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May 23rd, 2016:

Is this the end for British American Tobacco plc and Imperial Brands plc?

There’s no doubt that at least over the last 10 years, the UK government has been on a strong drive against smoking. By increasing taxes on tobacco, making it illegal to smoke indoors on public premises, and banning the displaying of cigarettes in shops, the government has made its views very clear.

And if those measures weren’t enough, the UK government went one step further last week by implementing new ‘plain packaging’ rules. These rules mean that from now on, all cigarettes to be sold in the UK will have to be packaged in standardised, dull, ugly packaging with health warnings covering a huge 65% of the pack.

Together, these strategies are expected to reduce the prevalence of smoking, and consequently reduce the burden of disease caused by tobacco.

Clearly, there are likely to be long-term ramifications for smoking rates here in the UK and from an investment perspective, investors will be wondering about the impact these rules could have on prominent UK tobacco stocks.

Income favourites
Tobacco stocks British American Tobacco (LSE: BATS) and Imperial Brands (LSE: IMB) have long been favourites for UK investors. Just look at legendary fund manager Neil Woodford’s portfolio and you’ll find both of these stocks in his top five holdings.

With their resilient earnings and ability to generate and distribute cash, there’s no doubt that both of these companies have rewarded shareholders over the long term.

If you’d bought shares in British American Tobacco five years ago, you would have enjoyed total annualised returns of a healthy 12.9% per year in this time. And Imperial Brands’ shareholders would have done even better, seeing annualised total returns of a fantastic 15.8%.

Given that tobacco stocks are generally seen as stable, boring portfolio holdings, these returns are certainly impressive. But are the glory days over?

While the new plain packaging rules may reduce smoking rates here in the UK, don’t forget that both British American Tobacco and Imperial Brands are truly global companies. For example, British American Tobacco sells its brands such as Dunhill, Kent and Lucky Strike in over 55 countries.

And while revenues at the tobacco giant fell 6.2% last year, the company still managed to increase its earnings per share by 10.1% and lifted its dividend by 4% to 154p per share, putting the current dividend yield at around 3.7%.

Similarly, Imperial Brands’ revenues fell in 2015, but the company’s earnings rose by 8.2% and the dividend was boosted by 10.1% to 141p, a yield of 3.9%.

Long-term sustainability doubts
While at first glance these earnings and dividend increases look positive, personally I’d be approaching the tobacco companies with an air of caution right now.

Dividend coverage ratios for British American Tobacco and Imperial Brands stand at 1.5 and 1.26, respectively, levels that indicate their dividends might be at risk going forward.

And with British American Tobacco saying that trading conditions are “challenging“, and the strong possibility of more government intervention both here in the UK and worldwide going forward, it’s definitely worth thinking about the long-term sustainability of tobacco company revenues before buying shares in this sector.

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Axa stubs out tobacco investments

Axa is giving up cigarettes, saying it “makes no sense” for the insurer to keep its €1.8bn portfolio of tobacco investments.

The French insurance group, which manages more than €1 trillion, will sell off its current tobacco shareholdings that are worth approximately €200m, while its bond portfolio worth about €1.6bn will be gradually wound down.

“This decision has a cost for us, but the case for divestment is clear: the human cost of tobacco is tragic; its economic cost is huge,” said Thomas Buberl, deputy chief executive at Axa.

“We strongly believe in the positive role insurance can play in society, and that insurers are part of the solution when it comes to health prevention to protect our clients.

Hence, it makes no sense for us to continue our investments within the tobacco industry.”

The move follow’s Axa’s decision last year to withdraw from coal assets in the face of the threats from climate change.

Ethical investing policies have prompted a number of the world’s biggest investors to blacklist industries including tobacco. Calpers, the Californian pension fund, has this year restarted a review into its 16-year ban on tobacco investments.

Norway’s sovereign wealth fund pulled out of tobacco companies in 2006, in a decision that it estimates has cost the fund $1.9bn in forgone profits.

Governments around the world are exerting pressure on tobacco firms, including in the UK, where this week plain packaging has been introduced on cigarettes in an attempt to reduce the appeal of particular brands to smokers.

However, these measures are yet to dent global earnings for the largest tobacco companies. The MSCI ACWI tobacco index, which tracks the industry across 46 countries, has delivered returns of 14.4pc over the past decade, far outperforming a 3.89pc gain in the broader MSCI share index.

A study by the Smith School of Enterprise and the Environment at the University of Oxford suggested that divestment programmes risk creating “stranded assets”, such as funds that are stuck in illiquid holdings in assets such as coal after others withdraw from the industry.

They also found that share prices in fossil fuels are unlikely to suffer directly from divestment efforts, as less ethically driven investors swoop in to buy the assets being sold.

Axa’s Decision to Quit Tobacco is not as Pure as it Looks

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Health Ministry Will Levy Fines for Public Smoking Offenders

People smoking tobacco in offices, restaurants and other public spaces will have to indulge their habit in clearly demarcated smoking areas or both the smoker and establishment owner will face fines, the Ministry of Health announced.

Following the government’s approval in March of a sub-decree banning smoking in public places—including fines of 20,000 riel (about $5) for offending smokers and 50,000 riel (about $12.50) for establishment owners—the ministry released a statement last week laying out specific implementation plans.

“The ban sign has to be written in both Khmer and English saying ‘No Smoking,’ along with the picture of a cigarette inside a red circle, with a red diagonal line across,” said the statement, dated Wednesday.

Health Ministry spokesman Ly Sovann said on Sunday that the release of the statement signaled the end of a short “probation period” following the sub-decree’s approval and the start of a system to fine those found to be violating the Law on Tobacco Control.

Mr. Sovann said that the ministry’s own judicial police officers would be tasked with enforcement.

Sok Sokun, director of the Phnom Penh municipal health department, said the ministry has multiple police units tasked with enforcing health laws, but that so far the new tobacco unit had not issued any fines.

“So far, no restaurant owners or a single individual have been fined. The ministry is still in the process of informing people about it,” he said.

Mark Schwisow, country director for the Adventist Development and Relief Agency, which works to reduce tobacco use in the country, said the main challenge would be notifying authorities and business owners outside of Phnom Penh of the new requirements.

“Your local police officers aren’t going to go out and enforce these rules,” he said. “It will take shopkeepers to know of them and decide to act.”

According to the World Health Organization, smoking is among the leading causes of death in Cambodia, with 10,000 people killed each year by smoking-related diseases.


Instead of a regressive policy which targets the poor, the ongoing rise in tobacco excise benefits the poor more than it does the rich, say experts.

Public health physician Dr Nathan Grills and research assistant Nicole Hughes, both with the Nossal Institute for Global Health at the University of Melbourne, argue in MJA InSight today that suggestions the tobacco excise harms low-income people is “a shortsighted analysis and demonstrates a poor understanding of a sophisticated tobacco control intervention”.

“In reality, the policy actually benefits the poor far more than the rich because it is a progressive tax in terms of public health and long-term economic benefit,” the pair write.

“This tax will reduce the long-term financial losses and payments more in lower than in higher socio-economic groups, by reducing medical expenses and protecting livelihoods especially in poorer groups. Ultimately it saves more lives in lower SES groups than in higher SES groups.”

They say that the evidence that increasing the cost of tobacco increases intentions to quit, ultimately resulting in help to quit, is “beyond all reasonable doubt, unless you represent Big Tobacco”.

“Using studies on the effect of price increase on tobacco usage, we can estimate that a 100% price increase (as these excise increases will deliver) will decrease cigarette purchases by around 42%. That is, a price elasticity of –0.42,” the pair write.

Annual tobacco surveys show that taxation has contributed significantly to reducing tobacco use to one of the lowest rates in the world, they say.

And poorer people are more likely to be influenced to quit by an increase in the price of cigarettes, they say: price elasticity is higher among those who have lower incomes.

This is particularly the case for young people, who tend to have lower incomes, because they are less likely to take up the expensive habit in the first place or become addicted.

“Increasing the pack price to $40 will not only save more lives, but it will also protect more livelihoods in low SES groups than in high SES groups,” they write.

“These lower SES groups are often the least able to afford to have their breadwinners sick or dying from tobacco-related illness: a result that happens more often than not for those who are long-term smokers.”

Dr. Susan Desmond-Hellmann, Guide of the Gates Foundation

On her second anniversary as chief executive of the Bill & Melinda Gates Foundation, a global colossus of philanthropy, Dr. Susan Desmond-Hellmann wrote of progress against smoking in the Philippines, polio across the world and sleeping sickness in Africa.

Before joining the foundation, she led development of the cancer drugs Avastin and Herceptin at Genentech, then was chancellor of the University of California, San Francisco. We spoke for an hour at her office in Seattle. A condensed and edited version of the conversation follows.

What are some of the coolest, most surprising things the foundation is doing?

What I think the foundation ought to be known for is making sure we do things that others can’t or won’t. So I wrote about the tobacco work for a couple reasons. One, people probably didn’t know we did tobaccocontrol work. I’m an oncologist, so I know that tobacco is the cause of death for six million people.

What did you do in the Philippines?

They increased the tobacco tax. So we can pay, and did pay, for a group that can supply them with legal aid. If you’re a relatively small government and Big Tobacco, you might call it, has a legal staff that can challenge your use of a tax or a policy, you could access excellent legal advice.

Tell us a little bit about how you’re trying to figure out what’s killing millions of kids before their fifth birthday.

If you look at what’s happened 1990 to 2015, vast improvement. But we want to decrease by half again that under-5 mortality by 2030. About 40 percent of those deaths now are in the first 30 days of life, most coming actually on your birthday. So here’s a good news story. We know where pregnant women have H.I.V. in sub-Saharan Africa, so we can do extremely effective, nearly universally effective ARVs [antiretrovirals] for pregnant women. Using that precision public health, we decreased H.I.V. transmission from mother to child in sub-Saharan Africa by nearly half in five years. So we’re doing surveillance.

You’re doing actual autopsies?

What we’re doing actually is minimally invasive tissue sampling. So the way that we used to do it — and we still do it —- is actually reasonably effective but excruciatingly difficult. A baby dies and you go to Mom, and it might be weeks after the death, and you say, “Did the baby have a fever, were they holding their stomach, did they vomit?”

A verbal autopsy, it’s called. What we’re doing is adding minimally invasive tissue sampling: liver, lung.

Are mothers receptive or horrified that you’re suggesting this?

These families have lost a child. And to my delight, the principal investigator said that one of the things that people felt is this helps with closure.

How will you use the information?

Most importantly, we can start to see here’s what we believe about epidemiology of H.I.V., TB, malaria, all of the things that we think are going on, and here’s actually truth. I want the Minister of Health to say here’s why babies die in this community, in my country. What do I have in my tool kit? What are the kinds of medicines I want my government to buy?

Bill Gates and the foundation have joined the fight against polio. Do you think this is going to be the year that it ends?

It’s almost like you’re afraid to celebrate, but Nigeria has been poliofree now for over a year, and that means the continent of Africa has been wild polio virus-free for over a year. And we’re down to Pakistan and Afghanistan. I’m a believer. I think we’re at the end of polio.

[On family planning] Melinda has now made it this cause to get. …

Absolutely, 120 million more women [receiving contraceptives] by 2020. That’s a lot of women, and you do have these now phenomenally effective long-acting contraceptives: implants, injectables, IUDs.

There’s an effort to develop an injectable that the woman herself can use.

The potential for self-administration is huge. She may not want others in her house to know she’s using contraception. It gives her agency to make her own decisions on spacing her children, and it makes her more powerful.

You’ve been managing the foundation for two years now, and you’ve been managing Bill and Melinda Gates. What have you learned about their styles, their passions?

I would say that the two of them have three things in common: They’re fierce. They’re so all in. They’re generous. And they’re really committed to their family. It’s a family foundation, and I’m a big family person. I’m one of seven kids, my husband’s one of seven kids. So I’ve had the opportunity to see them as parents and the Gates as a family. Bill Sr. works here. That’s kind of fun, too, and it’s so big a part of the history of this place.

So it hasn’t complicated your life.

Oh, of course it’s complicated my life.


Bill and Melinda are my bosses. And like when I was accountable to the president of the University of California or the C.E.O. of Genentech, I always like to understand how do I work with my boss. Melinda’s really instinctive. Melinda connects with the human condition. We’ve had this new work in poverty, and we were talking about incarceration at a young age. And I was telling Melinda how sad it made me and how I just wanted to cry when I heard this young man’s story. And Melinda said
sometimes, you just have get to that place where you just can’t even stop thinking about it and you cry. Then you think, “How can we help?”

And what about Bill?

Bill is more the numbers guy. I go on trips with Bill and Melinda separately. The trip I took with Bill, we’re driving through Tanzania, and he misses nothing. He’s got the population of Tanzania, G.D.P. of Tanzania, what proportion of their population is educated. He’s looking at every sign. “Wow, there’s three telecom companies in Tanzania.” He’s basically got an Excel spreadsheet of all the data and facts about every country we work in. So his intellect and his ability to connect dots and use data and analytics to try and frame a problem or a strategy is extraordinary.

You’re answering to both of them.

I’m answering to both of them, and what I’ve tried to do is to tap into each of their — they call them in their letter — their superpowers. They have very different superpowers, and yet what unifies them is this commitment to equity and generosity.

Smokers Should Lose Child Custody – Intl Family Law Conf

WASHINGTON, D.C. (May 23, 2016): Fighting smoking by challenging the custody of parents who smoke around their children, and requiring emergency room physicians to file complaints of suspected child abuse against parents whose children arrive in hospitals in respiratory distress because of their parents’ smoking, are only two of the proposals put forth on the opening day of the North American Regional Conference of the International Society for Family Law.

The lawyers who handle many of the nation’s divorce and custody cases, and influence many others, were also urged to take legal action to prohibit smoking when foster children are in a house or car, and to punish parents or others who smoke when children are in the car, says public interest law professor John Banzhaf.

At their annual conference beginning today, the most influential lawyers and law professors in the family law area were reminded that, as the New York Times reported, “at least 6,200 children die each year in the United States because of their parents’ smoking . . . More young children are killed by parental smoking than by all unintentional injuries combined,” and that parental smoking annually causes over five million serious ailments which add almost five billion dollars to the nation’s medical expense costs.

Attendees were told how to effectively raise the issue of parental smoking in custody proceedings, and how to either prohibit smoking indoors at least 48 hours before the child arrives, or to deny Child Custody to the smoking parents. Several cases in which the children of parents who lost Child Custody because they smoked around their offspring were discussed, says Banzhaf, who was the major presenter on this controversial topic.

Banzhaf, who has been called “The Man Behind the Ban on Cigarette Commercials,” “The Law Professor Who Masterminded Litigation Against the Tobacco Industry,” and “a Driving Force Behind the Lawsuits That Have Cost Tobacco Companies Billions of Dollars,” also explained how emergency room physicians who fail to file complaints of suspected child abuse when parental smoking causes allergic or other serious reactions to the child may be subject to both criminal and civil liability, how their licenses to practice may be challenged, and how they could even be hit with medical malpractice law suits.

Child Custody

He explained that Massachusetts, for example, requires reporting of possible child abuse for “all but the most negligible or de minimis injuries to children,” including even slight bruising, and that mere suspicion by the physician is enough to trigger this legal requirement.

They were told that family law attorneys have a moral and perhaps also a legal responsibility to protect children, especially infants and toddlers, from deadly carcinogenic secondhand tobacco smoke, and to use the legal proceedings in which they are involved, as well as their influence with law makers, to insure this protection.

They were reminded that “‘With great power comes great responsibility’ is more than a catch-phrase from a Spiderman movie.”

“We, as attorneys, probably have greater power than other professionals to right wrongs, and to change society for the better, because we can use the tremendous power of law for the public good rather than just to benefit paying clients. And you, as family attorneys, can and should be using the great power of law to right serious wrongs being done to children,” Banzhaf told them.

Professor of Public Interest Law
George Washington University Law School,
FAMRI Dr. William Cahan Distinguished Professor,
Fellow, World Technology Network,
Founder, Action on Smoking and Health (ASH)
2000 H Street, NW, Wash, DC 20052, USA

WHO Director Advocates Strong Health Systems, Warns Against Profit-Oriented Mechanisms

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The World Health Assembly opened today with World Health Organization Director General Margaret Chan repeating that this year has a record number of agenda items and over 3,000 participants. She slapped at profit-seeking mechanisms leading to “slow-motion disasters,” which put economic interests above concerns about well-being.

In particular, she underlined the lack of research and development for antimicrobial treatments and the rise of chronic non-communicable diseases.

On the side of the assembly, a new initiative to tackle neglected tropical diseases was launched by the WHO Regional Office for Africa.

The 69th World Health Assembly (WHA) is taking place from 23-28 May.

In her opening remarks, Chan praised health achievements, such as decline in malaria mortality in Africa, and the fact that 15 million people living with HIV are now receiving antiretroviral therapy, up from about 650,000 in 2000. “That’s quite an achievement!” she said.

However, a number of pressing issues remain on the global health agenda, such as drug-resistant pathogens including the growing number of “superbugs,” and infectious diseases causing new concerns, such as the Ebola and Zika viruses, as well as resurgence of treatable diseases such as yellow fever.

In an interconnected world, “very few threats to health are local anymore,” she said, citing as example the Ebola outbreak affecting three small countries but paralysing the world “with fear and travel constraints.”

“The rapidly evolving outbreak of Zika virus warns us that an old disease that slumbered for six decades in Africa and Asia can suddenly wake up on a new continent to cause a global health emergency,” she said.

She underlined the importance of strong health systems to act as a first line of defence for countries, in particular in those occurrences when there is no treatment or diagnosis yet available, and the importance of the implementation of the International Health Regulations.

“WHO is the organisation with universal legitimacy to implement the International Health Regulations,” she said, and stressed the WHA agenda item on the reform of WHO’s work in health emergency management.

Slow-Motion Disasters

Chan underlined what she called the “slow-motion disasters”: a changing climate, the failure of more and more mainstay antimicrobials, and the rise of chronic non-communicable diseases as the leading killers worldwide.

“These are not natural disasters. They are man-made disasters created by policies that put economic interests above concerns about the well-being of human lives and the planet that sustains them,” she said.

“Medicines for treating chronic conditions are more profitable than a short course of antibiotics that is why there is no investment,” she added. For antimicrobial resistance, we are on the verge of a post-antibiotic era in which common infectious diseases once again will kill,” she said.

“Unchecked, these slow-motion disasters will eventually reach a tipping point where the harm done is irreversible,” she warned.

Victories to Celebrate

Chan applauded the United Kingdom recent legislation on plain packaging for tobacco products. “More countries are exercising their legal right to mandate plain packaging for tobacco products, with the UK being the latest on the list of countries,” she said. “Keep up the good work!” she said.

“These are critical victories. No country can hope to bring down the burden of non-communicable diseases in the absence of a strong legislation for tobacco control,” she said.

She also complimented WHO member states for being “on the verge of delivering a solid framework for engagement with non-state actors that will mainstream a major area of reform.”

New WHO AFRO Initiative to Tackle Neglected Tropical Diseases

Today a new initiative was launched on the side of the WHA. The Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN) is a partnership hosted and managed by WHO Regional Office for Africa (AFRO).

ESPEN is dedicated to reducing the burden of the five most prevalent neglected tropical diseases (NTD) on the African continent, according to the AFRO website. Those five NTD are the following: lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminths and trachoma.

According to the project, ESPEN “will provide technical and fundraising support to endemic countries to help control and eliminate” those NTD. The project is expected to run from 2016 to 2020. The African region bears about forty percent of the global burden of NTDs, and all the 47 countries of the AFRO region are endemic for at least two NTDs, according to AFRO.

According to an ESPEN document [pdf] “Under the leadership of the Regional Director and the AFRO team, ESPEN will facilitate a robust engagement with all local contributors and implementers to assess collectively how best to implement national NTD plans through: 1) maximizing the effective use of existing resources and technical contributions at the local level, 2) identifying where funding and technical gaps exist, 3) providing complementary support (both technical and financial) where critically necessary, and 4) identifying funding opportunities and investment targets for in-country programme sustainability.”

The document further states that in 2016, ESPEN will focus notably on acquiring appropriate staffing, providing continued technical support to member states on NTDs, and develop and advocacy and resource mobilisation plan to fund the five-year project.

“AFRO, with support from the NTD community and ESPEN’s Steering Committee, will seek funding from bilaterals, multilaterals, public and private foundations, philanthropists and global implementing partners.” according to the document.

Study finds e-cigarette marketing linked to teen e-cigarette use

Exposure to e-cigarette marketing messages is significantly associated with e-cigarette use among middle school and high school students, according to researchers at The University of Texas Health Science Center at Houston (UTHealth). The study will be published in the June print edition of the Journal of Adolescent Health.

Using data from the 2014 National Youth Tobacco Survey, researchers found that youth were exposed to e-cigarette marketing messages through many channels: retail settings, internet, print, television and movies. Of the 22,007 middle and high school students who were surveyed, 20 percent had tried e-cigarettes before and 9 percent were current users.

Students who had tried e-cigarettes before were 16 percent more likely to have encountered an e-cigarette marketing message in print, retail settings, internet, television or movies compared to non-users. Further, current users of e-cigarettes were 22 percent more likely to have encountered one marketing message compared to non-users.

With each additional exposure to another channel of e-cigarette marketing, students’ odds of using e-cigarettes grew exponentially.

Half of the students reported seeing e-cigarette marketing messages in retail settings, making it the most common place they appeared, followed by messages on the internet at 40 percent.

“You go to a convenience store and the entire wall behind the cashier is tobacco advertising. We’re seeing e-cigarettes are following that trend. The internet and social media are also a concern because e-cigarette companies have a big presence online,” said Dale Mantey, M.P.A., lead author and predoctoral fellow at the Michael & Susan Dell Center for Healthy Living at UTHealth School of Public Health in Austin.

According to the paper, spending for e-cigarette marketing tripled from 2011 to 2012 from $6.4 million to $18.3 million and expenditures through the second quarter of 2013 outpaced all of 2012. Mantey said this reveals a trend that is not likely to change.

“E-cigarette companies are following what cigarette companies did. There are no restrictions on the messaging they can use, and health warnings do not appear on e-cigarettes like they do on cigarette packages. Flavored e-cigarettes are widely available and appeal to youth,” said Maria Cooper, Ph.D., co-author and postdoctoral fellow at the Center for Healthy Living.

The authors are members of the Tobacco Center of Regulatory Science on Youth & Young Adults (Texas TCORS), a center created to develop research that can guide future decisions on tobacco regulations at the national level. The researchers are examining how marketing messages from e-cigarette companies affect youth in Texas over several years. They also have plans to study the role that e-cigarette marketing plays on college campuses.

“While the current study is unable to definitively say e-cigarette marketing causes e-cigarette use, since data on exposure to advertising and e-cigarette use were collected at the same time, the longitudinal studies underway at the Texas TCORS will be equipped to answer such questions,” said Mantey.

Swapping one vice for another? Ex-smokers who end up becoming ADDICTED to nicotine gum

• Under new legislation, cigarette packaging is to be stripped of its bright colours and will, in future, be a uniform green-brown colour
• To go by the experience of other countries, this will lead to many more smokers switching to nicotine replacement therapy (NRT) such as gum
• These effective products will inevitably see many become addicted to them

My childhood was peppered with my father’s euphemisms for smoking. Every evening after our family meal, he’d get up from the table and inform us he was ‘just going to check on the weather’ — or ‘the oven’, or even ‘a giraffe’ he had apparently seen in the garden.

Each of these was actually an excuse for my dad to have his after-dinner cigarette. My father, Anthony, now 68, smoked more than 20 a day for 40 years — and this was a routine almost every night for the 20 years I lived at home.

But three years ago, he quit smoking. Instead of going out for a cigarette, he now fishes in his pocket for a packet of nicotine gum and pops a small, white square into his mouth, like a petit four.

Around an hour later, he will have another, then an hour after that we’ll hear the rustle of the packet again. For while he has given up cigarettes, he is now addicted to nicotine gum. He can’t go anywhere without it.

‘I never wanted to give up cigarettes,’ he says. ‘I enjoyed them too much. But the doctor said it was crazy to keep smoking. I thought about an e-cigarette, but I didn’t want to be one of those sad people outside buildings blowing apricot smoke over everyone, so I decided to use the gum.’

That was three years ago. Initially, the gum was prescribed by the NHS — you’re given a 12-week course (in fact, the manufacturer’s recommended dose), with the idea that you use it to wean yourself off nicotine.

But, like many people, Dad couldn’t do that. Instead, he started buying the gum in the High Street, where it is available everywhere, from Sainsbury’s to Boots. He buys a box, costing up to £26, a week and chews 15 gums a day (the maximum initial amount recommended by doctors before you should taper off and stop completely).

He says it works — ‘If I feel like a cigarette, I have a piece of gum and it stops the cravings’ — and has noticed real health benefits. ‘My breathing is already better and I can walk and run properly.’

But he is definitely addicted. ‘I take them everywhere with me. I can’t run out. One day, I’ll try to give up nicotine completely — but the gum is addictive.’ His case is far from unusual. While gum was meant to bridge the gap between addiction and freedom for smokers, many have trouble weaning themselves off it.

They now have a new addiction: to gum, with 10 per cent chewing it four times longer than they should (a year) and 5 per cent for two years. Some use it for ten years.

Under new legislation that came into effect last Friday, cigarette packaging is to be stripped of its bright colours and will, in future, be a uniform green-brown colour.

To go by the experience of other countries that have done this, it will lead to many more smokers switching to nicotine replacement therapy (NRT) products, such as gum.

And inevitably, many will end up addicted to it.

The nicotine in the gum is released on chewing and absorbed through the tissues lining the mouth.

When the taste becomes strong or hot (this signals that the nicotine has been released), users are told to ‘park’ the gum in the side of their cheek until the feeling fades, before continuing to chew.

There are two strengths, 2mg and 4mg. The latter (which Dad uses) is recommended for people on more than 20 cigarettes a day. One 2mg piece of gum has double the amount of nicotine absorbed (on average) from a cigarette, though experts say gum-chewers don’t absorb it all.

There is no doubt that gum, even a decade of use, is ‘safe’ compared with smoking.

Half of all lifelong smokers die early, losing around three months of life expectancy for every year after the age of 35 that they smoke, according to a report last month.

Some 8.7 million people in the UK still smoke.

As Professor John Britton, chairman of the Royal College of Physicians tobacco advisory group, explains, smokers are ‘like people in a nightclub when a fire breaks out’ — they just need a way out, and that’s what nicotine gum provides.

Yet while the gum doesn’t contain the toxins that put smokers at such high risk of disease and premature death, it may not be as benign as people think.

The leaflet that accompanies nicotine gum brand Nicorette, for instance, warns that ‘very common side-effects’ include stomach discomfort, nausea, headaches and tingling or numbness in hands and feet, with more than one user in ten affected. Less common are vomiting, palpitations and hives.

Some effects may be due simply to the act of chewing itself, as Dr Andy McEwen, of the National Centre for Smoking Cessation and Training, explains.

‘The effects of chewing ten to 15 pieces of gum a day are pretty onerous,’ he says. ‘That’s around one piece every hour, with recommended chewing of around 20 minutes, so people do say they have sore jaws. And nausea, dizziness, insomnia and headaches can also be side-effects of the gum, but they are for most medications.’

There is some evidence of more serious harm. In 2014, a study by scientists at the Virginia Bioinformatics Institute, in the U.S., found nicotine was such a powerful carcinogen, it caused thousands of cell mutations similar to those known to be a precursor to cancer.

But Professor Britton said while there was evidence that nicotine can promote cancer growth, it didn’t cause the disease.

‘The long-term risks have been tested as far as 12 years, and we know there were no very adverse health effects,’ he says — although he adds that the same cannot yet be said for 20-year or 30-year use. There may be a risk to unborn babies. A study by the Loma Linda University School of Medicine and California State University, in the U.S., found that, in rats, nicotine is absorbed by the foetus and can lead to high blood pressure and heart problems later in life (the NHS, however, says the gum is safe to use in pregnancy).

And patients who have recently had a stroke or heart attack, or have angina or heart rhythm problems, are advised to talk to their doctor before using the gum, because nicotine can increase heart rate and blood pressure.

People with dentures or dental work may also want to avoid gum because it can stick to them; prolonged use may irritate the mouth or affect the teeth.

But the fact remains that for the ‘small percentage’ using gum long-term, ‘nearly everything is safer than smoking’, says Dr McEwen.

There are more than 7,000 chemicals in cigarette smoke, including carbon monoxide, arsenic and cyanide, and at least 69 of them can cause cancer.

Most of the ingredients in nicotine gum, such as the gum base and flavourings, are the same as in normal chewing gum.

How addictive a nicotine product is depends on the speed of absorption, says Robert West, a professor of health psychology at University College London.

In theory, the nicotine in gum, which is absorbed relatively slowly into the bloodstream (taking around half an hour), shouldn’t be as addictive as people such as my father find it. So what’s going on?

‘Most people using the gum for years will have had failed attempts at giving up smoking,’ says Professor West. ‘They’ve made a mental calculation that they really don’t want to go back to smoking and are quite happy using the gum.

‘Most health professionals will tell you that you’d live a happier, richer, healthier life if you had no nicotine at all, but the gum is a buffer and a transition to abstinence.

Some people use it for many years — but most reduce their use eventually.’