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January, 2017:

The Surgeon General’s Report on E-Cigarettes: Quitters & Starters

By Dr. Sudip Bose, MD

http://www.huffingtonpost.com/dr-sudip-bose/the-surgeon-generals-repo_b_14046964.html

Jan. 7, 2016 — A report on e-cigarettes released at the end of last year by the US Surgeon General’s office shows a number of risks related to the popular product — particularly regarding young people — that should make them a lot less popular, but likely won’t. The act of “vaping” is often thought of as a safer alternative to smoking, but that’s not necessarily the case. Here are the dangers and potential dangers people should be paying attention to related to e-cigarettes:

The Debate

E-cigs are at the center of one of the most contentious debates in public health. The availability and appeal of using e-cigs as an alternative to smoking cigarettes has been growing quickly over the years for both those who are new to smoking, as an introductory product, and to those who are trying to quit smoking, who see it as a more “healthful” way of trying to kick the smoking habit.

However, e-cigs don’t solve the nicotine problem at all. Yes, e-cigs eliminate tar, and yes, e-cigs eliminate the tobacco — both dangerous elements to one’s health. And that’s definitely good. But what they do not eliminate is the critical element of nicotine. Nicotine is one of the most highly addictive substances on earth. It’s presented in a liquid and then vaporized form in an e-cig; you inhale through the e-cig, and as you inhale, the nicotine and other substances in the liquid are atomized and absorbed into your lungs. The nicotine in an e-cig is a lot more concentrated and potent.

New Users

For those who have never smoked and who are interested in the experience, e-cigs are an entry-level product that have been promoted and marketed as being safe. They’re not. They may be “safer” than cigarettes, but that’s only by degree.

While a new “vaper” isn’t exposed to the other substances of tar and tobacco such as are found in a normal cigarette, he or she is getting concentrated and more potent doses of nicotine. That’s not good. And we’re seeing younger and younger people trying these. Also not good. The e-cig “e-liquid,” which is what produces the vapor that users inhale and exhale, are marketed in an array of flavors that appeal to younger users — junior high and high school age kids — they’re available for order online, and you’re getting addicted right away to the habit of using nicotine. The flavors available boggle the imagination: bubble gum, banana, “Mother’s MIlk,” blueberry-lemon, banana cinnamon nutbread, pomegranate, strawberry — it goes on endlessly. These teenagers — and even younger children — are getting addicted early, which could lead to smoking, and e-cigs can easily become a gateway to trying and developing an addiction to more serious drugs. Addiction correlates to crime. People need to feed their habit, they break into homes to steal things to resell, they commit robberies on the streets, all to get money to feed their addiction. Ultimately they make some very poor choices and place themselves in very dangerous situations.

We may see less cancer as a result of e-cig use, because the tobacco and tar are gone. But we won’t be able to tell that for years or decades to come. Remember there are other chemicals mixed in with the nicotine in the solution that also could cause cancer down the road. The liquid that becomes vaporized in e-cigs, which you inhale and exhale in a cloud of vapor, contains not only nicotine but an array of other substances, such as propylene glycol, glycerine, flavorings and sometimes components like diacetyl, acetyl propionyl, benzaldehyde and the less-threatening sounding vanillin. We know that when inhaled, diacetyl causes a type of bronchitis known as “popcorn lung” — a scarring of the tiny air sacs in the lungs resulting in the thickening and narrowing of the airways. It may sound benign to a degree, but according to the American Lung Association, “it’s a serious disease that causes wheezing and shortness of breath, similar to the symptoms of chronic obstructive pulmonary disease (COPD).”

Quitting Smoking

If you’re trying to quit smoking, remember the key drug, nicotine, is still very much available through an e-cig and at much higher, concentrated doses. So while you will be eliminating the tar and tobacco of a cigarette, you’re amping up the accessibility of nicotine. That’s not exactly a great way to wean yourself from something harmful — to add more of it to your system.

We’re seeing a lot more nicotine toxicity. For example, little babies we see in the emergency room — sometimes they get a hold of a cigarette and they chew on it, which is usually not that harmful. But if they get a hold of an e-cigarette and ingest some of that liquid nicotine, which again is so concentrated in an e-cig form, we see nausea, vomiting seizures, paralysis — bad things.

Being that the nicotine is one of the most addictive substances, it’s not really helping you quit your addiction, it’s not the path to accomplishing that. And we’re seeing younger and younger people getting into it.

An Alternative to Smoking

There is a rising “connoisseur-ship” that’s evolved in the world of vaping in which vapers discuss vaping in the same way that wine aficionados discuss the nuances of whatever wine they are drinking. That’s great, but that doesn’t lessen the dangers outlined above.

Are vapers listening? Not really. In 2013, e-cigarette-related sales were $1.7 billion, which was double what they were in 2012. In 2015, those sales had risen to $2.9 billion. Many tobacco manufacturers also are in the e-cigarette game. More than 250 e-cig brands are on the market.

Perhaps this Surgeon General’s report will help refocus attention on the dangers of e-cigarettes and give people enough of a reason to take a pass at the growing trend of vaping.

For more about Dr. Sudip Bose, MD, please go to SudipBose.com and visit his nonprofit TheBattleContinues.org where 100% of donations go directly to injured veterans

Follow Dr. Sudip Bose on Twitter: www.twitter.com/docbose

Clarification of When Products Made or Derived From Tobacco Are Regulated as Drugs, Devices, or Combination Products

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Price hike alert: GCC gears up for higher taxes on tobacco, soft drinks, luxury cars

New taxes will be added to the existing ones, which are 100 percent on tobacco and alcohol, and that the total taxation on such products will become 200 per cent. (Pixabay)

http://www.albawaba.com/business/cigarette-tobacco-gcc-tax-price-hike-soft-drinks-luxury-cars-923098

The six-nation Gulf Cooperation Council (GCC) is gearing up to double the taxation on certain items like cigarettes in the coming months.

The GCC will gradually implement a selective tax on 93 commodities starting the second quarter of this year and expand to cover all member countries by the beginning of 2018, said Abdulrahim Al Naqi, secretary-general of the Federation of Chambers of GCC.

According to the Saudi budget document published recently, “the GCC countries have already agreed to implement selective taxes on tobacco, and soft and energy drinks during the current fiscal year 2017″.

Al Naqi revealed that the list of items that will be taxed includes energy drinks, tobacco and luxury cars. He explained that each GCC country will determine the value of its own selective tax.

Khaleej Times has further learned that the tax will be added to the existing tax, which is 100 per cent on tobacco and alcohol, and that the total taxation on such products will become 200 per cent.

Last week, the Saudi Ministry of Finance clarified that the tax will be imposed only after the ratification of the uniform agreement on selective tax and the issuance of the domestic rules of procedure in line with the decisions adopted by the Supreme Council of GCC leaders. The proposed date for its implementation is April 2017, the statement added.

Al Naqi said there is a need to spread awareness among the region’s residents as well as the private sector before the implementation of the decision.

The UAE currently imposes 100 per cent tax on tobacco products. The GCC tax code includes 50 per cent taxes on soft drinks and 100 per cent taxes on power drinks, tobacco and its derivatives.

By Mustafa Al Zarooni

UK’s detailed TPD plans suggest light-touch approach

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Next chief executive should back annual tobacco tax hike in Hong Kong

Your editorial (“Preventive health care is an investment, not a burden [1]”, January 1) has hit the nail on the head regarding the importance of, and investment in, prevention versus cure in Hong Kong.

We all need the “ambulance and curative services” to rescue us when we are taken ill, but unless the whole of government – particularly the finance, trade and economic branches, as well as the Independent Commission Against Corruption and the Ombudsman – grasps the political nettle of issues such as tobacco control, health will never improve, nor will the many thousands of annual deaths from tobacco be reduced.

Indeed, the entire Hong Kong government is under an international obligation to do so, being a party to the World Health Organisation Framework Convention on Tobacco Control.

One of the most important platforms of any incoming chief executive is their future preventive health plan for Hong Kong citizens.

Let us call upon each of the potential chief executive candidates to outline their health platforms. We should discard all those who see these platforms in terms of more hospital beds, which will never solve the problem of improving Hong Kong’s health. And the current health paradigm is such that improvements will only come about by addressing the vested interests of big business – the tobacco, alcohol, food, and even salt industry –including their often unrecognised front groups.

With tobacco control, we have known for decades what works, and how very cost-effective these measures are. Yet governments around the world hesitate to act.

Increasing tobacco tax heads the list of the best single measure to reduce smoking. It may be surprising to many that a fiscal measure is more important than health education in schools or banning sales to youth, for example, but it is the single best action governments can take to reduce consumption among the young.

Why can Hong Kong not follow Australia and New Zealand and commit to an annual tobacco tax increase of, say, 10 per cent per annum to the year 2025?

Any chief executive candidate who would endorse this would get my (hypothetical) vote.

It would give us an orderly and planned route to follow, and avoid the incredible waste of time and energy lobbying annually for tobacco tax increases. And it would have a massive effect in saving young and middle-aged lives, and in what is termed “frailty avoidance” in the elderly.

Dr Judith Mackay, Clear Water Bay

Sudan Scholars – ‘Tobacco Not Allowed in Islam’

Last week, the head of the Sudan Scholars Corporation issued a religious decree banning tobacco.

http://allafrica.com/stories/201701090127.html

Sheikh Mohamed Osman Saleh, head of the Sudanese Scholars Corporation told the state-owned Sudan News Agency (SUNA) last week that tobacco is forbidden in Islam.

The use of tobacco is no less dangerous and evil than the use of drugs, Saleh said.

He demanded the Sudanese security apparatus to combat the cultivation, sale, and use of tobacco in all parts of the country.

Asked about the donation of the North Darfur government of 10,000 tons of tobacco in support of the ruling National Congress Party, the sheikh said that the gift consisted of various in-kind materials. He accused the Sudanese media of highlighting the tobacco item, “for the purpose of creating sensation and chaos”.

In response, former North Darfur government adviser on economic affairs Rashid Ismail told reporters in Khartoum that “the fierce attack against tobacco trade in the country has led to the idea that it is something abnormal”.

According to Ismail, “the recent campaign against tobacco is probably intended to hit the Darfur economy. It will put the livelihoods of 900,000 Darfuris at stake”.

Governments To Introduce Super Tax On Tobacco Industry

http://www.huffingtonpost.co.uk/david-green/governments-to-introduce-_b_13966906.html

Cigarettes are the most effective killing machine on the planet. Something radical has to be done to stop 1 in 7 of children becoming smokers.

1 billion people smoke cigarettes which in time will kill half of its users amounting to over 6 million people each year. That’s equivalent to wiping out the population of Britain in a decade.

Meanwhile, the world leading tobacco companies boast an income of $315 billion and the top 6 companies make profits of $44bn.

Tobacco deaths account for 20% of all cancer cases. 14 million people are diagnosed with cancer each year. And before people buy into the highly addictive E- cigarettes as the ‘healthy’ option, according to the World Cancer Report, they contain 3,000 chemicals and 28 carcinogens with similar nasties as cigarettes.

Just as 1,000 leading doctors are calling on Theresa May to create a brave new policy on smoking, a bold clear thinking leader could easily introduce a Super Tax forcing tobacco companies to set aside monies to build and run standalone cancer hospitals exclusively for the use of its loyal customers that they are killing. This would reduce substantial pressure on hospitals and release monies to care for people who do not choose habits that make them ill.

There are enough people sadly affected by illness not of their own making, so let’s eradicate the illnesses that are of our making and penalise the industries that make money out of suffering.

Every problem can be solved if we deal with the cause. It’s all about the cause but who wants to deal with the cause?

Obama just announced a bill to spend $6.3 billion to fight cancer over the next decade. Very admirable.

BUT how stupid are we?

Over 2.5 million of cancer deaths per year are avoidable. Main causes being SMOKING, OVEREATING, ALCOHOL ABUSE.

It’s a sad fact of life that we are safest and cause less harm to ourselves and others when we are asleep!

Just as governments found the banks to be sitting ducks to fine handsomely for their misdemeanours, there is far higher justification to target the tobacco companies to save lives, save tax-payers money, save grief, save pain and save suffering.

Our addictions and bad habits cause the majority of our problems but only when we accept this brutal naked truth do we realise we have the power to change ourselves rather than pollute ourselves. Life is tough enough without making ourselves ill.

Many amazing people help and inspire us to overcome our addictions, yet governments are slow to do what is right to implement radical and aggressive change. It should be mandatory for school children to visit cancer wards from a young age to see the effects of cigarette and alcohol abuse as part of the curriculum as well as drug addiction facilities to witness how drugs can destroy people.

I have recently been staying in Manhattan Beach, a smoke free city in California. Here you can’t smoke outside anywhere. Someone made it happen. Other cities and countries could easily follow.

On Christmas Day, the legendary George Michael passed away. On the same day, a brave friend of mine Murray Goldstein also left us. Murray had an important message for the smokers in the world:

“My father was a heavy smoker all his life. He lived to 90 with the occasional cough. Had I known then that he was the exception to the rule I probably would never have become addicted. But in those days, there was no information available that told you smoking was bad for the health.

I smoked a few packets a day from the age of 16 and had a heart attack in my 30s because of smoking and poor diet. I carried on smoking which ruined my chance of a healthy life.

The last 12 years have been a form of purgatory as I have developed COPD – chronic obstructive pulmonary disease – which is irreversible, fighting for every breath. My world has revolved around my illness, affecting my near and dear ones especially my wife who has made a great sacrifice to care for me. During the last few years I have needed 24 hour care and the emergency services have revived me several times.

My advice to present day smokers – GIVE IT UP BEFORE YOU GET ILL – it’s not as hard as you think. Don’t wait until the first heart attack or the news that you have cancer. Please learn from my mistakes. I stopped 8 years ago and have never had any cravings and I was a forty-a-day man for years!”

Congratulations to all smokers who finally kick the habit and take Murray’s advice.

Meanwhile, our leaders would do well to reflect on Gandhi’s wise words:

“The difference between what we do and what we are capable of doing would solve most of the world’s problems.

E-cigarette flavours pose unknown harm risk

http://medicalxpress.com/news/2017-01-e-cigarette-flavours-pose-unknown.html

Electronic cigarette users are more at risk of lung damage if they use flavourings such as menthol and butterscotch, according to a new study by scientists at the University of Salford.

Scientists say that ‘vaping’ flavours contain toxins, including harmful substances that are not inhaled by users of standard tobacco cigarettes.

And they claim the huge variety of non-standard vaping liquids is exposing people, particularly younger smokers, to unknown risks.

Studies have shown that vaping liquids contain aldehydes, compounds which can cause damage to lungs, but the Salford study is the first to test flavoured liquids – inhaled as ‘smoke’ – on normal lung tissue.

All proved toxic

“We are talking about flavours which are normally ingested in food where tissue is much different from tissue in the lungs,” explains Dr Patricia Ragazzon of the Biomedical Research Centre at the University of Salford.

“When inhaled, some of the flavours we tested proved to be substantially toxic, with prolonged exposure killing bronchial cells completely.”

The experts, who publish their findings in the journal Scientific Progress, studied 20 liquid refills in nine flavours – cherry, strawberry, ice-mint, menthol, tobacco, blueberry, vanilla, bubble-gum and butterscotch – bought from shops, chemists and over the internet.

In laboratory tests on cell lines of human bronchial tissue, both embryonic and adult cells were exposed to vapour at a range of concentrations over 24, 48 and 72 hours. All proved toxic to the cells varying from less toxic (fruit flavours) to moderately to highly toxic (menthol, bubblegum, coffee, butterscotch and tobacco).

“We showed that cells can recover after 48 hours but not once they were exposed for 72 hours or more, which has serious implications for regular smokers,” said Dr Ragazzon.

Unregulated products

Moreover whilst adult cells were less impacted, the majority of samples proved moderately to highly toxic to the embryonic cells.

Of additional concern, she notes, is the huge variation of flavours and their component ingredients: “The composition of refills is highly irregular – some are natural flavours, some are single compounds, some are synthetic flavours, – there are so many varied products on the market, it’s difficult to gauge their harmfulness,” added Dr Ragazzon.

“Our work supports the opinion that e-cigarettes and especially the ingredients of the e-liquid, which can change in structure after the process of heating, have not been thoroughly characterised or evaluated for safety.”

Mom’s E-Cig Liquid Almost Kills Girl, 6

Dad accidentally gave daughter liquid nicotine that was in ibuprofen bottle

http://www.newser.com/story/236464/girl-drinks-moms-liquid-nicotine-from-ibuprofen-bottle.html

When a 6-year-old girl in Oregon sprained her ankle, her father reached for their liquid child ibuprofen bottle and gave his daughter a 10ml dose. She lost consciousness almost immediately and her limbs began to jerk, so he took a tiny sip and realized it was liquid nicotine for his wife’s e-cigarette; she had used the empty container to mix her own e-liquid, reports Health Day. The father called poison control and 911, and the girl barely survived a harrowing night in the emergency room and intensive care unit, where she was treated for acute nicotine poisoning and placed on a ventilator, the doctors report in the journal Annals of Emergency Medicine.

The case study comes on the heels of the surgeon general calling e-cigarettes “a major public health concern,” researchers write in a press release. “As electronic cigarette use proliferates, children are now increasingly at risk of toxicity from ingestions of much larger quantities of nicotine from highly concentrated refill liquid,” one toxicologist says. The girl had ingested 700 milligrams of liquid nicotine, higher than the 500mg threshold that can kill an adult, and her blood nicotine level was 348 nanograms per milliliter, far higher than the 12 to 54 ng/ml found after an adult smokes one regular cigarette, reports Live Science. The doctor says that “slightly different circumstances” would have easily led to “a tragic outcome.” (Many victims of e-liquid poisoning are younger than 4.)

Southampton smokers buying cheap cigarettes ‘unknowingly funding international terrorism’

http://www.dailyecho.co.uk/news/15005528.Southampton_smokers_buying_cheap_cigarettes__unknowingly_funding_international_terrorism_/

Smokers who seek out cheap cigarettes and tobacco in Southampton are unknowingly helping to fund organised crime and even international terrorism.

That’s the fear of experts who say that millions of pounds in profits from illegal and fake tobacco products easily available from rogue traders is finding its way into the pockets of the worst of criminals and killers.

This week the Daily Echo has revealed how our exclusive research in Southampton has shown how a flood of illegal and fake tobacco products are openly being sold by some unscrupulous traders and individuals.

Our independent undercover investigators had no trouble in buying packets of cigarettes and roll you own (RYO) tobacco at a fraction of the true cost of legal, branded products.

We reported how many of the fake fags were actually made of poor grade tobacco and included such ingredients as rat droppings, human excrement, dead insects, plastic and asbestos.

And we told how there are fears that the trade in illegal and fake cigarettes was funding organised crime and even international terrorism.

Today we look at how the trade is funding the worst of crimes as gangs seek to profit from the high taxes levels in the UK that entice some smokers to seek cheaper products.

Those who buy counterfeit and illegal tobacco products are almost always unaware that they are unwittingly part of an elaborate criminal network that inflicts pain and misery throughout the globe.

The recent terror attacks in France and Germany as well as the Middle East and further afield have shown how dangerous these people can be.

Yet few buying cheap cigarettes or rolling tobacco in Southampton would make the link between their actions and the men and women people who control the killers.

Cheap tobacco products are made in unregulated factories around the world, especially in the Far East. The products are then smuggled into the UK which has some of the highest taxes on tobacco in the world. In some parts of the country as much as 50 per cent of rolling tobacco is believed to be illegal or fake brands.

The United Nation’s Security Council’s investigative body was reported to have found that millions of pounds in illicit tobacco revenue is reaching the Taliban and al-Qaeda. The UN also says it has found links to Congolese rebels who have been recruiting child soldiers and carrying out atrocities in the African country.

Europol – the European wide law enforcement agency – says that some countries in Eastern Europe and Asia act as transit countries where gangs can establish warehouses and factories before sending the finished goods to the lucrative Western European markets.

Joining in with the fight against the trade is HMRC who say that they are determined to stamp out illegal tobacco.

“HMRC will not cease in its efforts to track down cigarette smugglers and stop their activities,” said a spokesperson.

“In particular, the illicit trade in tobacco, alcohol and pharmaceuticals is more attractive to organised criminals than, for example, drug trafficking, given that it is a low-risk and high-value activity.

“The high profit margins associated with illicit trade are used to fund other criminal and terrorist activities, a fact not widely understood by the British public.”

Each year HMRC and Border Force prevent billions of cigarettes and hundreds of tonnes of illegal tobacco entering the UK. Inland, HMRC and Trading Standards departments make further seizures.

In the past five years (2011/12 to 2015/16) HMRC and Border Force have seized more than 8 billion cigarettes and close to 2,000 tonnes of RYO.

It’s not difficult to understand why smokers would seek cheap tobacco products. Examples discovered here in Southampton included a counterfeit packet of Amber Leaf tobacco that was sold to a researcher for £4 when its normal cost would be around £16.60 from legitimate traders.

A pack of 20 Mayfair Cigarettes was handed over for just £3 when the legitimate cost would be £8.39.

UK taxes on tobacco, and therefore prices, are among the highest in the world, and have been so for many years. This has led to many smokers seeking out cheaper alternatives, sometime purchasing products when they go abroad, or from ‘black market’ channels.

For example, a 10g pack of Roll Your Own (RYO) costs around £3.90 in the UK while 50g of RYO can be bought in Belgium for around £4.35 – five times the quantity for only a little bit more.

Test purchasing carried out as part of our research has shown illegal cigarettes are on sale in Southampton for as little as £2.50 per 20, with RYO on sale for £4.00 per 50g.

HMRC estimates that £2.4 billion in tax revenue was lost because of tobacco smuggling in 2015/16. Since the turn of the century (2000/1 to 2015/16) the total revenue loss is £41 billion, money that could be used to build hospitals and pay for schools as well as social care.

And illegal tobacco not only represents a loss of tax revenue to the Treasury but also a loss of turnover and profits to the UK’s estimated 57,000 retailers that sell tobacco products with 6,900 here in the South East.

The Daily Echo has worked with tobacco company JTI in its investigation into illegal tobacco sales in Southampton.

Steve Wilkins, JTI Anti-Illegal Trade Operations Director said: “The link of illegal tobacco to serious and organised crime is very real and together with the crime-fighting charity Crimestoppers, JTI hopes to rid our streets of illegal tobacco and stop criminals infiltrating our communities.”

Since September 2013, JTI has removed gantries from 26 retailers convicted of selling illegal tobacco.

“JTI has had to do this as we continue to see some independent retailers get sucked into this illegal trade, giving honest hard-working retailers a bad name. If this type of crime continues, customers who buy tobacco products will lose faith and trust in their local shops as the perception grows that the independent trade is rife with ‘dodgy cigarettes”, added Mr Wilkins.

“Smokers buying cheap fake cigarettes and tobacco on the streets of the UK may be getting more than they bargain for as these fake imitations has been found to contain asbestos, mould, dust, dead flies, rat droppings and even human excrement.

“JTI fully supports efforts to rid our streets of illegal tobacco and stop criminals infiltrating our communities, and would urge local residents to work with community groups and trading standards to eradicate this type of activity.”

A spokesperson for Crimestoppers told the Echo: “The link this trade has to serious and organised crime is very real, and with the help of information from the public on those supplying and selling these fake products, our aim is to ensure your community is a safe place to live.”

What do those trading and dealing in illegal tobacco risk?
• Criminal prosecution with a custodial sentence of up to 7 years (upper level crime)
• Financial wrongdoings penalties of up to 100% of the duty due (resulting from the sale of goods which are subject to unpaid duty) In 2015/16, 1,335 tobacco related wrongdoing penalties were issued
• Fines of up to £5,000 for selling illicit tobacco not bearing the UK duty paid fiscal markings
• Vehicle seized (if illicit tobacco products are transported in it)
Additional sanctions following successful prosecution
• HMRC may make confiscation orders under the Proceeds of Crime Act 2002
• Prohibition on the sale of tobacco products for up to 6 months
• Revocation of the store’s alcohol licence
• National Lottery terminal may be removed
• If JTI tobacco gantry is in situ, this may be removed and any further assistance from JTI terminated.

The tobacco industry has identified four areas that make the UK an easy target for organised criminals to sell illegal and fake tobaccoproducts:

Plain packaging for packets of cigarettes introduced recently into the UK makes it much easier for gangs to produce fake tobacco products with no complicated designs to copy.
High taxes in the UK means more are tempted to buy cheaper illegal products from rogue traders.
The EU’s Tobacco Products Directive bans small packets of cigarettes and rolling tobacco which widens the price gap even more between legal and fake products.
The recent introduction of the retail display ban at stores where shelves are required to be hidden from view blurs the distinction between legal and fake tobacco products.
Anyone with information about this type of crime should contact Crimestoppers anonymously on 0800 555 111.