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June, 2016:

‘Komunitas Kretek’ rejects tobacco control ratification

Jun 16th, 2016
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http://www.thejakartapost.com/news/2016/06/16/komunitas-kretek-rejects-tobacco-control-ratification.html

“Komunitas Kretek” or the Clove Cigarette Community has rejected any call for ratifying the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), saying that Indonesia would lose its own cultural heritage if the government ratifies it.

“Indonesia has its tobacco product called kretek, which has its own uniqueness with a blend of tobacco and clove. Ratifying the convention means that the government would deny its own cultural heritage,” Alfa Gumilang, the general secretary of Komunitas Kretek said on Thursday.

Earlier on Thursday, the National Coalition of Civil Society for Tobacco Control called on President Joko “Jokowi” Widodo to ratify the convention as a strategic step and argued that it was in the best interest of the nation. “WHO FCTC ratification would be of benefit to Indonesia’s future,” said Ifdhal Kasim, a coordinator of the coalition.

The convention contains several provisions regarding smoke-free areas, packaging and labeling, pricing and taxing, and prohibition of advertising and promotions, including through sponsorship.

Alfa warned that the WHO FCTC also regulated the standardization of all tobacco products, including its ingredients and level of tar and nicotine.

“One of the articles in the convention urges the government to implement tobacco diversification plans, which could damage the economic well-being of tobacco farmers across the country,” he said.

“Modifying agricultural traditions is also not easy, as it has existed for hundreds of years. Besides, it would affect farmers’ market access,” Alfa said. (vps/bbn)

Boost for tobacco brands as poll confirms consumer fears over counterfeit impact of plain packaging

Jun 16th, 2016
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http://www.worldtrademarkreview.com/Blog/detail.aspx?g=82cde779-058b-483e-b19e-f76e579dc529

One of the arguments made against the introduction of plain packaging for cigarettes and other tobacco products is that the absence of branding would exacerbate the problem of counterfeiting, with potentially unsafe products becoming more accessible. As Malaysia lays the groundwork for a plain packaging regime, a recent poll of Malaysian consumers would seem to support that concern.

A nationwide survey carried out by the Merdeka Center for Opinion Research, on behalf of the Malaysia Singapore Coffee Shop Proprietors’ General Association (MSCSPGA), has found that 81% of Malaysians believe that plain packaging would make it easier for counterfeiters to produce fake tobacco products. Moreover, 65% of respondents are concerned that this would lead to an increase in criminal activity in the country; while 88% think that the introduction of plain packaging would boost sales of fake and smuggled cigarettes as smokers turn to the black and grey markets to buy cheaper packs. However, it is not clear if respondents believe this will happen as a reaction to the plain packaging itself and a desire for branded packs, or more simply because black and grey market alternatives sell for less.

To my knowledge, Malaysia is the only east Asian government that has so far announced plans to introduce plain packaging regulations for cigarettes and other tobacco products – though at this stage, the proposals remain far from concrete. “We are planning to do that in stages, but at this moment, we don’t have a firm date,” Chong Chee Keong, director of the disease control division of Malaysia’s Ministry of Health, told the Malay Mail back in February, adding that the government believes plain packaging measures would have the biggest impact on reducing smoking, particularly among younger and less frequent users. As expected, the announcement was met with support from health campaigners and opposition from the tobacco industry, which claims that such measures trample its trademark rights.

Smoking is prevalent in Malaysia, with the country’s Ministry of Health reporting approximately 4.7 million smokers out of a population of around 30 million as of April 2015. Smoking among males is particularly widespread, at 38%; older World Health Organisation data from 2008 puts this figure significantly higher, at 54.4% of the male population.

In any case, smoking remains a major public health issue in this rapidly developing country. With an estimated 20,000 deaths each year from directly smoking-related illness, it is clear why the government is keen to take action. Late last year, it increased excise tax on cigarettes by 40%, following a 12% hike in 2014, in addition to the recent introduction of a 6% goods and services tax. Tobacco companies raised prices as a result of these moves and argued that the government’s moves would further contribute to Malaysia’s already ingrained problems with counterfeit and grey market cigarettes.

According to the MSCSPGA, these account for about half of all of the cigarettes sold in the country at present. In Malaysia, where smoking is still legal in many public places and any bans that do exist are often not strictly enforced, cafes and restaurants – including those represented by the MSCSPGA – benefit from being able to sell tobacco products on their premises. Ho Su Mong, president of the MSCSPGA, told the Mail that fakes and smuggled cigarettes are costing retailers over 500 million ringgit (US$122 million) in lost income every year.

With this knowledge, it is clear why the MSCSPGA commissioned the survey and this economic interest will likely be pointed to by plain packaging proponents.

Nevertheless, the survey results will come as a much-needed fillip – albeit a small one – to trademark owners in the tobacco industry, and other sectors where plain packaging could potentially be implemented, at a time when they are most certainly on the back foot. Whether consumer concern causes the government to pause for thought remains to be seen.

Senate rejects advertising ban

Jun 16th, 2016
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http://www.tobaccojournal.com/Senate_rejects_advertising_ban.53648.0.html

A general ban on tobacco advertising called for by Health Minister Alain Berset was rejected in the senate today, international news site of National Broadcasting Corporation, swissinto.ch, reported.

The cabinet argued in Parliament that advertising for tobacco products had a large impact on young people but opponents of the ban argued that no proof was given that a ban on advertising would stop people from smoking, the site reported.

Swissinfo.ch commented that the senate had voted “to protect a free market economy, rather than support health concerns.”

Who Does the Biggest Lobbying Force in the US Represent? Not Its Members

Jun 15th, 2016
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‘Member companies become de facto promoters of tobacco and adversaries of climate action’

http://www.commondreams.org/news/2016/06/15/who-does-biggest-lobbying-force-us-represent-not-its-members

Who does the biggest lobbying force in the United States represent? Not its members.

That’s according to a new investigation (pdf) by a group of U.S. senators, which found that on the issues of tobacco use and climate change, there’s a profound disparity between the U.S. Chamber of Commerce’s positions and those of the companies it supposedly speaks for.

The investigation, which comes on the heels of leaked polling results showing how the group attempts to suppress the “empathy” of its members on pro-worker positions, is based on research and correspondence with 108 private sector members of the Chamber’s Board of Directors.

Led by Senators Sheldon Whitehouse (D-R.I.) and Elizabeth Warren (D-Mass.), it was triggered by a series of 2015 New York Times articles exposing how the group was working to thwart global anti-smoking efforts and fight President Barack Obama’s plan to limit power plant emissions of greenhouse gases.

The findings, the report states, “[call] into question the Chamber’s allegedly transparent decision-making process, and [suggest] that the Chamber does not accurately represent the positions of its member companies.” As noted in the report:

Approximately half of the companies on the Chamber’s Board of Directors have adopted anti-tobacco and pro-climate positions that contrast sharply with the Chamber’s activities.

Not a single Board member explicitly supported the Chamber’s lobbying efforts.

Despite the Chamber’s description of the Board as its “principal governing and policy-making body,” not one Chamber Board member explicitly indicated that they were fully aware of and able to provide their input and views to the Chamber regarding its actions on tobacco and climate.

In fact, “We found a corporate America far more concerned about public health and the environment than the Chamber’s efforts would suggest. We identified dozens of companies investing heavily to get their employees to stop smoking because they realize a healthy workforce is a productive one. We identified companies from all corners of the economy working to reduce their carbon footprints and affirmatively supporting the Obama Administration’s Clean Power Plan and its international efforts at the COP21 climate negotiations in Paris,” the senators write in their cover letter to Chamber Board members accompanying the report.

Yet these members “undermine their own efforts by affiliating with an organization that actively and aggressively undermines efforts to reduce tobacco use and tries to prevent action to address climate change,” the letter continues. “By lending tacit support to an organization that has spearheaded a decades-long effort against policies to address both problems, member companies become de facto promoters of tobacco and adversaries of climate action.”

The letter goes on to urge the members to reflect upon “the effects in Congress of your continued affiliation with the Chamber on these issues.”

Expounding on the influence the Chamber wields, Dan Dudis, director of Public Citizen’s U.S. Chamber Watch Program, writes in an op-ed at The Hill this week:

While the Chamber is well known in Washington as a big-spending mouthpiece for Big Business, even seasoned observers of the D.C. political scene might be surprised at just how far and wide the Chamber has spread its tentacles.

Dudis also writes that it has a “central role […] in corrupting our political system through more than $1 billion in lobbying and more than $100 million in election spending.”

And that speaks to the campaign spending issues that followed the Supreme Court’s Citizens United ruling. As Gretchen Goldman, lead analyst in the Center for Science and Democracy at Union of Concerned Scientists, wrote last year:

If its own board members aren’t standing with the Chamber on climate change, who is? Who is supporting the Chamber’s anti-science position on climate and other issues? And who is funding its work to undercut efforts to promote clean energy and reduce our emissions? We need greater transparency in our political system to hold accountable those blocking efforts to address climate change.

DOCTORS DENY VALIDITY OF STUDY LINKING E-CIGARETTES WITH CIGARETTE ADDICTION

Jun 15th, 2016
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http://www.capitalberg.com/e-cigarettes-cigarette-addiction/29453/

The war between electronic cigarettes and combustible cigarettes is still fighting.

A recent study promoted the idea that e-cigarettes are responsible for cigarette addiction in teenagers. Days after it was published, other members of the scientific community started commenting, denying the validity of the survey, accusing the authors of promoting misleading information.

WHAT WAS THE STUDY ABOUT?

The initial study used a sample of approximately 1,000 high-schoolers enrolled in the 11th or 12th grade. None of the participants ever smoked a combustible cigarette. Almost half of them tried an e-cigarette.

After 16 months since the first round of interviews, the team tracked down the participants and asked them again about their smoking habits.

According to the study that was published on Monday in the on-line journal, Pediatrics, almost half of the teenagers that admitted to smoking electronic cigarettes were now struggling with a cigarette addiction.

The conclusions formulated by the team were that electronic cigarettes are only gateway nicotine delivery systems that eventually lead to cigarette addiction. They ended the paper by stating that the FDA was right when implementing the new measure that says minors are not allowed to buy electronic cigarettes on the territory of the United States.

THE REACTION OF THE MEDICAL COMMUNITY

The study was not well received at all by the medical community. Many of the professionals specialized in cigarette addiction stated that the survey was too vague and that its conclusions are rash and incorrect.

According to Ann McNeil, a Tobacco Addiction Professor at London’s King’s College, the paper has some loopholes that cannot be ignored.

For once, the authors only mentioned that half of the surveyed adolescents used an e-cigarette. However, they didn’t specify if the device was used on a regular basis or if the teens only tried it once or twice in their life.

On the other hand, they never did any follow-ups. They just returned after 16 months and counted the adolescents that developed a smoking addiction.

However, that isn’t necessarily an indicator of the fact that electronic cigarettes can lead to the development of a smoking addiction. It just shows that the teenagers that are inclined to try one thing will ultimately be inclined to try the other one.

What the doctors are arguing is that electronic cigarettes are not to be blamed in the case of the teens that developed a smoking addiction, rather their entourage and their curious nature.

Electronic cigarettes have been deemed by previous studies as being the safest quitting or nicotine-delivery option on the market.

What do you think? Which side has the most compelling arguments? In the war between e-cigarettes and combustible cigarettes who do you side with? Share your thoughts in the section below.

Better safe than sorry when it comes to e-cigarettes

Jun 15th, 2016
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http://www.sandiegouniontribune.com/news/2016/jun/15/electronic-cigarettes-addiction/

Electronic cigarette (e-cigarette) use has spread rapidly within a few years and taken public health professionals in tobacco control, as well as the tobacco industry, by surprise. Most people thought this would be another fad like snus or bidis that would fade away. The use of e-cigarettes varies by country, and the U.S. shows that most teens and adolescents are trying and using them at several folds higher rates than previous years, while in Britain this might not be the case.

When the tobacco industry took notice, it bought some of these small companies or produced its own brands. E-cigarettes have become one of the most controversial public health topics today.

The public health controversy is whether e-cigarettes (also known as Electronic Nicotine Delivery Systems or ENDS) are harmful to public health because they introduce nicotine to nonsmokers or whether they are beneficial because they help smokers of combustion cigarettes quit. The controversy was triggered by some of the public health professionals and organized e-cigarette users (also known as vapers) and sellers who believed that e-cigarettes will completely replace cigarettes among smokers if they are publicized and supported and allowed to be used everywhere, including in smoke-free places. They argue that e-cigarettes are less harmful (and in some cases claim they are completely harmless) than combustion cigarettes. There might be evidence for them being less harmful than cigarettes given e-cigarettes do not have tobacco and the carcinogens it produces, but the claim regarding mass replacement of cigarettes is at best exaggerated and unsubstantiated.

Simply stated, if there was potential for such mass replacement of the more harmful regular cigarette, we would have witnessed this by now since e-cigarette use has been on this rapid rise for some time.

What is happening is that use of e-cigarettes is increasing rapidly among both smokers and nonsmokers, but there is no evidence it is meaningfully helping the smokers who use it to quit, except for anecdotal cases or small studies and experimental controlled settings that do not relate to the general population. However, there is evidence that individuals who never smoked cigarettes but used e-cigarettes are more likely to begin actual cigarette smoking afterward. This is expected given nicotine, delivered by e-cigarettes as vapor, is highly addictive. This is the most serious harm of e-cigarettes that most public health professionals fear will be introduced to teens and young adults who otherwise would not have tried nicotine or got addicted to it. Furthermore, new high-quality evidence is emerging to show that e-cigarettes are more harmful than had been claimed.

There is nothing preventing smokers from trying e-cigarettes instead of the cigarettes they use, but data from many sources show they try them and don’t continue and those who continue on smoke more cigarettes. The U.S. Prevention Task Force and the recent U.S. Surgeon’s General Report did not recommend the use of e-cigarettes for cessation purposes.

The burden of proof is on the producers of such products to show they do not cause harm before making them available to the public. Addiction to nicotine and then reverting to combustion cigarettes, or for smokers to have difficulty in quitting because of higher nicotine from their cigarette and e-cigarettes, is by all means and measures harmful to those individuals and the health of the public. Further, many e-cigarette users want to flout the tobacco smoking bans that were one of the most important among all tobacco control policies to change the social norm of tobacco smoking, protect the public, and also help smokers quit, according to numerous studies.

We have learned from the history of tobacco and its industry that we have to be on the safe side and not overlook or support a product that can cause harm. We are now at a similar stage with e-cigarettes as we were in the early ’70s when supposedly low tar and nicotine cigarettes were glamorized and propagated in the media and by its industry as being a harm reduction approach without substantial independent research to support it, only to find years later they were actually more harmful than regular cigarettes because they made users smoke more.

There is an optimism that the recent decision by the Food and Drug Administration to regulate e-cigarettes will be the first step in controlling the rampage of them in the market with different flavors, concentrations and harm reduction claims. It took many years to take that step, but better late than never.

We have to err on the safe side and protect the future generations from another source of addiction. Better safe than sorry applies to this situation, and safe here means saving thousands of lives who as a result of e-cigarettes become addicted to nicotine and eventually cigarettes.

Al-Delaimy, M.D., Ph.D., has been the director of the California-wide Tobacco Evaluation Surveys for more than 12 years and is associate director of the UC San Diego Institute for Public Health and has authored many reports and peer-reviewed articles regarding tobacco and e-cigarettes.

No general ban on tobacco advertising

Jun 15th, 2016
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http://www.swissinfo.ch/eng/health-or-free-market_no-general-ban-on-tobacco-advertising/42229592

A ban on advertising tobacco products in Switzerland has been rejected by the Swiss senate, who voted on Wednesday to protect a free market economy, rather than support health concerns.

The ban had been called for by the Swiss Health Minister Alain Berset, who said in Parliament that smoking was damaging not only from a health perspective, but also socially and financially.

The cabinet had argued that adverts had a particularly large impact on young people. According to a German study, the risk of young people taking up smoking increased by 46% if they were exposed to adverts for tobacco.

Opponents of the ban argued there was no proof that an advertising ban would stop people smoking.

Worldwide more than five million people die every year as a result of tobacco consumption. In Switzerland that number is 9,500.

Protecting youngsters

The nationwide ban on selling cigarettes and other tobacco products to minors was undisputed, with a majority of parliamentarians explicitly expressing their support for laws protecting children and young people.

In this respect, it was argued, a legal basis is needed for test purchases to ensure shops aren’t selling tobacco to underage customers. A majority also agreed the importance of an existing ban on tobacco adverts directed at minors.

Regional differences

Tobacco advertising is already banned on the radio and on TV in Switzerland, but in 15 cantons billboard advertising is also prohibited.

In ten cantons cigarettes cannot be sold to under 18s, but in other parts of the country they can be sold to 16-year-olds.

In eastern Switzerland, it’s traditional to see children lighting up as part of a special event that centres around a regional cattle show.

State bans sale of e-cigarettes

Jun 15th, 2016
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http://www.tobaccojournal.com/E-cigarette_sales_banned.53643.0.html

The government of Karnataka has banned the sale of e-cigarettes in the state, effective immediately, newspaper The Times of India reported.

The decision announced today follows the recommendation of the state’s Minister for Health and Family Welfare, U T Khader, who said a study on e-cigarettes conducted by a committee together with an NGO found that youth were becoming addicted to the products, the newspaper reported.

“The state hereby prohibits the sale (including online sale), manufacture, distribution, trade, import and advertisement of Electronic Nicotine Delivery Systems, its parts and components in any shape or size of cartridges containing nicotine in the interest of the public,” the newspaper quoted a government notice as saying.

E-cigarettes increase aortic stiffness, BP in similar manner to tobacco cigarettes

Jun 14th, 2016
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http://www.healio.com/cardiology/vascular-medicine/news/online/%7Bc6d82092-3c5d-4fb9-a967-689ff2fa095f%7D/e-cigarettes-increase-aortic-stiffness-bp-in-similar-manner-to-tobacco-cigarettes

Charalambos Vlachopoulos, MD, from the 1st cardiology department, Athens Medical School, Hippokration Hospital, Greece, and colleagues studied 24 smokers without other CV risk factors (mean age, 30 years) during 96 sessions.

The categories measured were: tobacco cigarettes smoked for 5 minutes; e-cigarettes smoked for 5 minutes; e-cigarettes smoked for 30 minutes; and no cigarettes smoked for 60 minutes (sham procedure). Carotid-femoral pulse wave technology measured aortic stiffness.

The researchers found that e-cigarettes smoked for 5 minutes induced a large pulse wave velocity increase (0.19 m/s) after 15 minutes. E-cigarettes smoked for 30 minutes induced a larger and more prolonged pulse wave velocity increase (0.36 m/s peak immediately after smoking). Tobacco cigarettes also were associated with pulse wave velocity increase (0.44 m/s immediately after smoking, sustained for entire period).

E-cigarettes smoked for 5 minutes resulted in a less potent pulse wave velocity increase compared with tobacco cigarettes (P = .005), whereas e-cigarettes smoked for 30 minutes showed a more potent pulse wave velocity increase over electronic cigarettes smoked for 5 minutes (P = .03) and a similar increase vs. tobacco cigarettes (P = .615), according to the researchers.

Both forms of smoking increased systolic BP (P for tobacco cigarettes vs. sham < .01; P for 5-minute e-cigarettes vs. sham < .05; P for 30-minute e-cigarettes vs. sham = .01), but the differences between them were not statistically significant. Similar patterns were observed for diastolic BP.

The researchers wrote, “With the strong tendency of [e-cigarettes] to spread worldwide, especially within younger ages, our findings have important implications that could aid recommendations regarding the use of [e-cigarette] smoking.” – by James Clark

E-cigarettes – where are we now? Update

Jun 14th, 2016
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http://www.lexology.com/library/detail.aspx?g=2fd418f1-e1d9-4d19-ac31-e9228c3c2b91

E-cigarettes have become ever more popular since they first appeared on the market in 2007, and regulators have struggled to keep up. There has been much debate about the advantages and risks of using them. Community pharmacy is playing a significant role in the way the debate plays out, because many sell e-cigarettes, yet others regard such sales as unethical.

Increasingly, e-cigarettes are being seen as a positive tool in the ongoing battle to reduce smoking and last year research published by NHS England concluded that e-cigarettes were 95% safer than conventional cigarettes. The Royal College of Physicians published its own report at the end of April 2016 entitled “Nicotine without Smoke – Tobacco Harm Reduction”. The report explains that due to the negative impact on health of smoking tobacco, combined with other undesirable effects such as a reduction in economic productivity, smoking is responsible “for more loss of quality and quantity of life in the UK than any other avoidable cause” and concludes that the use of non-tobacco nicotine products, particularly e-cigarettes, has “huge potential to prevent death and disability from tobacco use.”

The number of people who smoke tobacco has already reduced considerably over recent decades. In 1972 51% of men and 41% of women smoked. By 2014, those figures had reduced to 21% of men and 16% of women. However, even these reduced percentages mean that there are still 8.7 million current smokers in the UK. According to the Royal College, the resulting direct cost to the NHS from smoking related illness is currently exceeds £2 billion each year. Taking into account other associated costs, such as social care and a decrease in economic productivity, the overall annual cost to the tax-payer is estimated to be approximately £14 billion. The Royal College has been involved in reviewing the effect of smoking for many years although, at first there was little enthusiasm at Government level for any real control over tobacco. The College published a report in 1962 identifying tobacco smoking as the main cause in the significant increase of cases of lung cancer, but, it was not until 1998 that a comprehensive tobacco control policy in the UK was published.

Because approaches to reducing the number of smokers have not been wholly successful, together with the fact that nicotine, in itself, is not a highly dangerous drug (although the smoke which is inhaled when smoking tobacco is), has led the Royal College to conclude that the use of e-cigarettes is, on balance, beneficial. This approach is consistent with Public Health England’s research that “While vaping may not be 100% safe, most of the chemicals causing smoking-related disease are absent and the chemicals present pose limited danger.

The views of Public Health England and the Royal College of Physicians will not mean that sales of e-cigarettes will be unregulated. Ministers in Wales attempted, unsuccessfully, to ban e-cigarettes from public spaces this year, and in the UK, the MHRA recently licensed e-Voke as the first e-cigarette to have a licence as a medicinal product, opening up the possibility of vaping on prescription. However, given the costs of obtaining the necessary licence – which the Royal College of Physicians puts at between £252,000 and £390,000 plus annual costs of up to £249,000, this is unlikely to be a particularly popular option, despite the credibility having a licence gives the product.

For those e-cigarettes that do not have a licence, the EU Tobacco Directive will came into force on 20 May. This regulates the content of e-cigarettes and imposes labelling and leaflet requirements. E-cigarettes must not contain more than 20 mg nicotine per ml; there are restrictions on additives; child resistant packaging is mandatory; and information leaflets must include possible adverse effects, addictiveness and toxicity. E-cigarettes must also continue to comply with advertising codes enforced by the Advertising Standards Authority.

Tobacco companies tried to prevent the Tobacco Directive coming into force. In May, the European Court of Justice rejected this challenge, holding that human health requires a high level of protection that descriptions such as ‘low-tar’, ‘light’, ‘ultra-light’, ‘natural’, ‘organic’, ‘without additives’, ‘without flavours’ or ‘slim’, could mislead consumers, by suggesting that the products concerned are less harmful or that they have beneficial effects. An argument by the tobacco companies that their descriptions were helpful to consumers was dismissed by the court, which said the descriptions were “intended more to exploit the vulnerability of consumers of tobacco products who, because of their nicotine dependence, are particularly receptive to any element suggesting there may be some kind of benefit linked to tobacco consumption, in order to vindicate or reduce the risks associated with their habits.”

Despite any residual disquiet about the long term effects of e-cigarettes, it looks as though they are here to stay, and this is reflected in the increasing number of pharmacies which are now selling them.

Charles Russell Speechlys LLP – Rachel Warren

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