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September 25th, 2008:

Where There’s Smoke

Indonesia is a world leader in cigarette consumption, but health advocates face an uphill battle in the face of a powerful tobacco lobby and seemingly indifferent politicians

Fabio Scarpello – SCMP – Updated on Sep 25, 2008
The performance by American singer Alicia Keys in Jakarta in July was notable for more than just the quality of the music. The sultry R&B star took a stance against cigarette advertisements and earned herself more than a few extra fans among Indonesia’s anti-smoking lobby. Her position led to Philip Morris International withdrawing its sponsorship – something quite extraordinary in a country where tobacco advertisements are ubiquitous.

“I am an unyielding advocate for the well-being of children around the world and do not condone or endorse smoking,” Keys said at the time, and the comment could not have been made in a more appropriate place.

Indonesia, the world’s fourth-most populous country, also has one of the world’s youngest populations and it is the incidence of smoking among the young that is most disturbing to the anti-smoking lobby.

According to a World Health Organisation global youth tobacco survey last year, smokers in Indonesia are getting younger, with the number of smokers aged between five and nine climbing dramatically.

The same study said more than 141 million – or over half of Indonesia’s 220 million inhabitants – were smokers and as many as 78.2 per cent of those were youngsters. This percentage has doubled in just three years. Indonesia is third on the list of countries with the largest number of smokers, after China and Russia, but has the highest percentage of juvenile smokers.

Experts say this is due to the fact that producers are targeting young people, while the government and lawmakers do little to prevent it, with legislation limited and rarely enforced.

Rita Damayanti, of the University of Indonesia’s Faculty of Public Health, said that children too young to buy cigarettes were being targeted by the cigarette industry, which wanted to get them addicted and become long-term smokers.

“Even though it is illegal to show a picture of cigarettes, cigarette companies just work twice as hard to send the message,” she said.

Mrs Damayanti explained that creative advertisements exposed young audiences to positive images, exciting lifestyles of youth culture and heroic characters, followed by a cigarette brand. “And we can predict how children will react to that,” she said.

Cigarette companies regularly hold promotions in parks and at concerts and sports venues. The effect of advertisements is that young people receive strong messages suggesting that smoking is cool. A teenager, cited in a 2006 study conducted by Nawi Ng, a public health specialist, summed up prevailing attitudes among his peers, saying: “If I don’t smoke, I’m not a real man.”

Seto Mulyadi, head of Indonesia’s National Commission on Child Protection, said the government must do more to restrict youth smoking.

“Cigarette companies should not be allowed to sponsor school events and give out free cigarettes. This is simply immoral,” he said.

Mr Mulyadi said cigarette companies had intensified these two approaches since a recent regulation banned television advertisements before 9.30pm.

The major cigarette firms deny targeting the young. “In the last 10 years, all international tobacco companies have changed their policy to not focus on juveniles as their consumers,” Niken Rachmad a spokesman for Sampoerna, which is 98 per cent owned by Philip Morris, told The Jakarta Post.

He added that the tobacco industry targeted only young adults above the age of 18, “for example, university students, who can decide for themselves”.

Mr Mulyadi said that part of the problem was that the law prohibiting sales to minors was not policed. Schoolchildren smoked in the street to general indifference, he said. “The government should also ratify the Framework Convention on Tobacco Control (FCTC), which bans cigarette commercials altogether, among other things,” he added.

The FCTC is a global agreement on public health, which the WHO endorsed at a meeting in Geneva in May 2003. Indonesia was involved in drafting the FCTC but, although the framework has since been ratified by 157 countries, Indonesia has not signed it. North Korea is the only other country in Asia not to have done so.

The government’s relaxed attitude is mirrored by that of lawmakers. Parliament is yet to debate the Control of Impacts of Tobacco Products on Health Bill. The draft has been sitting idle for more than two years. Government inertia means there is unlikely to be an increase in the tobacco tax – a key to fighting cigarette addiction, according to experts.

“If you raise the tobacco tax, you make cigarettes more expensive. It means low-income earners will not waste their money on cigarettes, and young people will not find it affordable to buy cigarettes any more. That is the purpose of increasing the tax. The increased revenue can be put towards tobacco control,” Southeast Asia Tobacco Control Alliance representative Mary Assunta told The Jakarta Post.

The government “hasn’t taken the basic steps it needs to take – banning tobacco advertising, increasing tax, putting graphic warnings on cigarette packs and banning smoking in public places”, Ms Assunta said.

The issue of the tax on cigarettes is a delicate one for politicians who are fearful of damaging the tobacco industry. Indeed, they say it needs to be protected.

The global average for tobacco taxes is 70 per cent of the sales price. In Indonesia, the average is 37 per cent, the lowest in Southeast Asia. Indonesian cigarettes are among the cheapest in the world, with a pack of 20 selling for the equivalent of US$1. Indonesia is the world’s fifth-largest cigarette market and the US$8 billion tobacco industry provides jobs for 7 million people and contributes about 10 per cent of government revenue. The industry expects to pay 42 trillion rupiah (HK$35.02 billion) in excise taxes this year, up from 11 trillion rupiah in 2001. This constitutes the fourth-largest state revenue after value-added tax, corporate income tax, and oil and gas tax.

At a recent tobacco conference, Finance Minister Sri Mulyani Indrawati said that Indonesia needed a healthy tobacco industry and that “the economy and job creation are the government’s No1 priority”.

Tobacco producers represent a powerful and influential lobby that not even the Indonesia Ulama Council (MUI), the country’s highest Islamic body, is able to challenge.

When MUI deputy chairman Amidhan recently mentioned that the body was considering an edict forbidding the country’s 200 million Muslims from smoking, Abdum Hafidz Azis, secretary of the Association of Indonesian Tobacco Farmers, attacked him, saying that the tobacco industry provided jobs and “it would be more human if the MUI switched to a regulation supporting smoking”.

The MUI seems to have dropped the idea.

Health experts are adamant that smoking is a ticking time bomb and that Indonesia will pay dearly.

According to the WHO, about a quarter of deaths in Indonesia in 2005 were caused by smoking and 80 per cent of lung and respiratory cancer cases were due to cigarettes. The WHO estimates that 25 per cent of all male deaths in Indonesia will be smoking related within a decade.

The danger is compounded by the kretek, the clove-flavoured cigarette favoured by 90 per cent of Indonesia’s smokers. Kreteks have roughly double the nicotine and tar levels of ordinary cigarettes.

“I understand that the legislators are concerned about certain kinds of flavours that may lure the underage to smoke. But clove is not one of them. Clove has been used for ages as a flavour in cigarettes,” Indonesian Clove Cigarette Producers Association chairman Ismanu Soemiran told The Jakarta Post.

Anti-smoking campaigners also argue that smoking is making impoverished Indonesians even poorer. In a study of Indonesia’s tobacco economy, Sarah Barber, an economist at the University of California, Berkeley, found that among poor families, an average of 11 per cent of household income was devoted to cigarettes compared with 2.1 per cent spent on health and 1.8 per cent on education. Dr Barber added that “what poor people spend on cigarettes is more than double what they spend on meat, fish and eggs”.

Parents who smoke are also a negative role model.

“If a teenager has parents who smoke, it is really hard for him not to follow,” said Fransciskus, the secretary of the Youth Heart Club.

Fransciskus, 19, is among those trying to stop youngsters from smoking. His club, which operates under the Indonesian Healthy Heart Foundation, advocates healthy living and leading by example.

“We organise bike rides, camping and outdoor activities. We also receive and distribute material about healthy living,” he said.

Fransciskus, who only uses one name, added that what Alicia Keys did was very positive. “Her teenage fans may even support her in that campaign,” he said.

Kicking The Habit

BEN FAWKES – The Dominion Post | Thursday, 25 September 2008

Experts say nicotine is as addictive as heroin or crack cocaine, with most smokers taking close to 20 attempts to stub out the habit.

So when I was offered the chance to try the bioresonance stop smoking treatment – with a reported success rate of between 85 and 90 per cent after one month – I fell upon the opportunity with a mix of hope and disbelief.

Two weeks later, I was standing outside a health shop in Cuba St, smoking my “last” cigarette in preparation for a dose of bioresonance.

It would be my eighth attempt to quit.

The last big effort was in January last year, the result of a rather rash New Year resolution. Three days later, a flatmate found me and a friend going through the rubbish bin to retrieve a rather soggy pack of Marlboro Lights, enthusiastically discarded some time on the morning of January 1.

Undeterred, I made a further attempt six or seven weeks later. My undoing was the rural sports day I had to cover for the country paper I was working on at the time. Having dramatically tossed half a packet of fags out the car window on the way to the sports day, three hours of sheep shearing and dog trials got the better of me, and I spent half an hour on the return trip scrambling around a ditch looking for my discarded Special Filters.

So it was with some trepidation, 18 months later, that I lay plugged in to a machine at The Stop Smoking Clinic, one of two bioresonance providers in Wellington.

The clinic is run by Shona Ellis, a Southlander who worked as a radiographer before becoming interested in bioresonance after meeting a doctor who had it used on patients with allergy problems.

According to Ms Ellis, the advantage of bioresonance is that it not only rids the body of nicotine but also cancels out the craving to smoke.

“Bioresonance is designed to eliminate the cravings to a point where people don’t need to smoke,” she says.

The oldest person Ms Ellis has treated is an 81-year-old and she says it’s not uncommon to have clients who have previously smoked 40 cigarettes a day.

The most important criteria for successful treatment is a motivation to quit, she says.

“If the person is not committed and not serious about it, they’ll just keep smoking and not stop.”


I was determined to give it a crack, but my track record wasn’t so hot.

The treatment was quite straight forward. A probe was stuck into the soles of my feet to take a nicotine reading and I was plugged into the bioresonance machine.

Electrodes were placed on my forehead and chest.

The session lasted about an hour. To finish, I received acupuncture to pressure points in my ears and was dispatched with a potion designed to ease any cravings and an unusual metal disc which apparently carried a memory of my treatment and was to be worn for the next month.

Despite the helpsheet noting that some people had no urge to smoke after the first treatments session, I was not one of them.

The strong cravings I experienced in the first two or three days, progressed to extreme grumpiness and shortness of temper within a week.

But the foul mood eventually passed, and, to my extreme surprise, I didn’t have a single cigarette during the first month.

Another month on, I have smoked – on occasion – but I wouldn’t say I have started smoking again.

It’s more a case of having slipped up a few times, usually under the influence of a few drinks.

Bioresonance has its detractors, among them ASH – the country’s largest antismoking lobby group.

Director Ben Youdan says ASH doesn’t recommend bioresonance due to a lack of clinical evidence and the comparatively high cost when compared with other methods, such as government-subsidised nicotine replacement therapy.

At $395, it is not a cheap, though people who start smoking again inside the first month can opt to have a second treatment at no extra cost.

But nicotine patches – without the government subsidy – are not significantly cheaper.

A 12-week course of patches costs about $315 (based on the cost of a packet of seven patches from the local supermarket).

If subsidised, the same course of treatment costs less than $50.

And though Mr Youdan says nicotine replacement therapy is three to four times more effective than stopping cold turkey, the success rate is still not that high. Given that going cold turkey succeeds with only about three or four per cent of smokers, that puts the success of patches and gum at about 15 per cent.

“Because of the high level of [cigarettes’] addictiveness, it can be really tough to resist,” Mr Youdan says.

“It’s really important that you want to quit.”

How does bioresonance work?

* Bioresonance is said to work through the use of electromagnetic waves.

* It’s believed nicotine emits an electromagnetic charge over your body causing the craving to smoke.

* The machine then reads the energy pattern of the nicotine in the cigarette smoked prior to treatment.

* The opposing wave forms cancel each other out, reducing the electromagnetic charge of nicotine in the body, enabling it to be easily eliminated and dramatically reduce the cravings.

Commission Issues Warning

25 Sep 2008.

New Zealand’s Commerce Commission has issued warnings to three major tobacco companies that the use of the terms ‘light’ and ‘mild’ risked breaching the Fair Trading Act.

The Commerce Commission has been investigating whether the use of the descriptors ‘light’ and ‘mild’ on cigarettes could be potentially misleading under the Fair Trading Act.

“Our concern with these descriptors is that consumers may believe they are exposing themselves to less harm if they smoke these cigarettes, as compared to regular-strength cigarettes,” says Adrian Sparrow, director of the Commerce Commission of Fair Trading. “Whilst technical machine testing of these products might show them to have a lower level of toxicants, our investigations suggest that the impact of human behaviour results in there being little difference between the intake of toxicants from these products and their regular-strength counterparts.

During the investigation, British American Tobacco and Imperial Tobacco gave the commission assurances that they would remove the descriptors from their packaging. Philip Morris has planned to do the same by 17 October.

Meanwhile, the parliamentary health select committee has recommended the banning of tobacco and cigarette displays in shops. The committee’s report, issued on 29 September, found that displays could “create a false impression of the safety, social acceptability, and prevalence of tobacco use“. (pi)