Shift in status for anti-smoking aids

A major shift in the government’s anti-smoking policy has been quietly announced, allowing nicotine products to be sold as a long-term substitute for smoking, not just as an aid to quitting.

The announcement acknowledges that some smokers are nicotine junkies, who find it close to impossible to give up the addictive element in cigarettes.

While nicotine is highly poisonous in large quantities, medical nicotine is relatively safe. It is the smoke and tar in cigarettes, not the nicotine, that causes the toll of deaths and ill-health.

The change is quietly noted with no fanfare towards the end of a new anti-smoking strategy published on Monday which aims to halve the proportion of the population who smoke to 10 per cent by 2020.

In what is known as a “harm reduction” approach, the government recognises that “people have different levels of addiction” to cigarettes and so different methods will be used in future “including using nicotine replacement therapy for extended periods of time”.

The Medicines and Healthcare products Regulatory Agency has already granted a licence for the Nicorette inhalator for longer term use as “a safer alternative to smoking” and is inviting manufacturers of other gums, patches, nasal sprays, inhalators, tablets and pastilles to follow suit. The agency said it is also “encouraging the development and wider availability of safer nicotine delivery medicines”.

Allowing nicotine to be actively marketed for longer-term use and not just as a short term “quit smoking” aid, has been controversial as some see it as encouraging or endorsing drug addiction.

But the move was welcomed by Action on Smoking and Health which has been campaigning for the change for some time.

“This is quite a substantial shift in policy, and important one,” a spokesman said. “It is the first time the government has come out and said it supports a harm reduction strategy, and not just a quit smoking approach”.

The new strategy announced on Monday contains few other new elements beyond those already announced, although Andy Burnham, the health minister, said the government will consider forcing cigarettes to be sold in plain packaging and extending the ban on smoking in public places to the entrances of buildings.

Source: The Financial Times, 01 February 2010
Link: http://bit.ly/avfkxf

NICE Citizens Council report on harm reduction in smoking published

The Citizens Council of the National Institute for Health and Clinical Excellence (NICE), which provides public input into the Institute’s work, has published a report on its meeting to discuss smoking and harm reduction. The public is now invited to comment on the Council members’ views on the theoretical strategy of harm reduction with regard to smoking – an approach not currently used in the UK. This includes the pros and cons of promoting the switch to alternative products such as medicinal nicotine, alongside supporting smokers to quit. NICE has not been asked to produce guidance on harm reduction in smoking. However, should guidance be requested on this topic, the views of the Citizens Council on issues which should be taken into account will be helpful to inform NICE’s independent committees.

Whereas smoking cessation strategies are familiar – helping smokers to quit both smoking and their reliance on nicotine completely – the concept of harm reduction in smoking has a different focus. Instead, it aims to reduce the harm associated with smoking cigarettes for people who cannot quit. This may include replacing cigarettes with a clean form of nicotine, or with cigarettes which intend to deliver lower levels of toxins. In this scenario, nicotine continues to be provided through a less harmful method than by standard smoking.

The Citizens Council voted overwhelmingly in favour of the position that harm reduction in smoking is a valid strategy. In particular, using harm reduction as a way to quit smoking and break addiction was supported. However the notion of considering harm reduction as a way to provide a less harmful alternative to smoking – while accepting that nicotine addiction continues – proved relatively unpopular.

Sir Michael Rawlins, Chair of NICE, said: “The Citizens Council makes an important contribution to the work of NICE by enabling it to take the views of the general public into account when undertaking its work. The Citizens Council’s comments on harm reduction in smoking – a difficult social values issue that may be seen as contentious in some fields – is therefore particularly helpful.

“The concept of harm reduction conflicts with traditional smoking cessation as it does not necessarily seek to help people stop smoking altogether, nor does it treat nicotine addiction. What would this approach mean for the goal of having a smoke free society? The Citizens Council’s view will help guide our independent advisory committees, should they be required in the future to make recommendations about harm reduction in smoking. But first, we are very keen to hear what the general public thinks about the conclusions the Citizen’s Council reached, before the report is presented to the NICE Board.

“Importantly, the Citizens Council discussion also revealed that there seems to be general public misunderstanding about nicotine, namely that many people may think that it is the nicotine in a cigarette that kills you. Many members of the public are also unaware of the smoking cessation services already available. The Citizens Council’s view was that there was a need for better public information about these services. I’d like, once again, to thank the Council for its consideration of this issue.”

The report on the Council’s views is available for public comment, at www.nice.org.uk . Comments must be sent in by 5pm on Wednesday, 31 March 2010.

Source: pharmiweb.com, 01 February 2010
Link: http://bit.ly/cITa47

Singapore: 40% fall in supply of illegal cigarettes

Singapore Customs’ (SC) annual enforcement results for 2009 have seen steady improvement in the contraband cigarette situation.

This is the result of Customs’ stepped-up enforcement action against smuggling, peddling and buying of duty-unpaid cigarettes over the past few years. SC’s public education programmes and close collaborations with its law enforcement partners have also further curtailed cigarette smuggling activities, as well as other Customs offences such as evasion of duties on motor vehicles and liquors.

2009 saw a 37% fall in contraband cigarettes seized compared to 2008 (see Table 1 in Appendix 1). This reflects SC’s success in curbing the supply of contraband cigarettes. Syndicates purveying contraband cigarettes had to resort to more elaborate and cunning schemes and methods of concealing their contraband goods. Last year, SC detected that the syndicates had to constantly vary their modus operandi (MO) to bring their illegal cigarettes supplies to Singapore. The quantities brought in were also deliberately kept small to minimise the chances of interdiction and detection.

Such risk-spreading and meticulous manner in the illegal groups’ planning and execution observed over the past year was a contrast to the tactics carried out the year before. Examples of more elaborate methods of concealment encountered in 2009 include hiding the illegal goods within plastic film rolls and cementing pockets of cigarettes into concrete slabs.

Although the cover-ups used by syndicates were increasingly more innovative, Customs officers managed to detect and dismantle key contraband syndicates. In 2009, SC successfully crippled three major contraband cigarettes smuggling syndicates – two in January 2009 and one in December 2009 – which resulted in 13 members from the groups arrested and prosecuted. The previous year saw two syndicates smashed and six members arrested and prosecuted. The eradication of the larger players in the black market resulted in a cut in the illegal cigarette supplies to the local market.

Last year, duty collection from cigarettes increased by 13% from $763 million to $861 million, on top of a 10% increase in 2008. The duty collection indicates the level of demand among smokers for legal (duty-paid) cigarettes. The strong and sustained rises in duty collection over the past two years show that smokers are increasingly switching from illegal to legal cigarettes for their smokes. The increase in the quantity of duty-paid cigarettes in 2009 amounted to 122 million packets of cigarettes. The fall in quantity of contraband cigarettes seized was 1.7 million packets (from 4.6 million packets in 2008 to 2.9 million packets in 2009.)

The price differentials for legitimate cigarettes in the region remain high. Therefore international syndicates still find it lucrative to take advantage of the large price gaps to carry on with their illegal activities in distributing contraband cigarettes to Singapore. SC will maintain its vigilance and continue with its enforcement efforts to eradicate such organised crimes.

Source: The Gov Monitor, 25 January 2010
Link: http://bit.ly/a6RPl8

Wales: Alarming rise in the number of women getting lung cancer

Lung cancer is now the second most common form of cancer diagnosed in Welsh men and women.

New figures show that the incidence of lung cancer in women is increasing at an alarming rate. There has been a 10% increase in the number of women diagnosed with the disease in the past four years.

And clinicians said they are seeing more younger women being diagnosed with the disease.

Unlike other common forms of cancer, lung cancer still has a high mortality rate, not least because of a lack of research into the disease.

It is thought that the popularity of smoking a generation ago may account for some of the increase in lung cancer cases, but not all.

Dr Simon Noble, a consultant in palliative care at Cardiff University and the Royal Gwent Hospital, in Newport, said: “In our clinical practices we are seeing more women with lung cancer and more younger women with lung cancer, including non-smokers.

“The human genome for lung cancer has recently been mapped and we know that there are more than 35,000 genetic abnormalities in people who have lung cancer.

“We know that lung cancer is not just a matter of external influences, such as smoking or industrial substances – there is a genetic predisposition."

“Some people will have these genes that makes them more likely to develop lung cancer if their bodies are put in the right environments – like smoking or exposure to asbestos – which acts like a trigger."

“Whether this is young women we don’t yet know but further research will help us.”

The figures published by the Welsh Cancer Intelligence and Surveillance Unit (WCISU) reveal there were 949 cases of lung cancer in women in 2004, rising to 1,049 in 2008.

More than 130 cases of lung cancer were diagnosed in women under the age of 60 during 2008.

The increase in cases over lung cancer over the four-year period has been smaller in men, rising from 1,318 in 2004 to 1,335 in 2008.

Rates of the disease for both men and women are highest in South East Wales and an earlier report by WCISU noted that the highest incidences of lung cancer in Wales are found in those local authority areas with greater levels of social deprivation, which is in turn associated with a higher prevalence of smoking.

Dr Emrys Evans, chair of the British Lung Foundation Wales and a respiratory consultant at Abertawe Bro Morgannwg University Health Board, said: “These figures show that lung cancer remains a huge problem in Wales.

“It’s the second most common cancer for both men and women, and the general trend in incidence is going up."

“Yet lung cancer doesn’t always get the attention it deserves. We have to keep up the good work to tackle the causes, especially smoking."

“And we need to encourage anyone showing symptoms – such as a troublesome cough – to get themselves checked out straight away. Early diagnosis is absolutely crucial.”

Dr Noble added: “These figures illustrate the fact that lung cancer is an ongoing problem.

“While we are making some excellent progress in the treatment of breast cancer, colorectal cancer and prostate cancer to the point that people’s lives are being extended and the condition cured, lung cancer remains a major problem and still has a poor prognosis.

“It underlines the need for continuing efforts to for research in this area and to raise funds for it.”

Source: Wales Online, 01 February 2010
Link: http://bit.ly/cOJKJc

Government announces new tobacco strategy

Plans to cut the number of smokers by pressurising them not to light up at home and in cars have been unveiled. 

The Government’s ‘tobacco control strategy’ also proposes banning smoking at entrances to buildings and selling cigarettes in plain grey packets as part of a series of policies aimed at halving the number of smokers by 2020.

The plans were dismissed as ‘ meddlesome’ and ‘unworkable’ by critics.

But Health Secretary Andy Burnham said: ‘I make no apology when it comes to protecting children and giving them the best start in life.

‘I want to see a smokefree future, a future where people lead longer and healthier lives because they don’t smoke.’

The proposals, to be announced today, include a review of the law to consider if areas such as entrances to buildings should be included in the smoking ban.

Children’s health forms a key part of the crackdown, which proposes running ‘smokefree community’ campaigns highlighting the benefits of smokefree homes and cars.

Social workers and other health professionals will be ‘encouraged’ to talk to parents about the impact their habit has on their children.

Cigarette packaging could be stripped back to basics, with logos, colour and graphics banned and just the text of the brand of cigarettes on show against a grey background.

Other plans include stopping the sale of tobacco from vending machines and a crackdown on the illegal import of cheap cigarettes.

Smoking is the leading cause of preventable death in Britain, claiming up to 80,000 lives a year. It is blamed for 1.4million hospital admissions a year and costs the NHS £2.7billion.

Despite numerous anti- smoking drives, some eight million Britons smoke and around 200,000 young people take up the habit each year.

Professor Terence Stephenson, president of the Royal College of Paediatrics and Child Health, said: ‘We are pleased that children are a priority in this new strategy.

‘Secondhand smoke has been found to be strongly linked to chest infections in children, asthma, ear problems and cot death.’

Tory MP Philip Davies said: ‘Given that people are well aware of the dangers of smoking, the Government should let people decide for themselves what they want to do.'

‘What they don’t want is Government ministers jumping into their cars with them to see whether they happen to light up a cigarette.’

Chief Medical Officer Sir Liam Donaldson said: 'We must keep pushing hard for a tobacco free future and keep up the momentum gained by England going smoke-free in 2007.

'It will also discourage children from taking up smoking and prevent a great number of unnecessary and early deaths.'

Simon Clark, director of the smokers' lobby group Forest, said halving the number of smokers by 2020 will require even more laws and 'will further erode our ability to choose how we wish to live our lives'.

He said the government has introduced 'some of the most draconian anti-smoking laws in the world' and added: 'In an allegedly free society, this is nothing to be proud of.'

Mr Clark said Forest was concerned that existing legislation may be extended to prohibit smoking in outdoor areas.

'The current smoking ban, which has had a devastating impact on community pubs
and clubs, is out of all proportion to the harm allegedly caused by second-hand smoke. Further restrictions will only accelerate that trend.'

Mr Clark said Forest supports 'reasonable efforts' to stop young people smoking but said some of the Government's proposals were designed to 'denormalise' a legal activity.

'The Health Secretary says he wants to crack down on cheap illicit cigarettes, but at the same time the government says it will consider increases in tobacco duty.

'Don't they understand that one of the reasons Britain has such a problem with illicit cigarettes is because this government has increased tobacco taxation to record levels and that has encouraged criminal gangs and individuals to smuggle millions of cheap cigarettes into the country?'

Mr Clark added: 'We accept that some people wish to quit smoking and we therefore welcome the Health Secretary's comment that the NHS is there to help everyone, including smokers.

'What alarms us is that yet again the government fails to recognise that many people choose to smoke and have no intention of giving up.'

Source: The Daily Mail, 01 February 2010
Link: http://bit.ly/9jEAEn