Letters
Next chief executive should back annual tobacco tax hike in Hong Kong
Your editorial (“Preventive health care is an investment, not a burden [1]”, January 1) has hit the nail on the head regarding the importance of, and investment in, prevention versus cure in Hong Kong.
We all need the “ambulance and curative services” to rescue us when we are taken ill, but unless the whole of government – particularly the finance, trade and economic branches, as well as the Independent Commission Against Corruption and the Ombudsman – grasps the political nettle of issues such as tobacco control, health will never improve, nor will the many thousands of annual deaths from tobacco be reduced.
Indeed, the entire Hong Kong government is under an international obligation to do so, being a party to the World Health Organisation Framework Convention on Tobacco Control.
One of the most important platforms of any incoming chief executive is their future preventive health plan for Hong Kong citizens.
Let us call upon each of the potential chief executive candidates to outline their health platforms. We should discard all those who see these platforms in terms of more hospital beds, which will never solve the problem of improving Hong Kong’s health. And the current health paradigm is such that improvements will only come about by addressing the vested interests of big business – the tobacco, alcohol, food, and even salt industry –including their often unrecognised front groups.
With tobacco control, we have known for decades what works, and how very cost-effective these measures are. Yet governments around the world hesitate to act.
Increasing tobacco tax heads the list of the best single measure to reduce smoking. It may be surprising to many that a fiscal measure is more important than health education in schools or banning sales to youth, for example, but it is the single best action governments can take to reduce consumption among the young.
Why can Hong Kong not follow Australia and New Zealand and commit to an annual tobacco tax increase of, say, 10 per cent per annum to the year 2025?
Any chief executive candidate who would endorse this would get my (hypothetical) vote.
It would give us an orderly and planned route to follow, and avoid the incredible waste of time and energy lobbying annually for tobacco tax increases. And it would have a massive effect in saving young and middle-aged lives, and in what is termed “frailty avoidance” in the elderly.
Dr Judith Mackay, Clear Water Bay
Vaping: It’s not a safe way to quit smoking
http://www.dl-online.com/opinion/4147107-vaping-its-not-safe-way-quit-smoking
I am a respiratory therapist and tobacco specialist at Essentia Health St. Mary’s Hospital, and I work nearly every day with people struggling to breathe due to smoking cigarettes. It can be very difficult to quit smoking, and I want to offer smokers all the support they can get when quitting.
Unfortunately, I see a growing number of patients who turn to e-cigarettes as a means to quit smoking. That is why I felt I had to write the Detroit Lakes Tribune in response to an article “The End of Vaping?” that may have led some readers to believe that e-cigarettes have been conclusively proven safe and effective as a tool for people to quit smoking. I’d like to offer the following perspective as a local health care professional.
Research shows that the aerosol produced by e-cigarettes contains heavy metals, formaldehyde and other cancer-causing chemicals. E-cigarette aerosol also contains nicotine, the substance in tobacco that addicts smokers.
There is also no conclusive scientific evidence that e-cigarettes are effective for smoking cessation; in fact, quite often, users become addicted to both. If people wish to quit smoking, I encourage them to use evidence based support services and approved cessation aids.
At Essentia Health, we have specialists trained to provide these support services in person and for as long as you would like. Additionally, anyone in Minnesota can call QUITPLAN (1-888-354-7526) to find out about other free and low-cost services available to all Minnesota. Why would anyone want to take a chance on e-cigarettes when we already have tools that are safe and scientifically proven to work?
Also, despite the implication from the retailer in the article, there is no conclusive clinical research, or research of any kind, for that matter, that shows e-cigarettes reverse the symptoms of Chronic Obstructive Pulmonary Disease (COPD). COPD is a debilitating disease that causes permanent damage to lung tissue.
This past summer, the U.S. Food and Drug Administration deemed e-cigarettes a tobacco product, just like cigarettes, cigars, and chewing tobacco. When the deeming regulations are fully implemented in 2019, manufacturers will have to disclose the ingredients in e-cigarette liquid and include the Surgeon General’s warning on all packaging, among many other important consumer protections. This will provide more transparency to consumers and will aid in research about the health effects of e-cigarette use. In the meantime, I urge our community not to be unduly swayed by the self-interested statements of the e-cigarette industry.
(Vickie Lee is a registered respiratory therapist and certified tobacco treatment specialist at Essentia Health in Detroit Lakes)
Op-Ed Response to “Shoddy Research on E-cigarettes Harms Public Health “
From: Bareham David (LCHS)
Sent: 07 July 2016
Subject: Op-Ed Response to “Shoddy Research on E-cigarettes Harms Public Health ” by Lindsay Stroud: Muddle-Headedness on Electronic Cigarettes.
Importance: High
To the Editor,
The recent Inside Sources piece by Lindsay Stroud on E-Cigarettes lacks sound insight into this issue, and the science related. For example, it is highlighted that Ann McNeill argued, regarding the cited Pediatrics piece that:
“Ann McNeill, a professor of Tobacco Addiction at King’s College London, says the study erred by examining teens who had just “tried” e-cigarettes, rather than studying consumers who use the product frequently”
Lindsay Stroud appears unaware that McNeill and colleagues have previously stated, with regard to adolescent nicotine dependence, that:
“There does not appear to be a minimum nicotine dose or duration of use as a prerequisite for symptoms to appear.”
McNeill’s previous work and subsequent opinion appears to justify the utilisation of “ever use” in the Pediatrics paper. It further appears, therefore, that at certain times, it suits Professor McNeill to minimise the risks of very low level exposures to nicotine, but at others, to highlight and magnify them. This somewhat “schizophrenic” relationship with nicotine likely emanates from the Professor’s long-standing affinity to the theory of “Tobacco Harm Reduction”, and a tendency to therefore believe that “all-things e-cigarette” can and will only lead to good, and to oppose the application of Precautionary Principle. These cognitive biases appear to have transitioned to some “muddle-headedness” related to nicotine.
Lindsay Stroud also states: “One of the criticisms of the study is the small sample size. The study relied on only 300 students who identified themselves as “nonsmokers.”
If one is familiar with the evidence base for electronic cigarettes and smoking cessation, then it is widely accepted that the “highest quality” data available currently is the randomized controlled trial by Bullen et al, where the sample size of the experimental group was only: 289. Of these, only 21 were tobacco abstinent at 6 months. These authors themselves state with regard to the scientific robustness of their research:
“Achievement of abstinence was substantially lower than we anticipated for the power calculation, thus we had insufficient statistical power to conclude superiority of nicotine e-cigarettes to patches or to placebo e-cigarettes.”
Therefore, it would certainly be “shoddy” – the descriptor used by Stroud – to read too much, currently at least, into the efficacy of e-cigarettes in assisting adult smokers to quit tobacco on such profoundly weak evidence. It is certainly worth the reader knowing, moreover, that participants in the patches group had to collect a voucher from a chemist before they could obtain their medication: a potentially significant confounder that may have reduced the efficacy data found here.
It is troublesome, moreover, that while Peter Hajek, who is cited in the Inside Sources piece as suggesting that the rate of decline in numbers of children smoking tobacco has never been as great subsequent to E-cigarettes becoming popular on the market, Action on Smoking and Health data for the U.K. demonstrates this to be an erroneous conclusion. The percentage of 15 year old boys and girls regularly smoking tobacco fell from 20% in 2006 to 12% in 2010: before the surge in “interest” in E-Cigarettes.
Stroud also promotes: “the fact these products that are 95% less harmful . . . than normal cigarettes.” This presumption, based on weak methodology and virtually no bioassay data, has very recently been challenged by toxicologists in New Zealand, who argue that long term users of e-cigarettes expose, potentially, to “a substantial level of exposure” of toxicants and subsequent disease, although less than for cigarettes. Other expert toxicologists, Robert Combes and Michael Balls, have therefore argued that the “95% safer” figure, based on current scientific data, is “reckless” to promote.
It is very early days indeed for anyone claiming to advocate an “evidence-based approach” on e-cigarettes to be making sweeping judgements about them: that really would be “shoddy”.
Yours sincerely
David Bareham.
David W Bareham BSc Hons (Physiotherapy) MSc (Pain Management).
Specialist Respiratory Physiotherapist
Lincolnshire Community Health Services NHS Trust
Locality Office
Louth County Hospital
Louth
Ditch tobacco sponsors, health experts warn cultural institutions
1,000 experts sign open letter to London’s leading cultural bodies, including British Museum and Royal Academy, over ‘morally unacceptable’ sponsorship
https://www.theguardian.com/culture/2016/apr/30/arts-institutions-ditch-tobacco-sponsors-health-experts-letter
More than 1,000 healthcare experts, including 57 professors, have signed an open letter calling on some of London’s most respected cultural institutions to abandon their financial links with big tobacco.
The British Museum, the Royal Academy of Arts, the South Bank Centre and the London Philharmonic Orchestra, have long-standing lucrative corporate membership and sponsorship deals with two leading cigarette manufacturers, which are banned from advertising in the UK.
The links have dismayed many in the medical community. “As a doctor specialising in the care of people with emphysema, I see the harm smoking causes every day,” said Dr Nick Hopkinson, reader in respiratory medicine and honorary consultant physician at the National Heart and Lung Institute, who is leading a campaign against the tie-ups.
“Tobacco companies, which rely on getting people addicted to products, which maim and kill, must not be allowed to use arts sponsorship as a way to present [themselves] as respectable.”
Tobacco giant JTI has corporate membership deals with the British Museum, the London Philharmonic Orchestra and the Royal Academy of Arts. JTI pays almost £40,000 a year to the Royal Academy for a premier membership package that sees the company listed in all exhibition catalogues. The company is also a corporate supporter of the Southbank Centre on whose website its logo appears.
British American Tobacco is an associate member of the Royal Academy of Arts and a corporate sponsor of the London Symphony Orchestra.
The Framework convention on tobacco control – to which the UK is a signatory – states that tobacco companies’ investment in corporate social responsibility initiatives should be treated as a form of advertising.
In 2007, Philip Morris International Inc, manufacturer of Marlboro, stopped funding a number of New York art institutions.
In their letter, published in Sunday’s Observer, health experts, including John Moxham, professor of respiratory medicine at King’s College London; Richard Ashcroft, professor of bioethics, Queen Mary University of London; and John Britton, director, UK centre for tobacco and alcohol studies, University of Nottingham; call on cultural organisations to rethink their relationship with big tobacco.
They warn: “Tobacco advertising has now been banned along with sponsorship of sport. However, tobacco companies continue to use sponsorship of some high-profile arts organisations to promote the spurious idea that they are responsible corporate citizens.”
Hopkinson added: “People can’t believe that the galleries, museums, orchestras they love could do this.”
Pressure on the likes of the Royal Academy to drop their links with big tobacco companies comes after BP ended its sponsorship of the Tate after 26 years following anger from environmental groups. The British Museum, National Portrait Gallery and other institutions have also been forced to defend themselves against claims that they accommodated the demands of the oil company, a major sponsor.
In a statement to Hopkinson, Will Dallimore, director of public engagement at the Royal Academy of Arts, said that JTI’s support had “indisputably helped the academy fulfil its endeavours to contribute to the artistic life of the country”.
A spokesman for the London Philharmonic said: “The LPO is grateful to JTI for its support and for providing our organisation with many platforms for us to make classical music more accessible and widen access to the arts.”
A spokesman for the British Museum said: “JTI supports an acquisition fund at the British Museum, which allows us to acquire objects for the museum’s modern Japanese collection. JTI have supported the Museum since 2010. The British Museum is grateful to JTI for their long-term support.”
A spokesman for JTI said: “It seems illogical that in a democratic society like the UK and at a time when funding for cultural and artistic institutions is under pressure, people would want to prevent a legitimate company like JTI from making a contribution to good causes.”
A British American Tobacco spokesman: “Like many other businesses we support art and cultural institutions throughout the UK through corporate memberships. The small amount of corporate memberships we have do not result in our brands being featured anywhere but simply provide the opportunity for our staff, customers and business partners to attend events, concerts and exhibitions alongside other corporate members.”
But Hopkinson suggested that the tobacco firms were using their support for the arts to retain key staff to give themselves a commercial advantage.
“In its annual report, British American Tobacco identifies the difficulty recruiting people because of the industry’s poor reputation, as a risk to its future profits,” Hopkinson said. “Arts sponsorship is one way that the tobacco industry can enable its own employees to deceive themselves about the true nature of what they are doing.”