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Tob Control: first published as 10.1136/tc.2009.034454 on 2 December 2009. Downloaded from

KAZAKHSTAN: PUBLIC BAN News analysis Like (see page 429), just a few years ago would not have been NEW ZEALAND: INDUSTRY FACES GRILLING URUGUAY: NEW HEALTH WARNINGS expected to turn up on a list of countries OVER MAORIS Uruguay is set to have the largest health likely to ban smoking in all public places. In which country might one hear the warnings in the world. A new set of six But as the health ministry said when most refreshingly straight talk about the graphic pack warnings, each covering 80 announcing such a move in September, industry in the national legisla- per cent of the front and back of the pack, the central Asian country is now following the recommendations of the World Health ture? There may be no easy, single was finalised in September. They will Organization, according to whose data answer, but recent experience suggests have to be in place by 1 March 2010, more than 30,000 people die every year in that New Zealand must be a contender. though the warnings they replace, which Kazakhstan from smoking. Sports stadiums While the majority of New Zealanders covered 50 per cent of the pack, were and public transport facilities were already have been reducing their tobacco con- ordered to be expanded to 80 per cent by smoke-free, but Kazakh bars and night- sumption for several decades, the indigen- December. The two large sides of the pack clubs, and all other remaining public areas ous Maori people still have alarmingly are not the only place where Uruguayan not previously covered by the ban, have high smoking rates. New data announced smokers will see health warning informa- now been forced to go smoke-free. At the by the health ministry in September tion: a statement will also be required on same time, the age at which people may be showed that 49.3 per cent of Maori the side of tobacco packages, in black on sold alcoholic drinks has been raised from white, to the effect that the product women and 41.5 per cent of Maori men eighteen to 21, in view of the country’s still smoke, compared to just over a fifth inside contains , tar and carbon significant problem of alcoholism. of the adult population as a whole. Like monoxide. many countries with a relatively long The bold assurance with which a history of public education about tobacco, relatively small country in Latin America : WHAT IS JTI PLAYING AT? it is among the lower income, more has ordered yet another set of warnings— The acting profession and the tobacco vulnerable minority population where the fourth since 2006—is a mark of just industry have shared a long and infamous tobacco companies see their greatest how far this aspect of has history, promoting the fiction that smok- hopes of sustaining sales. come in a relatively short time, as well as ing is glamorous. While campaigns, Not surprisingly, then, Mr Hone of the Uruguayan government’s admir- including Smoke Free Movies, have Harawira, a member of parliament for able determination to place appropriate exposed the industry’s extensive use of the Maori Party, wants tobacco company labels on a uniquely dangerous product. tactics such as paid endorsement and executives to be summoned personally to The bloody fights waged in countries such product placement, the linking of smok- http://tobaccocontrol.bmj.com/ face questions at an inquiry by the Maori as Canada, a pioneer of modern graphic ing with aspirational lifestyles remains a Affairs parliamentary select committee warnings, seem a very long time ago. key strategy. into the impact of tobacco use on Maori Absurd arguments and desperate threats This is evident in a casting call this people. The committee would talk to may still be used by the tobacco indus- autumn for jobbing British actors by everybody concerned, he said, before it try—in Canada, for example, they gave Eyecandy Model and Promotions Agency got to the tobacco companies, implying straight-faced assurances that more than a for a job to help launch a new brand of that he was determined that the fullest few colours were technically impossible, in Russia. But the call is not for powers available to the parliament’s while threatening to take their package an acting part in a commercial film. Speaker be used to force the New printing work to the USA—but now that Regulation of tobacco advertising has Zealand-based chairpersons and chief the great graphic warnings race is well progressively tightened in Russia since on September 25, 2021 by guest. Protected copyright. executives, not just the public relations and truly off the starting blocks, we 2002, with restrictions on television and ‘‘spin doctors’’, to be involved. should see progressively less of such radio, and a ban on outdoor tobacco advertising since 2007. New legislation is Mr Harawira made it plain that he nonsense, and progressively more creative currently making its way through the expected this to be an uncomfortable and effective ways of showing just what Russian parliament which would make experience for those involved. Just in case is contained in those once alluring packs. the country compliant with FCTC stipu- anyone missed any slight nuance of lations for a comprehensive ban on meaning in his announcement, he added: tobacco advertising, promotion and spon- ‘‘to be brutally frank I’d like to lynch sorship. According to Euromonitor, these these bastards... This is a war against restrictions have made it extremely diffi- people who kill New Zealanders ... I don’t cult to launch new brands in Russia, particularly give a shit about what they currently the third largest cigarette mar- say [in their defence].’’ ket in the world by volume. Tobacco companies in Russia have therefore shifted increasingly to indirect marketing methods. The casting call for a All articles written by David Simpson ‘‘good looking’’ British actor aged 25-48, unless otherwise attributed. Ideas and Uruguay: the back and front of one of the new with ‘‘well groomed hands’’, is a good items for News Analysis should be sent Uruguayan pack health warnings, focusing on example. The 8-week job takes the now to: [email protected] the little known presence of toxic chemicals familiar distribution of free samples in such as lead and cadmium in cigarette smoke. bars even further by requiring the actor to

Tobacco Control December 2009 Vol 18 No 6 427 News Analysis Tob Control: first published as 10.1136/tc.2009.034454 on 2 December 2009. Downloaded from play the part of a ‘‘vitolier’’, a seemingly European countries such as and need, with half as many patients as made up word meaning ‘‘tobacco expert’’, . While staggering levels of alco- receive a lung transplant dying while still which is likened to the respected position hol consumption have a lot to answer for, on the waiting list for one; and if the of sommelier, a master of all aspects of smoking is also taking a major toll. With hospital did not use the lungs of smokers, fine wines. For £125 ($204) per day plus male smoking rates at 61 per cent, the the number of lung transplants would be £15 ($24) expenses, the actor will visit number of reported cases of lung cancer significantly lower. restaurants, with an interpreter, to play has increased by 63 per cent over the last out the following scenario on unsuspect- ten years. Smoking is cited as the main : EXPO REJECTS TOBACCO FUNDS ing members of the public. cause for 52 per cent of all cancer cases, Organisers of the 2010 Shanghai World A script outline dictates the essential the biggest cause of premature deaths Expo recently responded to concern and shape of each visit, starting with the alongside heart disease. rejected a 200 million yuan (US$29 million) ‘‘vitolier’’ and interpreter entering a res- With most Russians struggling to earn a donation from the Shanghai tobacco com- taurant and taking a seat at the bar, decent living, JTI’s attempt to launch a pany in order to observe the promise of looking for a table with smokers, sending new luxury brand of cigarette really does a ‘‘healthy and smoke-free Expo’’. The over a waiter with a note in which ‘‘a belong in the realm of fantasy. The whole announcement came in response to several British tobacco expert from London’’ asks campaign has an air of fiddling while weeks of heated debate around China in to talk to them. After introducing himself, Rome burns. One must also ask whether July on the legitimacy of allowing tobacco the actor says he has been invited by tobacco advertising executives really are promotion and sponsorship in a public Tobacco International (JTI) to visit that out of touch with reality. Or is this event like the World Expo. their country and that he is ‘‘really just another example of the creativity of The debate was partly triggered by an interested in the tastes of Russian smo- the industry in seeking to circumvent earlier suggestion from a group of Chinese kers.’’ He is then to converse with them stronger regulation? JTI claims that it health experts that Expo organisers about their tastes and preferences regarding ‘‘believes that appropriate regulation of should reject the donation, which would premium , also telling them about tobacco is both necessary and right, in the have been a ‘‘public showcase of tobacco ‘‘the English tobacco traditions’’, mention- interest of public health. We believe that advertising’’ and a ‘‘violation of interna- ing Sobranie cigarettes and recommending the WHO, sovereign governments, non- tional treaties’’. They cited Article 13 of the new Sobranie product. Finally, ‘‘He government organizations and the the World Health Organization’s tells them about the tones of premium should all work together Framework Convention on Tobacco tastes… the latest trends in contemporary to resolve these issues.’’ If the company Control (FCTC), under which parties are art, and recommends the current art- really believes this, perhaps it should thus obliged to undertake a comprehensive ban project of Sobranie in Moscow.’’ stop play-acting and tell the truth. on tobacco advertising, promotion and Sobranie of London, established in KELLEY LEE sponsorship, at both domestic and inter- 1879, is one of the oldest tobacco brands http://tobaccocontrol.bmj.com/ London School of Hygiene & Tropical Medicine, UK national levels. China, the world’s largest in the world. Originally handmade and [email protected] tobacco producer and consumer, signed supplied to royal courts across , the FCTC in 2003 and committed to today Sobranie brands (including Black ending all types of tobacco advertising Russian) are produced by JTI and are UK: SMOKER’S LUNGS KILL TRANSPLANT and promotion by 2011, and to making among the most expensive in Russia. The MAN workplaces totally smoke-free. company’s aim is to encourage smokers to A coroner’s court examining a British Shanghai Tobacco, which produces ‘‘trade up’’, from lower priced cigarettes to soldier’s death from lung cancer in 2008 China’s major cigarette brands including higher priced brands. To promote its high- heard recently that the 31-year-old man Panda and Chung Hua, donated 200 end image, Sobranie also sponsors the had received a bilateral lung transplant million yuan in May to help build the Millionaire Fair Moscow, ‘‘a leading exhibi- the previous year after being diagnosed China Pavilion, which is expected to cost tion of luxury, despite and contrary to the with an incurable lung condition. on September 25, 2021 by guest. Protected copyright. 1.5 billion yuan. world financial crisis’’. The casting of a Immunosuppressive drugs prescribed to The decision by the World Expo autho- British actor to play the part of a ‘‘vitolier’’, help his body accept the new lungs, which rities to refuse tobacco funding was praised dressed in a suit and armed with a ‘‘frank, had an undetected tumour, simply by the World Health Organization. straightforward, honest, and pleasant increased the speed of its growth. On However, health experts say that an even smile’’, is part of that strategy. investigation, it was revealed that he had What is perhaps most remarkable is received the lungs of a smoker of 30 to 50 how out of touch the whole campaign is hand-rolled cigarettes per day. with the economic and social realities of While most people know that on life for most Russians today. Amid global average, smokers die younger, often from recession, the Russian economy has been serious diseases caused by their smoking, hard hit by the decline in world commod- it came as a shock to realise how many of ity prices. Unemployment reached 8.5 per their bodies were being recycled for cent in October and the official inflation transplantation. In 2007, 22 per cent of rate for 2009 is running at 13 per cent. British adults aged 16 and over smoked These recent problems have worsened and a further 27 per cent were ex- longer term declines in living standards smokers; so it is not surprising that 51 since the mid 1990s. Male life expectancy per cent of all organs for transplants China: Shanghai Expo organisers initially has plummeted to less than 59 years in originate from smokers. The transplant- accepted a 200 million yuan (US$29m) cheque 2008 (compared to 72 years for females), ing hospital said that the soldier’s case from Shanghai Tobacco, which they later well below the 74 years of men in western was extremely rare, in an area of great rejected.

428 Tobacco Control December 2009 Vol 18 No 6 News Analysis Tob Control: first published as 10.1136/tc.2009.034454 on 2 December 2009. Downloaded from

notified by the tobacco control section of the government’s Department of Disease Control (DDC) and asked to remove all the offending packages from sales outlets. The company asked for and was granted permission to obliterate the illegal pic- tures and wordings by placing a white paper cover over them. Not long afterwards, British American Tobacco asked DDC to consider a model prepared by the company for its Pall Mall cigarette packs. The design contained a phrase promoting the product, with a logo stating, ‘‘Sun Ripened Tobacco’’ and the accompanying phrases, ‘‘Naurally Sun Ripened Tobacco’’ and, ‘‘More Taste.’’ The company also enclosed a photocopy of a document from the Department of Intellectual Property accepting BAT’s request to register this as a trademark. In a decisive blow for health, the proposal was turned down by DDC— shutting the door on a promotion that covered part of the health warning on the : a leaflet promoting the Smokeshirt Thailand: companies using promotional devices cigarette package. holder. partly covering the health warnings on cigarette SUNIDA PREECHAWONG packs to get round Thai advertising and health Chulalongkorn University, Thailand warning regulations have been ordered to stop [email protected] using them. bigger challenge is now before the Shanghai BULGARIA: TAX RISE TO CURB SMOKING Municipal Government, as it considers Having previously had little or no effective how far to go in protecting the city’s tobacco control policies, Bulgaria sprang http://tobaccocontrol.bmj.com/ population of 17 million people by requir- into action recently when its finance ing workplaces and public places to be minister not only announced a 43 per cent smoke-free from 2010. rise in tobacco excise tax to be applied from next year, but stated plainly why the new THAILAND: WIPING OUT THE LAST ADS government, elected in July, was taking the Thailand enacted laws prohibiting all measure. While it will raise much needed forms of advertising from April 1992 and revenue, the minister emphasised that it banning misleading descriptors from was primarily a health measure. March 2006. The law mandating pictorial Bulgaria is the second heaviest smoking health warnings, occupying 50 per cent of country in Europe, after , partly both principal cigarette pack surfaces, influenced by its former position as the on September 25, 2021 by guest. Protected copyright. became effective from March 2005. most important tobacco supplier within However, despite these stringent regula- the former socialist bloc of central and tions, transnational tobacco companies eastern European states. More than half sneakily placed promotional gimmicks of men and more than a third of women on the remaining 50 per cent of pack are smokers, with the population suffer- surfaces on their imported cigarettes, not ing correspondingly high rates of tobacco only promoting the cigarettes, but also induced disease. The government is also India: a Smokeshirt pack holder. effectively ruining the visual impact of the to ban smoking in all public spaces from health warnings. June next year. For those whose experi- available at easily accessible tobacco out- In March 2009, it was found that ence of Bulgarian public places is of some lets at all the markets which young people packages of Philip Morris (PM) brand of the smokiest in the world, the imple- frequent. The product is called a ‘‘smoke- L&M Select bore such promotional items mentation of this major change will be of shirt’’, a name that might suggest that it in the form of colour pictures of tobacco particular interest. is made of cloth; however, it is an leaves and a peeling filter, with the texts, attractive, sophisticated cover for a cigar- ‘‘A premium smooth taste with lasting ette packet. Creatively designed pamph- flavour. Blended to perfection.’’ and ‘‘A INDIA: COUNTERING THE IMPACT OF PACK lets promoting smokeshirts are being premium cool sensation with lasting WARNINGS distributed in up-market areas, apparently flavor. Chilled to perfection.’’ A new type of product, already familiar in targeting Indian young women and girls. As these were considered violations of other countries, was launched onto the They give detailed information about the Thai laws, PM Thailand Ltd was Indian market recently and is now readily smokeshirts, positioning them as a stylish

Tobacco Control December 2009 Vol 18 No 6 429 News Analysis Tob Control: first published as 10.1136/tc.2009.034454 on 2 December 2009. Downloaded from accessory with designs to suit everyone’s immediately, because it’s always our Edward’s Addiction Research Unit at the taste. They are available in a variety of policy to overproduce during the first Institute of Psychiatry, he chose smoking top grade textiles, the leaflets say, from manufacturing run. We see this as an as his research thesis topic and in 1971 stripes and polka dots to leopard skin important service we offer our retail published a seminal paper concluding that print, to match one’s clothes and suitable partners.’’ nicotine was the motive force behind for any occasion. As increasing numbers of countries add smoking. Currently smokeshirts are being the requirement for pictorial health warn- Recognising the need to measure smoke imported from Germany. Made by a ings to their tobacco control laws, they intake accurately, Russell recruited bio- company called Lifestyle and Fashion, will need to address the likely emergence chemist Colin Feyerabend to develop a they were invented by two brothers, of smokeshirts to counter the effect of the method for measuring blood nicotine. By Joerg and Michael Knobloch. Their aim warnings. They will not only need to 1974 he could quantify intake with was to enable smokers to cover up the legislate specifically against products precision and even measure non-smokers’ graphic health warnings on cigarette intended to cover up the warnings, but, exposure from , one of packets that are now being adopted in unlike India, show that they mean busi- many ‘‘firsts’’ in the field. As his under- many countries. The Knobloch brothers, ness by acting quickly and decisively to standing grew of smokers’ self-titration to who describe the smokeshirt as a ‘‘life- enforce this and all other tobacco control maintain nicotine levels, he was also one style product’’, reportedly conducted regulations. of the first (at least outside the tobacco extensive research of patent offices PRIYANKA DAHIYA & MONIKA ARORA industry) to understand how lower emis- around the world to ensure that they HRIDAY (Health Related Information Dissemination sion cigarettes were flawed. were launching a unique product, as well Amongst Youth), India It was Mike Russell who persuaded a as selecting product features and pricing [email protected] pharmaceutical company to produce the based on market research in Germany. world’s first nicotine chewing gum, They also researched pack sizes of cigar- designing a randomised trial to test its ettes around the world to determine the MICHAEL RUSSELL efficacy at the Maudsley clinic, as well as dimensions of their product. A design The distinguished research scientist later co-developing nicotine nasal spray. team then produced a range of smokeshirt Michael Russell, whose work was so His work thus laid the foundations of the designs. important to understanding why people nicotine replacement industry. India delayed the implementation of smoke and how they can be assisted to In addition to the full spectrum of pictorial warnings time and again from stop, has died aged 77. Born in Capetown, tobacco pharmacology, Russell’s research 2006, due to pressure from the tobacco South Africa, he studied medicine in the also covered wider aspects of applied industry, but they were finally enforced , at Oxford and Guy’s cessation. He showed, for example, how on 31 May 2009. The launch of smoke- Hospital, London, returning to South the mere completion of a questionnaire shirts in India, just a few months before http://tobaccocontrol.bmj.com/ Africa and working as a junior doctor at about smoking by patients waiting to see the pictorial health warnings were imple- Groote Schuur Hospital. After deciding to a family doctor led to a measurable long- mented, is clearly a way of countering the specialise in psychiatry, he and his wife, term reduction in their consumption, impact of the new warnings. Along with Audrey, both deeply unhappy with apart- with brief advice from the doctor yielding the implementation of pictorial warnings, heid, returned to London to train at the around five per cent one year abstinence. India’s new regulations prohibit the sale Maudsley hospital. Working in Griffith of any product which can be used to cover He was a familiar figure at tobacco or obscure the warnings. Thus, with the control meetings, where his sometimes new regulations coming into force, the fiery defence of his views contrasted with sale of smokeshirts has become illegal in kind and caring support to successive India, but they continue to be on the directors of Action on Smoking and Health and other tobacco control work- market. Smokeshirts also have a comple- on September 25, 2021 by guest. Protected copyright. mentary neckband, whose use makes the ers. Russell was appointed Professor of smokeshirts easily accessible and visible, Addiction in 1986. making it unnecessary to keep them in a He was the recipient of the Alton purse or pocket. Ochsner Award, an international prize Apart from India, smokeshirts are for outstanding research on tobacco and available in European clothing and design health, in 1996, and the Ferno Award of shops from Portugal to Hungary and in the Society for Research on Nicotine and many locations in China. A statement Tobacco in 1998. Having returned to from the Knobloch brothers about their independent South Africa, Michael product reads, ‘‘Our retail partners aren’t Russell’s last few years of retirement in taking any risks because our products Capetown were marred by Alzheimer’s practically sell themselves in no time at disease. He is survived by Audrey and his all, and they offer excellent value for sons James and Nicholas. money. We receive follow-up orders all Professor Michael AH Russell, 9 March 1932 to Tobacco Control 2009;18:427–430. the time, and we are able to fill them 16 July 2009. doi:10.1136/tc.2009.034454

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