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August 1st, 2016:

Tobacco ‘Deeming’ Regs Go Into Effect Aug. 8

WASHINGTON — As of next Monday, Aug. 8, it will have been 90 days since the U.S. Food and Drug Administration (FDA) announced its final “deeming” regulations for cigars, pipe and hookah tobacco and electronic cigarettes. Aug. 8 also marks the date when the regulations officially go into effect.

A press release from the FDA’s Center for Tobacco Products (CTP) outlines which provisions affecting retailers will go into effect next Monday. As of that date, retailers:

• Must not sell e-cigarettes, hookah or pipe tobacco, or cigars to people under 18 years of age; also must check photo ID of everyone under age 27 who is attempting to purchase such products.
• Must not sell tobacco products covered under the rule in a vending machine (except in a facility where people under age 18 are not allowed on the premises).
• Must not give away free samples of any newly regulated tobacco products. (This provision also applies to manufacturers, importers, and distributors.)

Also, as of Aug. 8, manufacturers are prohibited from marketing “modified-risk tobacco products” without an FDA order in place. A modified-risk tobacco product includes a product with label, labeling or advertising that claims:

• It presents a lower risk of tobacco-related disease or is less harmful;
• The product or its smoke contains a reduced level of/presents a reduced exposure to a substance; or
• The product or its smoke does not contain/is free of a substance.

The FDA said modified-risk tobacco products using descriptors such as “low,” “light” or “mild” will be provided additional time to comply.

Aug. 8 also marks the deadline for manufacturers of newly deemed products to introduce new products without first obtaining FDA approval. Products on the market as of Aug. 8 will be provided additional time to comply with certain submission requirements, such as ingredient listing, health document submission and premarket tobacco applications.

The press release acknowledged that additional requirements for retailers and manufacturers will become effective at the end of the month, the end of 2016 and in the years that follow. A chart of compliance dates can be found here.

Changing Perceptions of Harm of E-Cigarettes Among U.S. Adults, 2012–2015

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Cigarette Affordability in China: 2001 – 2016

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Change in the air as Hong Kong health bureau bids to ban e-cigarettes and improve organ donation

In an exclusive interview with the Post, Undersecretary for Food and Health Professor Sophia Chan Siu-chee reveals the bureau’s goals in the final nine months of the current administration

Improved organ donation, regulation of e-cigarettes and more assistance for breastfeeding mothers are top priorities in the next nine months, the health bureau’s No 2 has revealed.

In an exclusive interview with the South China Morning Post, Undersecretary for Food and Health Professor Sophia Chan Siu-chee said they were all on the agenda in the final months of the current administration.

Chan was speaking in the aftermath of a setback for the ¬bureau, following the failure to ¬reform the doctors’ watchdog, the Medical Council. The reform bid collapsed after a prolonged ¬filibuster by medical sector lawmaker Dr Leung Ka-lau ran to the end of the final session of the Legislative Council.

“I was very disappointed … but looking ahead, there is a lot more to be done,” she said.

The campaign to promote ¬organ donation aims to double the number of registered donors in Hong Kong to 400,000 in the next two years.

The current rate of organ ¬donation in the city is among the lowest in the world, with only 5.8 donors for every million people in 2015 – suggesting at most a total of 42 donors, according to a recent Legislative Council study.

As of June 30, some 2,500 people were still in queues for vital organs. Chan said the donation rate was far from satisfactory and vowed that the government would improve education and awareness of the situation.

A committee to promote ¬organ donation, which Chan heads, was established in mid April and she said the government was planning a renewed push on the issue next month.

One suggestion was for the city to adopt an opt-out scheme, which would make all Hongkongers potential donors unless they gave specific instructions to the contrary.

But Chan, stressing the government was open to the idea, said a survey would be launched to gauge public opinion on the scheme, with a report to be made available by the end of the year.

The bureau is also determined to tighten regulations on e-cigarettes and is currently in talks with various government departments to look into banning their import and sale in Hong Kong.

Chan said a bill would be submitted on the matter in the next legislative term.

Reports had revealed children as young as six were among the users of e-cigarettes, a practice known as vaping, and she said that notices had been sent to schools warning them about the trend.

“This is very worrying as there are researchers suggesting that ¬e-cigarettes contain harmful ¬substances,” Chan said.

“And it seems the product is targeting young people.”

Meanwhile, with World Breastfeeding Week starting ¬today, local hospitals and clinics have been bidding to be recognised as baby friendly health ¬facilities – part of a breastfeeding initiative promoted by Unicef.

Queen Elizabeth Hospital in Yau Ma Tei is set to be the first hospital in the city to be officially awarded baby friendly status, while the Department of Health has also piloted breastfeeding friendly practices in three clinics.

In May, a Unicef survey ¬revealed that Hong Kong was ¬lagging when it came to providing family-friendly facilities.

Some 40 per cent of mothers in the city said they had an unpleasant experience while breastfeeding in a public place.

Other plans included a review on medical manpower and a ¬proposal to reform the health ¬insurance scheme, Chan said.
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The doctor who beat big tobacco

When Dr Bronwyn King discovered her pension fund was investing in the cigarette companies that were killing her cancer patients, she was staggered. And she knew she had to act

On Good Friday this year, Dr Bronwyn King and her husband were staying with her parents in the quiet coastal town of Torquay in Victoria, Australia. They started watching a movie – although King, as she often is, was only half-there, busily pecking at her laptop.

“AXA – news …” said the subject line of the email from a French insurance executive. “In confidentiality,” it read: “we have decided to divest tobacco … If you can, let’s discuss further. Thanks for your help.” King felt momentarily giddy. It was six years since she had sent the first of tens of thousands of hopeful, courteous but determined emails with such ends in mind. She had already persuaded 35 Australian superannuation funds, as Australians call their private pension funds, controlling nearly half the total funds under management to shun tobacco. AXA, the world’s second biggest insurer, was her greatest success yet. But she passed up a celebratory glass of wine: there was work to do, on the details and timing of the announcement. When her family turned in, they left King, as they often do, at her laptop.

Two months later at Geneva’s plush Beau Rivage Hotel, King looked out over a sea of faces, mostly delegates gathered for the World Health Assembly, and introduced her “new best friend”, AXA boss Thomas Buberl. AXA, he said, would forthwith sell €200m of tobacco stocks: there was applause. It would also, he added, run down €1.6bn of tobacco corporate bonds. There was a hush. Had he just said billion?

In an old war, a new front had opened. Tobacco kills six million people a year: the McKinsey Global Institute deems it humankind’s greatest self-generated social burden, ahead even of war and terrorism. Yet as an issue, observes King’s colleague Clare Payne, it has receded in public consciousness: “There’s this tendency for people to think: ‘Oh we’re done with tobacco, aren’t we? Everyone knows. It’s just a choice thing for people now.’ When we’re actually in an epidemic – history’s first epidemic of a non-communicable disease.”

To restore it to the headlines, then, is no mean feat. “She’s a star,” says Cary Adams, CEO of the Union for International Cancer Control, who just over a year ago put King in charge of the Global Task Force for Tobacco Divestment. It’s not a mantle that rests easily with King. All the 41-year-old oncologist at Melbourne’s Epworth Healthcare feels she’s done is take to heart her hippocratic oath, especially the injunction to “do no harm”.

Into her mid-20s, King’s career had seemed mapped out. At Fintona Girls’ School in the Melbourne suburb of Balwyn, she had been a star junior swimmer, thriving on the daily pre-dawn starts and unrelenting competition, climaxing in medals at national championships and a victory in the Pier-to-Pub, a famous open water race in Australia. On completing medical studies in 1999, she became an Australian swimming team doctor, and weighed up specialising in sports medicine and paediatrics.

In February 2001, however, King began three months as a radiation oncology resident in the lung cancer unit of Peter MacCallum Cancer hospital. She was, she confesses, a reluctant conscript. Radiation oncology, which uses giant linear accelerators to beat back advancing cancers, is a technically and emotionally challenging field of medicine, undertaken underground for the containment of its x-ray emissions, dedicated chiefly to the very sick. And sickest of all are smokers.

For King it was an education. The five-year survival rate after diagnosis for lung cancer is 15%: her job was largely to alleviate its acute associated sufferings. Most people have an image of lung cancer sufferers propped in bed subsiding gently, maybe with a bit of a cough, possibly on oxygen. The reality is very different. In a fifth of cases, for example, lung cancer metastasises to the brain, inducing paralysis and loss of cognitive function: the patient, literally, loses their mind. Death can come violently too. One morning King arrived to find the corner of a ward absent not only its bedclothes but its curtains and furnishings. The night before a patient had essentially drowned in her own blood from a burst vessel, drenching staff in her death throes. In the room were three other terrified patients who had heard the whole thing.

Almost every interaction bore witness in some way to tobacco’s toll. Taking a history from a new female patient one day, King asked her age. “I’m 43,” the woman replied. “I’m getting quite old.” It transpired that her whole immediate family had died in their 40s from smoking-related cancers. “I had this overwhelming sense of the impact of tobacco,” King recalls. “The public did not know what was going on. They didn’t know because I was a doctor and I hadn’t known. Until I worked there. I started to wish I had a television camera with me, so people could see what I was seeing.”

But so much was out of sight for a reason – to which King was first introduced by an older patient who beckoned her from his bed, looked around furtively, and whispered: “This is because of the smoking, isn’t it?” When she said it probably was, he nodded and looked away. Here were lung cancer’s little-acknowledged secondary symptoms: disgrace and shame. Where families could be relied on to rally around sufferers from breast and prostate cancer, tension surrounded those with tobacco-related illness, who were perceived as having brought cancer on themselves. This has been an unforeseen impact of the public health campaign to scare smokers straight: in a recent survey, 30% of Australians agreed with the sentiment that lung cancer patients were less deserving of sympathy than other cancer patients. “Lung cancer has become the syphilis of the 21st century,” says the head of Peter MacCallum’s lung cancer unit, Professor David Ball. “Patients are regarded as victims of their own lack of self-control. Whereas they’re actually victims of a concerted and successful campaign by the tobacco industry to turn them into addicts.”

It was Ball, a fixture at Peter Mac since 1973, who became King’s lodestar. He instilled an environment of kindness and hope. Young doctors, says Ball, can feel overwhelmed: “I’ve had people in training in this specialty who’ve eventually been reduced to tears, saying they can’t go on. They want all their patients to get better. Life’s not like that.” He encourages them to think differently:

For a doctor, lung cancer sufferers are tremendously rewarding to work with. They don’t come in saying: ‘Why me? I’m pissed off. Why aren’t you working harder to find a cure?’ They come in feeling ashamed. When you reassure them that you want to make their life as good as it can be, they’re immensely grateful. Because they tend to stay long periods, you get to know them as people too. And you’re at that very serious time of life, where the questions are deep and philosophical, and existential concerns come to the fore.

Those questions resonated with King. “People say that if you don’t know what you want to do before you work with David, you will afterwards,” she says. “He was the first doctor I really wanted to be – a great teacher, a great colleague, interested in everyone and everything. In that three months, I got to know patients, I got to know families, I worked with an inspiring medical team, I felt so privileged, and it changed me forever.” She dug in for what became the seven-year haul towards adding FRANZCR – Fellow of the Royal Australian and New Zealand College of Radiologists – to her postnominals. After a couple of years she was joined in this pursuit, and in her life, by Dr Mark Shaw, a quietly-spoken New Zealander whom she met at Geelong’s Andrew Love Cancer Centre and married. Yet her life-change remained incomplete until she and her husband emerged from their high-stakes, high-stress discipline to do something of utmost normality – buy a house.

King calls it “the story”; maybe it should be “The Story.” It’s how she prefaces most presentations – if ever time precludes it, she feels regretful. “It explains everything, really,” she says. “Sometimes I apologise to audiences for having told it so often. But people always come up afterwards and say: ‘I love that story’.”

The scenario, a conversation about her finances with a consultant from superannuation fund Health Super in the Peter MacCallum cafeteria in March 2010, could hardly have been more prosaic. In fact, King was standing to leave when a final question crossed her mind: was she meant to specify how she wanted her money invested? No need, said the consultant: her money, as it is with 75% of Australians, was in the “default option”.

King asked about the alternatives. Oh, came the reply, there was a “greenie option”, involving no investment in mining, alcohol or tobacco. The answer brought her up short. “Does that mean I’m currently investing in tobacco?” she asked. Well yes, the consultant replied: “Everyone is.” King sat back down.

It was worse. Two weeks later the consultant confirmed that four of the five biggest holdings in the international component of Health Super’s default option were tobacco-related: British American Tobacco, Imperial Tobacco, Philip Morris and Swedish Match. King shared this exposure with the overwhelming majority of Peter Mac’s 2,500 staff members. “We’re a dedicated cancer hospital,” she recalls. “There was nowhere else this could have mattered more. The idea that all of us, the doctors, the nurses, the occupational therapists, the speech pathologists, were invested in tobacco companies … well, it had to be fixed.” King’s concerns were immediately shared by Peter Mac’s CEO, Craig Bennett, who accompanied her to a meeting with members of Health Super’s executive and investment team.

The response was cordial but bemused. “It was strange for a financial institution to be approached by members about these issues,” King recalls. “Mainly they were surprised.” A “good-natured” discussion ensued. Other factors then conspired to relegate tobacco to a back burner: Health Super commenced a merger with Sydney-based First State Super. In the hiatus, King started educating herself. Australian super funds had only between 0.5 and 1.3% of their assets in tobacco. But in a $2tn pool, that was still in the region of $10bn. The seven biggest funds with health professionals as members all offered “greenie” opt-outs, designated “sustainable”, “ethical” or “socially responsible”. But four of these actually had money in tobacco.

After a year’s to-and-fro with Health Super, King finally got in front of its board, flanked by Craig Bennett and David Ball, punctuating her PowerPoint presentation with knockout statistics: that someone in the world dies from tobacco use every eight seconds; that these include 15,000 Australians a year; that no substance takes a steeper toll of lives and years lost.

King was nervous and exhilarated: “I was presenting to all these people from a world I knew nothing about sitting next to the man who knows everything [Ball].” She was also shortly to take maternity leave: “I thought: ‘If this doesn’t work, it’s probably going nowhere.’” But the response was gratifying: “I could also tell by the end of that meeting we had a lot of friends.” The impression deepened at the first instance of what would be a recurrent experience, when a director trailed her to the lift. “Just so you know,” the director said, “my mother died of lung cancer. Thank you for doing this.”

About to fold, Health Super’s board bequeathed the issue to its new parent. First State Super CEO Michael Dwyer is an unusual boss – inspired by visiting Timor-Leste in 2000, he co-founded Australia for UNHCR, which raises funds for the United Nations High Commissioner for Refugees. He sensed a problem it might be prudent to get ahead of: a group with 40% of its members in health services that had $170m invested in tobacco was bound to hear more about it.

Like other super funds, First State Super was required to observe the Superannuation Industry (Supervision) Act, binding trustees at all times to act in members’ best interests, which has tended to be interpreted by law in a narrowly financial sense. But at this point, another statute made its presence felt: tobacco share prices were hit by, among other things, the proclamation of Australia’s Tobacco Plain Packaging Act in 2011. “I could tell the board that these were stocks whose product was being condemned and restricted by every government round the country,” says Dwyer. “They had no redeeming feature. As Bronwyn says: ‘There’s no such thing as a safe cigarette.’” In July 2012, CEO and doctor put their names to a press release declaring First State Super the first Australian superannuation fund to renounce tobacco; six months later HESTA, whom King had also courted, followed suit. And though the process had taken two years, she was used to long hauls. “I started thinking,” she says, “if they could do it, why not others?”

Superannuation conferences can be dry affairs. So when Dwyer started dropping King into programmes through 2013 and 2014, her presence and message quickly gained a following. Grabbing audiences with The Story, she did not let go. “I’ve never seen anyone network like Bronwyn,” says Michael Baldwin, CEO of the Funds Executive Association, an industry group whose conference she addressed in June 2013. “It’s a skill I wish I had. People love dealing with her.” She distributed a business card bearing the rubric Tobacco Free Portfolios, featuring a logo designed online for $300 transfiguring the ribbon that is a cancer remembrance’s best-known symbol into a cigarette. She piled up cards she collected and studiously emailed the addressees, politely petitioning to meet directors, trustees and investment managers – even just to “have a coffee”.

Those meetings regularly begat further meetings, and also elicited personal confidences. In any group of five people she sat down with, King found, at least one person would be harbouring a story about how tobacco-related illness had touched their lives; down the track, two chairmen would recuse themselves from votes about their funds’ tobacco exposures, fearful of emotion clouding their corporate decision making.

Pregnant through some of this time with a second child, King found that her most incisive pitch was illuminating the tobacco industry’s exploitation of the young. The average age at which Australian smokers take the habit up, 15 years and nine months, is actually high by world standards. Globally it’s estimated that 80-100,000 children start smoking every day – so much for the notion of smoking being based on mature, fully-informed choice. What’s more, according to the International Labour Organisation, up to 60% of the 33 million engaged in tobacco farming worldwide are under 16. To those who challenged that tobacco stocks were historically good performers, King had a brisk rejoinder: “If a business can live with six million deaths and externalising €2tn in health costs a year while employing mainly children, then it probably won’t find it difficult making money. All it has to do is adjust its moral compass.”

King was careful, all the same, not to scold. After all, much of this information was new to her too – and as a medical practitioner she might have been expected to know it. In fact, as she realised, medicine has historically been divided between clinicians like herself, who treat people, and public health specialists, concerned with society. So she sought out the likes of Professor Simon Chapman at University of Sydney and Professor Mike Daube from Curtin University, whose experiences in tobacco control stretched back to the 1970s. They were impressed. “I get a lot of approaches from people with crackpot ideas,” says Chapman. “Bronwyn immediately struck me as different – someone highly intelligent, very organised, and street smart. Not to mention engaging and vivacious in an area that’s stereotyped as deadly earnest and tinged with moralism.”

Says the wryly humorous Daube: “She’s such a deeply unpleasant person, isn’t she?”

While the tone of King’s campaign came naturally, she was shrewd enough to understand it as an attribute. She shrank from calling herself an “activist”; she was simply an “oncologist”. She denied hers was a “cause”; she spoke instead of pursuing her “interest”. She did not regard financial institutions as “targets”; instead she was seeking “partners”. She respected confidentiality, avoided confrontation, declined to court the media, and drew on her own experience as exemplifying the involuntary nature of much tobacco investment, which had its institutional counterparts. “I presented to one fund that took sustainability very seriously,” King recalls. “They had a ‘sustainable investment’ option. I looked into it. They chose their international shares via the Dow Jones sustainability index – a best of sector index which BAT [British American Tobacco] is part of … The board members of this super fund were … well, they felt tricked. Before I got home I had an email from their CEO saying: ‘We’ve issued a comprehensive tobacco free mandate across our portfolio.’”

By mid-2014, King’s initial epiphany had become almost all-consuming. A dozen funds had divested more than $A1bn of tobacco stocks. With two small boys, she was not sleeping much anyway, but she was enjoying herself. Tobacco Free Portfolios was winning support not only from business leaders but Australian politicians of all stripes: Liberal health minister Sussan Ley, former Labor health minister Nicola Roxon, the Greens’ Richard Di Natale and independent Andrew Wilkie all recorded video testimonials. Papers were being invited for the forthcoming biennial World Cancer Conference, which the Union for International Cancer Control (UICC) happened to be staging in Melbourne. When King impulsively submitted an abstract, she had her first glimpse of the world of global tobacco control, and an opportunity to spread The Story. It cast its now-familiar spell.

The only time King falters in making the case for Tobacco Free Portfolios is in making the case for herself. And four and a half years after starting, she remained a one-woman band paying for things on her credit card. “I’m a doctor,” she says. “Doctors aren’t good with money. Most of us don’t even really like talking about it.” Introduced to the UICC boss, Cary Adams, she started talking about how much more she could do in Australia if she could afford it – just a little money to cover expenses. “You know,” said Adams, “you’re not thinking big enough.”

Adams is a former banker: prior to this role, he had been chief operating officer of Lloyds TSB. Maybe it was time his new community started talking to his old industry. Unbeknownst to King, the UICC every two years takes a local project to a “global platform”. They were shortly to do it again. “Leave this with me,” Adams said. “I’ve got big plans.”

There had been such plans before. Under the anti-tobacco sun, little is outright new. In the UK, activists had eyeballed the City as far back as the 1970s, buying single shares in tobacco companies so as to lob questions at annual meetings. After one, Mike Daube recalls, he was taken aside by Rothmans chairman Lord Pritchard, who offered to fund the protest campaign of his choice … providing it had nothing to do with tobacco.

Divestment was trialled in the US in the 1980s, partly inspired by the boycott of companies invested in apartheid South Africa. Activists first cajoled the American Medical Association into urging medical schools to withdraw from tobacco funds. In the 1990s several universities and state pension funds followed suit. But efforts petered out after 1998’s Master Settlement Agreement (in which 46 states settled healthcare lawsuits with the four biggest US tobacco companies), which perversely aligned the interests of big tobacco and state legislatures dependent on them for future funds. And opinion remains divided on the efficacy of divestment. “As long as another investor buys what a university, pension fund, or a health insurer sells,” says leading anti-tobacco authority Professor Alan Blum, of the University of Alabama, “there’s no net loss of investor confidence in the stock or capital in the company’s coffers.”

Anything attached to what’s conventionally abbreviated as CSR (corporate social responsibility) and ESG (environment, social, governance) also raises fiduciary questions. Does a manager of funds owe clients anything other than maximum returns? Is socially responsible investment even possible? In the 1990s, Philip Morris ran a stealth campaign against “social investing”, relying on an oft-cited 1980 paper by two distinguished American law professors. In “Social Investing and the Law of Trusts”, John Langbein and Richard Posner argued, in the context of disinvestment in South Africa, that “the trustee who sacrifices the beneficiary’s financial well-being for another object breaches both his duty of loyalty to the beneficiary and his duty of prudence in investment”; Langbein was subsequently employed by Philip Morris as a consultant.

Has the position changed? Professor Richard Daynard of Northeastern University, another veteran of the anti-tobacco movement, thinks so: “The Chicago School position argued by Milton Friedman is that the corporation has only one objective, which is greed, or shareholder return. Which means that any organisation doing socially responsible investing can get away with it only if is a complete fraud… and does not cost the company a penny. But nobody argues that any more. Lots of companies flourish their social responsibility credentials. They’re good for business. And there are business judgment rules which offer a board of directors a large amount of leeway.”

Two multilateral instruments have further widened that leeway. Ten years ago, after consultation with a group of big institutional investors, the United Nations laid out six “Principles of Responsible Investment”: there are today 1,500 signatories. The principles are aspirational and non-binding, but the first articulates a departure from circumscribed conceptions of fiduciary duty: “We will incorporate ESG issues into our ownership policies and practices.” And while UN PRI does not single out tobacco, another UN treaty does: in force since 2005, the World Health Organisation’s Framework Convention on Tobacco Control has been signed by 180 countries, representing 89%of the world’s population. The framework is exacting and comprehensive, committing governments to a wide variety of risk minimization measures, taxes, regulations and prohibitions – including on investment. Article 5.3 specifies that “no branch of government, including local government, should have any financial interest or investment in the tobacco industry.” So far, only three countries have complied: New Zealand since 2007, Norway since 2009, Australia since 2013. Some even seem unaware of it, and not just the usual delinquents: the UK is presently rolling local government pension funds including their tobacco investments into seven sovereign wealth funds.

So divestment, says public health specialist Simon Chapman, has a different context, as well as a broader purpose. “The standard critique that someone sells then someone else buys misses the symbolic importance of building the rank odour around the industry,” he says. “That odour already exists in the health and medical professions and in the general population – when we poll them, we even get it from smokers. Building that consciousness among people making financial decisions furthers that delegitimisation.” Investment in tobacco, argues King, is a devil’s bargain. “When you invest in a company, you want that company to thrive, don’t you?” she says. “But do you really want big tobacco to thrive?”

Like a lung cancer, tobacco is also metastasizing as a public health issue. When the UICC appointed Tobacco Free Portfolios to run its global divestment initiative in March 2015, Adams appointed to its as chair a darling of the anti-cancer movement. Since her son’s diagnosis with leukaemia 20 years ago, Princess Dina Mired has dedicated her life to improving cancer treatments in Jordan: she is director-general of the Amman foundation of the King Hussein Cancer Center, her country’s largest.

Introduced to King, Princess Dina loved The Story: “It was one person seeing something shameful and deciding to do something about it, by herself, knocking on doors, showing commitment and never giving up.” More than that, she sensed the need for a form of tobacco control aimed at supply rather than demand. It is poorer countries, with weaker public health consciousness, that will chiefly bear tobacco’s brunt: the World Health Organisation estimates that by 2030 they will account for four in five tobacco-related deaths. The reasons are not far to seek.

“As countries like Australia, the US and Canada have been increasing regulation and hiking up prices, tobacco companies have made extra efforts in the Middle East and Africa,” she says. “Since the Arab Spring, we are a stressed-out population, and we are game … They [tobacco companies] are zooming on our youth in a really big way.” Today more than a third of Jordanians smoke and the proportion is growing: the crop of tobacco-related cancers being sown prelude a bitter harvest. “And if you invest in tobacco,” she adds, “you are part of that killing machine.”

Heading a Global Task Force, King still had unfinished business in Australia. But she now had a helper. Lawyer Clare Payne worked at Macquarie Bank for 11 years before founding an initiative called the Banking and Finance Oath: an attempt to popularise for finance industry professionals a code of practice akin to the hippocratic oath. So when she and King watched each other speak consecutively at a responsible investment conference in November 2014, they felt a natural kinship. “Bron’s achieved more than most people have in20 years of responsible investment,” says Payne. “She’s got more than engagement. She’s got action.” Payne joined Tobacco Free Portfolios as “chief operating officer”, even though her “office” was a cleared out built-in wardrobe in the Sydney cottage she shares with her young daughter.

Boards now faced two advocates, Payne with her corporate experience perhaps slightly steelier. Where King was always sunnily optimistic, Payne groaned inwardly at counterarguments trotted out, like a board chair who couldn’t see a problem with tobacco because an uncle had smoked till he was 95, not to mention the familiar slippery slope fallacies. “I remember one day this American saying to me: ‘Let me just play devil’s advocate here… ,’” says Payne. “And I thought: ‘Really? Aren’t we beyond that now? Unless it’s your view. Otherwise we’re just proceeding from a silly starting point.’” To Payne, the problem was straightforward: it was persuading the powerful to heed the people. “Australian society accepts tobacco control,” she says. “They don’t want their children to smoke. If they smoke themselves, they want to stop. They want fewer people to die. Governments want better health outcomes. Funds should reflect that.”

King, meanwhile, was pondering how to replicate across the world her Australian system. She tapped her “partners” for contacts and introductions, never failing to follow up the faintest lead. She would start days in oncology at Epworth Healthcare with two sheets of paper: her patient schedule, and her Tobacco Free Portfolios to-do list. The patients came first, their needs acute, their questions poignantly familiar. “‘How long?’” says King. “That’s what they all want to know. ‘My daughter’s getting married. Will I make it?’ ‘My daughter’s having a baby in January. Will I live to see it?’ ‘My son’s graduating next year. Will I be able to go?’”

Of time, she was constantly reminded, there was never enough. So any minute before, between or after patientcare was an opportunity to make a phonecall, send an email, or dash into the central business district. Nights steadily became Skype marathons. One evening her husband walked in with a cup of tea suggesting she take a break. “Quick, close the door!” she exclaimed. “I’m about to talk to Kuwait!” King laughs: “He looked at me and it was, like, ‘Who are you?’ He thought I’d lost the plot.”

Extending the filaments of her network also involved serious travel. In July 2015, King made her first trips to Washington and New York. In September, she took in a Principles of Responsible Investment conference in London and visited the World Health Organisation in Geneva. In November she travelled to Istanbul for the World Cancer Leaders summit, and swung on to London for a first look at the City.

Where doors were now open in Australia, they were only tentatively ajar in the UK. Big tobacco and City merchant banks align snugly. Rock star fund manager Neil Woodford has made a fortune from tobacco stocks for his eponymous investment boutique, explaining that clients expect him to “exercise an investment judgment” not a “moral judgment”. King notes: “The influence of companies like BAT and Imperial Brands is enormous.”

A roundtable for 20 investment professionals at the Whitechapel offices of Principles of Responsible Investment, a UN-supported NGO, became an eye-opening realtime experiment in City attitudes.

One guy, a very senior leader in UK finance, was quite difficult,” said King. “He just kept saying: ‘Our approach is to engage with the tobacco companies. We engage with the industry.’ He was getting very fired up, and I just had to hold my ground. Finally I said: ‘I understand engagement is a useful tool, and it’s important to be a good steward of capital. But this is the exception. Engagement with the tobacco industry is futile. Positive influence is impossible. There’s not one example in all the history of engagement leading to fewer deaths.”

Of course, this was very uncomfortable for him. Suddenly, out of the blue, this other guy whom I’d not met says: ‘We’re getting bogged down in the nitty-gritty here. What about the big vision? Isn’t this industry just killing six million people a year and we’re part of it if we’re investing in it?”

The interjector, Dawid Konotey-Ahulu, had arrived at the last minute, without particularly high expectations: “I assumed it would be a run-of-the-mill discourse on the dangers of tobacco and the virtues of shunning it.” Now he was excited. A former Merrill Lynch banker, Konotey-Ahulu has for the last decade run an investment and risk management consultancy for pension funds, Redington. King reminded him of a popular business concept: the Big Hairy Audacious Goal, or BHAG, coined by Jim Collins in his 1994 management bestseller Built to Last. Since the roundtable, he has become Tobacco Free Portfolios’ City adviser, including on the recruitment of a new London representative, Dr Rachel Melsom. “We are living in an era where ‘Do the Right Thing!’ is increasingly the guiding principle, and pension funds, by and large, want to do the right thing,” says Konotey-Ahulu. “It will not surprise me if in the near future, several large pension funds elect to disinvest from intrinsically harmful assets such as tobacco.” They now have an example.

On 28 February, after months of planning, King landed in London on her first European mission: 12 days, six countries, 45 meetings, with pension funds, insurers, sovereign wealth funds and health leaders. She had pursued every introduction, cadged every favour on offer. To her excitement, not one approach had been rebuffed. To her further excitement, she had arranged to spend the weekend in Paris with friends, the De Viennes, for whom in 1997 she had worked as an au pair. Then, unable to help herself, she asked round her Australian business “partners” with whom in France it might be worth meeting. The CEO of a major funds management business connected her with AXA.

So it was that six years after that meeting in her hospital’s cafeteria, King sat across a luncheon table at Café Chic on Rue du Faubourg from Sylvain Vanston, the 44-year-old responsible for the company’s corporate social responsibility initiatives. A year earlier Vanston had been instrumental in AXA’s ceasing to invest in coal; but since agreeing to meet, he had been musing that this was the first red flag ever raised about a vastly more significant killer. “Tobacco has been a problem for health, but it has not been a problem for investors,” he observes. “When I met Bronwyn, she immediately started putting together the pieces of the puzzle that we hadn’t.’

In King’s telling, that puzzle of tobacco’s unique iniquity has four pieces. Can the product be used safely? No: zero is the only safe number of cigarettes. Can an investor have a positive influence on the tobacco industry? No: the risks are indivisible from the product. Is the problem huge? Yes: the WHO forecasts a billion tobacco-related deaths in the 21st century. Is there a UN treaty? Yes: the WHO’s convention on tobacco control has sought to limit tobacco usage for more than a decade. A concluding pith: would you set up an industry now knowing that in the next year it would kill six million people and cost the health care system €2tn? Vanston was taken aback: “I thought I knew about tobacco, but in reality I’d missed important facts.” Did she have all this written down, he asked? King fished a Tobacco Free Portfolios information kit from her bag. That night she rang Payne. ‘I’ve got a good feeling about this,’ she said.

Likewise Vanston. This was a far bigger deal than coal: four times the size of investment, and entailing not insignificant financial sacrifices. But AXA’s incoming CEO Buberl had been promoting a redesign of its health business, arguing that insurance must change from being a payer of bills to a helper of clients toward healthier life choices incurring fewer health costs. And if AXA wanted clients to forswear tobacco, it could hardly do otherwise. Besides, Buberl observes, the calculus has changed: “Once, lung cancer meant a quick death. As treatment has improved and lives have been prolonged, it has gone from being a lethal to a chronic illness, and costs are exploding. It’s a simple equation – the social, medical and taxation consequences of smoking have grown considerably worse.”

Vanston was commissioned to present to Buberl’s management team; King, now back in Melbourne after whirling through Geneva, Stockholm, Copenhagen and Oslo, contributed by email. Back at work at the Epworth, preparing prognoses, counselling patients about their survival chances, she messaged Vanston just before his presentation, three weeks after their single meeting: “Good luck with your speech. Just imagine that you have every oncologist and every patient who has suffered from tobacco standing right beside you.” His CEO actually needed little convincing. “Decisions take longer when they’re ambiguous,” says Buberl. “There is nothing ambiguous about tobacco.”

Nor, it must be said, is there anything ambiguous about the money tobacco makes. It is a high cash-flow, low-volatility business – a classic defensive stock pick in times when they are scarce. Yet no industry could exercise so dark an allure – something accentuated by the profile of smokers, skewed increasingly towards the poor, the young, and, frankly, the darker-skinned and further away.

It is a problem of a magnitude that occasionally dismays King, although never for long. “I’m an optimist,” she says. “Some people I’ve met have been unconvinced by the arguments. Others have said ‘Oh it’s a bit early’ or ‘Can you come back with more information?’ But I’ve watched literally dozens of people move from that position of initial resistance, to thinking ours is a reasonable position, to being completely convinced and ringing up a few months later asking: ‘Is there anything I can do?’ I never hear ‘no’ as ‘never’; I hear it as ‘not yet’.” Since AXA, she has had contact with a score of European financial institutions: one sovereign wealth fund has already divested, although is yet to announce its decision. King’s travel schedule for the rest of the year looks unsparing, and she is resigned to forgoing sleep because of it. “But if I knew what I know and did nothing,” she says, “I couldn’t sleep at all.”

Auckland Council to review investments

Auckland Council will conduct a full review of its investments after revelations that one of its funds holds shares in sugary drink and tobacco companies.

It will also investigate why it invested in the fund in the first place.

The council had about $320 million invested with 11 different fund managers in New Zealand and overseas.

An investigation by RNZ News found one of those funds holds shares in the world’s biggest soft-drink manufacturer Coca-Cola, the chocolate and confectionary giant Hershey’s, theinternational coffee chain Starbucks and British American Tobacco.

The Janus Global Research Growth fund also invested in two of the world’s biggest alcohol companies SABMiller and Pernod Ricard.

Those investments contradicted the work the council was doing to fight obesity and smoking, as well as its responsible investment policy, Councillor Chris Darby said.

He told Checkpoint with John Campbell the stake in British American Tobacco was of particular concern and the council’s investment agency should have known better than to invest in it.

“I would expect that those in governance and management at that entity to have identified that particular investment well in advance. I mean, it should have been revealed by them much, much earlier and sold down,” he said.

Mr Darby feared there may be similar investments among some of the other 10 funds the council invested in.

Last week the council announced it would ban all sugar-sweetened drinks from vending machines at its 21 leisure centres in a bid to “show leadership in the battle against obesity and type 2 diabetes.”

In 2013, smoking was banned at all parks, playgrounds, stadiums, sportfields, swimming pools, council buildings and bus and train stations.

The council will this week consider strengthening its smoke-free policy as part of its commitment to making New Zealand smoke-free by 2025.

Councillors shocked at investments

Auckland councillors contacted by RNZ were shocked to learn of the investments.

“This is more than a little embarrassing for council,” councillor Chris Darby said.

“It’s inconsistent with where the council wants to go and without question it’s not a good look. I believe that my colleagues around the council table will see this rectified,” he said.

“For two years I have been working with the Smoke-free Coalition and Cancer Society on getting council to move faster towards being smoke-free.

“After almost a year’s delay the Smoke-free Policy Review paper comes before the Regional Strategy & Policy Committee this Thursday. So the British American Tobacco stake poses an even bigger embarrassment, one that requires full sell down as soon as possible,” Mr Darby said.

He told Checkpoint with John Campbell the stake in British American Tobacco was of particular concern and the council’s investment agency should have known better than to invest in it.

“I would expect that those in in governance and management at that entity to have identified that particular investment well in advance. I mean, it should have been revealed by them much, much earlier and sold down,” he said.

He feared there may be similar investments among some of the other 10 funds the council invested in.

Auckland Council finance committee chair Penny Webster was also surprised to learn of the investments in soft drink, alcohol and tobacco companies.

“I wasn’t aware of it, but I will certainly go back and ask some questions now,” she said.

The council had a responsible investment policy but councillors would not necessarily be given that level of detail unless they asked for it, she said.

Auckland University epidemiologist and FIZZ founder Gerhard Sundborn said the council needed to better align its policies with its financial decisions.

“It’s important that councils do check where they are investing their funds and ensure they’re investing them responsibly in companies that meet the ethical considerations that they have,” he said.

“The decision to remove sugary drinks from vending machines was a great start. I’m confident that the council and government will take into consideration more now where they invest their funds,” he said.

Council has ‘responsible investment policy’

Auckland Council treasurer John Bishop said the council did not know exactly which companies its 11 funds were invested in because that information was often confidential.

The decision to drop sugar-sweetened drinks from vending machines at council-run leisure centres was an operational, not policy, decision, he said.

“The portfolio originates from funds held by legacy councils. Investments are made through a range of fund managers, based in New Zealand and overseas, and advice is taken from a professional investment advisor,” he said in a statement.

“As part of this process we continually look to align our investment policies with best practice, including those associated with responsible investment.

“Auckland Council has a responsible investment policy which is regularly reviewed in association with our overall investment policies. We have certain confidentiality restrictions with some of our fund managers which inhibit our ability to disclose specific asset holdings,” he said.

The fund managers were required to act consistently with the council’s responsible investing policy, he said.

The council’s policy did not ban particular investments but stated it should choose fund managers that could demonstrate a high degree of alignment with the principles of responsible investing.

“Council considers that a policy of active engagement with companies rather than screening or avoiding companies based on environmental, social and governance criteria will deliver the least cost, best outcome,” it stated.

The government-owned New Zealand Superannuation Fund and ACC banned investment in tobacco companies in 2007, but still invested alcohol, soft drink and fast-food companies.

The council was looking at divesting its investment portfolio over the next two years to help pay for infrastructure costs.

Cancer-Causing Toxins Found in E-Cigarettes

Berkeley, CA – Scientists have discovered two additional cancer causing toxins in the vapor of e-cigarettes.

The chemicals, used to create artificial smoke transform into carcinogens when heated.

Their research also found the hotter the e-cigarette coil becomes; the more chemicals are released in its vapors.

That means the first puffs of an e-cigarette tend to contain the fewest toxins.

Fresh analysis reveals probable carcinogens in e-cigarette vapour

Vaping emits harmful compounds – including propylene glycol and glycerine – as solvents are broken down by heat

The vapour from electronic cigarettes includes not only the carcinogens formaldehyde and acrolein, but also probable carcinogens like propylene oxide and glycidol, according to new analysis by a group Lawrence Berkeley National Laboratory (LBNL) in the US. The researchers discovered that the thermal decomposition of two common solvents in e-liquids that are vaporised by e-cigarettes – propylene glycol and glycerine – leads to emissions of significant levels of 31 harmful chemical compounds.

There have been ongoing debates about whether cigarette smokers should be encouraged to switch to e-cigarettes amid a dearth of data about the short and long-term health effects of this relatively new technology.

This study also showed that factors like the temperature, type, and age of an e-cigarette affect emission levels. E-cigarettes were shown to release more toxins as voltage increases and with repeated use. In fact, increasing the voltage and heat in a single-coil vaporiser tripled the aldehyde emissions per puff and bumped up the acrolein levels by a factor of 10. For example, conventional tobacco cigarettes emit 400–650µg of acrolein per cigarette, and assuming 20 puffs on an e-cigarette equals smoking a conventional cigarette, the researchers estimated that total emissions of acrolein per e-cigarette are about 90–100µg. In the study, aldehyde emissions increased by more than 60% after the device was reused several times, which the researchers said was likely due to the buildup of polymerisation by-products that degraded upon heating.

The LBNL team suggested that their findings could help the efforts of manufacturers and regulators to minimise the negative health impacts of e-cigarettes.


M Sleiman et al, Environ. Sci. Technol., 2016, DOI: 10.1021/acs.est.6b01741

E-cigarette advertisements are luring ex-smokers back to tobacco, warns Quit Victoria

Cancer Council research has shown the ads harm attempts to quit.

E-CIGARETTE advertising has the power to drive former smokers back to real cigarettes, new research has suggested.

While debate rages about whether the battery-powered cigarettes are a safe or effective way to quit smoking, a study of 800 former smokers has found advertising for the products had the opposite effect.

Findings of the Cancer Council study have prompted calls to ban e-cigarette promotions in the same way tobacco advertising was restricted decades ago.

Quit Victoria director Dr Sarah White said failing to ban e-cigarette advertising could undermine the resolve of former smokers as well as decades of gains since tobacco advertising was outlawed.

“Some of these ads look very much like people using a cigarette, (and) probably just watching people using that ¬motion doesn’t help former smokers suppress their urges,” she said.

E-cig ads can trigger ex-smoker’s urges, health authorities fear.

“We have lost hundreds of thousands of people to cigarettes, we have spent tens of millions of dollars trying to help people get off cigarettes that kill two out of three people, we have legislation in place to help people get off cigarettes, so we need to keep watch we are not letting something else come through that plays on the similarities.”

After showing 800 former smokers e-cigarette advertisements that had screened on television or online, the Cancer Council Victoria’s Centre for Behavioural Research in Cancer found their desire to start smoking normal cigarettes ¬returned, as did an urge to use e-cigarettes.

Results published in the journal Tobacco Regulatory Science showed twice as many former smokers felt a desire to smoke after watching the ads compared to those who viewed promotions for other products, while a quarter felt an “urge” to use tobacco.

Lead author, Associate Professor Sarah Durkin, said the e-cigarette ads were also found to adopt the same techniques as long outlawed tobacco ads, suggesting the products ¬increase a person’s social status and ¬romantic appeal, and portray users as “independent and ¬rebellious”.

“The e-cigarette finding is unsurprising, since the aim of these ads is to encourage people to use e-cigarettes,” she said.

“What is concerning is the e-cigarette ads also reminded former smokers of smoking ¬tobacco cigarettes, increased their desire to smoke tobacco cigarettes and reduced their confidence to abstain.”

$45M Settlement Proposed in Arkansas Tobacco Lawsuit

Attorneys for cigarette smokers and for tobacco manufacturer Philip Morris USA have agreed to a $45 million settlement of a lawsuit over the marketing of Marlboro Lights in Arkansas.

The settlement was submitted to Pulaski County Circuit Judge Tim Fox on July 29, three days before the start of an estimated six-week trial in a class-action lawsuit, the Arkansas Democrat-Gazette reported. The lawsuit alleged that Philip Morris violated the Arkansas Deceptive Trade Practices Act in its marketing of Lights and Ultralights, which are now sold as the Silver and Gold.

The estimated amount of the payments to individual smokers was not clear. Plaintiff’s attorney Tom Thrash said there could be more than 1 million people eligible. The funds also will be used to pay attorney fees, which are to be decided by the judge.

Philip Morris spokesman Brian May said the company is glad to resolve the now 13-year-old case.

“After over a decade of litigation in this case, we’re pleased to put it behind us and believe the agreement is in the best interest of the company,” he said.

Lawyers now will begin establishing a process for how potential claimants can apply for payments, how their claims of tobacco use will be validated and the time frame for paying out the money.

Thrash said he did not expect any payments to be made until early next year.

Those eligible for payments are smokers who bought the Lights brands in Arkansas between Nov. 1, 1971, when the Lights brand was introduced, and May 29, 2003, the effective date of the lawsuit.

Smokers who filed the lawsuit said the company, a subsidiary of Virginia-based Altria Group, misled consumers about the safety of the cigarettes by leading smokers to believe the brands had lower levels of tar and nicotine.

Company officials said Lights did what they were advertised to do — deliver less tar and nicotine — if they were smoked correctly. The Lights filters were specially ventilated to reduce tar and nicotine, but smokers could get more by inhaling more deeply or more often, the company stated.