDA reducing the label to 20 percent of the packaging and requiring warnings on either the front or back of the packaging.

There has been considerable debate among advocates and health officials, as well as local smokers, about whether the labels would be effective.

For example, an FDA study released in October 2010 found that although the labels may stir the emotions of smokers, they might not cause smokers to quit.

President Barack Obama – who recently became tobacco-free, according to his medical checkup – has weighed in on the label issue since Leon’s ruling, saying cigarette manufacturers “don’t want to be honest about the consequences.”

In January 2010, Judge Joseph McKinley Jr. of U.S. District Court for the Western District of Kentucky ruled tobacco manufacturers could continue to use color and graphics in marketing their products. He also ruled manufacturers can claim a product is safer if it gains approval from the FDA.

But McKinley upheld the majority of the provisions in the Family Smoking Prevention and Tobacco Control Act, which became law in June 2010, including requiring large health warnings on cigarette packs.

Also joining the lawsuit were Reynolds American Inc. subsidiary Santa Fe Natural Tobacco Co. Inc., Commonwealth Brands Inc. and Liggett Group LLC.

Source: Winston-Salem Journal (March 1, 2012)