Clear The Air News Tobacco Blog Rotating Header Image

November 11th, 2012:

Tobacco Taxes A Win–Win Measure for Fiscal Space and Health

Download PDF : ADB 2012 Tobacco Taxes a Win-Win Measure

Let us now praise famous men and women

(Published 13 November 2012)

Cite this as: BMJ 2012;345:e7605

  1. Tony Delamothe, deputy editor, BMJ

Richard Doll and the BMJ (and BMA) go back a long way together

Notoriously forgetful, science has made an exception for Richard Doll. The 100th anniversary of his birth was marked by a reception at Green-Templeton College, Oxford. Three days of presentations followed at the Richard Doll Building, which houses part of Oxford’s Medical Sciences Division. According to Richard Peto, the driving force behind the celebrations, every major epidemiological study of smoking was represented at the meeting.

Both the Lancet and BMJ published articles to coincide with the anniversary. The Lancet’s Million Women Study reported that among UK women smoking causes two thirds of all deaths of smokers in their 50s, 60s, and 70s; smokers lose at least 10 years of life.1 The BMJ’s Life Span Study found that Japanese men and women who smoke from early adulthood also lose about 10 years of life, settling the question of whether the Japanese people were truly “different” when it came to the effects of smoking.2 A coauthor of both papers, Peto summed up the message of the Lancet study as, “If women smoke like men they die like men,” and that of the BMJ study as, “If the Japanese smoke like Brits they die like Brits.”

He also warned the meeting against expecting many surprises from the 60 year follow up of the British Doctors Study, which is heading into print soon. By now almost all the smokers are dead, Peto said. And anyway, he preferred the Million Women Study, whose enormous numbers allow the calculation of effect sizes with much greater confidence.

So with so few mysteries left to solve about the lethal effects of smoking, is it time to wrap the whole epidemiological project up, I asked Peto. His answer was that if you wanted to convince the policy makers in countries such as India and China, they needed data on their own populations. By themselves the results of the British Doctors Study are not enough.

Still, it would be understandable if readers (and staff) of this journal felt a little nostalgic over this study. As described in Conrad Keating’s biography of Doll, Smoking Kills: The Revolutionary Life of Sir Richard Doll,3 its genesis lay in a case-control study of cancers of the lung, stomach, colon, and rectum reported by Doll and Austin Bradford Hill in the BMJ in 1950.4

The logical next step was a prospective study, and with the assistance of the BMA Doll and Hill sent 59 600 British doctors a questionnaire about their smoking habits. An open letter from Hill, chivvying them to respond, followed in the BMJ, 61 years ago this month.5

The British Doctors Study was the first major prospective study of smoking and death anywhere in the world. And when British doctors read its findings in the BMJ, beginning in the mid-1950s, they became the first group in the world to reduce their smoking. Although some of them undoubtedly influenced their patients to follow suit, it was the Royal College of Physicians’ Smoking and Health (1962) that marked the beginning of the concerted fightback against tobacco in the United Kingdom.6

Despite being intensely political when young, Doll did not lobby politically for the changes that his epidemiological work indicated, according to Keating. Instead he saw his role as being “a neutral dispassionate scientist describing the relationship and leaving the public and physicians to draw their inevitable conclusions.”

The role of dispassionate scientist is not one that would appeal to Judith Mackay, who spoke to the Oxford meeting on the topic “From tobacco research to policy.” Mackay, who won the BMJ Group’s first ever lifetime achievement award in 2009, has been a scourge of the tobacco industry for almost 30 years.7

For Mackay the battle is ultimately political and will happen “in the corridors of power, not on wards.” She regrets that some people believe that putting research findings in the public domain is somehow “unprofessional” and that few medical schools’ curriculums teach health advocacy (that is, how to communicate research findings to influence policy). The tobacco industry is not shy to lobby, noted Mackay, although over the past few years it has taken to the courts to try to block antitobacco legislation. The latest Tobacco Atlas (coauthored by Mackay) lists 18 countries where legal challenges have been mounted recently (

But there have been many successes. Despite several legal challenges, Australia switches to plain cigarette packaging on 1 December. In the UK the prevalence of smoking has fallen from 82% in 1948—the highest in the world—to closer to 20% now. New Zealand is working to become smoke free by 2025; Mackay predicts that her own Hong Kong will beat them to it. Nevertheless, a billion people may die from smoking related diseases this century, compared with “only” 100 million last century, such has been the explosion in smoking.

The heirs of Doll, who made their way to the Oxford meeting from the countries that will bear the brunt of the 21st century smoking epidemic, will need to team up with a Mackay when they get home. Robust scientific evidence on its own is not enough.


Cite this as: BMJ 2012;345:e7605


  1. Pirie K, Peto R, Reeves GK, Green J, Beral V, for the Million Women Study Collaborators. The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet2012, doi:10.1016/S0140-6736(12)61720-6.
  2. Sakata R, McGale P, Grant EJ, Ozasa K, Peto R, Darby SC. Impact of smoking on mortality and life expectancy in Japanese smokers: a prospective cohort study. BMJ2012;345;e7093.
  3. Keating C. Smoking kills: the revolutionary life of Sir Richard Doll. Signal, 2009.
  4. Doll R, Hill AB. Smoking and carcinoma of the lung: preliminary report. BMJ1950:ii:739-48.
  5. Hill AB. Do you smoke? BMJ1951;ii:1157.
  6. Delamothe T. Deaths from smoking: the avoidable holocaust. BMJ2012;344:e2029.
  7. Hawkes N. Promoting hand washing, stroke prevention, and tobacco control are recognised at BMJ Group award ceremony. BMJ2009;338:b1428.

ADB: High tobacco prices save lives

Smoking-related deaths in Thailand and four other Asian countries where tobacco use is amongst the highest in the world would drop by 20% if cigarette prices were doubled by increased taxation, according to an Asian Development Bank study released on Tuesday.

Photo by Jetjaras na Ranong

The Manila-based bank claimed that even a 50% price hike would save 27 million people from dying from smoking-related diseases and cause nearly 67 million current smokers to quit, or youths not to take up the habit, in China, India, the Philippines, Thailand and Vietnam.

“An even higher price increase of 100% yields greater benefits, saving nearly 55 million lives in the five countries or about 20% of the projected deaths,” the study said.

An estimated 402 million people are smokers in China, India, the Philippines, Thailand and Vietnam, while 130 million more are projected to be future smokers.

“In the absence of intervention, smoking will eventually kill about 267 million current and future cigarette smokers who are alive today in the five countries,” it said.

A 50% increase in cigarette prices would also generate more than US$24 billion (936 billion baht) in additional tax revenues annually, the study said.

Smoking in Movies: A New Centers for Disease Control and Prevention Core Surveillance Indicator

Tim McAfee, MD, MPH; Michael Tynan

Suggested citation for this article: McAfee T, Tynan M. Smoking in Movies: A New Centers for Disease Control and Prevention Core Surveillance Indicator. Prev Chronic Dis 2012;9:120261. DOI:

Youth who are heavily exposed to onscreen smoking are approximately 2 to 3 times as likely to begin smoking as youth who are lightly exposed (1), and the Surgeon General concluded that there is a causal relationship between depictions of smoking in the movies and smoking initiation among young people (2). Among the 3 major motion picture companies with policies aimed at reducing tobacco-use incidents in their movies, the number of onscreen incidents per youth-rated movie (rated G, PG, or PG-13 by the Motion Picture Association of America) decreased 95.8% from 2005 through 2010 (3). These results appeared to indicate that movie companies were making progress at reducing smoking depictions in youth-oriented movies and that a company-by-company approach of adopting voluntary policies could be effective in nearly eliminating youth exposure to tobacco imagery in movies. However, new data from 2011 published by Glantz and colleagues (4) in Preventing Chronic Disease raise serious concerns about this individual company approach.

Glantz and colleagues found that in 2011, depictions of tobacco use per youth-rated movie rebounded; estimated instances of tobacco use in 2011 were more than one-third higher than in 2010 (4). Furthermore, the authors found that the largest increase in tobacco-use incidents in youth-rated movies was among the 3 movie companies that had produced the dramatic decline from 1995 through 2010 and had policies designed to discourage depictions of smoking in their movies. As a result of this sharp rebound, the difference in tobacco-use incidents per youth-rated movie between companies with policies and companies without policies diminished in 2011 (4). This difference suggests that individual company policies may not be sufficient to sustain a reduction in youth exposure to tobacco-use and other pro-tobacco imagery in movies and that more formal, industry-wide policies are needed.

The World Health Organization and other public health groups have recommended formal policies aimed at eliminating smoking in the movies (5,6). These policies include awarding an R rating to any movie with smoking or other tobacco-use imagery (with exceptions for portrayal of actual historical figures who smoked or the portrayal of negative effects of tobacco use), certifying that no payments have been received by studios for depicting tobacco use in movies, and ending the onscreen depiction of real tobacco brands.

Reducing smoking and tobacco use in youth-oriented movies is not a niche issue. The Surgeon General has concluded that there is a causal relationship between depictions of smoking in movies and smoking initiation among young people, and the US Department of Health and Human Services has set a goal of reducing youth exposure to onscreen smoking (7). Furthermore, among the nationwide goals set by Healthy People 2020, one of the objectives is the reduction of onscreen tobacco use imagery in youth-oriented movies and on television (8). These goals and objectives were set because the population-attributable risk associated with onscreen tobacco imagery is significant (9,10).

To assess progress toward the Healthy People 2020 objective, the Office on Smoking and Health at the Centers for Disease Control and Prevention (CDC) will now track and report annually on tobacco use imagery in youth-oriented movies as a core surveillance indicator by using the methods described in previous CDC publications (3,4). These data will be added to regular CDC reports to the public on smoking prevalence among youth and adults, total and per-capita cigarette consumption, and progress on tobacco control policies.

One of the major conclusions in the Surgeon General’s 2012 report on preventing tobacco use (2) was that after years of steady progress, declines in tobacco use by youth and young adults have slowed for cigarette smoking and have stalled for smokeless tobacco use (2). Each day in the United States, approximately 3,800 young people younger than 18 years smoke their first cigarette, and approximately 1,000 youth younger than 18 years become daily cigarette smokers (2). More than one-third of these smokers will eventually suffer and die from smoking-related illness. We all have a responsibility to prevent youth from becoming tobacco users, and the movie industry has a responsibility to protect our youth from exposure to tobacco use and other pro-tobacco imagery in movies that are produced and rated as appropriate for children and adolescents. Eliminating tobacco imagery in movies is an important step that should be easy to take.

Author Information

Corresponding Author: Tim McAfee, MD, MPH, Centers for Disease Control and Prevention, Office on Smoking and Health, 4770 Buford Hwy, NE, Mailstop K50, Atlanta, GA 30341. Telephone:  770-488-5709 . E-Mail:

Author Affiliations: Michael Tynan, Centers for Disease Control and Prevention, Atlanta, Georgia.

Top of Page


  1. National Cancer Institute. Tobacco control monograph 19: the role of the media in promoting and reducing tobacco use. Bethesda (MD): US Department of Health and Human Services, National Institutes of Health, National Cancer Institute; 2008.
  2. A report of the Surgeon General: preventing tobacco use among youth and young adults: a report of the Surgeon General, 2012. Atlanta (GA): US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2012
  3. Centers for Disease Control and Prevention (CDC). Smoking in top-grossing movies — United States, 2010. MMWR Morb Mortal Wkly Rep 2011;60(27):910–3.
  4. Glantz SA, Iaccopucci A, Titus K, Polansky JR. Smoking in top-grossing US movies, 2011. Prev Chronic Dis 2012;9:E150. CrossRef PubMed
  5. Sargent JD, Tanski SE, Gibson J. Exposure to movie smoking among US adolescents aged 10 to 14 years: a population estimate. Pediatrics 2007;119(5):e1167–76.CrossRef PubMed
  6. World Health Organization. Smoke-free movies: from evidence to action. Geneva (CH): World Health Organization; 2009. Accessed 10/18/2012
  7. Ending the tobacco epidemic: a tobacco control strategic action plan for the US Department of Health and Human Services. Washington (DC): US Department of Health and Human Services; 2010.
  8. Tobacco use. In: Healthy people 2020. Washington (DC): US Department of Health and Human Services; 2010.
  9. Sargent JD, Tanski S, Stoolmiller M. Influence of motion picture rating on adolescent response to movie smoking. Pediatrics 2012;130(2):228–36. CrossRef PubMed
  10. Millett C, Glantz SA. Assigning an “18” rating to movies with tobacco imagery is essential to reduce youth smoking. Thorax 2010;65(5):377–8. Erratum in: Thorax 2010;65(9):844. CrossRef PubMed

Conference of the Parties to the WHO Framework Convention on Tobacco Control.

Report to the fifth session of the Conference of the Parties of the Chairperson1 of the Intergovernmental Negotiating Body on a Protocol on Illicit Trade in Tobacco Products

Download PDF : FCTC_COP5_7-en

Draft protocol to eliminate illicit trade in tobacco products

Download PDF : FCTC_COP_INB-IT5_5-en

Out of puff: Lazard’s Ryan cuts overvalued tobacco stocks

Lazard’s global equity income fund manager Pat Ryan has warned investors off buying tobacco companies after the rush to buy safe haven-style stocks sent valuations sky-rocketing.

Speaking to Investment Week, Ryan said he has removed the last of his exposure to the sector within his fund, with legal risks and declining volumes leaving them looking vulnerable.

“They are now trading at a premium to the broad market, but people are overlooking the litigation risks in these stocks,” he said.

Tobacco companies remain among the largest and most popular stocks in the UK market, with British American Tobacco (BAT) appearing among the top 10 of 44% of funds in the UK Equity Income sector, according to data from FE.

Globally names including Reynolds American and Altria have also been popular.

The UK-listed stocks have delivered very strong returns for investors in the past decade, with British American Tobacco delivering a total return of 661.44% over the period, while Imperial Tobacco returned 230.54%, according to Morningstar.

However, Ryan and other managers are growing concerned over the outlook for the sector. PSigma’s Bill Mott, as well as Liontrust’s Stephen Bailey and RLAM’s Martin Cholwill, have significantly cut their tobacco holdings in recent weeks amid fears over the impact of plain packaging rules being introduced in Australia.

A key market for cigarette manufacturers, the country is bringing in plain packaging rules next month, meaning brand names will be removed from packets, and other countries are poised to follow suit. Managers believe this could cause margins to decline if smokers turn their backs on certain brands.

Ryan said there were also other worries for the sector. “Volumes go down in developed markets every year, and we removed the last of our exposure recently,” he said.

Read more:
Investment Week – News and analysis for investment advisors and wealth managers. Claim your free subscription today.

Healthier Crops


November 11, 2012, 6:53pm

US Submariners Learn To Live Without Smokes – News item. It’s a tough tour of duty for smokers in nuclear-tipped, filter-tipped submarines.

Never mind the PH ban on nuclear weapons. Non-smoking US subs are welcome to enter Makati’s no-smoking ordinance zone.

On Atty. Ignacio Bunye’s “Central Banking for every Juan and Maria,” as a non-practicing economics graduate of Fr. Michael McPhelin, SJ, I will be at the Nov. 16 launch at Fully Booked on Nov. 16 and get myself a copy to learn to save or make my money work for me.

Our very own Kevin Balot won the “Miss International 2012” title for transsexuals at Pattaya, Thailand. I cave in… Patay kang bata ka!

To beat my editor’s deadline for this Monday article, I just cut-and-pasted the item headlined: HEALTH GROUPS TO TOBACCO FARMERS: WE ARE NOT YOUR ENEMY.

(CAVEAT: I did not write the following article. The opinions expressed are neither mine nor that of the management, but a verbatim press release of an NGO group. Have patience till the last!)

“MANILA, Philippines – With the recent celebration of World Tobacco Growers Day, tobacco farmers slammed the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), claiming that they have always been consistently deaf to the plight of tobacco farmers and stakeholders. However, on November 12-17, health representatives from all over the world will converge in Seoul, South Korea, for the 5th Conference of Parties (COP5) to discuss the FCTC. Part of its agenda includes Articles 17 and 18, which ensures the protection of tobacco farmers.

“The WHO FCTC is not your enemy, we are not your enemy,’ said Irene Reyes, Managing Director of HealthJustice, a public health policy NGO. “In fact, although the first mandate of the FCTC is to reduce smoking prevalence, one of its guiding principles stresses the importance of technical and financial assistance to ensure that those whose livelihoods are affected by tobacco control are given suitable alternatives.’

“Southeast Asian Tobacco Control Alliance (SEATCA) Director Bungon Ritthiphakdee said that the International Tobacco Growers Association (ITGA), a known tobacco industry front group, is ‘clearly perpetuating a falsehood – a strategy also used by the tobacco industry in other parts of the world – that the tobacco control measures to which the Philippines is committed will leave them all twisting in the wind. This is not true. In fact, 15% of the incremental revenues from excise tax allocation goes into the welfare of farmers to take care of them.’

“Health groups also condemned the statements of Philippine Tobacco Growers Association President Saturnino Distor, who said that the WHO proposals ‘put the lives of some 2.7 million tobacco farmers and their dependents at risk without offering them economically viable alternative crops.’

“Former tobacco farmer Avelino ‘Ka Abe’ Dacanay has shifted to planting corn, which he says earns him more money due to its multiple rotations. ‘Hindi Sin Tax ang papatay satobacco industry, kundi ang di tama na pagbigay ng presyo sa tobacco. Ang industriya ang dapat ikatakot ng mga magsasaka,’ he says.

“Ka Abe is also a representative of the Solidarity of Peasants Against Exploitation, better known as Stop-Ex. He now fights for farmers’ rights in the country.

“Studies show that crops such as corn, peppers, onions, and tomatoes stand to earn farmers a bigger profit as compared to tobacco. ‘COP5 aims to discuss the guidelines on the implementation of alternative livelihood for tobacco farmers so that the government can invest in programs that can help them shift to these healthier and more profitable crops,’ continues Reyes.” FEEDBACK: