Tobacco Advertising
How Philip Morris is selling regulators on its hot new smoking device
Part 4: Philip Morris executives are traversing the globe to lobby health authorities on the benefits of iQOS, the little machine the tobacco giant says is key to the company’s future. The novel argument: While iQOS uses tobacco, it shouldn’t be categorized as a cigarette because it doesn’t burn the leaf.
https://www.reuters.com/investigates/special-report/tobacco-iqos-marketing/
TOKYO/TEL AVIV/BOGOTA – In Tokyo’s upscale Ginza shopping district, around the corner from the sparkling storefronts of Tiffany & Co and Cartier, shoppers searching for a new device called iQOS can buy it in a boutique behind a glass façade. The store combines a high-tech aesthetic with the feel of an exclusive club: The young woman at the door says a members-only smoking lounge is upstairs.
The device is advertised under the slogan, “This changes everything,” with a hummingbird in fluorescent green and blue floating in midair. From the small “i” of its name when it was rolled out to the minimalist white box it comes in, the iQOS evokes the marketing-and-design savvy of the American technology giant Apple Inc.
But this little machine is sold by the tobacco giant Philip Morris International Inc. And it isn’t a smartphone.
The iQOS is essentially an electronic cigarette that heats – without burning – plugs of tobacco, releasing tendrils of nicotine-laced aerosol. And the world’s largest publicly traded tobacco company by market value, which has spent more than $3 billion in developing new smoking devices, says iQOS is nothing less than its future.
Philip Morris International says the lack of combustion means iQOS produces far lower levels of carcinogens than regular cigarettes. It’s early days, but iQOS is already bringing in piles of cash. The device drove up sales of the company’s new-generation smoking products to nearly $1 billion in the last quarter, from some $200 million just a year ago.
Wowing consumers with the prospect of a less harmful smoke built on flashy technology is essential to iQOS’ rapid success. Consumers,though, aren’t the only target. Interviews with government officials and trade groups reveal how the company is seeking to sell national authorities on the benefits of the device, before regulators can toss up hurdles.
A key objective: convince governments of iQOS’ benefits so they don’t slap the same taxes and restrictions on the device as they do on cigarettes.
Philip Morris is employing a novel argument: The tobacco plugs inserted into the iQOS device shouldn’t be classified as cigarettes because they do not burn or produce smoke. And the device itself, the company says, is an electronic product and so should not be regulated like tobacco.
In Japan, Philip Morris blitzed officials with the science of iQOS to persuade them to classify the device in a way that would lead to a lower tax rate than cigarettes. In Israel, the company flew in an executive to convince a senior health official of the upside of the device. And in Colombia, the health ministry says Philip Morris launched iQOS without seeking the agency’s approval.
The approach is outlined in internal company documents seen by Reuters.
Evidence that iQOS “is ‘not smoked’ is the most critical element,” says a 2014 PowerPoint briefing on iQOS and other new smoking devices.
Reuters has published that document and others in a searchable repository, The Philip Morris Files.
Other traditional cigarette companies, notably British American Tobacco Plc and Japan Tobacco Inc, have launched similar devices. None have reported anything close to the global sales of iQOS.
The iQOS is championed by Andre Calantzopoulos, Philip Morris International’s chief executive, who in media interviews makes the point that he smokes the device. In September last year, Calantzopoulos told investors it was the company’s “aim to become the undisputed leader” of a new tobacco category it dubs “reduced-risk products.” The goal he said, is to have “RRPs” ultimately replace regular cigarettes.
TWITTER ADVICE: A page from a Philip Morris social media training handbook provides guidance on how to engage online users.
Philip Morris now has an application pending at the U.S. Food and Drug Administration for permission to market the device in America as being less harmful than cigarettes.
A Reuters investigation published Wednesday identified shortcomings in the training and professionalism of some of the lead investigators in the clinical trials that underpin the tobacco giant’s application to the FDA. Former Philip Morris employees and contractors described irregularities in those experiments.
The company chose Japan as its first iQOS market, launching in late 2014. If the company could achieve its goals in “priority” markets like Japan, it would provide “good reference points to other countries,” said the 2014 Philip Morris presentation on reduced-risk products like iQOS.
It unveiled the device in an unlikely venue – Nagoya, a city of more than 2 million people on a bay of the Pacific Ocean. Nagoya is close to Toyota Motor Corp’s headquarters, a town of skyscrapers and automotive plants; a place with neither the buzz of Tokyo nor the charm of Kyoto.
At first, business lagged. An internal company review of Asia, dated June 2015, put iQOS sales figures toward the end of the Japan market rundown. It showed iQOS sales dropping about 40 percent from that January to May.
Philip Morris pushed ahead with a national expansion in September 2015. In an in-house newsletter for the Japan operations the next month, Ashok Rammohan, director of reduced-risk products, told employees that “building iQOS will take time and focus as we need to educate LAS” – legal-age smokers.
By early 2016, the buzz surrounding iQOS in Japan was growing, thanks in part to a group of Japanese entertainers. That April, six popular Japanese comedians were on a national TV show when the presenters began to talk about smoking. One of the comedians, Terumoto Goto, a household name, held up a red iQOS.
“It doesn’t release smoke,” he explained. “It’s like steam coming out of my mouth.” The five men sitting around him on the TV set, decorated with bright rainbow stripes, held up iQOS units as well.
Goto said he bought an iQOS because his wife wouldn’t let him smoke cigarettes inside their house and the neighbors didn’t like him standing around and smoking outside.
Toshiyuki Itakura, just behind Goto, chimed in about smoking the device in public: “There doesn’t seem to be any harm.”
Searches on Google for the Japanese word for iQOS spiked that day.
The talent agency that represents Goto and Itakura, Yoshimoto Kogyo Co Ltd, said in a statement: “Our company received absolutely no payment from Philip Morris or affiliated companies” for the appearance. The network that carried the show, TV Asahi Corp, said it did not consult with the tobacco company beforehand.
That promotional bump came during a period when Philip Morris was working to use social media to propel iQOS into the national consciousness.
“That IQOS moment.” “My IQOS way of living.” Those are two of the catchphrases the company’s social media team considered using as catalysts to promote online chatter about the device. The guidance appears in a 2017 online-content strategy paper, marked “confidential,” that cites examples from Japan.
A separate document, a 54-page training handbook for social media teams in 2016, warns that the company’s postings walk a fine line. “Since the law is set up to prevent tobacco companies from promoting their products on social media, and iQOS is a product that uses tobacco, you’ll always be walking through a minefield of sorts,” the document says.
Away from the public eye, Philip Morris employees equipped with pages of scientific findings were lobbying government officials in Japan. They set out to convince regulators to tax iQOS at a lower rate than cigarettes and exempt it from ordinances that ban smoking in public places and restaurants.
Koki Okamoto, a member of the Tokyo Metropolitan Assembly, said the city’s planned public smoking regulations almost certainly will exempt iQOS. “My personal view, as a lawyer, is that there will be reluctance to apply penalties to something without scientific evidence on health hazards,” said Okamoto, a lead for tobacco control issues in the party that won the capital’s elections this July.
To date, Philip Morris is responsible for the majority of the science that has been published about iQOS.
Philip Morris executives say the product is meant only for people who would not otherwise quit smoking. That is inconsistent with where the company has chosen to introduce iQOS.
Industry sales numbers show Philip Morris is selling iQOS almost entirely in countries where cigarette sales are already in decline – in other words, where people are quitting. While the global average for cigarette sales was down 1.9 percent from 2005 to 2016, in 30 countries where iQOS is now sold the drop in sales was about 30 percent, according to a Reuters analysis of industry numbers from Euromonitor International.
Philip Morris said in response that there are more than 180 million smokers in the countries where iQOS has been launched. “Those 180 million people deserve an opportunity to switch to a potentially less harmful product than cigarettes,” the company said.
As the company honed its strategy in Japan – impressing officials with its scientific findings while advocating for lower taxes – it set out to conquer new markets.
More than half a year before iQOS launched in Israel, Moira Gilchrist, a corporate affairs vice president for reduced-risk products, flew into the Holy Land and took a March 2016 meeting with a senior health ministry official to talk about the company’s science.
A few weeks after that meeting, the official, Itamar Grotto, sent a letter to the country’s tax authority saying iQOS was in a new product category exempt from marketing and advertising restrictions on tobacco products. In a later court filing, Philip Morris cited the letter in explaining its decision to launch iQOS in Israel.
Asked why he said iQOS was exempt from tobacco regulations, Grotto told Reuters that the ministry was being cautious after losing a case against e-cigarette companies a few years earlier. Grotto also said he thought at the time that the question of regulating iQOS was “theoretical.” He had understood from Philip Morris that it did not plan to market the device in Israel until it had approval from a European or American regulatory authority, Grotto said.
Told of Grotto’s remarks, Philip Morris said in a statement, “We did not state that PMI would wait for the approval of a foreign regulatory authority.”
In Israel, iQOS has faced obstacles. This March, a group headed by an activist named Shabi Gatenio challenged the health ministry and Philip Morris in the country’s top court over the sale of iQOS without the same marketing restrictions imposed on regular cigarettes. An Israeli tobacco company also challenged the government and Philip Morris in a similar filing.
During an interview in Tel Aviv, Gatenio, 45, marveled at the reach and access of Philip Morris. He said within two and half hours of his filing the court petition, before it had become public, he got a text message from Erez Gil-Har, co-chief executive of Policy Ltd, Philip Morris’ powerful lobbying company in Israel. The message, viewed by Reuters, accused Gatenio of becoming a “tool” in the hands of the local tobacco company – a charge he dismisses.
Gil-Har, who attended the meeting with Grotto and Philip Morris’ Gilchrist, declined to comment. The tobacco company, Dubek Ltd, declined to talk as well.
Before the court could give a final ruling, the health ministry reversed its position and said it would treat iQOS as it does traditional cigarettes. The ministry said it planned to revisit its decision after seeing how the U.S. FDA regulates the product.
The about-turn left Philip Morris scrambling. According to a government official familiar with the matter, Philip Morris hired more than two dozen women for an urgent task: They manually peeled off the old labels from thousands of tobacco-insert packs in a warehouse near Tel Aviv and stuck on new ones with more prominent health warnings. The packs were then released.
Half a world away in Colombia, Philip Morris kicked off its sale of iQOS this March with a large white balloon at a music festival. Emblazoned with “iQOS” in blue and green letters, the balloon was hoisted 20 feet in the air by a crane.
Tobacco advertising and promotion are banned in Colombia, the first country in Latin America to get iQOS. According to a health ministry official, Philip Morris launched iQOS without getting approval from the agency to sell the tobacco inserts in the country as is required by law.
“This is a product which is derived from tobacco and which must have a prior evaluation by this ministry,” said senior health ministry official Jose Fernando Valderrama.
Philip Morris said it is in compliance with Colombian law. The company said it is required to submit the tobacco inserts for health ministry approval following the release of the agency’s tobacco warnings in November each year. Its Colombian affiliate will do so “in the next month,” the company said in a Dec. 7 statement to Reuters.
On a stroll through the capital Bogota a few months ago, iQOS could be seen being sold at the front of a restaurant with bright displays of packs of the tobacco inserts and the hummingbird emblem facing the sidewalk. In a trendy quarter of the city, a large white billboard advertised a coming “iQOS Boutique,” next to a Starbucks and an Apple retailer.
A former Philip Morris employee in Bogota said the company’s position is that because the device itself does not include tobacco, unlike the inserts, marketing restrictions don’t apply to it.
The company confirmed that position, saying iQOS is an electronic device, and “as such, the current tobacco law does not regulate its commercialization as a tobacco product.”
Back in Japan, sales of the device have taken off. Philip Morris says the iQOS tobacco inserts made up 11.9 percent of the Japanese tobacco market in the third quarter, up from 3.5 percent a year ago.
That growth took on additional significance for company revenue in light of the lower tax rates. The iQOS kit retails for about 11,000 Japanese yen, roughly $100. The company said that cigarettes in Japan are taxed at 60 percent, while the iQOS tobacco inserts – priced about the same as a pack of Marlboros – are at 51 percent.
Philip Morris shows no signs of slowing down. Paul Riley, president of the company’s operations in Japan, this January called on Emiko Takagai, who as a former vice health minister is an influential voice on national health policy. They met in Takagai’s seventh-floor office in Tokyo, one decorated with stuffed animals and posters of healthy food groups.
During that conversation, Riley laid out the company’s pitch on iQOS, said Takagai. In documents later sent to her office, Philip Morris said the product reduces the levels of harmful substances by at least 90 percent compared to regular cigarettes.
When Reuters in August interviewed Takagai, a member of the upper house of parliament for the nation’s ruling party, it seemed the tobacco giant’s message was hitting home.
If the company’s scientific claims bear out, she said, “we must make efforts to thoroughly tell people.”
Philip Morris takes aim at young people in India, and health officials are fuming
The tobacco giant is pushing Marlboros in colorful ads at kiosks and handing out free smokes at parties frequented by young adults – tactics that break India’s anti-smoking laws, government officials say. Internal documents uncovered by Reuters illuminate the strategy.
http://www.reuters.com/investigates/special-report/pmi-india/
S. K. Arora spent more than three years trudging through the Indian summer heat and monsoon rains to inspect tobacco kiosks across this sprawling megacity, tearing down cigarette advertisements and handing out fines to store owners for putting them up.
But as fast as he removed the colorful ads, more appeared.
The chief tobacco control officer at the Delhi state government, Arora asked the major cigarette companies to put a stop to the cat-and-mouse routine. In official letters and face-to-face meetings, he told them India’s tobacco control laws barred such public advertising and promotion of cigarettes.
That included the Indian arm of Philip Morris International Inc, the world’s largest publicly traded tobacco company. Early last year, Arora said, he met with a Philip Morris director for corporate affairs in India, a man named R. Venkatesh, and told him the signs were an unequivocal violation of Indian law.
Like other tobacco companies, Philip Morris kept up its ad blitz.
Venkatesh says Philip Morris is doing nothing wrong. In response to questions from Reuters, he said the company’s advertising is “compliant with Indian law” and that Philip Morris has “fully cooperated with the enforcement authorities” on the matter.
But Indian government officials say Philip Morris is using methods that flout the nation’s tobacco-control regulations. These include tobacco shop displays as well as the free distribution of Marlboro – the world’s best-selling cigarette brand – at nightclubs and bars frequented by young people.
In internal documents, Philip Morris International is explicit about targeting the country’s youth. A key goal is “winning the hearts and minds of LA-24,” those between legal age, 18, and 24, according to one slide in a 2015 commercial review presentation.
As with the point-of-sale ads at kiosks, public health officials say that giving away cigarettes is a violation of India’s Cigarettes and Other Tobacco Products Act and its accompanying rules.
Philip Morris’ marketing strategy for India, which relies heavily on kiosk advertising and social events, is laid out in hundreds of pages of internal documents reviewed by Reuters that cover the period from 2009 to 2016. In them, Philip Morris presents these promotions as key marketing activities. In recent years, they have helped to more than quadruple Marlboro’s market share in India, where the company is battling to expand its reach in the face of an entrenched local giant. Reuters is publishing a selection of those documents in a searchable repository, The Philip Morris Files.
The company’s goal is to make sure that “every adult Indian smoker should be able to buy Marlboro within walking distance,” according to another 2015 strategy document.
In targeting young adults, Philip Morris is deploying a promotional strategy that it and other tobacco companies used in the United States decades ago. A study published in the American Journal of Public Health in 2002 found that during the 1990s, “tobacco industry sponsorship of bars and nightclubs increased dramatically, accompanied by cigarette brand paraphernalia, advertisements, and entertainment events in bars and clubs.”
With cigarette sales declining in many countries, Philip Morris has identified India, population 1.3 billion, as a market with opportunity for significant growth. “India remains a high potential market with huge upside with cigarette market still in infancy,” says a 2014 internal document.
According to government data, India has about 100 million smokers. Of those, about two-thirds smoke traditional hand-rolled cigarettes. Tobacco use kills more than 900,000 people a year in India, and the World Health Organization estimates that tobacco-related diseases cost the country about $16 billion annually.
Philip Morris is not alone in using marketing methods that Indian officials say are illegal. The country’s largest cigarette maker, ITC Ltd, uses similar tactics, such as advertising at kiosks. British American Tobacco Plc and Indian state-run companies have large, passive stakes in ITC, which controls about 80 percent of the market.
Tobacco-control officer Arora, a short, mustachioed man with a gruff demeanor, sent a letter to Philip Morris and other tobacco companies in mid-April, giving them until the end of the month to remove all advertisements. “Legal action will be initiated against the company” if it did not comply, he wrote in the letters, copies of which were reviewed by Reuters.
A day after Arora’s deadline passed, he and his team conducted a raid in an affluent area of cafes and coffee shops in New Delhi that showed his letters did not have the desired effect.
On that hot afternoon in May, the team cut down about a dozen advertisements for Marlboro and various ITC brands. As word of the raid spread, worried vendors covered their ads with newspapers or took them down.
One kiosk owner, Rakesh Kumar Jain, removed his Marlboro ads before Arora’s team arrived. Jain said the signs had been put up by Philip Morris representatives. In return, he said, he received free cigarettes each month worth about 2,000 rupees (about $30). Jain knew that putting up the posters was illegal, but they helped improve sales, he said.
About a dozen kiosk owners interviewed by Reuters said that tobacco companies paid them a monthly fee for advertisements and product displays, with the amount determined by factors such as location, volume of business and type of promotional material.
In payment receipts seen by Reuters, Philip Morris’ India unit promised to pay 500 Indian rupees ($7.50) a month to a cigarette seller with a small roadside kiosk in New Delhi for putting up Marlboro ads. The receipts were signed by a company representative.
During the raid, fines were issued to some vendors, many of them repeat offenders, and they were threatened with court action if the ads went up again.
Like Philip Morris, ITC says that it is in full compliance with India’s 2003 tobacco control law. If it wasn’t, the company said in a statement to Reuters, then “the relevant government authorities would have initiated action.”
Since Arora’s threat of legal action in April, there are fewer Philip Morris advertisements outside cigarette shops in the capital. But both Philip Morris and ITC say that advertising inside a shop is allowed.
“Advertisements of tobacco products at the entrance and inside the shops selling tobacco products are clearly and categorically permitted,” ITC said in response to questions from Reuters.
Arora, however, said all advertising is prohibited – “There are no two ways about it,” he insisted – but he can’t start legal proceedings until getting further guidance from the federal government. He has yet to receive an answer.
Federal health officials say in interviews that the ads are out of bounds. Amal Pusp, a director for tobacco control at the health ministry, told Reuters that “there is no confusion”: All advertisements – inside and outside shops – are illegal.
The 2003 law allows tobacco companies to advertise at shops, but subsequent rules issued by the government prohibit it.
“India remains a high potential market with huge upside with cigarette market still in infancy.”
From a 2014 internal Philip Morris document
In 2004, India became one of the first countries to ratify the World Health Organization’s Framework Convention on Tobacco Control (FCTC) treaty. The pact has 181 members and contains a raft of anti-smoking provisions, including tobacco taxes, warning labels on cigarette packs and advertising bans. The country enacted its national tobacco control law the year before ratifying the FCTC, and since then the government has added rules to strengthen the law in line with the treaty’s provisions.
The health ministry published rules in 2005 that banned any display of brand names, pack images or promotional messages. The rule specified that tobacco retailers could only display a 60-by-45 centimeter board, roughly 24 by 18 inches. The sign can have a description of the type of tobacco products sold – such as cigarettes or chewing tobacco – but cannot include any brand advertising and must carry a large health warning.
The health ministry’s rules were challenged in court by a group of cigarette distributors and put on hold by a state-level High Court for seven years. They finally came into force in 2013 on orders of India’s Supreme Court.
The High Court had overlooked the fact that advertisement of tobacco products “will attract younger generation and innocent minds, who are not aware of grave and adverse consequences of consuming such products,” the Supreme Court said in its ruling.
Philip Morris has lobbied against the passing of stricter tobacco control rules by the Indian government. In documents detailing the company’s plans for the biennial FCTC treaty convention in India last November, Prime Minister Narendra Modi emerges as a prime target. A key goal: to pre-empt Modi from taking “extreme anti-tobacco measures” before delegates were to gather from around the world for the treaty meeting, according to a 2014 corporate affairs PowerPoint presentation.
Excerpts from the Philip Morris Files
Reuters reviewed hundreds of pages of internal Philip Morris International documents relating to India. These excerpts show the company’s marketing and lobbying tactics, which are aimed at bolstering the Marlboro brand among young adults and blocking the “enactment of extreme anti-tobacco measures.” Letters from Indian officials detail the government’s efforts to enforce the country’s tobacco control regulations. (Some documents include highlighting by Reuters.)
A slide from a Philip Morris training manual shows the kinds of people the company aims to target for Marlboro sales in India. LAS = legal age smokers.
A slide from a 2014 strategy presentation shows Philip Morris’ goals for marketing Marlboro Red in India. LA-24 = legal age to 24-year-old smokers.
This slide from a 2012 marketing presentation shows where Philip Morris planned to target 18-to-24-year-old smokers in India.
A Philip Morris training manual lays out rules for how those marketing its cigarettes should look. FWP = field work personnel.
Another slide from the Philip Morris training manual includes instructions for company representatives handing out free cigarettes at kiosks as part of brand promotion. (IPM = India Philip Morris; GPI = Godfrey Phillips India; POS = point of sale.)
Kiosk owners in Delhi say that Philip Morris pays them a monthly fee to put up its advertisements. Names have been redacted on this Philip Morris receipt.
Keshav Desiraju, then a senior health ministry official, wrote to state governments in January 2013, instructing them to stop all tobacco advertisements.
In April, S.K. Arora, the chief tobacco control officer in Delhi, warned Philip Morris International in a letter that it could face legal action over its advertising.
An excerpt from a 2013 letter from a health ministry official to state governments shows specifications for the board that can be displayed at shops selling tobacco products. According to Indian law, the board cannot include any brand names. Beedis are traditional hand-rolled cigarettes.
Ahead of the World Health Organization’s global tobacco control treaty meeting in India last November, Philip Morris planned to engage Prime Minister Narendra Modi in an effort to head off new anti-tobacco measures. The slide is from a 2014 corporate affairs document. CoP7 = Conference of the Parties, the biennial treaty meeting.
The company planned to gain Modi’s ear through those close to him. It identified several people in this group, including Commerce Minister Nirmala Sitharaman, Health Minister Jagat Prakash Nadda, and Amit Shah, president of the ruling Bharatiya Janata Party.
Modi and the other politicians didn’t respond to requests for comment. Philip Morris International also didn’t comment on the plan.
The tobacco giant’s efforts to fend off anti-smoking steps have had limited impact so far. Last year, for instance, India ordered manufacturers to cover 85 percent of the surface of cigarette packs with health warnings, up from 20 percent. The rule, which is still being challenged in a state court by the tobacco industry, including Philip Morris’ India partner, was implemented by order of the Supreme Court.
Marlboro has just a 1.4 percent share of the almost $10 billion cigarette market in India. The industry is dominated by ITC, which has a strong grip on distributors and retailers.
One major method Philip Morris is deploying to gain ground, the marketing documents show, is the free distribution of cigarettes at bars and nightclubs – known as Legal Age Meeting Points, or LAMPs, in company jargon. The hiring of young women and men to work at these gatherings is outsourced to event management companies, according to people with knowledge of the gatherings.
Some of the recruiting takes place online. “Hey girls…We are searching A++ Hot & Gorgeous girls for the Marlboro pub activity…Pay: 2000/day…Work: Promotion in clubs in Delhi,” read one post on a Facebook public group in June last year. There was no company name attached to the ad.
At several parties attended by Reuters in Delhi and Mumbai, young women dressed in the colors of the latest Marlboro variant handed out packs of cigarettes. During one party at a nightclub in a Delhi hotel, a young woman walked around with a tablet showing an ad that highlighted Marlboro features. A television screen played a video promoting the brand: “For trendsetters, for forward thinkers, a smooth and balanced smoking experience.”
In many ways, it was right out of the Philip Morris 1990s playbook. The American Journal of Public Health study, drawing on previously secret industry documents, found that Philip Morris ran bar promotions in 1990 using racing jackets, and added “neon message boards and cocktail trays” in 1991. The study described methods for collecting names for a company database “to generate smoker profiles, direct mailing campaigns, and conduct telephone research studies after the bar events.”
At the parties in India, people who took the Marlboro packs were asked their names, ages and preferred brands. Philip Morris calls this distribution of free cigarettes “sampling,” which it says in an internal document is allowed under the law.
The company has spent millions of dollars on these activities. In 2014, for example, Philip Morris estimated it spent $1.6 million on LAMP events and sampling at kiosks in India, according to the 2015 commercial review presentation.
The company planned to use LAMPs in 2015 to generate 30,000 “trials,” or samplings of cigarettes. And it planned to generate another 500,000 trials that year through sampling at cigarette shops and kiosks, according to the 2015 strategy document.
The company instructs employees to watch their words. An undated training manual for market researchers says: “Do not say this is a ‘PROMOTION’ or ‘ADVERTISING’.”
Indian health ministry officials say that anyone who hands out free cigarettes, whatever the circumstances, is breaking the law.
The Health Ministry’s Amal Pusp says the law against distribution of free cigarettes is unambiguous. He cites Section 5 of the country’s tobacco control act, which says: “No person, shall, under a contract or otherwise promote or agree to promote the use or consumption of” cigarettes or any other tobacco product. The law carries a fine of up to 1,000 rupees (about $15) and a sentence of up to two years in prison for a first conviction.
“We believe we market our products in a responsible manner, and in compliance with Indian regulations,” Philip Morris’ Venkatesh said, without elaborating.
In October last year, the month before India was due to host delegations from around the world at the biennial FCTC tobacco control conference in Delhi, tobacco-control officer Arora said he suddenly started getting traction.
The cigarette ads vanished and Delhi was “cleaned,” he said.
That success couldn’t have come at a better time for Arora and his colleagues at the federal health ministry: They wanted to make sure foreign delegates visiting India saw the country was serious about its tobacco regulations.
Weeks after the FCTC delegates left town in November, however, kiosks in the capital were again displaying ads for Marlboro.
STOREFRONT ADS: Marlboro advertisements can be seen on this kiosk in a marketplace in New Delhi in April. Despite warnings from health officials, Philip Morris has continued to advertise its Marlboro cigarettes. REUTERS/Adnan Abidi
Additional reporting by Aditi Shah in New Delhi, and Abhirup Roy and Swati Bhat in Mumbai.
The Philip Morris Files
By Aditya Kalra, Paritosh Bansal, Tom Lasseter and Duff Wilson
Design: Troy Dunkley
Photo Editing: Tom White and Altaf Bhat
Edited by Peter Hirschberg
Ban on display of tobacco products to take effect on Aug 1 as grace period ends
After a one-year grace period, the ban on displaying cigarettes and other tobacco products in stores will take effect on Aug 1, the Ministry of Health (MOH) reminded in a news release on Tuesday (Jul 18).
http://www.channelnewsasia.com/news/singapore/ban-on-display-of-tobacco-products-to-take-effect-on-aug-1-as-9041262
Retailers must keep the tobacco products in plain, undecorated storage devices, and out of customers’ direct line of sight.
“Existing display cabinets can be modified to one that is permanently fixed, self-closing and opaque,” said the ministry. “Alternatively, new storage units that meet the same requirements can also be constructed.”
Laws to ban the display of tobacco products were passed in Parliament last March, under amendments to the Tobacco (Control of Advertisements and Sale) Bill. It is part of MOH’s efforts to discourage smoking, particularly among younger people in Singapore.
Under the regulations, the point of sale will remain fixed at the cashier, to reduce the accessibility of cigarettes to youths and non-smokers.
In addition, a text-only price list based on a template prescribed by MOH may be shown to customers only at their request.
Retailers convicted of flouting the ban face a maximum jail term of six months, a fine of up to S$10,000, or both. The penalties are double for repeat offenders.
Why Smoking in Films Harms Children
We want to believe we’re raising our kids to think for themselves, and not to do dumb or unhealthy things just because the cool kids are doing them.
https://www.nytimes.com/2017/07/17/well/family/why-smoking-in-films-harms-children.html
But research shows that when it comes to smoking, children are heavily influenced by some of the folks they consider the coolest of the cool: actors in movies.
“There’s a dose-response relationship: The more smoking kids see onscreen, the more likely they are to smoke,” said Dr. Stanton Glantz, a professor and director of the University of California, San Francisco, Center for Tobacco Control Research and Education. He is one of the authors of a new study that found that popular movies are showing more tobacco use onscreen.
“The evidence shows it’s the largest single stimulus,” for smoking, he said; “it overpowers good parental role modeling, it’s more powerful than peer influence or even cigarette advertising.”
He said that epidemiological studies have shown that if you control for all the other risk factors of smoking (whether parents smoke, attitudes toward risk taking, socioeconomic status, and so on), younger adolescents who are more heavily exposed to smoking on film are two to three times as likely to start smoking, compared with the kids who are more lightly exposed.
Those whose parents smoke are more likely to smoke, he said, but exposure to smoking in movies can overcome the benefit of having nonsmoking parents. In one study, the children of nonsmoking parents with heavy exposure to movie smoking were as likely to smoke as the children of smoking parents with heavy movie exposure.
To Dr. Glantz, and the other people who study this topic, that makes smoking in movies an “environmental toxin,” a factor endangering children.
“There’s no excuse for continuing to have smoking in movies that are rated to be sold to kids, and so the policy objective we have is there should be no smoking in movies that are rated for kids,” said Dr. Glantz, who maintains a website called Smoke Free Movies. “The studios have it in their power to fix this with a phone call.” The rating system needs to start treating smoking like a proscribed obscenity, he said; if it’s in the movie, the movie gets an R rating.
The Centers for Disease Control and Prevention’s fact sheet on smoking in the movies estimates that taking smoking out of films rated for children would save 18 percent of the 5.6 million young people alive today who will otherwise die of tobacco-related diseases – a million lives. “There’s nothing you could do that would be so cheap and save so many lives,” Dr. Glantz said.
This has been studied in 17 different countries, he said, and though policies vary widely and cultures are very different, the results are remarkably similar. “You consistently see this two to three times risk in kids who are exposed to a lot of onscreen smoking, all over the world.”
Five years ago, the people who worry about the impact on the young of seeing smoking in the movies thought things were looking good. In movies rated for a young audience (that is, G or PG or PG-13), there had been a steady drop in the number of “onscreen tobacco incidents.” Not only that, but in 2012, convinced by a heavy array of scientific evidence, the Surgeon General issued a report saying explicitly that seeing people smoke in movies caused kids to start smoking: “longitudinal studies have found that adolescents whose favorite movie stars smoke on screen or who are exposed to a large number of movies portraying smokers are at a high risk of smoking initiation.”
But after 2010, despite the accumulating evidence, the rate of cinematic smoking started to rise in those youth-rated movies, according to the new study, published this month in the C.D.C.’s Morbidity and Mortality Weekly Report, which looked at incidents of tobacco use in top-grossing movies from 2010 to 2016.
As far as movies rated G, PG, and PG-13, “When we compared 2010 to 2016, there was a slight decrease in the number of movies, but an increase in the number of incidents,” said Michael Tynan, a public health analyst in the office on smoking and health at the C.D.C., and the lead author of the new study. Dr. Glantz is also an author, and he and two of the four other authors have received grants from the Truth Initiative, an antismoking group.
The number of times that an actor used a tobacco product in a top-grossing movie “increased 72 percent among all movies and 43 percent among PG-13 movies,” Mr. Tynan said. In other words, he said, by 2016 there were “more tobacco incidents concentrated in fewer movies.”
One out of every four movies rated for youth today continues to feature tobacco use, Mr. Tynan said, “and we know this is harmful to youth and causes youth to start using tobacco.”
And the policies that the studios have in place, which seemed to be working as of 2012, are clearly not sufficient, Mr. Tynan said. “The frequency of tobacco use in PG-13 movies is a public health concern.” So what should be done? “One change is to rate movies with tobacco use with an R rating,” he suggested. Other steps that might help would be to have studios certify that there was no paid product placement, and to end the use of any actual tobacco brands on the screen. All of these strategies are supported by the American Academy of Pediatrics, which has issued a statement calling the new study “alarming.”
In a study done back in the ’90s, researchers pointed to some of the differences between who smokes on screen and who smokes in the real world. In the real world, smokers are likely to be “poor people, people with mental illness,” Dr. Glantz said. “If you look at the power players, the rich people, people who are in control, they’re not smoking.” But in movies, it tends to be more desirable or powerful characters, even if they’re the bad guys, and in that way, movie images may reinforce images in cigarette advertising.
And movie images are powerful. In one experiment, young people who were smokers were shown montages of clips from recent movies; the participants were randomized so that some saw clips with smoking in them and some did not. Then they were given a 10-minute break, and the people who saw the smoking images were significantly more likely to smoke during the break than the smokers who had not seen the images.
“Keeping smoking onscreen is like putting arsenic in the popcorn,” Dr. Glantz said. The new study “shows they’ve taken half of the arsenic out,” he said. “Now they need to take the rest out.”
Inside the murky world of Nairobi’s smoking zones
The Kenyan government has cracked down on cigarettes with a ban on advertising and smoking in public, driving the habit into the shadows
https://www.theguardian.com/world/2017/jul/12/nairobi-kenya-smoking-zones-cigarette-crackdown
There is a wooden shed in the middle of Nairobi city centre, dark, full of fumes, crowded and deliberately built beside the public toilets. It feels like a place of shame.
Jairus Masumba, Nairobi County’s deputy director of public health, calls it in jest the gazebo. It’s the public smoking place, created by his department. It is claustrophobic and filled with smoke, some of which drifts out through slats, but most of which hangs heavily in the fugged air inside.
Those who enter have to be desperate – and they’re usually men. A 27-year-old woman, who comes from the south of Kenya, is a rarity. She is heavily made-up and stands in the doorway. She smokes seven to 10 cigarettes a day. “It’s bad for you, no?” she says several times, though she knows the answer.
The men inside, barely visible as you enter because of the darkness and the fug, are smoking hard, standing up like a football crowd, all facing the same way though there is nothing to look at except the wooden slats of the far side of the shed. Music blares but nobody is dancing. They are grim faced, doing what they have to do. A young man, high probably on khat and cigarette in hand, chases some of the butts and the ash out with a broom, seeking money from the other smokers for cleaning up. He says he has a diploma in business marketing and another diploma in substance abuse counselling.
At the door are two cigarette sellers, doing a busy trade. It’s rare for anyone to buy whole packets. Packs of cigarettes in Kenya are broken up and sold by vendors as single sticks. That makes them cheap for women, children and the poor, despite manufacturers being banned from producing packets of less than 10. One of the two sellers sitting passively inhaling smoke is a woman who taps a packet of 20 and shakes them deftly out, one at a time, exchanging them for small coins. Men buy one, sometimes a couple, sometimes three. They will not all be smoked here. The sellers sit at the large red wooden boxes, with open lids that become the display cabinet. Most popular and cheapest is Sportsman at 100 shillings a pack (75p, 97 cents) or 5 shillings (less than 4p, 5 cents) for a single. Smokers buy sweets too, to take away the smell of tobacco when the worker goes back to the office.
The shed is vile, but few dare smoke even on the pavement outside in the cleaner air in the knowledge that the plain clothed official public health enforcers will be circling, ready to impose fines on anyone they catch. Nairobi city has got tough on smoking. The Kenyan government has banned advertising and marketing and smoking in public places, but it is up to the individual counties to interpret and enforce that and they all do it differently. Nairobi County has cracked down hard. Lighting up on the open street in the city centre can result in a stiff fine of 50,000 shillings (£374, $485) or even arrest. But it’s not so everywhere, or even outside of the city centre.
Yusef, 58 and from Kenya’s second city, Mombasa, on the Indian Ocean coast, says people smoke openly in Mombasa. He has been smoking since the 1970s. His 28-year-old daughter died recently from colon cancer. That gives him a different perspective. “I’m more worried about GM foods,” he says.
Nairobi’s Uhuru Park is just under the nose of the ministry of health and has two small designated open-air smoking areas. On a Saturday, young women who are not smoking are there laughing and chatting with the young men who are. It’s somewhere to hang out. Elsewhere in the park, the same snack stalls proliferate. After 5pm, when the official public health enforcement officers go home, vendors and smokers relax. Cigarettes are sold and smoked openly.
Outside of the city centre, the restrictions do not appear to be enforced at all. In the High Ridge residential area, a predominantly Indian community, stall holders are grilling corn and frying cassava crisps on the street. Others run the small stalls selling sweets, biscuits, fizzy drinks and cigarettes, openly smoking themselves. People wander along the road with a cigarette between their fingers. A large lorry stops and a man jumps down to buy two sticks, lighting both and passing one to his fellow labourer before they unload.
These stalls are common near schools. A recent report compiled by the Consumer Information Network, a campaigning Kenyan anti-tobacco organisation, with Johns Hopkins University in the US, found such stalls selling sweets and single cigarettes within yards of primary schools across the country.
You won’t see an advert for Dunhill or Rothmans in Kenya. At least, nothing that looks like an advert. Advertising and promoting cigarettes has been banned. But everybody knows what the large red wooden boxes and red wooden display trays at stalls at the side of roads contain. Red is the colour of British American Tobacco (BAT). The words have been stripped off the red umbrellas that protect street vendors from the sun or patched over, but the colour is a tacit reminder of what they used to say and what is still sold there.
BAT said its products were for adult smokers only and that it would much prefer that stalls sold whole packets rather than single sticks, “given our investment in the brands and the fact there are clear health warnings on the packs.
“Across the world, we have very strict rules regarding not selling our products to retailers located near schools. BAT Kenya provides support to many of these independent vendors, including providing stalls painted in non-corporate colours, and providing youth smoking prevention and health warnings messages. We also educate vendors to ensure they do not sell tobacco products near schools.
“We are a company that takes its responsibilities very seriously, and we are naturally keen to look further into any instances that are brought to our attention, so we can take action if necessary.”
Pictures and video by David Levene. Multimedia editing by Ekaterina Ochagavia.
Tobacco: a deadly business – about this series
This series is focused on the damage caused by the tobacco industry, which continues to endanger the lives of millions of the world’s most vulnerable people
https://www.theguardian.com/world/2017/jul/11/tobacco-a-deadly-business-about-this-series
This content is funded by support provided, in part, by Vital Strategies with funding by Bloomberg Philanthropies. Content is editorially independent and its purpose is to shine a light on both the tobacco industry and the world’s most vulnerable populations, who disproportionately bear the brunt of the global health crisis resulting from tobacco consumption.
Although tobacco consumption remains one of the world’s greatest health threats, media coverage has decreased as the sense of urgency to address the issue has waned. This investigative reporting series seeks to renew the focus on tobacco consumption and deaths worldwide, contextualised through the duel lenses of global inequality and health.
All our journalism follows GNM’s published editorial code. The Guardian is committed to open journalism, recognising that the best understanding of the world is achieved when we collaborate, share knowledge, encourage debate, welcome challenge and harness the expertise of specialists and their communities.
Unless otherwise stated, all statements and materials posted on the website, including any statements regarding specific legislation, reflect the views of the individual contributors and not those of Vital Strategies and/or Bloomberg Philanthropies.
Russian showpieces to be tobacco-free events
This year’s FIFA Confederations Cup and next year’s FIFA World Cup™ will be tobacco-free events. FIFA and the Local Organising Committee (LOC) confirmed this on Wednesday 31 May, as World No Tobacco Day is celebrated across the world in conjunction with the World Health Organisation (WHO).
http://www.fifa.com/confederationscup/news/y=2017/m=5/news=russian-showpieces-to-be-tobacco-free-events-2890503.html
This decision is based on FIFA´s long-standing commitment to counter the use of tobacco and its negative impacts, which started in 1986 when FIFA announced it would no longer accept advertising from the tobacco industry.
“FIFA has banned smoking at FIFA World Cups since 2002 in order to respect and protect people’s Human Rights as a part of FIFA´s social responsibility commitment,” said Federico Addiechi, FIFA’s Head of Sustainability & Diversity. “FIFA´s Tobacco-Free Policy for FIFA Tournaments ensures that those who choose to, may only use tobacco products in designated areas, if in existence, to ensure that it does not harm others. The policy protects the right of the majority of the population, who are non-smokers, to breathe clean air that is not contaminated by carcinogens and other harmful substances in tobacco smoke and e-cigarettes.”
“All our actions in preparing for the tournament are taken in strict compliance with the Sustainability Strategy,” said Milana Verkhunova, Director of Sustainable Development at the Russia 2018 LOC. “One of the objectives in this area is to create a tobacco-free environment at all World Cup stadiums and FIFA Fan Fests.
“Creating a tobacco-free environment at all World Cup stadiums and FIFA Fan Fests is a very important objective of the 2018 FIFA World Cup Sustainability Strategy”, said Milana Verkhunova, Director of Sustainability Department at the Russia 2018 LOC. “In order to fulfill this task, we actively interact with the World Health Organization, the Ministry of Health, the expert community, host cities, stadium operators, the World Cup ambassadors and fans, as well as with the Russian Football Union. We hope that by joint efforts we will be able to contribute to the reduction of tobacco consumption in Russia.”
Here, FIFA.com highlights the key dates in FIFA’s work towards smoke-free sporting events.
1986: FIFA announces it will no longer accept advertising from tobacco-industry sponsors.
1999: At the FIFA Women’s World Cup™ in the USA, FIFA supports an anti-smoking campaign launched by the U.S. Department of Health and Human Services (HHS).
2002: FIFA supports a smoke-free campaign launched by WHO and the HHS. World football’s governing body is consequently bestowed with the WHO Director General’s Award for an anti-smoking campaign.
2002: Korea/Japan becomes the first smoke-free FIFA World Cup, meaning it has no links whatsoever to tobacco. Every FIFA World Cup since has followed suit.
2010: FIFA, the LOC and other stakeholders develop and adopt the ‘Stadium Code of Conduct’, which describes the applicable measures and policies for stadium visitors and staff, including prohibition of smoking in the stands and around the pitch.
2011: FIFA provides input to the European Healthy Stadia Network for policy position and enforcement guidelines for UEFA, concerning a smoke-free UEFA EURO 2012.
2013/2014: The FIFA Confederations Cup and World Cup in Brazil take place as tobacco-free events.
2015: World No Tobacco Day celebrated as ‘World Smoke Free Day’ at the FIFA U-20 World Cup New Zealand 2015
2017/2018: The FIFA Confederations Cup and the FIFA World Cup in Russia will both be tobacco-free events.
Health Ministry sued over soft treatment of iQOS
Dubek, a manufacturer and importer of tobacco products, sued the Health Ministry for showing favouritism by allowing Philip Morris International to skirt advertising restrictions in marketing iQOS, the Jerusalem Post said.
http://www.tobaccojournal.com/Health_Ministry_sued_over_soft_treatment_of_iQOS.54143.0.html
Health Minister Ya’acov Litzman reportedly is waiting to see how US regulators deal with the tobacco heating device. In the meantime, iQOS is being sold and marketed without restriction in Israel. In its complaint to the High Court of Justice, Dubek said this discriminated against its tobacco products, which face restrictions, the Post said.
Commentary: Smoking is an archaic habit with no place in modern society
The move to raise the legal age for smoking gives a much needed boost to Singapore’s efforts at reducing the prevalence of smoking among youths.
http://www.channelnewsasia.com/news/singapore/commentary-smoking-is-an-archaic-habit-with-no-place-in-modern/3584938.html
Shocking as it sounds, many doctors used to smoke.
The groundbreaking study which first confirmed the link between smoking and lung cancer was carried out on British doctors in the early 1950s. UK Medical Research Council member Sir Richard Doll, who conducted the study chose doctors as his research participants because many of them smoked, and it would be easier to observe what happened to them as a result of smoking.
Within three years of observation, 37 died from lung cancer. All were smokers. The number of deaths rose to 70 after five years. His work provided strong evidence of the dangers of smoking and laid the groundwork for future public debates about smoking
Since then, governments around the world have put in place policies and programmes to stop people from picking up the habit and help smokers kick theirs. For instance, the United States introduced the tobacco advertising ban and tax in the 1960s.
Singapore became the first Asian country to ban tobacco advertising in 1971, followed by the banning of smoking in various public places. The Singapore Government has also dramatically increased the excise tax on tobacco since 1983.
The impact of such combination of measures was visibly evident. The proportion of smokers among male Singaporeans aged 18 and above declined from 42 per cent in the late 1970s to 24.3 per cent in 2010, and the per capita consumption of tobacco decreased from 2.36 kilograms to 0.77 kilograms in a short span of 30 years. The incidence of lung cancer also halved from around 60 per 100,000 in the 1980s to 30 per 100,000 today.
Nonetheless, the decline in the proportion of smokers has since hit a plateau over the last ten years, hovering around 23 to 24 per cent in males, and 3.5 to 4 per cent in females, and has not budged since. What this effectively means is that the number of new smokers now equal those who have died from or quit the habit. To lower the proportion of smokers, more aggressive efforts will be required to prevent Singaporeans from picking up the habit.
WILL RAISING THE MINIMUM LEGAL AGE REALLY HELP STEM THE HABIT OF SMOKING?
Senior Minister of State for Health, Dr Amy Khor, announced recently on Thursday that the legal age for smoking and buying tobacco products will be raised from 18 to 21.
This will be a much needed boost to Singapore’s efforts at reducing the prevalence of smoking among youths.
Raising the minimum legal age (MLA) makes it harder for them to get tobacco products either directly or through their social networks. More importantly, it contributes toward de-normalising smoking.
95 per cent of smokers in Singapore had their first puff before age 21. Increasing the legal smoking age to 21 reduces youth exposure to tobacco products during their adolescence – a critical stage of life where they are more susceptible to peer pressure, where their psycho-social maturity, including sensation seeking, impulsivity, and future perspective taking, are still not fully developed.
Detractors may question the rationale for raising the MLA.
Some critics argue that raising the legal smoking age is simply delaying initiation into the habit. But the fact is that those who do not pick up smoking by age 21 are unlikely to ever begin. There is evidence that the younger the adolescent is when he starts smoking, the higher the level of nicotine dependence, and the greater the probability of him becoming a long-term, heavy smoker.
Others may make invidious comparisons. After all, if an 18 to 20 year old can legally marry, drive, consume alcohol or serve national service, why is he not allowed to smoke?
Tobacco smoking is clearly very different from and far outweighs the aforementioned activities when it comes to fatalities. It is deliberately designed to be addictive and is known to cause disease and disabilities in both the smokers, as well as those breathing in secondhand smoke. There is no moderate level of consumption at which tobacco smoking is safe – for the smoker and those around him. It is a unique product that kills its user when used as instructed.
Another objection is that raising the MLA may lead to the emergence of a black market peddling tobacco products to underage smokers. To deal with that, law enforcement efforts can be intensified, and harsher penalties imposed on the sellers. For instance, New York City stepped up its enforcement and increased penalties for supply of illegal tobacco products when it raised the MLA.
Of course, even with these efforts, it is impossible to entirely curtail a black market. However, future generations of youths will be discouraged from smoking, disease will be averted and lives saved albeit with this negative “side effect”.
ADOPT AN APPROACH THAT IS SYMPATHETIC, EDUCATIONAL AND SUPPORTIVE
In meting out consequences for underage smokers, we ought to bear in mind that they too are victims of Big Tobacco advertising strategies directed at the aspirations of impressionable youth.
Our best defence would be to adopt an approach that is sympathetic, educational and supportive of their efforts to quit the habit. To successfully curb smoking initiation in our youths, we would do well to ensure adequate enforcement of the MLA on retailers who sell tobacco to minors.
The debate over the Government’s move to raise the minimum legal age is a reminder that no single silver bullet to reduce smoking prevalence exists. The MLA is only but one of the existing and additional future measures for effective tobacco control. Singapore has banned electronic cigarettes which tobacco companies intentionally market as “safer” to youths. They also claim that heated cigarettes are safer but studies have shown that they have the same nicotine content as traditional cigarettes.
There are other measures that we can consider in the fight against smoking. First, there is evidence that increasing the size of graphic health warnings (GHW) on the cigarette packaging prevents youth smoking initiation, boosts motivation to quit, reduces smoking among adults and sustains smoking cessation. Expanding the size of the GHW is a highly cost-effective control measure that we should consider implementing.
Second, several countries like Australia, France and UK have augmented their GHW with standardised packaging. Also known as “plain packaging”, this requirement removes all branding elements such as colour, image, trademarks, logos and text, and only allows the brand name to be printed in a standardised font, size and location on the pack. This reduces the appeal of the pack, weakens any branding power each product might have, and strengthens the impact of the GHW.
Australia was the first nation in the world to adopt plain packaging in 2012. Even though the health impact of the policy will take years to be fully seen, a post–implementation review published in February 2016 reported that the policy has reduced smoking and exposure to tobacco smoke, and is expected to continue doing so.
Third, price and taxes are effective tools for tobacco control. According to the World Health Organisation, a 10 per cent increase in tobacco prices will reduce consumption by about 4 per cent in high-income countries. We should raise tobacco taxes further as part of our suite of enhanced control measures, if we think that smoking remains a serious issue even after the MLA has been raised.
Last, internationally, there is a movement to go beyond conventional tobacco control strategies and adopt fundamentally different strategies that aim to eliminate smoking altogether. These are broadly classified as “Endgame Strategies”. Singapore should begin thinking about eliminating smoking completely. We would not be the first country to endorse and adopt this approach. New Zealand, Finland, Canada, Sweden and France have all endorsed the goal of achieving a smoke-free society in the next eight to 23 years.
Smoking was introduced commercially in the 1880s. It is an ancient and archaic habit, and has no place in our modern and progressive society.
Professor Chia Kee Seng is Dean of the Saw Swee Hock School of Public Health at the National University of Singapore.