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October, 2016:

Azerbaijan subsidizes tobacco manufacturers

Oct 5th, 2016
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http://en.apa.az/azerbaijan-economy/agrarian-industry/azerbaijan-subsidizes-tobacco-manufacturers.html

President of Azerbaijan Ilham Aliyev has issued an order on providing state support to development of tobacco-growing.

APA reports that AZN 0.05 will be paid in subsidy to the tobacco manufacturers for each 1 kg of dry tobacco and 10 kg of wet tobacco sold to the processing enterprises.

The subsidy also concern dry and wet tobacco sold to the processing enterprises in 2016.

The Cabinet of Ministers is to approve the rules on paying subsidies to the manufacturers by agreeing with the Azerbaijani President within two months, and the Ministry of Finance is to provide the funding.

Transparency, Yes. Interference, No.

Oct 5th, 2016
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http://www.huffingtonpost.com/vera-luiza-da-costa-e-silva/transparency-yes-interfer_b_12351906.html

Vera Luiza da Costa e Silva Head of the Secretariat of the WHO FCTC

There was a time when public health discussions on tobacco were an extraordinarily open process. Government officials met a wide range of people and listened to their concerns and ideas as they formulated policy.

Among the “contributors” were representatives of the tobacco industry, which offered assurances about its earnest intentions. The tobacco industry had access to policy-makers and infiltrated public health forums and because everyone involved was open the industry gained access to internal government documents listing a wide range of ways of regulating the industry.

All that changed when courts, particularly in North America, began considering cases from tobacco victims. Judges ordered – as is normal in such matters – that the tobacco industry discloses internal documents to plaintiffs. It became clear that the industry lied when denying the harms caused by their products, disputing scientific findings, and luring millions, including the world’s youth, into addiction, in a drive to build its business.

The publication of this mountain of paperwork (the documents are now numbered in the millions) from the late 20th and early 21st centuries was a watershed moment, providing incontrovertible evidence that the tobacco industry could not be trusted. There was no sign of the earnest partner the industry claimed to be.

Documents show how the industry worked behind the scenes successfully lobbying policy makers to discontinue or water down tobacco control measures. The documents mapped efforts to delay and confound policy initiatives and to create vast new markets in the developing world. They also show how the tobacco industry created or co-opted front groups to defend their interests and used tobacco farmers to prevent governments pushing on with public health policies.

As British American Tobacco’s (BAT) chairman noted in an internal memo in 1990: “We should not be depressed simply because the total free world market appears to be declining… There are areas of strong growth, particularly in Asia and Africa… it is an exciting prospect.”

The revelations kept on coming, including the disclosure that industry research was suppressed or secretly moved to other countries to put material beyond the reach of the courts. Other documents showed how the industry conspired in attempts to raise the proportion of women smokers to the levels of men.

The tobacco industry documents had a significant effect – firstly on the court cases to which they related, but just as importantly in creating a resolution among policy-makers. If the tobacco industry was now a global industry seeking to expand to new markets, the response must be equally global.

The UN Tobacco Control treaty itself, the WHO Framework Convention on Tobacco Control (WHO FCTC), was a response to the transnational nature of the business and the need for a global response to curb the epidemic. It entered into force in 2005 becoming the first global health treaty, an attempt to strongly regulate the trade in this noxious product.

The Convention brought together various government sectors with public health experts, researchers and others in the certainty that unified action was required to counteract the industry’s behaviour. This, we fervently hoped would save millions of lives.

We have been successful in doing so, even as we recognise that the tobacco industry is expanding its markets, placing many more people at risk of premature death.

The tobacco industry is targeting Parties’ delegations attending the world’s largest intergovernmental meeting solely dedicated to tobacco control. At the last Conference of the Parties in 2014, letters were sent representing tobacco industry interests petitioning finance officials on taxation.

We cannot sit at the negotiating table with the people who caused this global disaster because one thing is crystal clear – this industry lies. Publicly it speaks in a mild voice, while behind the scenes it executes policies in absolute opposition to its public statements, ultimately killing one in every two regular users of its products.

So when we meet in Delhi in November for the WHO FCTC’s seventh session of the Conference of the Parties (COP), we will be making documents available, we will be briefing journalists and we will publicize our decisions.

We will also guard against tobacco industry interference, this most untrustworthy of businesses. It would be a dereliction of our duty to do otherwise.

That means some sessions will be held in public and some behind closed doors, normal in international meetings and as provided by the rules of the FCTC Conference of the Parties. We will be as open as possible, but we are not naive. We have learned a critical lesson – this industry can never be trusted and will try to disrupt and confound the tobacco control process.

COP7 will, I believe, send an unequivocal message to the tobacco peddlers. The world understands who you are and what you do, and is determined to stamp out the global plague which you do so much to spread.

Follow Vera Luiza da Costa e Silva on Twitter: www.twitter.com/@vera_dacosta

The Real Reason Why E-Cigarettes Can’t Help More American Smokers

Oct 5th, 2016
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http://www.huffingtonpost.com/dr-amy-fairchild/the-real-reason-why-eciga_b_12308108.html

Dr. Amy Fairchild Professor of Sociomedical Sciences, Columbia University’s Mailman School of Public Health

Co-Authored by Amy L. Fairchild, Ronald Bayer, and Sharon H. Green

Over the past few years, the chances are high that you have seen fewer smokers and more vapers—that is, people using e-cigarettes. These devices have become ever more popular, but they also have ignited a bitter battle. Remarkably, this dispute has not pitted public health professionals against Big Tobacco flacks, as in decades past. Rather, the fight is playing out among scientists committed to drastically reducing if not eliminating the prevalence of smoking. Traditional cigarettes kill 480,000 Americans each year and will take one billion lives worldwide this century. Scientists around the world are actively debating: What can be done to stop them?

Given the anti-e-cigarette messaging of some influential anti-tobacco groups, many may be surprised to learn that it is increasingly difficult to make a scientific case against e-cigarettes. Last month, a second Cochrane Review—the gold standard when it comes to assessing the state of the evidence on hot topics from salt to fat to smoking—concluded that e-cigarettes may help smokers quit without serious health consequences. The review concluded that of all 24 studies included, not a single one reported serious health risks to vapers from up to two years of e-cigarette use. Like the first review in 2014, this update is guarded, but it also gives an approving nod to 15 currently ongoing randomized trials that are underway.

As the evidence moves in favor of e-cigarettes, this latest report is sure to add fuel to a raging firestorm. This debate highlights two key tensions. First, what do we do in the absence of scientific certainty about all possible harms? This question was at the heart of a furious exchange of letters between scientists over the course of 2014. This feud over e-cigarettes can’t be understood absent the values that animate it.

Framing the position of those who favor e-cigarettes is Michael Russell, a pioneer of smoking cessation methods who famously wrote, “People smoke for nicotine but they die from the tar.” By extension, many scientists argue that e-cigarettes can satisfy nicotine addictions without causing harmful exposures to tar and combustion. They believe e-cigarettes could drastically reduce if not eliminate cigarettes.

This “harm reduction” perspective acknowledges that many smokers cannot or will not quit. Even if e-cigarettes carry some risks, those risks are far less serious than those of smoking. Thus, weighing the risks of e-cigarettes requires a comparison to the well-documented harms of smoking.

On the other side of the debate are those who preach precaution. Until the uncertainty about e-cigarettes is resolved, these devices have no place in a public health anti-tobacco arsenal. And there is uncertainty regarding the harms smokeless products may pose, particularly in the face of unknowns about how the FDA’s new regulatory regime may impact quality control. But even if e-cigarettes may be a better option for any individual smoker who wants to quit but cannot, how might they change the pattern of disease in the long run? The fundamental question, in other words, isn’t how e-cigarettes might help or harm individuals, but whether they will change population-level smoking patterns.

This tension between harm reduction and precaution, then, highlights a second vital question: Whose risk matters?

In 2015, Public Health England, the United Kingdom’s equivalent to the CDC, roiled the waters when it endorsed e-cigarettes for harm reduction. Remarkably, while they drew fire from the Lancet and the British Medical Journal, they received the backing of ASH, a major anti-tobacco NGO with an unimpeachable record of opposition to cigarettes. In 2016, they were also joined by the Royal College of Physicians, which advocated for a harm reduction approach that included not only e-cigarettes but also other forms of smokeless tobacco.

The positions of British organizations that embraced e-cigarettes reflected a long history of support for harm reduction. Also, the UK organizations have focused on populations in immediate, certain danger: smokers themselves.

In the US, in sharp contrast, federal agencies have remained staunchly opposed, not only because of precaution, but also because of a focus on a different population: vulnerable youth and non-smokers. Former FDA commissioner David Kessler and Campaign for Tobacco-Free Kids president Matthew Myers wrote in an op-ed in the New York Times, “we cannot afford to waste more time while the tobacco industry addicts another generation of kids.” For advocates of precaution, protecting populations that haven’t yet been seduced by tobacco has remained paramount. For the non-smoker, an e-cigarette does nothing but increase risk.

Data alone cannot tell us what to do. Interpreting the emerging evidence on e-cigarettes relies on values and priorities: harm reduction or precaution, immediate peril or potential risks. While there can be no question that the public health community must look for emerging scientific data regarding risks and benefits, we must acknowledge the values that animate the controversy. Only then will we be able to reduce the enormous health burden of tobacco.

‘E-cigarettes can reduce burden of smoking-related deaths in India’

Oct 5th, 2016
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Electronic-cigarettes, popularly known as e-cigarettes, provide a third line of option to stay away from harmful effects of tobacco, and can significantly reduce the burden of smoking-related deaths in India, a renowned expert on vaping has said.

http://timesofindia.indiatimes.com/city/delhi/E-cigarettes-can-reduce-burden-of-smoking-related-deaths-in-India/articleshow/54692029.cms

“The first line option to shield yourself from the toxicity of tobacco products is to quit smoking altogether and the second line of option is to quit with the help of medication,” Konstantinos Farsalinos, from the University of Patras in Greece, told reporters at an event here.

Farsalinos, who is a research fellow at Onassis Cardiac Surgery Centre, is on a visit to India to interact with Indian medical fraternity and government authorities to share his latest findings on how e-cigarettes have helped millions of Europeans to quit smoking.

“Just as medicines offer a harm reduction technique for diseases or helmets provide bikers harm reduction in case of accidents, e-cigarettes adds a harm reduction option for smokers,” said Farsalinos.

He called upon Indian public health officials and anti-tobacco activists to maintain an open-minded and evidence-based approach, and provide proper education to the society concerning these products.

Use of electronic cigarettes has helped 6.1 million smokers in the European Union to quit smoking, according to a 2014 study that analysed data involving a representative sample of nearly 28,000 Europeans, Farsalinos pointed out.

“India is a country where smoking and harmful tobacco use is thriving. The WHO Global Adult Tobacco Survey (GATS) study found that 34.6 per cent of adults use some form of tobacco, while about one million Indians die annually from smoking-associated disease (2010 data),” Farsalinos said.

“For countries with high prevalence of smoking and harmful smokeless tobacco use (unfortunately snus is virtually non-existent in India), e-cigarettes should be considered a golden opportunity to reduce harm in a cost-effective manner,” he explained.

In November India will be the host to the Seventh Conference of Parties (COP-7) of the Framework Convention on Tobacco Control (FCTC) where public health officials from 180 countries will participate in discussions on Electronic Nicotine Delivery Systems and potentially agree on guidelines for policy and regulation.

The focus of tobacco control community and anti-smoking activists have been on nicotine, which, according to Farsalinos, is misleading because in reality none has ever died from nicotine dependence.

“Disease and death is associated with the vehicle used to deliver nicotine and is caused by the combustion of tobacco,” he noted, adding that e-cigarettes, on the other hand, involves evaporation of a liquid that contains nicotine, thereby reducing the harm associated with conventional cigarettes.

Association between use of flavoured tobacco products and quit behaviours

Oct 5th, 2016
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Detection of 5-hydroxymethylfurfural and furfural in the aerosol of electronic cigarettes

Oct 5th, 2016
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Are E-Cig Injuries Exploding Upward?

Oct 5th, 2016
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These images show injuries to the thigh and hand that resulted from burns from flames after the lithium-ion battery of an e-cigarette exploded. Credit: The New England Journal of Medicine © 2016

These images show injuries to the thigh and hand that resulted from burns from flames after the lithium-ion battery of an e-cigarette exploded.
Credit: The New England Journal of Medicine © 2016

Injuries from exploding e-cigarettes appear to be on the rise, according to a new analysis from a Seattle hospital.

Over a nine-month period from October 2015 to June 2016, health care workers at the University of Washington Medical Center treated 15 patients for injuries from exploding e-cigarettes.

For comparison, from 2009 to 2014, there were a total of 25 reports of injuries in the U.S. from these devices, the authors wrote in a letter published today (Oct. 5) in the New England Journal of Medicine. [E-Cigarettes: What Vaping Does to Your Body]

“We suspect that with the growing use of [e-cigarettes], many hospitals around the country will see an increase in injuries related to e-cigarette explosions,” the authors, led by Dr. Elisha Brownson, a surgeon specializing in burn care, wrote in the letter.

Of the 15 Seattle patients, 12 experienced burns from flames, according to the report. These injuries require extensive wound care and a procedure called skin grafting — in which a piece of the patient’s healthy skin from another part of the body is transplanted to the burned area — the authors wrote.

Chemical burns were also a common type of injury from an exploding e-cigarette: among the Seattle patients, five experienced such burns, which also require wound care.

These burns are caused by the alkaline chemicals found in the device’s battery, according to the report.

Four of the patients experienced “blast injuries,” the authors wrote. These injuries caused tooth loss and “extensive” soft-tissue loss in the patients, and some patients needed surgery to remove damaged tissue and close up their wounds, according to the report.

Some of the patients with blast injuries also had “traumatic tattooing,” which occurs when foreign particles get embedded below the surface of a person’s skin, creating a tattooed appearance.

The authors noted that more than half of the injuries were to the thigh or groin, one-third of the injuries were to the hands and one-fifth of the injuries were to the face.

Patients injured by e-cigarettes often require medical treatments from a number of different specialists, including emergency medicine providers, plastic surgeons, burn care providers, vocational counselors and psychologists, according to the report.

In all of the cases that the authors described, the device’s lithium-ion battery caused the explosion.

The authors noted that the Food and Drug Administration recently announced that it would begin to regulate all tobacco products, including e-cigarettes, but that it’s unclear if the agency would also regulate the batteries.

Originally published on Live Science.

Plain packaging on cigarettes and tobacco due in May 2017

Oct 4th, 2016
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Health warnings with graphic images of health consequences to dominate packaging

http://www.irishtimes.com/news/politics/oireachtas/plain-packaging-on-cigarettes-and-tobacco-due-in-may-2017-1.2816748

Plain packaging on cigarette and tobacco products will come into effect in Ireland in May next year, Minister for Health Simon Harris has confirmed in the Dáil.

The Government has been adamant it will introduce plain packaging despite threats from the tobacco industry of legal action and the loss of 87 jobs in Mullingar following the decision to close the Imperial Tobacco manufacturing plant.

Health warnings with graphic images of the consequences of smoking will feature predominantly on packaging.

Mr Harris was speaking as he introduced the Health (Miscellaneous Provisions) Bill – an amalgam of measures to amend four pieces of legislation relating to different aspects of health.

The Bill amends six sections of the Public Health (Standardised Packaging of Tobacco) Act 2015 relating to the regulation of the appearance of tobacco packaging.

Reducing appeal

Mr Harris said the regulation of the appearance of tobacco packaging is aimed at improving public health by reducing the appeal of tobacco products to consumers, and increasing the effectiveness of health warnings on the retail packaging of tobacco products.

It will also reduce the ability of the packaging of tobacco products to mislead consumers about the harmful effects of smoking, the Minister said.

The Bill will allow the Minister prescribe “the colour of the outer and inner surfaces of tobacco packaging, the form and manner of barcodes and the manner in which a name may be printed on tobacco products”.

The legislation also amends the Irish Medicines Board Act 1995 to allow fees to be paid to board members of the Health Products Regulatory Authority, former the Irish Medicines Board, which licenses medication in the State.

Board members will be paid €7,695 a year, resulting in an overall additional cost to the authority of about €61,560.

The Minister said some members might choose to waive their fee and he pointed out that the “One Person One salary” principle would apply to members of the board who are also in receipt of a salary from the public service.

‘Onerous responsibility’

Mr Harris said he was introducing the changes because “there is an onerous responsibility and significant time commitment placed on members of the authority and we wish to attract the highest calibre of people to apply to be members of such boards”.

A separate amendment to the Nursing Homes Support Scheme Act 2009 will mean that anyone applying for the nursing home Fair Deal scheme will not have to include for means testing certain ex-gratia payments received arising from Government decisions.

The legislation deals with four Government schemes including three linked to the Lourdes Hospital – the hospital’s Redress Board which involved 119 women; the hospital’s payment scheme which compensated women excluded from the Redress Board on age grounds, affecting 47 women; the Surgical Symphysiotomy Payment Scheme which made awards to some 400 women and payments made by the government or the German Contergan Foundation to 32 Irish survivors of thalidomide.

Hungary to introduce fees for e-cigarettes

Oct 4th, 2016
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As another step in further regulating the market, the Hungarian government is foreseen to levy many new fees on retailers and sellers of electronic cigarettes from November, Hungarian news agency MTI reported today, based on a decree published in the latest issue of the official gazette Magyar Közlöny.

http://bbj.hu/business/hungary-to-introduce-fees-for-e-cigarettes_122876

An administration fee of HUF 475,000 on sellers of e-cigarettes will be introduced, along with a separate fee businesses will be required to pay for every brand and strength of nicotine and nicotine-free e-cigarette as well as refill cartridges they sell, according to the decree.

Additionally, businesses will be forced to pay a HUF 306,000 fee, per item, for any modifications to the range of products they sell.

Revenue from the fees will go to the National Institute of Pharmacy and Nutrition (OGYEI), according to MTI.

HALF-HEARTED TOBACCO CONTROL

Oct 4th, 2016
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http://www.thejakartapost.com/news/2016/10/04/half-hearted-tobacco-control.html

With the current government aiming high on health development, its decision to raise cigarette excise by an average of 10.54 percent starting next year shows otherwise. The incremental increase affirms the government’s lackluster effort to build a healthy nation to say the least.

When the Finance Ministry regulation takes effect in January, cigarette retail prices will only go up by 12.26 percent from the current price. History beckons that excise rate hikes on cigarettes have so far failed to force smokers to quit the habit.

Many of them did not even reduce their cigarette consumption either. That happened because the cigarette retail price remained affordable for everybody, including teenagers who relied on pocket money from their parents to indulge their smoking habit.

We could have expected a far different story had the government taken a bold move by setting an extremely high duty that would double or triple the cigarette retail price. The considerably low cigarette prices is one of the reasons why the smoking population in the country keeps growing.

The latest UN Office of Drugs and Crime data found that Indonesia’s average cigarette price of US$1.32 per pack is among the cheapest in the world. In Southeast Asia, Indonesian cigarette prices are only more expensive than in fellow developing countries Cambodia, the Philippines and Vietnam.

In developed countries, apart from enforcement of regulations and legislation discriminatory against smokers, retail cigarette prices are set very high so as to deter people from smoking.

A few months ago, a study conducted by a University of Indonesia medical doctor sent shockwaves after finding that the majority of 1,000 respondents he surveyed said they would consider giving up smoking if pack of cigarettes increased to Rp 50,000 (US$3.80).

The Central Statistics Agency (BPS) has found that 70 percent of Indonesian smokers come from the poor families. It can be safely said had the government taken the survey into consideration in setting the new cigarette excise, the country’s population of smokers would likely dramatically decrease.

There is a risk, however, of rampant trade of illegal cigarettes if the excise is set too high. But it will boil down to the government’s commitment to improve monitoring. The Trade Ministry and Industry Ministry will contribute a lot in fighting illegal trade in cigarettes through registration of all cigarette machines operating in the country.

Various studies have discovered that the costs of treating tobacco-related diseases, not to mention production loss, outweigh state revenue from cigarette excise. The Global Adult Tobacco Survey (GATS) in 2014 revealed that cigarette consumption killed 190,260 people in Indonesia that year, or 500 lives lost every day. The number would skyrocket if it includes passive smokers, who are more vulnerable to cigarette-related diseases than smokers themselves.

The question that remains unanswered is why the government, despite the evidence of cigarette harm, has for a long time acted in favor of the tobacco industry and all multiplier effects it has created that go against the noble goal of promoting good health for all.

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