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May 3rd, 2013:

Standardised Packaging of Cigarettes Has the Government Caved in to Tobacco Lobbying?

Download PDF : mediabrief 03-May-2013

News and Events Bulletin – 16-30 April 2013

Tobacco News

England’s smoking ban linked to annual five percent drop in emergency admissions for asthma

Emergency admissions for asthma among adults fell by just under five percent in each of the first three years after the ban on smoking in public places was introduced in England, reveals the largest study of its kind, published online in Thorax.

See also:
– Emergency asthma admissions drop following smokefree law, University of Bath
– Short-term impact of the smokefree legislation in England on emergency hospital admissions for asthma among adults: a population-based study, Thorax

Source: Medical Xpress – 15 April 2013

Cancer Research wins second ban on ads attacking plain cigarette packs

A complaint by Cancer Research UK against an ad by JTI that claimed that standardised packaging would result in a “booming” black market has been upheld.

This is  the second time the Advertising Standard Autority has ruled that Gallaher’s claims in adverts about plain packaging were ‘likely to mislead’.

See also:
– Plain packet message for tobacco was ‘misleading’, The Times (£)
– Ad watchdog bashes plain packs claims, City AM
– Tobacco group will continue to ‘express our concerns’, ITV
– Further adverts from Japan Tobacco International ruled misleading, Cancer Research UK

Source: The Guardian – 17 April 2013

Plain packaging lobbyists under fire over links to tobacco company

A campaigning group run by two former senior police officers who lobbied parliament against plain packaging has come under fire after it was revealed that the organisation is linked with the tobacco industry.

Peter Sheridan, a former assistant chief constable in Northern Ireland, and Roy Ramm, previously a commander at Scotland Yard, warned in a letter to the government that standardised packaging would encourage smuggling. However, both men failed to declare that they were part of a group called the Common Sense Alliance that has links with British American Tobacco (BAT).

Deborah Arnott, chief executive of ASH, said: “It beggars belief that Peter Sheridan and Roy Ramm can try to claim they were acting in a personal capacity when one is a director and the other a founder member of an organisation funded by BAT. The government has legal obligations to protect public health policy from commercial interests and it can only do this if the tobacco industry is transparent about its lobbying activities”.

Source: The Observer – 28 April 2013

Dalligate: Leak of OLAF’s Dalli inquiry raises heat on Commission

The unauthorised publication this week of the results of an investigation by OLAF, the European Union’s anti-fraud office, into John Dalli has forced the European Commission to defend its decision to demand his resignation as European commissioner for health and consumer policy.

Malta Today, a newspaper, published on 28 April a leaked report of OLAF’s investigation into Dalli, Malta’s former European commissioner. The leaked version, which is missing two pages and 20 annexes, contains no direct evidence that Dalli was aware of an offer made by a Maltese businessman, Silvio Zammit, to influence – through his links with Dalli – imminent tobacco legislation, in exchange for €70 million.

See also:
Dalligate – the OLAF report, Times of Malta
– Witness reveals she had lunch with OLAF investigator after interrogation, Times of Malta
– Whistleblower MEP claims EU cover-up over Dalligate, Public Service Europe

Source: European Voice – 30 April 2013

Bob Blackman MP: Saying no to the tobacco industry

Bob Blackman, MP for Harrow East, former leader of Brent Council, member of the Communities and Local Government Select Committee and secretary of the All-Party Parliamentary Group on Smoking and Health, sets out the perils for local authorities as the tobacco industry ramps up its lobbying tactics.
Source: LGC – 16 April 2013

Experts propose strategies to reduce, end tobacco use

Several scholars, scientists and policy experts address the question of what it would take to end tobacco use for good in a supplement to the journal Tobacco control.
Source: University of Michigan – 16 April 2013

Match of the Day: QPR’s anti-smoking scheme (video)

Match of the Day visits Premier League club Queens Park Rangers to learn more about a new scheme designed to prevent local youngsters from taking up smoking.

The club’s Health Stars initiative aims to promote better health and wellbeing in the local community.

Source: BBC Sports – 18 April 2013

“Saving Lives and Preventing Misery”, Memoirs of Professor John Crofton, by Dr David Kilpatrick

Professor John Crofton (1912-2009) was one of the outstanding physicians of the 20th century. He led the pioneering medical team that first established that tuberculosis could be cured by combination chemotherapy (“the Edinburgh method”). He was also a prominent public health campaigner who did much to change public and political attitudes towards tobacco smoking and helped in the foundation of ASH.

His memoirs describe his childhood years, his student days and climbing holidays, his war years in the RAMC, his radical approach to the treatment of TB, his roles as Edinburgh University Vice-Principal and President of the Royal College of Physicians of Edinburgh, and finally his extensive public health campaigns waged after his retirement from medical practice.

Source: FastPrint Publishing – 15 April 2013
Parliamentary News

Northern Ireland: Tobacco Retailers Bill: Second Stage

Transcript of the debates of the Executive Committee for the second stage of the Northern Ireland Tobacco Retailers Bill.
Source: They Work For You – 23 April 2013

Committe Meeting: New clause on smoking in cars

Transcript of a Public Bill Committee meeting on a new clause to the Children and Family Bill introducing an offence of failing to prevent smoking in a private vehicle when children are present. The Clause was eventually withdrawn.
Source: Hansard – 25 April 2013

Parliamentary question: E-cigarettes

Mr Laurence Robertson: To ask the Secretary of State for Health what recent assessment he has made of any health risks associated with electronic cigarettes; and if he will make a statement.

Norman Lamb: There are a number of products on the market which claim to contain nicotine, such as electronic cigarettes, which are widely available but are not licensed medicines. Currently, any nicotine-containing product (NCP) which claims or implies that it can treat nicotine addiction is considered to be a medicinal product. This approach has allowed NCPs which do not make such claims to be used and sold without the safeguards built into the regulation of medicinal products.

In March 2011, the Medicines and Healthcare products Regulatory Agency (MHRA) published the outcome of a public consultation on whether to bring all NCPs within the medicines licensing regime. The response to the consultation highlighted the need for further information to inform a decision. Since this time, the MHRA co-ordinated a programme of research to advise on:

an investigation of the levels of nicotine which have a significant physiological effect through its pharmacological action;

the nature, quality and safety of unlicensed NCPs;

the actual use of unlicensed NCPs (excluding tobacco products) in the marketplace;

the efficacy of unlicensed NCPs in smoking cessation; and

modelling of the potential impact of bringing these products into medicines regulation on public health outcomes.

The MHRA is currently bringing to a conclusion this period of scientific and market research with a view to a final decision on the application of medicines regulation later this year.

Column 740W

Source: Hansard – 22 April 2013
Industry Watch

How UK tobacco firms stay one step ahead of the regulator: study

A new study has shed more light on the tobacco industry’s tactics to undermine attempts to reduce smoking.

The study, published in the journal Addiction, reveals how tobacco companies would use premium brands to absorb tax increases, as such brands are usually bought by high-income earners who are less likely to be deterred by increasing prices.

Such a tactic ensures that a price gap can be maintained between budget and premium brands, helping maintain their customer base and, by extension, protect their profits.

Source: The Globe and Mail – 17 April 2013

USA: Reynolds American first-quarter cigarette volume slumps

Despite an estimated 6.2% drop in cigarette volumes, Reynolds American profit jumped 88% in the first quarter of the year.
Source: ADVFN – 23 April 2013

Protest as BAT announces that price hikes offset declining cigarette sales

The second-biggest tobacco firm in the world announced at its AGM that its revenues had risen despite falling volume sales.

British American Tobacco (BAT) said that in the first quarter of the year, price hikes had driven a 1% rise in revenues. This was despite a 3.4% fall in the amount of tobacco it sold.

See also:
– BAT Sales Top Estimates as Higher Prices Offset Lower Volume, Washington Post
– BAT feels pinch as smokers kick the habit, The Times (£)
– Asian sales keeps fire burning under British American Tobacco, The Times (£)

As the meeting was taking place at Banqueting House in Whitehall, a group of about 70 young people from various parts of the country were protesting outside, calling for standardised packaging to be introduced. They later went to the House of Lords to meet MPs to discuss the subject.

Images of the protest and the meeting can be seen on our flickr account here.

Source: City AM – 26 April 2013

Altria to launch e-cig in response to fall in cigarette sales

Altria Group Inc., which reported a reduction in cigarette volumes for the first-quarter, will enter the e-cigarette market later this year, a move to address a change in the market.

Profitability grew 16% for the quarter, aided by higher pricing for cigarettes and smokeless products, as well as a credit tied to a landmark tobacco settlement.

Source: ADVFN – 25 April 2013

Imperial Tobacco to develop e-cigarettes as profits drop

Imperial Tobacco, the world’s fourth-largest cigarette group by market share, said it had set up a venture to develop electronic cigarettes, as it battles an increasingly tough consumer environment in Europe.

See also:
– Imperial sees revenues and profits fall in first half, London South East

Source: Reuters – 30 April 2013

Philip Morris Int’l 1Q profit falls nearly 2%

Cigarette maker Philip Morris International Inc. said that its first-quarter profit fell nearly 2% on a decline in the number of cigarettes sold.
Source: Yahoo!/AP – 18 April 2013

Japan Tobacco expects record full-year profit

Japan Tobacco Inc. said it expects record profits for the current business year ending March 2014, aided by a solid performance of its overseas business and the yen’s weakness.
Source: Wall Street Journal – 25 April 2013
Recent Research

Early dialogue most effective in deterring teen tobacco, alcohol use

Early, substantive dialogue between parents and their children about the ills of tobacco and alcohol use can be more powerful in shaping teen behavior than advertising, marketing or peer pressure, a University of Texas at Arlington marketing researcher has shown.
Source: Medical Xpress – 25 April 2013

Protection from secondhand smoke in countries belonging to the WHO European Region

Objectives Comprehensive smokefree laws, as recommended by the WHO Framework Convention of Tobacco Control (WHO FCTC), are the most effective tool to protect the population from secondhand smoke (SHS) and to ensure healthy environments. Studies evaluating how laws govern SHS protection are scarce. This study assessed the level of protection from SHS of laws from countries belonging to the WHO European Region.

Methods A new methodology system was developed to evaluate the smokefree legislation according to the principles provided by the WHO guidelines for the correct implementation of Article 8 of the FCTC. For each law, six main sectors and 28 facilities were evaluated.

Results Overall 68 laws from 48 countries from the WHO European Region were reviewed. ‘Education’ and ‘Public transport’ were the most protected sectors from SHS. Many WHO European laws do not provide protection from SHS across all public sectors. For example, 48.5% of general health facilities and 71.2% of restaurants are unprotected from SHS. The level of protection provided in the 28 facilities studied was low; many WHO European laws still allow smoking under certain conditions, permitting smoking in designated and/or ventilated areas.

Conclusions Nine years after the adoption of the WHO FCTC there are still legal formulas in which smoking is allowed in several facilities, through the inclusion of separated areas, ventilated areas and other conditions. Tobacco control efforts still face the challenge of eradicating the legal clauses that prevent 100% smokefree environments.

Martínez, C., et al., Protection from secondhand smoke in countries belonging to the WHO European Region: an assessment of legislation, Tob Control doi:10.1136/tobaccocontrol-2012-050715

Source: Tobacco Control – 17 April 2013

Light smokers are less likely to receive advice to quit from their GP

Background: A substantial proportion of smokers nowadays smoke fewer than 10 cigarettes per day (cpd). These ‘light’ smokers are still exposed to significant health risks but may not receive as much attention from health professionals as heavier smokers. The Netherlands and England are two countries with very different smoking cessation treatment climates and may vary in the extent to which GPs advise on smoking cessation.

Objectives: To assess whether Dutch and English light smokers (< 10 cpd) are less likely to receive advice to stop smoking during a consultation with their GP than moderate-to-heavy smokers (≥ 10 cpd).

Methods: We compared data from two series of national surveys: the Dutch ‘Continuous Survey of Smoking Habits’ and the English ‘Smoking Toolkit Study’. We included respondents to both surveys from February 2010 to December 2011, aged 16+ years, who consulted their GP in the previous 12 months.

Results: A total of 7734 smokers responded to the surveys in the Netherlands and 10 383 in England. The percentage of Dutch smokers who received advice to quit from their GP was 22.6% (95% CI = 21.5–23.7) compared with 58.9% (95% CI = 57.6–60.2) of English smokers. Light smokers were less likely to receive advice to quit than moderate-to-heavy smokers, both in the Netherlands (OR = 0.57, 95% CI = 0.50–0.65) and in England (OR = 0.64, 95% CI = 0.57–0.72).

Conclusion: Smokers in the Netherlands are less than half as likely to receive advice to quit from their GP as smokers in England. In both countries, light smokers are less likely to receive advice to quit from their GP than moderate-to-heavy smokers.

Kotz, D., et al., Light smokers are less likely to receive advice to quit from their GP than moderate-to-heavy smokers: A comparison of national survey data from the Netherlands and England, European Journal of General Practice, doi:10.3109/13814788.2013.766792

Source: Informa – 20 March 2013

Expansion of the marketing license for NRT

Background: In December 2009 and January 2010, the UK Medicines and Healthcare Products Regulatory Agency expanded the marketing license for a number of nicotine replacement therapies (NRTs) to include smoking reduction without an intention to stop completely. This study examined whether this was associated with a change in incidence of use of NRT for harm reduction (i.e., smoking reduction and/or temporary abstinence) and in smoking cessation activity.

Methods: Data were taken from 10,497 smokers who took part in the Smoking Toolkit Study, which involves monthly representative household surveys of adults aged 16+ in England. Incidence of use of NRT for smoking reduction and/or temporary abstinence and attempts to stop smoking in 2009 was compared with the 2 years following the expansion of the marketing license.

Results: Expansion of the license was not associated with an increase in incidence of NRT use for harm reduction, which was already substantial prior to the change. The odds of a quit attempt were lower in the second year following the license change relative to the year before, but there was no change in the success of quit attempts.

Conclusions: Expansion of the UK marketing license for NRT to include smoking reduction without the intention of quitting was not associated with an increase in use of NRT for this purpose. It was followed by a reduction in the incidence of quit attempts (but not their success) although this may have been a continuation of a pre-existing decline.

Beard, E., et al., Was the Expansion of the Marketing License for Nicotine Replacement Therapy in the United Kingdom to Include Smoking Reduction Associated With Changes in Use and Incidence of Quit Attempts?, Nicotine Tob Res(2013) doi: 10.1093/ntr/ntt044

Source: Oxford Journals – 10 April 2013

Will the European Union’s new tobacco tax legislation lead to reductions in smoking prevalence?


Introduction: The European Union (EU) requires member states to apply minimum taxes on manufactured cigarettes. One of such taxes has operated in Spain since 2006. This study evaluates the impact of this reform of the tax regime on manufactured cigarette prices and on smoking prevalence, drawing implications for European tobacco tax policy.

Methods: Quasi-experimental design with treatment and control territories. We analyze series for prices before and after the reform and use cross-sectional health surveys to implement differences-in-differences estimators for smoking prevalence.

Results: Under the minimum tax regime, prices increased three times faster in the treatment territory. However, the new regime did not affect smoking prevalence among males, either shortly after its enactment or 3 years hence. For women, we find no significant effects on prevalence in the short run, and point estimates ranging between −3.36% and −4.3% 3 years hence, although only one of these is statistically significant.

Conclusions: The new tax regime affected cigarette prices in the intended direction. However, we find only weak evidence for a reduction in prevalence among women. The availability of cheap, fine-cut tobacco appears as the most likely cause for the poor results in terms of smoking prevalence. EU member states that have introduced a minimum tax on manufactured cigarettes might achieve little in terms of reductions in smoking prevalence if they allow a tax gap between fine-cut tobacco and manufactured cigarettes. In this sense, it is unfortunate that EU legislation consecrates a differential treatment for the two products.

López-Nicolás, A., et al., Will the European Union’s New Tobacco Tax Legislation Lead to Reductions in Smoking Prevalence? Evidence From a Quasi-experiment in Spain, Nicotine Tob Res (2013) doi: 10.1093/ntr/ntt038

Source: Oxford Journals – 04 April 2013

31 May 2013 – World No Tobacco Day 2013

Every year, on 31 May, The World Health Organisation and partners everywhere mark World No Tobacco Day, highlighting the health risks associated with tobacco use and advocating for effective policies to reduce tobacco consumption.

The theme for World No Tobacco Day 2013 is: ban tobacco advertising, promotion and sponsorship.

Venue: Everywhere

20 June 2013 – ASH Scotland 40th Anniversary Conference: Towards a Generation Free From Tobacco

Bringing together delegates from Scotland, the rest of the UK and across the world, the conference will provide an opportunity for tobacco control advocates, policy makers, researchers, health practitioners and community development professionals to learn from international good practice and innovation.

Themes to be explored include industry and regulation, protection from second-hand smoke, youth smoking prevention, cessation services in our communities and the role of advocacy in driving policy.

There will be a special focus on addressing health inequality and new ways of working with hard-to-reach groups.

Venue: The John McIntyre Conference Centre Holyrood Park, University of Edinburgh, Scotland

20 June 2013 – Towards a generation free from tobacco

Join speakers from the UK and from Uruguay, Belgium, Finland, New Zealand and Hong Kong for an engaging and interactive international conference exploring the ideas and actions that will drive us forward – towards a generation free from tobacco.
Venue: John McIntyre Conference Centre, Edinburgh

27 June 2013 – UK National Smoking Cessation Conference

Key topics for 2013 include the NICE guidance on tobacco harm reduction, e-cigarettes, electronic aids to cessation, getting the most out of current treatments, smoking cessation and mental health, international comparisons of tobacco treatment, treating pregnant smokers and the politics of tobacco growing – making it an essential event for everyone in the smoking cessation and tobacco control fields.
Venue: Victoria Park Plaza, London

Lancet on Tobacco

Download PDF :

2013 05 Asia TC. Mackay et al, Lancet.

2013 05 Mackay profile. Lancet

Lancet antitobacco series launches as ACC chides FDA inaction

London, UK – A special series of papers in the Lancet this week reviews the successes, failures, and ongoing challenges in beating back the “global tobacco epidemic,” including a report from FDA scientists touting the impact of the 2009 Tobacco Control Act in the US. That act gave the FDA much more sweeping legislative control over tobacco products, including labeling requirements.

The report, however, comes within weeks of an announcement from the FDA that it would not be challenging a US court of appeals decision ruling that graphic packaging on cigarettes was unconstitutional. That inaction prompted a letter April 25, 2013 from the American College of Cardiology (ACC) decrying the FDA’s decision [pdf below].

“What our letter to the FDA points out is that the FDA had not exhausted their legal strategies and probably should have taken this to the next level as opposed to recommending more research, because I think the research is fairly clear-cut on the impact of smoking, the CV risks of smoking, and what happens when you restrict smoking,” ACC president Dr John Gordon Harold told heartwire.

Studies have also indicated that graphic packaging has an impact on smokers, including prompting them to try to quit.

“From a professional society point of view, we don’t think this is an issue of freedom of speech, we think this is an issue of education and communication. The graphic images are showing reality—that’s what physicians see in the office and that’s what we see clinically all the time.”

Harold’s letter to FDA Commissioner Dr Margaret A Hamburg notes that graphic warning labels on cigarettes are already law in Australia, Canada, and Uruguay and that studies indicate packaging changes have a significant impact on smoking rates in the population.

Instead of challenging the ruling, the FDA has said it will “undertake research to support a new rule-making consistent with the Tobacco Control Act.”

The FDA’s decision, however, “not to forge ahead to the Supreme Court on this particular regulation and, instead, to conduct more research will delay implementation of graphic warnings, thereby delaying much-needed reductions in smoking among both adolescents and adults,” the ACC letter reads.

Across the pond

In fact, another one of the other papers in the Lancet series singles out the nonuniform use of print and pictorial warnings on cigarette packaging in Europe (along with underuse of mass-media campaigns and taxation) as a key failure of antitobacco efforts in Europe [1]. Only Belgium, France, Hungary, Latvia, Malta, Romania, Spain, and the UK have adopted the use of pictorial warnings on packaging, the paper notes.

But that, Harold points out, is still significantly better than the US.

“It’s unfortunate that we continue to fall behind many of our European and global colleagues on this important topic,” he told heartwire. “We are late to the table here, and this is an opportunity for legislation that we’ve been given and it’s going to require additional appeals.”

Harold pointed out that the Lancet paper by FDA staffers Corrine G Husten and Lawrence R Deyton does, appropriately, recount a number of important antitobacco wins as a result of the Tobacco Control Act [2]. Among them: increased pricing on tobacco products, smoke-free policies, countermarketing campaigns, advertising restrictions, etc. And the article itself acknowledges that legal challenges, such as the unconstitutionality claim argued successfully against graphic labeling, among others, have hampered progress.

“Some of the comments in the Lancet article are right on: the approach is multifaceted and we have to celebrate our success but also focus on our opportunities,” Harold said. “We’re talking about incremental progress, and this is a celebration of where we’ve come from the Surgeon General’s report back in the 1960s. . . . We’ve come a long way, but have we caught up to our European and Commonwealth colleagues? No. I think we can do more.”

A Commentary accompanying Husten and Deyton’s paper also points out that 175 countries have signed onto the Framework Convention on Tobacco Control; the US is not one of them [3].

Asked why freedom-of-speech concerns managed to trip up the new packaging rules in the US, Harold referred to the power of the tobacco lobby in the US and the big money behind it. But acknowledging that tobacco dollars are also being heaped on antismoking battles in other parts of the world, Harold agreed the US had some unique hurdles. “In the economies of many of our Southern states, tobacco plays a tremendous [role],” he said. “I think that our political microcosm is perhaps a little bit different than in other parts of the world.”

ACC letter on FDA decision not to appeal graphic warnings


1. Britton J and Bogdanovica I. Tobacco control efforts in Europe. Lancet 2013; 381:1588-1595.

2. Husten CG and Deyton LR. Understanding the Tobacco Control Act: Efforts by the US Food and Drug Administration to make tobacco-related morbidity and mortality part of the USA’s past, not its future. Lancet 2013; 381: 1570-1580;

3. Cohen JE. Saving lives with the US Tobacco Control Act. Lancet 2013; 381:1513-1514.


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tobacco gives women the trots in a big way

Smoking may pose a bigger health threat to women than men, say researchers.

Women who smoke have a higher risk of cancer than men, Norwegian investigators found.

They looked at the medical records of 600,000 patients and discovered the bowel cancer risk linked to smoking was twice as high in women than men.

Female smokers had a 19% increased risk of the disease while male smokers had a 9% increased risk, Cancer Epidemiology, Biomarkers & Prevention reports.

Start Quote

For men and women, the evidence is clear – being a non-smoker means you’re less likely to develop cancer, heart disease, lung disease and many other serious illnesses”

Sarah Williams of Cancer Research UK

In the study, nearly 4,000 of the participants developed bowel cancer. Women who started smoking when they were 16 or younger and those who had smoked for decades were at substantially increased risk of bowel cancer.

Biologically vulnerable?

The University of Tromso team who carried out the research say it is the first study to show women who smoke less than men still get more colon cancer.

But they were unable to take into account other factors that might affect the risk of this type of cancer, such as alcohol and diet.

The findings suggest that women may be biologically more vulnerable to the toxic effects of tobacco smoke.

Experts already know that women who start smoking increase their risk of a heart attack by more than men who take up the habit, although it is not clear why.

A new piece of research published in the Journal of Clinical Endocrinology & Metabolism suggests a possible explanation.

A team from the University of Western Australia found teenaged girls exposed to passive smoking had lower levels of the “good” form of cholesterol that reduces heart disease risk.

Second-hand smoke

Second-hand smoke did not appear to have the same impact on teenage boys, however.

The study looked at more than 1,000 adolescents living in Perth, Australia.

Lead researcher Chi Le-Ha said: “Considering cardiovascular disease is the leading cause of death in women in the Western world, this is a serious concern.”

Around one in every five men and women in the UK is a smoker.

Although smoking rates have been falling among both sexes, the decline has been less rapid in women.

In England in 2010, more than a quarter of secondary school pupils had tried smoking at least once and 5% were regular smokers. Girls were more likely to smoke than boys – 9% of girls had smoked in the last week compared with 6% of boys.

Quitting smoking cuts your risk of many diseases, including cancer.

According to research in more than one million women, those who give up smoking by the age of 30 will almost completely avoid the risks of dying early from tobacco-related diseases.

Sarah Williams of Cancer Research UK said: “It’s well established that smoking causes at least 14 different types of cancer, including bowel cancer.

“For men and women, the evidence is clear – being a non-smoker means you’re less likely to develop cancer, heart disease, lung disease and many other serious illnesses.”

June Davison, senior cardiac nurse at the British Heart Foundation, said more research was needed to understand the effects of second-hand smoke.

Editorial: Tobacco is a problem to be tackled, not dodged

Editorial: Tobacco is a problem to be tackled, not dodged

In scrapping plans for cigarette packets, Mr Cameron has taken Britain backwards

Of the 200,000-plus children who take up smoking each year, about half will become lifelong addicts. Of these, half will die from their habit. That is 50,000 deaths per year. Yet David Cameron has scrapped plans to force tobacco companies to use plain packets to market their lethal products, despite the evidence that such a move would make cigarettes less attractive to young people. A backward step, indeed.

When considering cigarettes, it is worth reflecting on the numbers. The H7N9 strain of bird flu now causing a global scare has infected 126 people in China in the past month and killed one in five of them. The smoking pandemic, meanwhile, snares millions around the world each year and has a death rate of 50 per cent.

In fact, the effects of smoking are so appalling that even a small statistical reduction can save many lives. Even if switching from branded to plain packs deters only a few children from experimenting with cigarettes, it would still have a marked impact on the nation’s health.

Nor is that the only way to reduce Britain’s annual smoking-related death toll. In spite of the harm caused, however, our efforts to prevent smoking, reduce its appeal or combat its ill effects are minimal. A specialist medical journal, The Lancet Respiratory Medicine, describes the situation as a “massive failure” of political and medical leadership.

Although six million people in England have used the NHS’s stop-smoking service since 2000 and two million have successfully given up (at least for a time), the facility still reaches only one in 10 smokers. And yet, despite such poor performance, England is a world leader in treatment and support to help smokers kick the habit. If any evidence were needed to illustrate the low priority attached to dealing with the scourge of tobacco in Europe, then this is surely it.

Britain has had some successes, notably the restrictions placed on advertising in 2003, the move to raise the minimum age for the purchase of cigarettes from 16 to 18 in 2007 and the ban on smoking in public, also in 2007. Together, such measures contributed to a sharp drop in the number of young smokers.

But there is so much more that could – and should – be done. Mandatory restrictions on the minimum size of packets, favoured by youngsters because they are cheaper, would be a start. More important still is to adopt a harm-reduction strategy for tobacco similar to that developed for hard drugs such as heroin and cocaine. That means giving smokers the drug they crave but in a form that is less damaging.

In fairness, nicotine-replacement therapy has been a cornerstone of stop-smoking services for more than a decade. But smokers too often find the delivery mechanism – chewing gum, say, or patches – expensive, ineffective and unsatisfying. Better substitutes are needed. One successful example is “snus”, a chewing tobacco increasingly used in Sweden – which now has the lowest smoking rate in the EU. Fears that snus might be a gateway to smoking have led to the product being banned outside Sweden. Perhaps it is time to reconsider.

Electronic alternatives are another promising development. Five years after e-cigarettes were introduced, their use is still low – only 7 per cent of Europe’s smokers have tried them and a mere 2 per cent use them regularly – but the market is growing rapidly. Yet a proposed revision of the EU Tobacco Products Directive could lead to the devices being all-but banned.

Neither commercial interests nor institutional inertia should be allowed to trump the interests of public health. And when it comes to plain packaging, the Prime Minister should think again.