War on smokers: The backlash

This week, the Department of Health put out a 70-page document titled A Smokefree Future, full of plans to make cigarettes the preserve of a very hard-bitten minority. On the front, a twentysomething father looks lovingly at his young son. Inside, scores of other parents are doing the same – all apparently enjoying the health and happiness that comes from a life without cigarettes.

Having banned smoking in all enclosed public spaces in 2000, thereby securing a 25% drop in recorded numbers of smokers, the government's new aim is to cut the proportion of us who smoke by another half – so that by 2020, only one in 10 Britons will still have the habit.

The proposed means to such an ambitious end include a new "doorway ban" on those droves of sad smokers who cluster in the entrances of workplaces, the expanded issuing of nicotine patches, the selling of cigarettes in plain packaging, the removal of tobacco products from display in shops, the banning of vending machines – and, just in case any top-flight athletes are hoping for a few pre-race gaspers – "a tobacco-free London 2012 Olympics".

In Scotland, things are a little further along: late last month, the Edinburgh parliament passed new legislation for much the same measures. So it is that the UK is moving yet further into the post-cigarette age: something that, for those of us who are old enough to remember a smoke-fugged country where the habit was all but encouraged, may prompt either a shiver of nostalgia, a sharp feeling of relief, or an ambivalent mixture of both.

If you are in your mid-40s or over, you will probably recall cigarette adverts on TV, mass smoking on public transport (the London Underground was a particular joy), the pleasures of motoring trips with perma-smoking adults, celebration boxes of fags that were obligatory for any family Christmas (we had JPS ones in our house, packaged in a huge black tube), and much more besides. Chatshow hosts and guests puffed freely, footballers had a crafty cig at half-time, and even high-profile athletes were partial. If you doubt this, you should google a hurdler named Shirley Strong, Olympic silver medallist and unabashed smoker, and marvel at what a weird place the world once was.

But no more. Smoking may still be on the rise in developing countries, by around 3.5% a year, but in most of the industrialised world, it's all falling numbers, anti-smoking zeal, and grim government statistics. You probably know the relevant figures: according to the official numbers, smoking causes 80,000 deaths in England each year, and costs the NHS an annual £2.7bn – and on a worldwide scale, cigarettes kill more people than illegal drugs, road accidents, diabetes and alcohol abuse put together. In the last century, smoking is estimated to have taken the lives of around 100 million people.

Still, in this country, around 10 million of us still do it. Behind that figure lurks no end of sociological intrigue. In our prisons, 70% of inmates smoke. Age-wise, smoking peaks in the 25-34 age group at 26%, and falls to its lowest among the over-60s. Among men of Bangladeshi origin, more than 40% are tobacco-users; but women from the same background hardly bother at all, registering a figure of 2%.

Yorkshire has the greatest regional concentration of smokers, at 25% of the population; London and the east of England bring up the rear at 19% each. As for pregnant women, 14% continue to smoke, and that figure is based on people filling in their own forms, so it's safe to assume it's actually higher.

By far the most clear-cut differences surround how smoking rates reflect the lifestyles of the UK's social classes. Among young illicit smokers, take-up rates across income and wealth divides are reasonably similar, but once adulthood kicks in, the better-off tend to quit, while those lower down the social scale are much more likely to carry on. The fifth of the population with the highest incomes register a smoking rate of 15%, whereas in the lowest income group, the figure is nearly twice that – and though smoking rates over the last decade have come down among the population as a whole, those classed as "manual workers" have only managed a paltry drop of two percentage points, from 31% to 29%.

And now, as smokers shiver outside pubs, clubs and factories, the government is coming for them – though this time, using rhetoric more cautious and cuddly than the stereotype of some great anti-smoking clampdown might suggest.

When I catch health secretary Andy Burnham on his way to yesterday's cabinet meeting, he is full of talk about "going with the grain of human behaviour", avoiding the invasion of people's private space, and assuring smokers that if they want to carry on blitzing their lungs and arteries and pouring money into the pockets of both the tobacco companies and the Treasury, it's their choice – though help is available, and more accessible than ever. The essential point, he claims, is to go for policy that's "heavily targeted on the new flow of smokers coming in, rather than restricting the liberties of smokers who are already there. If they look at where I was focusing my efforts yesterday, I hope they'll see that."

"At times," he tells me, "we've allowed ourselves to have this 'nanny state' tag thrown at us, by not being clear about the limits of where it's right to go. We've got to be more cautious and precise in our language." He is, he tells me, instinctively opposed to outlawing smoking in cars (even with children on board). But, like a good New Labourite, neither is he opposed to "having a debate".

When I ask him about the so-called "doorway ban", by contrast he sounds altogether more certain. "A doorway is part of a building, essentially," he says. "So where people are coming through, and there's lots of smoke around the entrance, and it gets wafted into the building – well, that's not an ideal situation, and it's not consistent with the ban."

As ministers and politicians continue their ongoing anti-smoking drive, a battle akin to the later stages of the cold war grinds on, with a besieged British tobacco industry in the role of the Soviet Union, facing off against the strident anti-tobacco lobby. Every time the government moves on smokers, the industry issues the usual protests about freedom of choice and human beings' inalienable rights to basic pleasures, often joined by a small handful of militant smokers who see the government's attempts to wipe out their habit as the stuff of outrageous authoritarianism.

Over Christmas, David Hockney used his guest editorship of Radio 4's Today programme to inveigh yet again against the evils perpetrated by anti-smokers – and when he calls me from his home in Bridlington, he needs no encouragement to do so yet again. A somewhat chaotic 10-minute diatribe includes – rather rumly – the recent death of the Labour MP David Taylor, who played a key role in pushing the smoking ban through parliament. "I noticed that on Boxing Day, he went for a walk, and dropped dead aged 63," he says. "If I'd have dropped dead, they'd have said it was my lifestyle. Nobody mentioned his meanness of heart."

Somewhat predictably, he disagrees with Burnham's insistence that, with these new measures, the government is not trying to restrict smokers' freedom. "It has gone much, much too far," he says. "I'm really outraged now." He traces his ire to "this fucking little mean-spirited country: I see Martin Amis says it's third-rate, but it's 10th-rate now." He ends with: "There's an awful lot of smokers who live to ripe old ages. Now, why is that? Why? Obviously, genes trump everything. Some people shouldn't smoke, but some people are perfectly happy smoking. Picasso, Monet, Matisse – they all smoked, and they all lived to ripe old ages, with very generous lives. Didn't they? Yes, they did."

Beyond voices like his, there is a whole tangle of blogs, websites, and pressure groups (including the pub lobby, who chiefly blame the smoking ban for Britain's current epidemic of closures), and, of course, the massed power of the tobacco industry.

Christopher Ogden is the 56-year-old chief executive of the Tobacco Manufacturers Association: a former army major who says he was drawn to speaking up for the tobacco industry by a lifelong belief in "freedom of choice and freedom of speech and fair play". Needless to say, he is a smoker himself.

"Enough is enough," he tells me. "The government have introduced such a huge range of tobacco control measures that it's almost as if they're running out of ideas. We've had the ban on advertising and promotion, the raising of the age of sale from 16 to 18, the smoking ban, the graphic pictorial health warnings. Now we've got vending and display bans. What more do they want to do?"

The one chance of a reprieve, he suggests, lies in slightly more sceptical noises coming from the Tories: he would presumably be cheered by an off-the-record Tory spokesperson telling me that many of the Burnham plans are "pretty unenforceable" and "not evidence-based", though there again, the same source is at pains to tell me that his party "supports any action that will reduce smoking".

Speaking to advocates for the tobacco industry is always a grimly amusing business, as you listen to people somehow acknowledging that smoking is not exactly good for you, while trying to wriggle free of specifics. When I ask Ogden about smoking's links to lung cancer, he says: "It's not in my gift to say. I wouldn't want to attribute it to any particular illness. I'd just say the consensus is that there are health risks associated with it."

My mention of heart disease is similarly dodged. Even the connections between parental smoking and Sudden Infant Death Syndrome (or cot death) get short shrift. "I don't have a position on that. I'm not privy enough to the science to give a comment."

But aren't the numbers of British smokers in inevitable decline? "Who knows?" he says. "I mean, fashions change, don't they? Society changes. Could smoking come back? I can't predict the future, but it's certainly a possibility, yes. Why not?"

How many a day does he smoke? "About a packet." And does he have moments of concern about his health? "Not at all." So does he think he'll smoke till he dies? "Oh, no. I shall probably give up at some point, as I have in the past. I've been through phases of my life where I haven't smoked for five years at a stretch. And I've decided to go back to it."

Why give up? Why not just carry on puffing away on his industry's output until he croaks? "Well, we're all going to go one day."

Over at Ash – Action On Smoking and Health – Ogden's opposite number is Deborah Arnott. She was fond of the occasional cigarette until 2003, when she decided to leave a job in TV production and devote her working life to the anti-smoking struggle. "I smoked Silk Cut," she says, "which probably shows my age."

Though she's in favour of going further than the government (she supports a complete ban on smoking in cars, whether they contain children or not), she says the new strategy deserves plenty of applause, chiefly because moves against smoking must be regularly renewed and extended, as proved by evidence from abroad. To pause is to run the risk of the numbers once again increasing: in Ireland, she tells me, the government successfully brought in smoke-free legislation, but "they didn't do anything else, and smoking started to creep back up again". Much the same thing apparently happened in Finland, where a similar failure to keep up the anti-smoking momentum meant that cigarette use stayed at much the same level and, among women, went up.

"There's a theory about this," she says, "which is that there's always an upward pressure on smoking. That's because it's still something that's attractive to young people, because it's still cool. If you talk to 8-, 9- or 10- year-olds, they'll be very anti-smoking. Puberty is when it happens: you're independent, you want to be cool, and you're not sure what do with your hands when you're talking to people of the opposite sex."

But how do you fight that? You can't ban pictures of Kate Moss smoking at awards ceremonies. "No, you can't. And that's difficult. But over generations, that will change. You need it to stop being seen as cool. And it's beginning to go that way. My children went to a comprehensive in central London – and actually, what amazed me was that they used to come home at night, and they didn't smell of smoke. It is becoming less cool."

Back in Westminster, Burnham suggests that in the early-to-mid 1980s, he was ahead of the generational curve. His experience of smoking, he assures me, is very limited indeed – because even as an impressionable youth, he found the supposed attractions of cigarettes baffling. "I had a couple under the slide in a park when I was 14, and that was it," he says. "I couldn't cope with it. I genuinely have never seen any upside from it. I think it's a unique activity in that sense."

Does he foresee a time when, in Britain at least, nobody smokes at all?

What he says next would surely chill your Hockneys and Ogdens to the marrow. "Honestly? I can imagine a day when people say, 'Why did it happen?' The costs, the health effects, what it does to your appearance, the smell . . . I can imagine people saying, 'Why did we ever do that?'"

And when might that happen? "Decades, I suppose. But I can imagine it coming."
 

Source: The Guardian, 3 Feb 2010
Link: http://www.guardian.co.uk/lifeandstyle/2010/feb/03/smokers-ban-backlash

Plain packets would propel illicit trade, says Imperial

Embassy maker Imperial Tobacco yesterday slammed plans to force firms to sell cigarettes in plain packaging and claimed the move would fuel illicit trade.

The group said UK government proposals, announced on Monday, for generic packaging would make counterfeisance easier.

Imperial added that there was "no credible evidence that young people start smoking or adult smokers continue to smoke because of
tobacco packaging".

"We remain strongly opposed to the plain packaging of tobacco products," it said.

The UK would be the first country to introduce a plain packaging rule, which could see current designs scrapped in favour of plain packs with the brand name in text. But the UK Department of Health stressed the plans were at a very early stage.

UK Health Secretary Andy Burnham outlined the idea as part of a raft of measures to cut the number of smokers in England from 21 per cent of the population to one in ten in the next decade. The UK government also hopes to cut the number of young people who start smoking – currently an estimated 200,000 a year.

Imperial yesterday said in a trading update that the UK cigarette market had increased by 1 per cent in 2009, with 45.5 billion cigarettes sold, while the fine-cut tobacco market grew by 21 per cent to 4,650 tonnes. Its average share of the market remained largely steady at 45.2 per cent. The group's brands include JPS, Davidoff, Lambert & Butler and Golden Virginia.

Source: The Scotsman, 3 Feb 2010
Link: http://business.scotsman.com/industry/Plain-packets-would-propel-illicit.6036756.jp

Indonesian man loses his teeth in a cigarette explosion

An Indonesian man has been given compensation after a cigarette he was smoking exploded, taking out six teeth.

Andi Susanto, 31, told Indonesian media the cigarette had blown up in his mouth while he was riding a motorcycle.

He accepted a payment of 5m rupiah ($535; £335) and all his medical costs from PT Nojorono Tobacco, makers of the brand of cigarette he was smoking.

Police are investigating what caused the blast, but Mr Susanto said he would try to give up smoking now anyway.

He told the Jakarta Post newspaper he had been smoking since he was a schoolboy and had never had any problems.

"The incident was all so unexpected," he said.

He told Metro TV the company had talked to his family and agreed to "settle it amicably" with an out-of-court settlement.

A spokesman for Clas Mild cigarettes, the brand Mr Susanto had been smoking, said there were no plans for a recall.

"We are communicating with the police and still waiting on the forensic laboratory tests," Iwan Sulistyo told the Jakarta Globe.

"We do not put any strange materials in the cigarettes, so we think that this is a weird case. This is the first time for us."

Indonesia has one of the highest smoking rates in the world, with more than 60% of men smoking regularly.
 

Source: BBC News online, 2 Feb 2010
Link: http://newsvote.bbc.co.uk/1/hi/world/asia-pacific/8493288.stm

Cigarette smoking a risk for Alzheimer's disease according to study

A UCSF analysis of published studies on the relationship between Alzheimer's disease and smoking indicates that smoking cigarettes is a significant risk factor for the disease. After controlling for study design, quality of the journals, time of publication, and tobacco industry affiliation of the authors, the UCSF research team also found an association between tobacco industry affiliation and the conclusions of individual studies. Industry-affiliated studies indicated that smoking protects against the development of AD, while independent studies showed that smoking increased the risk of developing the disease. 

Study findings were published online in the January issue (19:2) of the Journal of Alzheimer's Disease. An abstract of the paper is available at the link below.

"For many years, published studies and popular media have perpetuated the myth that smoking is protective against the development of AD. The disease's impact on quality of life and health care costs continues to rise. It is therefore critical that we better understand its causes, in particular, the role of cigarette smoking," said Janine K. Cataldo, PhD, RN, assistant professor in the UCSF School of Nursing and lead author of the study.

According to the Alzheimer's Association, 5.3 million Americans currently have the disease, and that number will escalate rapidly as the baby boom generation ages. AD also triples health care costs for Americans aged 65 and older, the organization states.

The UCSF team reviewed 43 published studies from 1984 to 2007. Authors of one-fourth of the studies had an affiliation with the tobacco industry.

The UCSF team determined that the average risk of a smoker developing AD, based on studies without tobacco industry affiliation, was estimated to be 1.72, meaning that smoking nearly doubled the risk of AD. In contrast, the team found that studies authored by individuals with tobacco industry affiliations, showed a risk factor of .86 (less than one), suggesting that smoking protects against AD. When all studies were considered together, the risk factor for developing AD from smoking was essentially neutral at a statistically insignificant 1.05.

Previous reviews of the association between smoking and AD have not controlled for study design and author affiliation with the tobacco industry, according to Cataldo. To determine if study authors had connections to the tobacco industry, the UCSF team analyzed 877 previously secret tobacco industry documents.

The researchers used an inclusive definition of "tobacco industry affiliation" and examined authors' current or past funding, employment, paid consultation, and collaboration or co-authorship on a study with someone who had current or previous tobacco industry funding within 10 years of publication.

"We know that industry-sponsored research is more likely to reach conclusions favorable to the sponsor," said Stanton A. Glantz, PhD, of the UCSF Department of Medicine and a study co-author. "Our findings point to the ongoing corrosive nature of tobacco industry funding and point to the need for academic institutions to decline tobacco industry funding to protect the research process."

Judith J. Prochaska, PhD, MPH, of the UCSF Department of Psychiatry, also is a co-author. The team's research was supported by grants from the California Tobacco Related Disease Research Program, the National Cancer Institute, and the National Institute on Drug Abuse.

Source: Medical News Today 2 Feb 2010
Link: http://www.medicalnewstoday.com/articles/177820.php