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September 22nd, 2011:

Electronic cigarettes: Help or hazard?

Kicking the cigarette habit is one of the best things that smokers can do for themselves. Nicotine replacement products, prescription medications, and counseling can all help. What about the newest tobacco substitute, the electronic cigarette? Despite the appeal of so-called e-cigarettes, we don’t know enough about their safety or effectiveness to give them the green light.

Electronic cigarettes come in a variety of shapes. Some look like cigarettes, pipes, or cigars, while others are disguised as pens or other more socially acceptable items.

Whatever their shape, they all are built around a battery-operated heating element, a replaceable cartridge that contains nicotine and other chemicals, and an atomizer that converts the chemicals into an inhalable vapor.

A study published this spring in the American Journal of Preventive Medicine concluded that electronic cigarettes may help smokers quit. Whether they are a safe way to quit is another question—preliminary studies from the FDA, New Zealand, and Greece raise some concerns.

There are three reasons to worry about electronic cigarettes. First, the dose of nicotine delivered with each puff may vary substantially. An FDA analysis recorded nicotine doses between 26.8 and 43.2 micrograms per puff. It also detected nicotine in products labeled as nicotine free.

Second, electronic cigarettes deliver an array of other chemicals, including diethylene glycol (a highly toxic substance), various nitrosamines (powerful carcinogens found in tobacco), and at least four other chemicals suspected of being harmful to humans. To be sure, the dose of these compounds is generally smaller than found in “real” cigarette smoke. But it isn’t zero.

Third, by simulating the cigarette experience, electronic cigarettes might reactivate the habit in ex-smokers. They could also be a gateway into tobacco abuse for young people who are not yet hooked.

We need scientific studies of e-cigarettes. Until then, it’s caveat emptor, buyer beware. And be aware that there are better and safer ways to quit. The most effective strategy involves using nicotine replacement or a medication along with some sort of counseling or support, either in person, by telephone, or even by text message.

If you want to quit, solid information and advice are available at, a Web site developed by the National Cancer Institute. Any of the approved methods are vastly preferable to smoking—and to electronic cigarettes.

Dr. Harvey Simon is Editor of the Harvard Men’s Health Watch, a monthly newsletter written to help men lead healthier, longer lives.

EU move on cigarettes

One of the biggest challenges the European Commission faces is to ensure that its proposal for plain packaging on cigarette products succeeds, the EU’s Director General (DG) of Health and Consumer Affairs, Ms Paola Testori Coggi, has told Irish Medical Times.

The Commission is currently working on a proposal for legislation in this area, which would require cigarette companies to indicate the additives contained in their products. The proposal is to also introduce in Europe — as has already occurred in Australia — plain packaging.

“The aim is to reduce the attractiveness of cigarette packaging,” said Testori Coggi. “At the moment, all ingredients in food must be indicated. With cigarettes, on the other hand, makers are not obliged to indicate all the additives.”

While some additives are needed, others increase addiction and enhance the taste. “We want to oblige industry to indicate all the additives on the packaging,” the DG said.

A total of €13 million will be devoted to a new pan-European campaign to encourage smokers to quit. John Dalli, European Commissioner for Health, has launched phase 2 of the European Commission’s anti-smoking campaign. He announced that over 500,000 Europeans to date have demonstrated their support for the campaign — ‘Ex-smokers are Unstoppable’ — by accessing its social media pages.

“The campaign is expected to last for three years,” said Testori Coggi. The basic web-based ‘coaching tools’ will remain the same, although the publicity campaigns will employ new approaches.  The EU Commission also plans to put forward a proposal for the revision of the 2001 Tobacco Products Directive in 2012, to strengthen and adapt it to developments of tobacco products as well as advances in science.

A central pillar of tobacco control is EU legislation on tobacco products and advertising and the Directive on Tobacco Advertising (2003) bans cross-border advertising of tobacco products. It also bans sponsorship of cross-border events.

No Smokers Hired

September 22, 2011 Updated Sep 22, 2011 at 7:11 PM PDT

It’s no secret that smoking comes at a high price. “Smoking is implicated in the top 3 causes of death,” says Baylor Pulmonologist Dr. Mark Millard.

But starting January 1st, it could cost you a job.

Millard continues, “We are not going to hire you if you have nicotine in your urine.” Baylor Dallas president Joel Allison added, “We do a drug screen on all applicants so it will be just added to that as part of that screen.

The Baylor network plans to adopt a new policy to not hire smokers. “It’s a way of Baylor saying we’re going to walk the talk,” Millard added.

Allison says, “As healthcare leaders we should be role models that we should set an example and for too long we’ve been in the sick care business it’s time we do the healthcare business.”

The new policy won’t apply to current employees, but the 5% of Baylor employees who do smoke pay anywhere from $50 to $600 more in insurance premiums, and are offered free smoking cessation classes.

“Personal freedom is important and cigarettes aren’t banned it’s just that smoking doesn’t take place in public places and now employees won’t be able to smoke,” Millard noted.

And attorneys say this sort of discrimination is perfectly legal.

Attorney Clint David said, “Employers can discriminate against you based on your smoking habits. Smokers are not a legally protected class, like race or religion. So employers can absolutely base their hiring decisions on whether or not people smoke and it’s absolutely legal.”

Baylor officials say adding a screening for nicotine will cost them about $60,000 a year.

Retailers at risk of £20,000 tobacco D-day fine


22 Sep 2011

HALF of all cigarette retailers look set to miss the deadline to register as official sellers of tobacco products, with just over a week to go before

a landmark change in the law.

It is estimated there are more than 14,000 outlets in Scotland selling cigarettes, including newsagents, supermarkets and licensed venues such as pubs, with all required to have signed up to the Scottish Tobacco Retailer Register by October 1.

Extra cost to tobacco and alcohol sellers

MAJOR retailers who sell alcohol and tobacco will have to pay a new “public-health levy” in their business rates as part of Scottish Government spending plans revealed yesterday.

Rimmer on NCD

NCD EPIDEMIC – Matthew Rimmer examines plain packaging as a way to curb tobacco use. Smoking is one of the biggest causes of non-communicable diseases.

In an episode of the television show Mad Men, Don Draper, the creative director of advertising agency Sterling Cooper, declares that tobacco is “the greatest advertising opportunity since the invention of cereal”.

The mad men of the tobacco industry have long used packaging to undermine health warnings; to engage in false and misleading advertising; and to encourage consumers to initiate and maintain the use of its addictive products.

Recent subversive tobacco packaging in the United Kingdom attests to this:

Packaging trying to undermine public health messages about smoking Matthew Rimmer

The World Health Organization (WHO) considers “tobacco use as one of the greatest threats to public health the world has ever faced” and its Framework Convention on Tobacco Control (FCTC) – subscribed to by 174 countries – is an evidence-based treaty designed to address the epidemic of tobacco-related illnesses.

The framework addresses measures to control the use of packaging, labelling, advertising, promotion and sponsorship aimed at encouraging consumption of tobacco products.

And the recently released WHO Report on the Global Tobacco Epidemic 2011 emphasizes that the combination of health warnings and plain packaging are best practice for tobacco control.

The Australian Government – led by the Minister for Health and Ageing, Nicola Roxon – has introduced the Tobacco Plain Packaging Bill 2011 (Cth) and the Trade Marks Amendment (Tobacco Plain Packaging) Bill 2011 (Cth) as an effective means of implementing its obligations under the FCTC.

The bills will be debated in the Senate within the next few days and, with the support of the Greens, they will become law.

What cigarette packs will look like in Australia after February 2012 -Matthew Rimmer

WHO Director-General Dr Margaret Chan describes the proposal to introduce plain packaging as a “bold and breakthrough” initiative, and has given Roxon special recognition for her leadership on this issue.

Public law

In response, the tobacco industry has mounted a legal campaign against the introduction of plain packaging as part of a larger strategy of seeking to frustrate and delay the implementation of regulation of FCTC.

It has threatened to challenge the constitutionality of the legislation – co-opting the language of human rights and civil liberties, and invoking the language of property rights, freedom of speech and due process.

But a close inspection of Australian constitutional law suggests such arguments will be ineffective.

And plain packaging of tobacco products certainly doesn’t involve political communication and doesn’t raise any larger questions of freedom of speech.

The outlandish, greedy submissions by Big Tobacco for billions dollars of compensation for an acquisition of property under the Australian Constitution are without merit and will no doubt be given short shrift by the High Court of Australia.

International law

At the international level, the tobacco industry has encouraged its allies to claim the introduction of plain packaging in Australia is a violation of the TRIPS Agreement 1994.

The Dominican Republic, for instance, has complained the law would be a “special requirement” that would “unjustifiably” encumber the use of trademarks “in a manner detrimental to its capability to distinguish the goods or services of one undertaking from those of other undertakings”.

But the tobacco industry is privately pessimistic about such arguments about international law. It is worth recalling that internal documents from British American Tobacco noted “current conventions & treaties afford little protection” for tobacco companies.

Critically, the documents say arguments against plain packaging about intellectual property, trade, and property rights under GATT/TRIPS would provide “little joy”.

The TRIPS Agreement 1994 clearly recognises “members may, in formulating or amending their laws and regulations, adopt measures necessary to protect public health”.

The World Health Organization has provided strong evidence about the problem of tobacco packaging, and the efficacy of plain packaging. And the Doha Declaration 2001 acknowledges that member states may make use of flexibilities in the TRIPS Agreement 1994 to address public health concerns.

Any worthy international lawyer knows the TRIPS Agreement 1994 should be read in harmony with theWHO Framework Convention on Tobacco Control.

Double standards

It shows effrontery on the part of tobacco industry to demand compensation from the Australian government over some perceived slight to its trade marks when it has been notoriously evasive about providing compensation for damage done by tobacco to smokers.

The epic litigation in Australia involving Rolah McCabe, and the reluctance – some might even say the recalcitrance – of the tobacco industry to provide her with fair and just compensation for lung cancer is only one such instance.

More generally, the tobacco industry has been evasive in admitting liability for tobacco-related health harm and damage, and has been embroiled in long-running litigation with governments around the world.

The annual social and health costs of tobacco in Australia are estimated at A$31.5 billion.

Health systems around the world are similarly afflicted by what the World Health Organization has called the tobacco epidemic. No wonder there has been enormous international interest in Australia’s plain packaging initiative.

Rather than ask whether the tobacco industry should be compensated for the plain packaging of tobacco products, the better question is whether the tobacco industry should provide full and comprehensive compensation for the untold damage it has caused to the health and well-being of people around the world.

This is the fifth part of our NCD epidemic series. To read the other instalments, follow the links here:

– Part One: Sir George Alleyne discusses why we need a new paradigm to tackle NCDs

– Part Two: Regulating alcohol to control NCDs

– Part Three: Stopping the obesity epidemic will require action on the population-level

– Part Four: The results of the UN High-Level Meeting on Non-Communicable Diseases on New York September 19-20



Matthew Rimmer

ARC Future Fellow and Associate Professor in Intellectual Property at Australian National University

Disclosure Statement

Matthew Rimmer is an academic at the Australian National University, and abides by its policy on the responsible practice of research: Matthew Rimmer does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations. Indeed, the Australian National University strictly forbids its staff from receiving direct funding from the tobacco industry: ‘Direct funding from foundations primarily funded by the tobacco industry will not be accepted. Direct funding from business units of companies involved in the tobacco industry will not be accepted if, in the opinion of the Deputy Vice-Chancellor Research, the unit is engaged directly in the production, manufacture, distribution, promotion or marketing of tobacco or tobacco products as its primary business; or acceptance of the funding involves any promotion or advertising that can be construed to support the tobacco industry or the tobacco lobby and its activities.’

Australian National University is a Founding Partner of The Conversation.

Our goal is to ensure the content is not compromised in any way. We therefore ask all authors to disclose any potential conflicts of interest before publication.

Chinese Primary Schools Named for Big Tobacco Sponsors


Familiar with the Sichuan Tobacco Hope Primary School?

State-owned China Tobacco — the largest tobacco company in the world — built it after a 2008 earthquake as part of the Hope project, described by theSydney Morning Herald as “a charity that has rolled out schools in the countryside for the poor.”

Along with naming rights, China Tobacco has also been given license to install educational sayings on the school grounds. For example, this says: “Talent comes from hard work — Tobacco helps you become talented.”

With 6 million smokers under the age of 15, or 6.3% of China’s entire youth population, it shouldn’t take much to reel in the other 92.7%. After all, according to the Herald, there are more than 100 primary schools sponsored by tobacco companies.

”It is not just primary schools, they also fund secondary schools and universities,” Wu Yiqun of the Think Tank Research Centre for Health Developmenttells the paper. “But it is difficult to count them, because the Ministry of Education would not help us. We know there are definitely more than 100 primary schools though.”

But wait — there’s more!

“Inside the schools, they often have branded uniforms and distribute sweets shaped liked cigarettes,” Wu tells the Want China Times. “Vendors near the school gates usually sell cigarettes one-by-one, rather than in packets.”

Last year, China Hush offered a handy list of Chinese elementary schools named after tobacco companies. A few names:

Zhongnanhai Heart Elementary school

Liaoning Tobacco Trade Hope Elementary School

Zunyi Tobacco Hope Elementary School

Panhe Tobacco Elementary School

And, of course, the venerable 四川烟草小学 (Sichuan Tobacco Elementary School).

The reaction from parents?

”The parents are actually very supportive of the tobacco companies,” Wu tells the Herald. ”They think they are giving something back to society, but they are just using charity as a front.”

Guidelines tightened on scrapping tobacco

Sep 22, 2011-China’s Chongqing City Tobacco Monopoly Administration has
taken steps to tighten control over waste leaf tobacco, according to a
Tobacco China Online story.

One of the steps being taken is aimed at ensuring the destruction of waste
tobacco to prevent its being illegally traded.

In a notice issued recently, Chongqing City Tobacco Co said that no
enterprise or individual would be allowed to provide enterprises outside the
[official] tobacco industry with waste leaf in any form.

All discarded tobacco that cannot be recycled will have to be scrapped.

And discarded tobacco destined for scrapping will have to be rendered
unusable before being transported away from tobacco manufacturing

Mayo Clinic to develop Global Smoke-Free Worksite Challenge

Mayo Clinic announced today at the annual Clinton Global Initiative (CGI) meeting in New York City its partnership with other organizations to develop a Global Smoke-Free Worksite Challenge.

The challenge’s goal is to expand the number of employees of all sectors able to work in a smoke-free environment. The effort is a global multi-sector partnership comprised of private sector companies, nongovernmental organizations and governments. Partners are committed to making their worksites 100 percent smoke-free and commit to assist others to do so.

“Mayo Clinic has had a leading role, as a large employer, in creating a smoke-free worksite for close to 30 years,” says John Noseworthy, M.D., Mayo Clinic president and CEO. “We are committed to the needs of our patients and employees, and we are excited to be a partner in this challenge to help make workplaces around the world smoke-free so all employees have the right to clean air.” Dr. Noseworthy was part of a press conference today to announce Mayo’s commitment.

The challenge builds on the commitment Mayo Clinic brought last year to CGI. That initiative, called Global Bridges, has begun to build and energize a worldwide network of health care providers to lead development of tobacco control and treatment programs in their countries and regions. In less than a year, Global Bridges has trained more than 5,800 health care providers from 31 countries in sessions ranging from short webinars to intensive workshops.

“Secondhand smoke affects everyone,” says Richard Hurt, M.D., chairman of Global Bridges and founding director of Mayo’s NicotineDependence Center. “This challenge protects workers from secondhand smoke who don’t have any choice. Smokers in a smoke-free environment are more likely to reduce their smoking and increase the chances of them quitting smoking, so it’s healthy for everyone. Right now, over 30 countries across the world have smoke-free workplace laws, which is pretty amazing. We’re hoping to increase that number dramatically with this initiative.”

Source: Mayo Clinic

Smoking can make you lose 1/3 of everyday memory

22 Sept. 2011

London: A study has found that people who smoke are at an increased risk of losing around one third of their everyday memory, more so than non-smokers.

The Northumbria University study also found that those who kicked the habit saw their ability to recollect information restored to almost the same level as non-smokers.

The study involved more than seventy 18 to 25-year-olds and included a tour of the university’s campus.

Those who took part were asked to recall small details, such as music acts listed to play at the students’ union and tasks completed at various points – known as real world memory test.

Smokers performed badly, remembering just 59 percent of tasks, while those who had given up smoking remembered 74 percent and those who had never smoked recalled 81 percent of tasks.

Dr Tom Heffernan, who leads Northumbria University’s Collaboration for Drug and Alcohol Research Group, said the findings would be useful in anti-smoking campaigns.

“Given that there are up to 10million smokers in the UK and as many 45 million in the United States, it’s important to understand the effects smoking has on everyday cognitive function – of which prospective memory is an excellent example,” the Daily Mail quoted him as saying.

“We already know that giving up smoking has huge health benefits for the body, but this study also shows how stopping smoking can have knock-on benefits for cognitive functions too,” he stated.