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October, 2008:

Addicted To Nicotine Gum

JANE SYMONS – The Sun Newspaper | 17 Oct 2008

RUBY WAX gave up smoking 12 years ago but remained hooked on nicotine for another ten years.

The nicotine replacement gum that should have been the solution to her addiction became a bigger problem than cigarettes ever were.

Ruby admits: “I was really addicted. I used the chewing gum for about ten years.

“I was chewing it even though I had sores in my mouth and it was doing terrible things to my stomach.”

Ruby ignored the instructions to chew the gum a couple of times then leave it in the mouth to slowly release nicotine.

Instead, she chomped through piece after piece, demolishing two packs of gum a day -the equivalent of 48 cigarettes.

Health experts recommend using no more than 15 pieces of nicotine replacement gum a day and advise quitters to try to wean themselves off it within three months.

But Ruby, who is about to start filming a new sitcom in Kenya, ignored the warnings and developed the secrecy and sneakiness that often go hand in hand with an addiction.

She admits: “I would buy it from different chemists so they didn’t realise how much I was using. It was so hard. If I had one, I would eat the whole pack.

“It cost me just as much as cigarettes and it was just as dangerous -you still get cancer, just a different type of cancer.”

Ruby found it easy to keep her nicotine addiction secret.

There was no telltale smell of stale smoke and the constant chewing became part of her sassy American image.

Not even her own children realised she was hooked. Ruby finally conquered her gum habit with the help of counsellors from Allen Carr’s Easyway.

But she says: “It still lurks around the corner. If I’m in a pharmacy I’ll notice the gum, like an old lover.”

The HK Broadcasting Authority’s Public Consultation on Provisions on Advertising of Nicotine Replacement Therapy Products (WC2/2008)

Dr Judith Mackay – World Lung Foundation/Bloomberg Initiative – Asian Consultancy on Tobacco Control – 17 October 2008


The harm caused by smoking is immediately reduced and can be virtually eliminated over time after smokers quit. This is true even for lifelong smokers.

Many people have little trouble kicking the habit, while others struggle through a difficult cycle of personal change.

While most smokers quit on their own (“cold turkey”), there are an increasing number of programmes and aides are helping to liberate smokers from their addiction. Nicotine replacement therapies (gum, patch, and inhaler) are available, with or without prescription, in most countries. Pharmacologic agents, such as bupropion and varenicline, are widely approved for use in smoking cessation.

Cessation programs not only change individual lives, they also reshape social norms and community values, fostering a world where children are less likely to casually experiment with cigarettes, and the confidence of adults in their ability to quit is strengthened.


NRT is a product entirely designed and marketed to encourage smokers to quit. NRT is pure nicotine. It is nicotine for which smokers smoke, so NRT satisfies smokers’ craving for smoking, yet delivers a much safer product. NRT therefore does not contain any of the cancer-producing elements, or thothat cause chronic obstructive pulmonary disease. Nicotine has an effect on the arteries, but this single component is infinitely safer than the thousands of dangerous chemicals in tobacco.

NRT doubles, if not trebles the quitting rates, if used properly, with support. It behoves the health authorities to support and promote the use of any product that saves lives to this extent.

There is no evidence that NRT encourages youth non-smokers to start smoking

In practice, the pharmaceutical industry puts funds into promoting NRT, and this amplifies any health promotion that the health departments and organisations are producing.

I do not know of any circumstances where the marketing of NRT has been in conflict with the messages of the health authorities.

HK Consultation document

Section 5 a, b:

I am not convinced that the advertisements for NRT need to comply with the advertisements for tobacco itself. The latter is in a uniquely different category, killing 50% of its users. NRT is designed to save lives.

Clauses 5 c,d,e are sensible and acceptable.

In addition to the relaxing of the advertising of NRT, the issue of allowing broadcasting of other proven tobacco cessation products cannot be ignored, and should be considered. I am not proposing a free for all, but only those approved by a medical licensing authority, or approved by WHO.

Finally, World Health Organisation is fully in favour of Public-Private partnerships, such as with the pharmaceutical industry, as it is realised that tobacco use cannot be reduced by the public sector alone.

Dr Judith Mackay, SBS, OBE, FRCP(Edin), FRCP(Lon)
Director, Asian Consultancy on Tobacco Control
Riftswood, 9th milestone
DD 229, Lot 147
Clearwater Bay Road
Kowloon, Hong Kong

Tel: +852 2719-1995
Fax: +852 2719-5741


A Restaurant By Any Other Name

SCMP – Public Eye

Have our courts gone crazy? First we have a judge who ruled in favour of dogs that drive you mad with their non-stop yelping and now we have another who says a restaurant is not really a restaurant if it sells a lot of booze. Huh?

By that same logic, a bar is probably not a bar if it doesn’t sell enough booze. Mr Justice Anselmo Reyes’ ruling involves three establishments that claimed they made more money from alcohol than food and so should be exempt from the smoking ban that applies to restaurants.

It is true that our smoking ban law contains a really stupid loophole that lets establishments off the hook until the end of next June if they’re genuine bars. The loophole was included, at the insistence of the once arrogant but now humbled Liberal Party for big business, which got thrashed in last month’s elections. Big business would rather sell cigarettes and keep the cash register ringing at bars than stop people from getting cancer. But all that aside, shouldn’t judges uphold the spirit of the smoking ban law rather than the right of establishments to exploit the loophole?

This is how one of the three establishments involved describes itself on its website: “The Bull & Bear has full catering facilities and serves full meals throughout the day such as bangers and mash, fish and chips and steak and ale pie catering to breakfast, lunch and dinner patrons.” That’s not a restaurant? For goodness sake.

Many of these “bars” operate a scam – full-blown restaurants during lunch that morph into bars in the evening. It’s easy to expand on the scam – reasonably-priced set lunches but costlier evening drinks. This makes the alcohol revenue higher which then qualifies them for the smoking ban loophole. It’s a nice little number, even Public Eye has to admit.

Implement Full Smoking Ban

SCMP – Updated on Oct 15, 2008

Imperfect laws always end up causing havoc (“Bars win in smoking-ban case”, October 9).

Instead of a simple smoking ban, as successfully implemented in restaurants in 2007, some Legco members pushed for extensions and exemptions in the indoor areas of bars open to those aged 18 and above, mahjong parlours and clubs, commercial bathhouses, massage establishments and nightclubs.

This was further complicated by clauses as to whether food was served and in what amount. There has been considerable confusion and challenges to this law, never mind workers continuing all the time to be exposed to second hand smoke. The health lobby always supported a complete ban to establish a level playing field, to aid implementation and to protect workers’ health.

One hundred and sixty countries have now ratified a WHO treaty that states: “Parties recognise that scientific evidence has unequivocally established that exposure to tobacco smoke causes death, disease and disability.”

Why did Legco not follow this mandate?

Virtually every study done on the introduction of complete smoke-free areas in restaurants and bars shows that such bans are good for the health and the wealth of establishments.

Legco should bring forward the date of a ban in the premises given exemptions and immediately make them smoke-free.

Dr Judith Mackay, director, Asian Consultancy on Tobacco Control

Court Decision Bad News For Workers’ Health

Oct 14, 2008 – SCMP

The decision by the Court of First Instance to reject the appeal board’s support for the director of health – in his quest to prevent abuse by hospitality venues of the criteria for exemption from the indoor smoking bans of the 2006 Smoking (Public Health) Ordinance – is bad news for public health in Hong Kong (“Bars win in smoking-ban case”, October 9).

This section of the ordinance, on the designation of so-called qualified premises for exemption, must be the most badly conceived and unenforceable piece of legislation ever to reach the statute book.

The Department of Health’s legal advisers are clearly unable to help the director try and achieve control of this chaotic situation.

Furthermore, among all the arguments about revenue from sales of alcohol versus food, there is no room for the most salient issue that the legislation was supposed to address – namely the prevention of lethal health problems of the heart, lungs and blood vessels caused by second- hand smoke among catering workers.

When catering managers called for a level business playing field (which a comprehensive ban would provide), they were denied it. Instead the government and legislature created a major health hazard for thousands of workers in over 1,000 exempted sites.

This is in spite of the toxicological evidence in Hong Kong that the body fluids of non-smoking workers in smoking premises are heavily contaminated with tobacco chemicals. The disgraceful social injustice created by the poisoning of catering workers will continue unabated until at least next June.

But it is now vitally important that the movement to extend the exemptions and also introduce “smoking rooms” is stopped in its tracks before we do further damage to occupational health in this city.

Anthony J. Hedley, department of community medicine, school of public health, University of Hong Kong

Success Of Nicotine Replacement Therapy Unproven

13 Oct 2008

As smokers spend millions of dollars purchasing over-the-counter nicotine replacement therapy, a Hunter researcher has revealed the treatments are of uncertain effectiveness when used alone.

Associate Professor Raoul Walsh from the Centre for Health Research and Psycho-oncology (CHeRP) reviewed 12 studies relating to the effectiveness of over-the-counter nicotine replacement therapy. He discovered that the results of the studies did not convincingly demonstrate that the therapy, when used alone without additional support, was effective in helping smokers to quit.

Associate Professor Walsh said his review revealed that the methods used in nicotine replacement therapy trials were very different from real life. Based on the results, people cannot make valid assumptions on the effectiveness of the therapies.

“Nicotine replacement therapies, such as nicotine gum, lozenges or patches, purchased at the local supermarket can be effective as part of an overall strategy to help people stop smoking. However we do not really know the long term success of over-the-counter nicotine replacement therapy when used alone without additional support.

“Many smokers regard patches as magic bullets in their quest to stop smoking. This may be misleading because minimal support, such as medical advice or telephone counselling, in addition to the patches may be the necessary ingredients for achieving modest success rates.”

Associate Professor Walsh said it was important that over-optimistic assumptions were not made about the effectiveness of the therapy when purchased over the counter.

“To gain realistic measures of success, future research must involve more innovative, rigorous controlled trials where nicotine dependence is adequately assessed.”

Associate Professor Walsh’s review findings are published in the latest edition of the journal Drug and Alcohol Review. He hopes the review will result in education programs that emphasise the need for people to use over-the-counter nicotine replacement therapy in conjunction with other strategies.

(Source: Drug and Alcohol Review: University of Newcastle: October 2008)

Signaling Pathway Through Which Nicotine Promotes Breast Cancer Migration Discovered

GEN News Highlights – 13 Oct 08

Researchers at the Beth Israel Deaconess Medical Center determined that breast epithelial-like MCF10A cells and cancerous MCF7 cells both express four subunits of nicotine receptor nAChR. When bound, it initiates a signaling process that promotes migration in mammary epithelial or tumor cells.

The treatment of these cells with nicotine enhanced the activity of protein kinase C (PKC)   without changing its expression level, the scientists reports. Nicotine also stimulated [3H]thymidine incorporation into the genome of these cells as well as forces serum-starved cells to enter S phase of the cell cycle, resulting in growth promotion.

Also on nicotine treatment, the mobility of MCF10A and MCF7 cells was enhanced, which could be blocked by the addition of nAChR or PKC inhibitor, the research team adds. Experiments using siRNA knockdown or ectopic expression of cdc42 showed that cdc42 functions as a downstream effector of PKC and is crucial in the regulation of nicotine-mediated migratory activity in the cells.

“The best known role of nAChR is in the nerve system,” according to Chang Yan Chen, Ph.D., M.D., lead author of the study. “Although cells from various tissue origins express different subunits of nAChR, we know very little about the functions of nAChR in nonneuronal cells and tissues, in particular in mammary cells.”

When injected into the tail of a mouse, the cancerous MCF7 cells migrated to the lungs. In vivo and in vitro studies indicated that nicotine is not a conventional carcinogen, thus no metastasis occurs with nicotine alone, according to the researchers. Rather, they say that it combines with other factors to enable tumorigenesis.

Scientists say the next step is to explore the effects of nicotine in relation to first- and second-hand exposure on breast cancer initiation and development. In particular, they want to study genetic backgrounds with loss or defect of different tumor suppressors.

The paper appears in Cancer Research.

Bars Win In Smoking-Ban Case

Peter Brieger – Oct 09, 2008

The director of health used a flawed process to decide which places of entertainment should be excluded from a wide-ranging smoking ban, the Court of First Instance ruled yesterday.

The decision was a win for three bars, which fought the prohibition, and threw into question how the health watchdog might fight other legal challenges to the ban, introduced two years ago but with exemptions for some premises until June 30 next year.

In his ruling, Mr Justice Anselmo Reyes said health inspectors must do more than just look at, for example, lunchtime sales to determine whether or not to allow smoking at an establishment.

The Bull and Bear pub in Wan Chai, Sticky Fingers in Tsim Sha Tsui and Biztro in Central had argued that alcohol accounted for the vast majority of their sales even though customers could order full meals.

The judicial review centred on whether the three – booted off a list of bars exempted from the smoking ban – sold mainly food or alcohol.

Smoking is not allowed at restaurants that rely on food sales for most of their revenue.

Health Department inspectors concluded that the three bars should be removed from the list on the basis of checks on their lunchtime trade.

Mr Justice Reyes wrote: “As a matter of logic, that an establishment serves certain foods at certain hours will not necessarily mean that it is `primarily’ engaged in the supply of meals. One has to look at what the establishment does as a whole.”

The judge sent the case back to the appeal board – which had upheld the Health Department’s ruling – for “reconsideration”.

“We will study the judgment of the court in detail in consultation with the Department of Justice before we decide on the way ahead,” a Health Department spokeswoman said.

The ratio of food to liquor sales might help determine what sort of business an establishment ran, but it was not the only factor to consider, Mr Justice Reyes wrote.

He also criticised the appeal board for having made “inconsistent decisions” in the past and noted that board members relied too much on what kind of food places served.

“This vindicates what our position has been throughout the process,” said Chris Dundon, a solicitor who represented Biztro and the Bull and Bear. “The approach of the Director [of Health] was misconceived all the way along.”

Yesterday’s ruling could open the door for other establishments to challenge their removal from the department’s list of exempted establishments, Mr Dundon said.

“As far as I’m aware, [health authorities] haven’t changed their approach,” he said. “Now that there’s actually been a judge pronouncing on this, it shows the route map by which bars can look at their operations and decide if they fit within the ordinance.”

The decision also helped create a “level playing field” for establishments that suffered under the dual system, said Ian Thomson, chief executive of the Bull and Bear’s parent company.

It had suffered an appreciable drop in sales when it had to ban smoking for a month until it won the right to fight the decision in court, he said.

“We’re pleased because it means we’re back to business as usual and on a level playing field with other bars,” he said.

Hong Kong Up In Smoke?

Star: World briefs – Oct 9, 2008

Hong Kong – Hong Kong’s city-wide anti-smoking drive faces a serious setback after three bars won a court ruling that may allow them to let smokers back in. The bars argued that health inspectors were wrong to ban them from allowing smokers inside, as they make most of their money from food, not drink. Currently, only bars that make most of their money from drink sales may admit smokers.

Hong Kong bars win court battle to allow smokers

The Sun Daily

Hong Kong (Oct 9, 2008) : Hong Kong’s city-wide anti-smoking drive was facing a serious setback Thursday after three popular bars won a court ruling that may allow them to let smokers back indoors.

The bars successfully argued in the High Court that health inspectors were wrong to ban them from allowing smokers inside on the basis that they make most of their money from serving food not drink.

Currently, only bars that make most of their money from drink sales are allowed to admit smokers while those that make most of their money from serving food are not.

At a hearing Wednesday, The Bull and Bear in Wan Chai, Sticky Fingers in Tsim Sha Tsui and Biztro in Central all had the findings of the health inspectors overturned on the basis that they visited at lunchtime only.

Scores more bars which have been forced to evict smokers on the basis that their main business is food may now be able to challenge the health inspectors’ findings.

The High Court ordered a new hearing into the status of the three bars and whether they should or should not be allowed to let people smoke inside.

Smoking was banned in all Hong Kong restaurants and bars at the beginning of 2007 but nightclubs and bars making most of their revenue through drink sales were exempted until June 2009. — dpa