ASH Daily News for 07 October 2008

Report says smoking costs NHS 2.7 billion pounds a year

Smoking costs the NHS 2.7 billion pounds a year, one billion more than a decade ago, according to a report published by ASH.

Action on Smoking and Health (ASH) said the cost would have risen to more than 3 billion pounds annually had action not led to a fall in the number of smokers from twelve to nine million.

The report called for the government to take more action in health legislation to be unveiled in December, with demands for plain packaging of tobacco products and a ban on shop displays.

Since 2003 it has been illegal for manufacturers to use any trademark or sign to suggest that one product is less harmful than another but ASH said more needed to be done to curb misleading branding and messages being given to young people.

It cited research from the University of Nottingham which found that using the word "smooth" or lighter coloured branding misled young people into thinking the product was not as bad for their health.

"The government could save thousands of lives and hundreds of millions from the NHS budget with an ambitious new tobacco control strategy," said Deborah Arnott, director of ASH.

"More than anything we need to protect young people from the aggressive marketing techniques employed by the tobacco industry."

Pro-smoking groups argue that measures such as banning tobacco displays and vending machines would not work. Instead, they advocate stronger enforcement of a ban on selling tobacco to those under 18.

"Far from being a drain on society, smokers make an enormous financial contribution," said Simon Clark, director of the lobby group Forest told the BBC.

"Each year smokers pay over 9 billion pounds in tobacco taxation, a figure that dwarfs the alleged cost of smoking to the NHS."

According to figures from ASH, over 80,000 people die from smoking related diseases every year, while one in seven 15-year-olds was a regular smoker.

Source: Reuters UK, 07 October 2008
Link: http://tinyurl.com/3gke6u

Guardian extract: All puffed out?

Below is an extract of a review article by Jon Henley from the Guardian:

The UK still has more than 9 million smokers - and a report out today [Beyond Smoking Kills] shows it is those living in deprived circumstances who are most resistant to giving up. Why is this? And can they be persuaded by shocking images of rotting teeth and throat cancer that cigarette packs will soon carry?

In Britain, there's no more tobacco advertising, cigarette packets inform you bluntly that smoking their contents will kill you, it's illegal to sell tobacco products to the under-18s, you can get help with quitting on the NHS, and, most striking of all, it has become illegal to smoke in pubs, clubs, restaurants, any enclosed public space.

That's not the end of it. Over the coming year, smokers are going to have to get used to seeing an attractive selection of pictures on the back of their fag packets. One is of some poor sod, chest riven open, undergoing open heart surgery. Another is a frankly repulsive close-up of a throat sprouting some gruesome, fleshy growth. A third shows someone's foul and cancerous mouth, all missing and blackened teeth and dark, diseased tongue.

There are 14 of these shockers, and every cigarette packet sold in this country will have to carry one of them by October 2009. We're in the vanguard here, the first EU country to introduce photo warnings. (In Canada, where they were launched in 2001, 31% of ex-smokers say they helped them kick the habit.) In fact, we're pretty good across the whole anti-smoking front: since the government's 1998 white paper Smoking Kills, Britain has become recognised as the European leader in tobacco control.

But 23% of men and 21% of women still smoke, or just over 9 million people still smoking. They must know, or at least be aware of, the risks they are running: half of all regular cigarette smokers will die from their habit. Each year, some 114,000 smokers in the UK die from smoking-related causes. Smoking remains the single biggest cause of preventable deaths in Britain, killing more each year than alcohol, obesity, road accidents and illegal drugs together.

So the real question is: who still smokes? The answer, according to Beyond Smoking Kills, a report published today by the broadly endorsed pressure group ASH, is the poor. Deborah Arnott, Director, said,  "The health inequalities involved are perhaps the most striking thing about smoking in Britain today. The more deprived your circumstances, the more likely you are to smoke."

According to Professor Martin Jarvis, a psychologist at University College London and a leading specialist in the field of smoking and health inequality, this is not a question solely of income: every main indicator of a lower socio-economic status is likely, independent of each of the others, to predict a higher rate of smoking. If your educational level is below the average, you are more likely to smoke. If you live in rented or overcrowded accommodation, you are more likely to smoke. Ditto if you do not have access to a car, are unemployed, or on state income benefit.

"There's already a considerable social gradient simply in who starts smoking," says Jarvis. "But the main, really steep gradient is in who manages to stop. People in depressed circumstances are basically far less likely to give up. This isn't to do with motivation - they actually want to quit just as much. They just don't seem to be able to. The more deprived you are, the more dependent you are on nicotine, the more nicotine you take in."

The public smoking ban will, experts believe, have gone some way to reducing the gap in smoking rates between social classes: the most recent figures show the decline in smoking recorded since its introduction occurred across the board, regardless of class, age or gender. But the government's future tobacco control policies should, ASH's Arnott says, clearly include measures - including more free help in giving up - targeted specifically at deprived groups.

So how to move forward? If the British public care deeply about questions of individual liberty, and will not in general support anything that unduly restricts it, most will back measures that might help cut tobacco consumption. Arnott cites the case of the public smoking ban, the idea of which was supported by just 20% of people in 2003, but this April by fully 78%. "Big majorities also support raising tobacco prices by more than inflation, halting sales from vending machines, and ending point-of-sale displays," she says.

"But perhaps the best indication of how the public feel about the whole smoking issue is the fact that compliance with smokefree legislation in Britain is so spectacularly high - more than 98%. Compare that with the proportion of people who comply with the 30mph speed limit in built-up areas. That's only around half."

Today's ASH report, 10 years after the important white paper Smoking Kills, estimates that smoking is costing the NHS in England some £2.7bn a year. It calls for a comprehensive new national tobacco strategy and tough targets, including a smoking rate of 11% in the adult population as a whole by 2015. Among its key recommendations are a ban on all tobacco product branding (which means selling cigarettes in blank packs, except of course for a graphic health warning); prohibiting retailers from putting cigarettes on display (the huge displays in tobacconists and supermarkets are, campaigners say, a "powerful promotional tool that encourages impulse buying"; banning them would essentially mean stocking cigarettes under the counter) and outlawing tobacco in vending machines, which are used by about 20% of under-age smokers.

The report also calls for a properly resourced fight against tobacco smuggling, which accounts for about 13% of the cigarettes and 20% of the hand-rolling tobacco smoked in Britain. It wants tobacco to be more expensive to buy than it is now (historically, cigarettes are 60% more affordable than they were in the 1960s). It would like to see deprived and marginalised groups given priority in all stop-smoking campaigns, and, for smokers who are really unwilling or unable to quit, it would like pure nicotine products such as gums and inhalers that deliver nicotine as effectively as cigarettes, but without the fatal by-products that come with smoking to be more widely available, more competitive, and even free on prescription.

Will all this work? The problem, as the number of dedicated smokers in Britain continues gradually to dwindle, is that those that remain will prove more and more resistant; any measure perceived as aggressive could just as easily prove counterproductive. The evidence from a sample of smokers accosted on the streets near the Guardian the other day was, certainly, not entirely encouraging. Confronted with those unpleasant picture warnings, most did not feel they would persuade them to stop.

"They might stop a few young people starting, I suppose," volunteers Adam Riley, 41, sucking on a B&H outside the sandwich shop. "But I can't see them doing much for me. They're horrible, yes, course they are, but we already knew the risks, didn't we? What's this going to add to that, beyond making us all feel even more persecuted?"

Perched puffing on the steps outside their dance school, Jackie, Mandy and Felicity were similarly unimpressed. "If you were already thinking about giving up, this might give you the extra incentive," concedes Felicity, 17. "They are revolting, though, aren't they? Ugh. That throat one . . . I don't want to look at that too often. But I think if you've kind of rationalised smoking, then you'll just shut your eyes to these too." Mandy says she's only going to smoke for three or four more years, anyway. "I'll be fine as long as I stop then. None of that stuff is going to happen to me, no way."

David Levy, unemployed and 40, says he won't be quitting any time soon, whatever the government comes up with next. "I'm a smoker. I have been for a very long time and I enjoy it. These won't stop people like me."

Source: The Guardian, 07 October 2008
Link: http://tinyurl.com/48pm2s

Women require less tobacco exposure than men to increase colon cancer risk

While smoking poses a health threat to both men and women, women require less tobacco exposure than men to have a significant increased risk for colorectal cancer, according to new research presented at the 73rd Annual ACG Scientific Meeting in Orlando.

In a separate analysis, researchers found smoking may increase the risk of pancreatic cancer precursor lesions, particularly in patients with a strong family history of the disease.

While research has demonstrated that smoking is associated with a two-fold risk for colorectal neoplasia, less is known about the exposure quantity needed. Joseph C. Anderson, M.D., of the University of Connecticut in Farmington and Zvi A. Alpern, M.D. of Stony Brook University in New York compared the quantity of tobacco exposure to increased colorectal cancer risk in men and women. The levels of tobacco exposure were measured by multiplying the packs of cigarettes smoked per day by the number of years smoked ("pack years.")

Patients were divided into three smoking groups: heavy exposure, low exposure, and no exposure. The heavy exposure group was placed into two different groups: those who smoked 30 pack years or less and those who smoked more than 30 pack years.

Women's Risk Higher for CRC with Fewer "Pack Years" After adjusting for potentially confounding factors such as age, body mass index, and family history, researchers found women who smoked less than 30 pack years were almost twice as likely to develop significant colorectal neoplasia compared to women who were not exposed to cigarette smoke.

"While men and women shared a similar two-fold risk for developing significant colorectal neoplasia, women required less tobacco exposure in pack years than men to have an increase in colorectal cancer risk," said Dr. Anderson.

In a separate study conducted at Memorial Sloan-Kettering Cancer Center in New York, Dr. Emmy Ludwig and her colleagues examined tobacco exposure and the risk of pancreatic cancer precursor lesions in patients enrolled in a familial pancreatic cancer registry and screening program.

In this analysis, at-risk relatives of familial pancreatic cancer patients were screened using MRCP (magnetic resonance cholangiopancreatography) or CT scan with an endoscopic ultrasound performed if imaging showed any pancreatic abnormality. Patients underwent surgery if suspicious lesions were found.

Of the 113 relatives who completed at least one screening study, 8.9 percent had a significant pancreatic lesion, 6 of whom underwent surgery. In a key finding, researchers found 70 percent of relatives with pancreatic abnormalities had a history of smoking compared to 40 percent of participants who did not smoke.

According to lead investigator Dr. Ludwig, "Because more of the relatives with positive findings smoked than did relatives without positive findings, our study suggests that smoking may have been responsible for the development of the precursor lesions, especially in light of the fact that smoking is a known risk factor for pancreatic carcinoma."

Source: News-Medical.Net, 06 October 2008  
Link: http://tinyurl.com/4xowhc

West of Scotland lung cancer 50% up on UK

People living in the west of Scotland are 50 per cent more likely to be diagnosed with lung cancer than in the rest of the UK, a report says.

The statistics also show that residents in the west of Scotland are 15 per cent more likely be diagnosed with the disease than people from other parts of Scotland.

The report says they are also 30 per cent more likely to die from lung cancer than those elsewhere in Scotland, while the rate of people dying from the disease is 50 per cent higher than in the rest of Britain.

Higher levels of deprivation are partly to blame, experts say.

The figures, contained in a report by the National Cancer Intelligence Network (NCIN), will be unveiled at a cancer conference in Birmingham.

Professor David Forman, of the NCIN, who is based at the University of Leeds, said: "Smoking rates are around 5 per cent higher in Scotland than the rest of the UK, and this significantly contributes to the higher rates of lung cancer – smoking is responsible for nearly nine in ten cases of lung cancer.

"We know that smoking rates are linked to deprivation – rates are about 10 per cent higher in working-class communities."

The report also says the rate of lung cancer among women in the west of Scotland exceeds that of men in some parts of the UK.

Women are almost 50 per cent more likely to get lung cancer in the west of Scotland than men in Surrey, West Sussex, and Hampshire.

Professor Sir Alex Markham, the chairman of the NCIN, said such data could help to target anti-smoking policies where it mattered.

He added: "Scotland has led the UK in protecting workers and the public from the dangers of second-hand smoke and has every right to be proud."

"But higher smoking rates in Scotland still account for much of the difference in cancer rates between England and Scotland."

In May, the Scottish Government launched its plan for reducing smoking. Key measures included restricting the display of cigarettes in shops and taking action to reduce the amount of smuggled cigarettes.

Last night, a Holyrood spokesman said: "It is well known that deprivation levels in the west of Scotland have contributed to its poor health record, but the Scottish Government is working hard to tackle the health inequalities that continue to blight the lives of too many people."

"We are making every effort to reduce smoking rates, which we know are singularly harmful to health and the principal cause of lung cancer."

The spokesman added that Scotland was the first country in the UK to ban smoking in enclosed public places and was continuing to build on this.

"Recently, we launched our smoking prevention action plan, 'Scotland's Future is Smoke-Free', backed by £9 million over the next three years, to further reduce smoking levels in Scotland – which have already been falling in recent years," he said.

"A key proposal is to end the display of cigarettes in shops to make them less accessible and attractive to our young people, because we know that 80 per cent of smokers start in their teens."

Source: Scotsman, 07 October 2008
Link: http://tinyurl.com/4vohzr

RCN calls on government to increase investment in anti-smoking measures

A failure to increase investment in anti smoking measures will further entrench health inequalities across the UK, according to the Royal College of Nursing (RCN). The RCN has thrown its’ weight behind ASH’s latest report and recommendations in the fight against tobacco use.

In welcoming the Beyond Smoking Kills: Protecting Children, Reducing Inequalities report, Dr Peter Carter, Chief Executive & General Secretary of the Royal College of Nursing (RCN) today said:

“This report marks the 10th anniversary of the white paper, Smoking Kills, and highlights the many inroads made in the reduction of tobacco use in the UK and strong public support to introduce interventions to support people in their attempts to kick the habit."

“However, the NHS does not have the required support to address the growing concerns of the uptake of smoking in deprived communities and the barriers many face in giving up their addiction."

“Although the Government’s efforts are commendable, more needs to be done if we are to change the attitudes of the millions of people, particularly children and young people, who continue to smoke despite the serious health risks."

“Nurses working in the primary care sector already play an influential role in helping people to give up smoking. There needs to be more resources in providing nurses with the skills and knowledge to deliver expert advice and appropriate treatment."

“The RCN is calling on the Government to fill these gaps within the sector, including the creation of national training standards for healthcare workers, delivery of skills training for nurses, and targeted public awareness campaigns in deprived communities across the UK.”

Source: Royal College of Nursing, 06 October 2008
Link: http://tinyurl.com/3zf5vh

Fight over 'light cigarettes' begins in US Supreme Court

Lawyers for the biggest US tobacco maker went before the Supreme Court to argue that Washington is to blame if anyone felt tricked into thinking that light cigarettes are less dangerous than regular cigarettes.

If the highest court in the United States rules against Altria -- whose Philip Morris unit is best known for Marlboro cigarettes -- tobacco manufacturers could find themselves being forced to pay out staggering legal settlements to ex-smokers.

Three residents of the northeast state of Maine who puffed on Marlboro Lights and Cambridge Lights for 15 years want to use a state law to sue for allegedly deceiving smokers into thinking that light cigarettes are healthier cigarettes.

Altria counters that cigarette packaging falls under the domain of the US Federal Trade Commission (FTC), which failed to act despite being aware that light cigarettes were no less a health hazard that regular cigarettes.

Lawyers for the plaintiffs were meanwhile peppered with questions from the bench as to why their case focused on public deception, rather than on the relationship between smoking and health.

Light cigarettes offer lower levels of tar and nicotine, but health experts say they do not eliminate the dangers posed by smoking.

At the heart of the case is the possibility that cigarette manufacturers used every trick in the marketing book to pitch their products.

Altria -- whose stable of brands also includes Benson and Hedges -- contends that a section of a federal law that deals with cigarette labelling and advertising trumps anti-tobacco legislation implemented at the state level.

That law was adopted in 1966, however, when smoking's impact on health was not as clear as it is today.

Quite apart from the obvious health aspect of the case, the Supreme Court will clarify the legitimacy of such exemption clauses.

A federal court in Maine initially ruled in favor of Altria, before an appeals court overturned its ruling.

Altria's lawyer, Theodore Olson argued that if Congress went through the trouble of drafting an exemption clause, it was certainly with the intention of seeing federal law taking precedent over state law. 

Source: AFP, 06 October 2008
Link: http://tinyurl.com/44uuj2