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essence, the court said it was a matter Turkey: first tobacco of free choice whether or not a person smoked; it was not proven that smoking litigation caused cancer by itself; and the causes In November 2000, Turkey’s first of cancer were not entirely clear. The tobacco litigation, a personal injury case patient could have become ill from other in the district court in Edirne, in the carcinogenic agents, including those north-west of Turkey near the borders found in many foods that were widely with Greece and Bulgaria, was filed sold and consumed. In addition, the against Tekel, the Turkish tobacco defendant, the tobacco company, was monopoly. The plaintiff was Yurdagu¨l providing a legal product, and did not Tufan, 44, a smoker since she was 17, have a legal obligation to look after who was responsible for the support of people’s health. The court also noted her blind husband and their young that there was a health warning on The woman at the centre of Turkey’s first daughter. cigarette packs saying, ‘‘Cigarettes harm tobacco litigation case, Yurdagu¨l Tufan, with After diagnosis and first line thera- your health’’, and in any case, the harm her blind husband and their daughter. pies, an improvement in her health was done by cigarettes was known by every- achieved. Knowing that as much as body, even without a health warning. the companies. Much more vigorous possible was being done for her physical This fact did not alter just because the tobacco control could be possible in health, albeit for a terminal disease, her product was advertised; it was the duty Turkey if such suits began to be won. doctor gave more thought to what else of every person to protect his or her As the World Health Organization has could be done for her overall well-being. health. recommended, the tobacco industry has The woman was desperately concerned After this judgement, the lawyer to be held responsible at both the for the welfare of her husband and appealed to the supreme court. national and international levels, by baby, for whom she would soon be However, after a process of two years it legislation, law suits and other methods. http://tobaccocontrol.bmj.com/ unable to care and then would leave just became too burdensome, and he Enlightened tobacco control leaders in behind for ever when she died. withdrew the case. He also decided not the industrialised world must not over- Although nothing could be done to save to appeal to the European Court of look the harm being wrought on those her life, at least she might be helped to Human Rights, as previously intended. living in countries with fewer resources, understand that she was not the only Although the case had been on the in terms of both finance and informa- one responsible for her situation, and national agenda in a big way, no non- tion about tobacco, by the same compa- could use her case to warn others not to governmental organisation, or scientific nies which they have been able, at least smoke. or legal association, had come forward partially, to control in their own coun- From what the doctor had learned to support it. tries. from international news media and the Even though the final result was internet, he conceived the idea of suing negative, this first attempt at tobacco CELAL KARLIKAYA the tobacco company whose cigarettes litigation had many important effects. Trakya University Medical School, Edirne, on September 25, 2021 by guest. Protected copyright. she had smoked. Despite finding little Firstly, it raised the level of discussion in Turkey; [email protected] support for the idea among colleagues, Turkey about the harm caused by and although a lawsuit seemed an cigarettes, and made them clearer in absurdly ambitious concept, he found a the public mind. The whole country USA: Pacific island lawyer, Rifat C¸ulha, who was persuaded watched the death of a mother and wife, to run the case without payment. So clears the air and the effects of her lung cancer, step Tekel was duly sued for compensatory The 9th December last year was a by step. Tekel and other tobacco firms and punitive damages of 1.1 trillion historic day on the Pacific island of changed some of their unhealthy prac- Turkish Lira (about US$1.6 million). Guam, an unincorporated territory of tices of their own accord. Tekel, due to It was an utterly new phenomenon in the United States. Governor Felix be privatised, was clearly attractive to Camacho signed into law a bill making Turkey, and a cause of general aston- the large international tobacco firms. ishment, reflected by widespread inter- restaurants and most enclosed public However, the privatisation programme places smoke-free. Bill 16 was written est from the mass media. A quick search fell behind schedule and it seems on the internet, by headlines and sub- by Democratic senator Lou Leon reasonable to speculate that at least Guerrero, who, in 2003, raised tobacco headlines, found almost 80 news items one factor may have been the litigation. about it. The story was also shown on taxes on Guam. While the bill that was In contrast to some of the US cases, the main news programmes of national passed was not as strong as the original Turkish citizens are still being killed by television channels. The disease process, version, it represents a step towards a tobacco without costs being imposed on the trial day, the death of the patient healthier future for the island’s 170 000 and the amount of compensation people, who have the highest adult claimed—all, in turn, were the basis of smoking prevalence of all US States substantial news stories. All articles written by David Simpson and Territories. The suit was eventually rejected by unless otherwise attributed. Ideas and It took a lot of manoeuvring and the local court, after two and a half items for News Analysis should be sent shrewd political strategy to get the bill years, and details of the judgement to: [email protected] passed, because of efforts to block and/ suggested significant confusion. In or dilute it by parties aligned with

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On 22 November, the finance com- and is an important trendsetter for the mittee finally released a compromise northern Pacific. The Federated States version for the legislature’s considera- of Micronesia (a US affiliated

tion. The revised bill stipulated that Micronesian country) is already looking Tob Control: first published as on 24 March 2006. Downloaded from restaurants and bars prohibit smoking to emulate the Guam law. until 9 pm, after which it would be allowed. The majority of senators ANNETTE DAVID rejected the compromise version, using Guam Department of Mental Health and arguments from the technical informa- Substance Abuse; [email protected] tion previously disseminated by various pro-health groups. On 30 November, 12 of the 14 Senators present voted to pass Spain: going smoke South Africa: fire on Table Mountain One of Guam’s first comprehensive smoke-free free the hazards of smoking which tends to receive public places law. The final version bans From 1 January 2006 the Spanish less attention than it merits was all too starkly smoking completely in enclosed public government introduced a new law illustrated by this fire on Table Mountain, places, workplaces and restaurants, but against smoking (Ley 28/2005). This outside Cape Town in January. It was started by allows smoking in bars. a British tourist throwing a cigarette butt out the law is not only a ban on smoking but window of his car. The man was spotted by an The combined efforts of community a compendium of public health mea- alert game guide, who radioed the police. The advocates, prevention workers, several sures against smoking and regulations man was later arrested and there were calls for senators committed to public health on the sale, supply, consumption, and him to be given the maximum sentence and policies, and the global tobacco control publicity of tobacco products. The law’s fine. community ensured that a sound ver- main objectives are to protect non- sion of the original bill prevailed. While smokers (especially at the workplace) not as comprehensive as the original tobacco-related interests. Introduced by from secondhand smoke—currently, version, the current law represents a 69% of the Spanish adult population, the health committee, the bill was major step forward towards creating a unexpectedly taken over by the finance both sexes combined, declare they are healthier, tobacco-free future for Guam. non-smokers—to prevent initiation committee, supposedly because of con- In addition, Guam serves as opinion cerns about adverse effects on business among young people, and to promote leader and setter of precedents for the smoking cessation. revenues. However, local community other US-affiliated Micronesian islands, advocates and political observers noted The law creates smoke-free environ- that the senator heading the finance ments in all enclosed public and private http://tobaccocontrol.bmj.com/ committee belonged to a powerful workplaces and smoking is now banned family that oversees the distributorship in all indoor public places, public trans- of tobacco and alcohol products on portation including closed stations, hos- Guam. In addition, the Guam Hotel pitals and other health care facilities, and Restaurant Association opposed schools and universities, as well as retail stores and shopping centres. There are the bill early on, purportedly because important (and worrying) exemptions of concerns that it would reduce hospi- regarding bars and restaurants: while tality revenues, particularly from hospitality venues of more than 100 Guam’s Japanese and South Korean square metres are smoke-free, the law tourists. Ironically, a recent market allows the owner to establish a smoking survey of more than 900 South Korean area of less than 30% of the total area. on September 25, 2021 by guest. Protected copyright. tourists revealed that over 80% approved Moreover, in ‘‘small’’ venues of less of smoke-free restaurants and bars. than 100 square metres (as most bars A public hearing held in March 2005 The Lone Star will no longer stand alone as a in Spain are) the owner may decide demonstrated overwhelming multi-sec- smoke-free restaurant, after Guam’s new legislation takes effect. whether to implement a smoke-free toral backing for the bill. Letters of support came from individuals and groups locally and worldwide, after a petition was circulated on GLOBALink. Testimonies and technical advice from experts on the US mainland and in the Asia-Pacific region were critical in strengthening the case for enacting a smoke-free public places policy. Despite clear public approval for the bill, the finance committee delayed its inclusion on the legislature’s agenda for eight months. During this period, the office of Senator Guerrero and various pro- health groups kept up pressure on the finance committee to release the bill for a senatorial vote. Critical information and research data were provided to individual senators regarding the posi- tive experience of other US states and Pakistan: Karachi was recently adorned with cigarette advertisements like this one, posing as countries that have enacted smoke-free promotions for a music event, ensuring young people continue to be bombarded with positive legislation. associations for British American Tobacco’s cigarettes.

www.tobaccocontrol.com 80 News analysis

effectiveness of the law and even to conspiratorial minds may even have improve it, by extending the ban to all seen it as vaguely threatening. hospitality venues if decreases of expo-

sure only occur in workers at smoke-free Tob Control: first published as on 24 March 2006. Downloaded from bars and restaurants. Lebanon: young stars Spain is the sixth European country, turned to smoke after Ireland, Norway, Sweden, Malta Arab Star Academy is a popular Arabic and Italy, to put in place comprehensive adaptation of a French TV reality show regulation to prevent and control smok- that has been broadcast on the Lebanese ing. This is of particular interest, since it Broadcasting Cooperation (LBC) and on demonstrates that the way traced by the its satellite, LBC International (LBCI), Framework Convention for Tobacco since 2003. The programme hosts a Control can be followed by different group of potential youth performers cultures and societies. The example of In Spain, a new law against smoking has been from all over the Arab world for four introduced, creating smoke-free environments these countries may encourage not only months where they take singing, dan- in all larger public and private workplaces. the rest of Europe, but similar initiatives cing and acting lessons under the super- in all countries under the threat of the vision and guidance of experts. tobacco industry. policy or not—and the first estimations Candidates are voted out regularly over the course of the series by viewers’ indicate that only 5–10% of such bars ESTEVE FERNA´ NDEZ telephone calls, or through a website, have gone smoke-free. The law limits Institut Catala`d’Oncologia, Barcelona, Spain; and results are announced in weekly the sale and supply of tobacco products [email protected] that can now be sold only at tobacco- prime time programmes. nist’s shops and smoke-permitted This year’s Arab Star Academy is aired (smoke-polluted) bars and restaurants. Senegal: Marlboro’s daily on LBCI from about 6.45–7.45 pm Vending machines are hence prohibited and for 24 hours on another affiliated channel (Nagham). The show has found in any other place. The legal age for vigil tremendous popularity among all ages, buying cigarettes increases to 18 years In November, a small delegation from but especially among young viewers. old, and vending machines will include the American Cancer Society partici- This year the show is hosting a total of control mechanisms to restrict their use pated in the Fifth International 19 youths (9 girls and 10 boys) from to adults. Regarding promotion, the law Conference of the African Organization Tunisia, Saudi Arabia, United Arab http://tobaccocontrol.bmj.com/ prohibits all type of advertisements, for Research and Training on Cancer Emirates, Bahrain, Morocco, Palestine, other forms of promotion, and tobacco (AORTIC). The conference was held in Algeria, Jordan, Lebanon, Kuwait, and sponsorship activities in all public and Dakar, Senegal, at the Hotel Sofitel- Egypt. private media. Again there is an exemp- Teranga. A significant portion of the In one of the programme’s advertising tion: a further three years has been conference programme was, appropri- breaks, a Davidoff cigarette ad is granted for sponsorship and publicity ately, devoted to tobacco control. During most of the four days of the shown—Davidoff is a brand of British- among participants and teams in motor- based Imperial Tobacco. The advertise- cycle and Formula One international conference, a sports utility vehicle (SUV), immaculately clean (rare for ment format and content is not parti- races. cularly associated with youth, rather it Not many years ago, this law was Dakar) and finished in full Marlboro regalia, was conspicuously parked at the is a typical brand ad like those shown in unthinkable in Spain. However, Spanish cinemas. The health warning is in society (ordinary citizens, including entrance to the hotel, in full view of all minute script, and ends with on September 25, 2021 by guest. Protected copyright. smokers, politicians, and society in the delegates and others who passed by. There was no activity connected to the Davidoff’s catchphrase, ‘‘The more you general) has matured. Several organisa- know’’. Interestingly, other ads in the SUV—it was just parked there, with a tions (not only scientific societies but same programme carry positive mes- driver always in attendance. Perhaps it also non-governmental organisations sages for young people about conserving was a coincidence or, more likely, a such as the National Committee for the environment, for example, or youth- subtle statement from the tobacco Smoking Prevention and several con- oriented product ads (with Pepsi as the industry to say, ‘‘We know you cancer sumers’ organisations) and public official sponsor). people are in there deliberating, and we health leaders created the necessary This is not the first time that Davidoff want you to know that we’re here, too— level of understanding about the rea- has broken ethical boundaries; previous all the time.’’ Very subtle. Those with sons for the new law. The message was examples have included activities con- simple: smoking and secondhand nected with a ‘‘Friendship Tour’’ in smoke are harmful to health. A number which young people are taken around of small but multilevel activities have Lebanon. The Arab Star Academy is just been conducted by many different the latest in a series of overt tobacco players, leading to a big achievement. advertisements aimed at young Arabs Now the task is to ensure compliance. everywhere. It is an issue not only of Improvements will come soon. In this promotion to young people, but also of connection, the regional governments cross border advertising. LBCI extends within Spain have the right and the its programmes throughout the world duty of assuring compliance (even reaching millions of Arabic speaking applying the penalties specified in the viewers in the Middle East, Europe, law) and the ability to improve the A pristine sports utility vehicle, emblazoned Africa, America, South America, and legislation in each region. Ongoing with the Marlboro logo, sits outside the Australia. In the United States, LBCI is entrance to the hotel where the recent annual studies to assess changes in individual conference of the African Organization for reported to have up to 100 000 viewers. and environment exposure to second- Research and Training on Cancer was held in In addition, in Australia where there is a hand smoke may help to evaluate the Senegal. large Arab speaking community, Arab

www.tobaccocontrol.com News analysis 81 Tob Control: first published as on 24 March 2006. Downloaded from

The new look Salem website could be mistaken for that of a health spa.

massaging techniques. Soothing music plays in the background, and various relaxing ‘‘earthy’’ products such as aroma candles and sound machines are featured. Most of the images of people featured on the site are white and A Davidoff promotional banner over the Lebanon Youth Orchestra shows how tobacco companies female, and little about the website can link their cigarette brands to positive, well publicised activities involving young people. would indicate to a user that this was a website for a cigarette brand. In fact, overall, one could easily mistake Salem’s Star Academy is listed as one of the website for that of a health spa. highest ranking TV shows by viewers These images and themes stand in watching LBC. In Lebanon, ratings have rather stark contrast to Salem’s last run reached 80% among viewers aged 15 of popular advertising. 2004’s ‘‘Stir the and 25 years. In Saudi Arabia, 53.6% of Senses’’ neon green and black ads had the programme’s viewers are in the age mysterious and ethereal themes and most group 15–24 years, 27.9% in the 25–34

often featured models from minority http://tobaccocontrol.bmj.com/ age group, 9.7% are 35–44 years of age, backgrounds, or used urban references and 8.8% are 45 and over. such fast-paced city scenes and lights. Tobacco advertising through satellite Salem’s ‘‘Stir the Senses Tour Series’’, also TV stations poses a major threat for promoted in 2004, featured hip-hop countries that are trying to impose themes, and was presumably targeted at restrictions. Such ads can smartly a younger more urban and minority based achieve several valued goals of the Mauritius: Kitsch clocks like these, somewhat behind the times in fashion, are turning up in audience. Although magazine advertising ‘‘new’’ tobacco industry. This case study various designs all over Mauritius, apparently was noticeably absent in 2005, direct mail confirms the importance of the two trading on the name of well-known and much- during that time at first echoed ‘‘Stir the issues of marketing to youth and cross- promoted cigarette brands. Health Senses’’ themes and then hinted at the border advertising. Health advocates campaigners say that all too often, tobacco upcoming campaign by introducing the must lobby their governments to ensure companies only take action over unauthorised

‘‘Refresh Your Spirit Gateway’’ on September 25, 2021 by guest. Protected copyright. it is stopped, by national action, regional use of their brand identifiers when challenged, otherwise seeming to approve of the free Sweepstakes, with the grand prize of a cooperation, and through the secondary publicity. spa getaway break. Conference of Parties to the World So what’s the reason for the sudden Health Organization’s Framework websites, which we are finding to be an shift? One section of the site is dedi- Convention on Tobacco Control. early warning system for tobacco brand cated to Salem’s ‘‘50th Anniversary WASIM MAZIAK promotions, images, and products. Celebration’’, an event that may provide Syria; [email protected] In January 2006, Salem’s password a logical time for doing something new. protected website (www.salemaccess. What seems likely to be a more impor- RIMA NAKKASH com) underwent a major change in both tant reason, however, is that since the Lebanon; [email protected] look and content, one that appears to acquisition of Brown & Williamson in signal a new identity for the brand. The 2003, RJ Reynolds (RJR) now owns RIMA AFIFI SOWEID revamped Salem website went live both KOOL and Salem, historically Lebanon; [email protected] online some time between 10–18 menthol brand competitors, and needs January 2006. Carried by the slogan to develop stronger brand differentia- USA: Salem’s new look ‘‘Refresh your Spirit’’, the website tion to maximise profits. replaces Salem’s most recent ‘‘Stir the Finally, and of particular concern, the website Senses’’ dark campaign look of black revised website suggests a coming cam- Trinkets and Trash (T&T: www.trinket- and neon green colours with white and paign in which a tobacco brand tries to sandtrash.org) is a surveillance system a natural green, for an overall lighter promote, or at least imply, perceptions and archive of tobacco industry pro- look and feel—apparently aiming at an of naturalness and health. Because ducts and promotions that regularly image of lightness, health, nature and Salem is one of RJR’s ‘‘selective-sup- monitors tobacco product development refreshment. ported’’ brands, which receive limited and industry marketing, including The main feature of the website as it marketing support compared to Camel magazine advertising, direct mail and stands now (there are some ‘‘coming and KOOL, we may not see an explosion promotional items. In the past year, soon’’ sections) are video clips that of promotional materials, but we can be T&T began to monitor tobacco brand portray couples demonstrating different sure whatever is developed will be

www.tobaccocontrol.com 82 News analysis carefully crafted and promoted. For this USA: cartoonists take National Museum of Health and reason, tobacco control professionals Medicine, produced in cooperation with should closely monitor Salem promo- up smoking the Association of American Editorial tions and begin to plan appropriate Delegates to the 13th World Conference Cartoonists, will include more than 60 Tob Control: first published as on 24 March 2006. Downloaded from advocacy activities. on Tobacco OR Health, to be held in original artworks, together with the headlines and other items related to MJANELEWIS Washington DC from 12–15 July 2006, the events that inspired the artists. [email protected] will be able to see a unique exhibition presenting a history of the past 50 years There will be an exhibition-related event OLIVIA WACKOWSKI of anti-smoking activities as seen at the museum during the conference, UMDNJ-School of Public Health, New Jersey, through the eyes of newspaper editorial including a talk by KAL, cartoonist for USA; [email protected] cartoonists. The exhibition, at the The Economist and The Baltimore Sun.

The Lighter Side...... http://tobaccocontrol.bmj.com/ on September 25, 2021 by guest. Protected copyright.

E 2005 Doonesbury, by G B Trudeau. Universal Press Syndicate. Reprinted with permission.

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