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March, 2009:

Electronic Cigarettes Are Ruled Illegal

Two arrested at Sham Shui Po shop for selling unregistered ‘quit-smoking’ products

Amy Nip and Agnes Lam – Mar 05, 2009 – SCMP

Electronic Cigars

Electronic cigarettes are an unregistered pharmaceutical product and it is illegal for the public to possess them, the Health Department warns.

Two people were arrested for selling electronic cigarettes, Health Department director Lam Ping-yan said at a press conference yesterday.

The items in question are cigarette-shaped electronic devices that atomise nicotine into an aerosol. No burning is involved in the process.

The Health Department and police raided an appliance shop yesterday in Apliu Street, Sham Shui Po, arrested two people and seized nine types of products. They included atomisers and “smoke cartridges”, which are refill products.

The two people arrested were a manager and a store employee.

Under the Pharmacy and Poisons Ordinance, electronic cigarettes containing nicotine and marketed as products to help people quit smoking are pharmaceutical items that require registration with the Health Department.

None of the electronic cigarettes sold in the city are registered and it is illegal to sell or possess the product. Anyone who sells or possesses the products is liable to a HK$100,000 fine and two years in prison.

“Keeping such products at home is not allowed,” Dr Lam said. “Anybody who has them should dump them quickly. If they don’t know how to deal with them, they can hand them to the Health Department. Department staff will dispose them.”

Using the unregistered product was dangerous, he warned.

“It is hard to predict how asthma patients or people with respiratory illnesses would react” to using them, Dr Lam said. “We found a high level of nicotine in the electronic cigarettes. There is 36 milligrams of nicotine in one smoke cartridge, higher than in one pack of cigarettes.”

A pack of cigarettes had an average 14 to 15 milligrams of nicotine.

It was difficult to ban Net ads for electronic cigarettes, Dr Lam said. They cost about 200 yuan (HK$230) on one mainland website.

Mr Chiu, whose shop was raided two days ago, said the Health Department had seized his stock of electronic cigarettes.

“The electronic cigarettes have been quite popular recently,” he said. “Health Department officers came to my shop and seized all my stocks after I was interviewed by reporters.

“The officers said all electronic cigarettes had to undergo examination. I don’t understand why. These products are helping smokers. I want to help smokers.”

He said most electronic cigarettes were made on the mainland and the products were very popular in Europe. “I don’t see why the government has to ban the sale of electronic cigarettes. How can these products be bad for people when they help people quit smoking?”

The Electronic Cigarette

‘As a smoker, there was no heft to the experience’

Dan Kadison and Agnes Lam – Mar 05, 2009 – SCMP

The electronic cigarette is strange and fun, mystifying and intriguing – but when push comes to smoke, the gadget is a novelty act, a pet rock, a gimmick to move with the times.

A Post reporter, who alternates his days between quitting heroically and smoking relentlessly, was asked to test the banned doodad.

The battery-operated device is a bit heavier than a coffin nail, but it is not bothersome. It delivered pleasing draws of nicotine relief that tasted like burnt chocolate. And a smoky mystery mist appeared with each exhale. Another plus is that the gizmo’s tip glowed orange with each draw.

Other benefits? The manufacturer claims there’s no second-hand smoke, no carcinogen worry, no falling asleep and burning down the house.

Still, with all the perks, the reporter can’t back the stick. As a smoker, there was no heft to the experience. As a non-smoker, there was no healthy sacrifice.

Electronic cigarettes were still available for sale yesterday at a wine store, Cheers at Olympian City, after the Department of Health called on smokers not to use the devices until their safety, efficacy and quality was established.

The product, which is sold at HK$580 with a coupon, originally cost HK$1,880.

“The product is made in China and then shipped back to Europe and then exported to other places. It contains no nicotine and it is legal for you to buy it and possess it,” a shopkeeper told a reporter posing as a customer. The shop assistant also told the reporter that the product was exempted from Hong Kong laws, claiming it was nicotine-free.

“Quite a lot of customers have brought this electronic cigarette and some elderly smokers told me that it can really help them quit smoking,” the shopkeeper said.

Electronic cigarettes were also available at another outlet of Cheers at Hollywood Plaza in Diamond Hill.

Too Pricey For Young Smokers

Mar 05, 2009 – SCMP

I agree with the 50 per cent increase in tobacco duty announced in the budget. The government has worked hard at promoting its anti-smoking campaign. This tax rise will make cigarettes unaffordable for teenagers and people on low incomes.

I think it will definitely prevent more young people from taking up smoking.

Michelle Young, Tin Shui Wai

We Need An Even Higher Tobacco Tax Hike

Mar 05, 2009 – SCMP

I refer to the letter by Chris Robinson (“Punitive tactics just put smokers on the defensive”, March 2). As he was a market sales consultant to tobacco companies, I can understand his irritation.

In contrast to Mr Robinson’s assessment of tobacco control in Hong Kong, there are still large gaps in essential public health measures, as prescribed by the World Health Organisation’s (WHO) Framework Convention on Tobacco Control which allows the tobacco industry to maintain brand value in the eyes of young people, its principal target.

While I agree with Sally Lo, of Hong Kong Cancer Fund (“Tobacco tax rise applauded”, February Post 27) and Sian Griffiths, of Chinese University’s school of public health (“A victory for public health”, March 2) that the increase in duty will lead to health gains, it will not compensate for the damage done during the eight years that this measure was stalled.

The present tax rise is necessary but not sufficient. Tobacco is still far too cheap and we will need further tax rises to ensure our tax is in the band recommended by the World Bank and the WHO.

We should be told why the advice of the government’s public health authorities, rather than the tobacco industry, was ignored for so long and need a much more consistent approach to public health policy if we are to benefit in the long term from a reduction in the tobacco epidemic and reallocation of resources from increased tax revenue to health care including smoking cessation.

I remain pessimistic about the prospect of a sustained programme of fiscal measures to support public health. On RTHK’s Backchat on February 27, when it was pointed out he would have more funds to strengthen disciplined services to combat smuggling, the financial secretary said: “I hope not to have increased revenue.”

While we may eventually reach a point where tax rises are revenue neutral, at present there is enormous scope and need to ensure we generate higher revenue through tax to fully exploit the effect of price on protection of youth and compensate public sector health services for the continuing costs of tobacco-induced disease. That would be an evidence-based approach rather than the measures advocated by tobacco industry lobbyists which are designed to support shareholder’s dividends but fail public health.

Anthony J. Hedley, school of public health, University of Hong Kong

Electronic Cigarettes On Sale On Internet

Hong Kong Digest – Updated on Mar 03, 2009 – Ming Pao Daily

Surge of tobacco duties by 50 per cent recently has led to the re-emergence of “electronic cigarettes” for sale on the internet. Claiming the product to be tax and tar – but not nicotine – free, a vendor said stocks of “electronic cigarettes” had been sold out since many smokers were turning to the product for financial reasons. He said the “smokeless” cigarettes contained no tobacco and could be used indoors without violating the law. The Department of Health declined to comment if internet advertising of “electronic cigarettes” was against the law.

One In Four Women Quit Smoking Under Centre’s Programme

Fox Yi Hu – Updated on Mar 03, 2009 – SCMP

One in four women taking part in a programme to help them stop smoking have managed to kick the habit.

Those who were not successful at least had the satisfaction of reducing their cigarette consumption.

A success rate of 24.1 per cent has been achieved by women at the Smoking Cessation Centre run by the University of Hong Kong’s department of nursing studies and department of community medicine.

The programme was launched in November 2006 for adult women. Up to last December, 274 smokers had taken part in the programme and undergone a three-month follow-up. Participants were on average 35 years old, and 93.7 per cent had received secondary education.

Sixty-six successfully quit smoking, accounting for 24.1 per cent of participants. Among those who failed to give up smoking, the average number of cigarettes they consume has dropped from 14 a day to seven.

The rate of participants describing their health as good has increased to 86 per cent from 70 per cent.

Lam Tai-hing, head of the university’s department of community medicine, said the 50 per cent increase in tobacco tax announced last week was a highly effective motivation for people to quit smoking.

“If a smoker spends HK$40 per day on cigarettes, he or she will save about HK$15,000 a year [by quitting smoking], which is good money that can be spent on many other things.”

Daily calls to the centre’s hotline have doubled since Financial Secretary John Tsang Chun-wah announced the tax increase last week.

“The figure of 50 per cent increase in tobacco tax should remind smokers about the serious mortality risk due to smoking,” Professor Lam added. “Research studies from HKU and elsewhere have shown that 50 per cent of smokers who continue to smoke will be killed by tobacco.”

Sophia Chan Siu-chee, head of the department of nursing studies, said it was a good time for women to take advantage of the centre’s service and quit smoking. “To celebrate International Women’s Day on Sunday, smart female smokers should give themselves a precious gift.”

Why Nicotine Prefers Brains Over Brawn

By Haley Stephenson – ScienceNOW Daily News – 2 March 2009

If nicotine liked muscle receptors as much as it likes brain receptors, a single cigarette would kill. Scientists have finally figured out why the molecule is so picky–a finding that may shed light on the addictiveness of smoking.

For nicotine–or any molecule–to interact with its receptor, the two must bind. Having opposite charges on the molecule and the receptor’s binding site, referred to as the “box,” helps. But the nicotine receptors in the brain and muscles are nearly identical–nicotine has a positive charge, and both receptors’ boxes have a negative charge. So something else must explain why the brain loves nicotine whereas muscles shun it.

Nicotine (center) nestled into brain receptor "box."

Nicotine (center) nestled into brain receptor "box."

After more than a decade of work, Dennis Dougherty, a chemist at the California Institute of Technology in Pasadena, and his colleagues finally have the answer. It turns out that a single amino acid makes all the difference. Near the box region, the brain receptor has a lysine molecule, whereas the muscle receptor has a glycine molecule. What the lysine does, Dougherty and colleagues report online this week in Nature, is change the shape of the brain receptor’s box, effectively making its negative charge more accessible to nicotine–a situation known as a cation-pi interaction. “The box reshapes so nicotine can cozy up,” Dougherty says.

For its part, the box in the muscle receptor is ideally configured for a molecule known as acetylcholine, which helps muscles contract. When Dougherty’s team switched out the muscle receptor’s glycine for a lysine, the muscle embraced nicotine as if it were acetylcholine. It’s a good thing that doesn’t happen in the body, says Mark Levandoski, a chemist at Grinnell College in Iowa, who was not part of the study. Smoking would immediately trigger abnormal contractions that would paralyze muscles, like those involved in breathing. “If nicotine were lighting up our muscles the way acetylcholine does, we’d be in big trouble,” Levandoski says.

Scientists can only speculate about why the brain and muscle receptors differ so much. For now, Dougherty and his lab want to determine whether the binding between other nicotine-family receptors and pharmaceutical drugs also involves cation-pi interactions. Studying the binding interactions within the nicotine receptor family might lead not only to new ways of helping people stop smoking, he says, but also to new treatments for illnesses such as Alzheimer’s disease, autism, Parkinson’s disease, and schizophrenia.

Punitive Tactics Just Put Smokers On The Defensive

Mar 02, 2009 – SCMP

The expected benefits of the 50 per cent rise in tobacco duty seem, at first sight, quite laudable – a reduction in cigarette smoking by young smokers unable to afford this debilitating habit.

Given such a draconian tactic and one that will affect a significant percentage of the community, is it not time that we reviewed the success of the anti-smoking tactics? Just what has been the success of all the initiatives that the anti-smoking lobby has had implemented over the last two decades in Hong Kong?

This lobby has been given everything it asked for. We have had advertising and promotion bans, smoking restrictions, community anti-smoking messages, on-premises smoking restrictions and cigarette pack warnings. But what have been the social benefits of all these policies? Unfortunately, there have been no benefits. The incidence of cigarette smoking in Hong Kong and many countries with similar restrictions continues to rise.

The only rationale is that these strategies have never worked, nor were they ever going to, because they do not properly address smokers’ motivations and the habit issue. Punitive approaches such as restrictions, bans and taxes clearly do not work. They just put smokers on the defensive. It can even make smoking attractive to some young people because it appears to be rebellious, and so they take up the habit.

Introducing penalties in the form of taxation to force down habit-formed consumption never works, as anyone who has been in the alcohol and cigarette industry knows.

It always leads to smuggling and tax avoidance. Criminal elements become involved, hell-bent on the monetary advantage untaxed cigarettes will offer.

This is a lesson that was learned in the 1930s during Prohibition in the US. Have we not progressed since then? Those who would quote examples of declines in cigarette consumption following tax hikes, make the mistake of relying on and quoting official figures for cigarette imports and production. These are obviously grossly inaccurate because there is no way to collect accurate figures regarding the volume of smuggling. Smuggling activities will increase dramatically as a result.

We need new and better policies to address this health issue in Hong Kong.

We must have more enlightened public-health thinkers who can see beyond punitive measures.

Is it not time to ask the anti-smoking lobby to set some performance goals and be accountable when policies fail, as will be the case with this most recent government tax initiative?

Chris Robinson, Pok Fu Lam

A Victory For Public Health

Mar 02, 2009 – SCMP

While much of the government’s attention is understandably taken up with the complexities of the global financial crisis it is to be congratulated for not ignoring the public’s health in Wednesday’s budget.

The increase of 50 per cent in tobacco tax is a very welcome and long overdue step. We know from international evidence that this tax increase will decrease the misery of smoking-related diseases not only among smokers, but also those exposed to their second-hand smoke, particularly children.

Coupled with a commitment to strengthening support for those who wish to stop smoking, this is a major step forward for public health in Hong Kong.

The additional resources to develop primary care, especially in poorly served geographical areas, and to implement programmes, such as pneumococcal vaccination for children, are also welcome as is the continued support for moving forward on e-health records.

These initiatives provide the opportunity to focus more on prevention and community-based care, moving forward on the health-care-reform commitments to improve primary care.

These must be steps in the right direction.

Sian Griffiths, director, school of public health, Chinese University of Hong Kong

The Anatomy of Addiction

(ABC 6 NEWS) – Cigarettes are highly addicting.

But why is it that some people who try cigarettes can put them down and never get addicted while others get hooked right away?

Doctors at Mayo Clinic say the answer lies in how your brain responds to nicotine.

A few puffs is all it takes for some people to become addicted to cigarettes.

And then there are people like Uncle Charlie.

“Everyone knows an Uncle Charlie,” says Dr. Richard Hunt. “Uncle Charlie was basically not a very productive person. He couldn’t hold a job, was married six times, smoked a pack of cigarettes a day for 25 years, and one day decided to stop smoking and he did. He didn’t have withdrawal symptoms, didn’t use any medications. So for the addicted smoker, they look at Uncle Charlie and say, if he could do that and I can’t there must be something wrong with me. And the reality is, there’s not something wrong with the person, it’s that their brain has been altered because of smoking cigarettes.”

Dr. Hurt heads the center for tobacco free living.

He says your chances of becoming addicted to cigarettes hinge on genetics, on how your brain responds to nicotine.

It only takes about five heartbeats for nicotine to go from the cigarette to your brain.

For many people it stimulates receptors that release dopamine and cause the pleasure response.

Over time, the receptors increase in number and change the anatomy of the brain.

So when you try to quit smoking you cut off the pleasure response because you are depriving the receptors of nicotine.

“And they object to that with withdrawal symptoms,” says Dr. Hunt.

Those symptoms include irritability, anxiety and the inability to concentrate.

If you make it through withdrawal and quit smoking, the number of nicotine receptors reduces to normal.

“But they don’t forget what all that felt like. So a smoker may have stopped smoking for six months and then be in a situation where they normally would smoke again, and the receptors say, ‘you know, it used to be when I was in that situation I’d have a cigarette, so I want a cigarette right this minute,” explains Dr. Hunt.

Such urges can last for years after quitting.

But Dr. Hurt says medications such as the nicotine patch or other non-nicotine prescription medications plus counseling can help smokers gain control over their addiction and move forward into a healthier, smoke-free life.