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News analysis...... Tob Control: first published as on 2 June 2004. Downloaded from

for his role as Jim Hacker, the hapless USA: Sex and the minister, later prime minister in the 1980s British television comedy series Ciggie ‘‘Yes, Minister’’ and ‘‘Yes, Prime The much hyped season finale of the US Minister’’, Eddington first rose to fame cable TV smash hit ‘‘Sex and the City’’ a decade earlier in a British sitcom featured the return of by the called ‘‘The Good Life’’. This featured leading lady. two couples, neighbours, one relatively Iconic, independent woman Carrie successful and wealthy, the other doing Bradshaw smoked throughout the first less well in life. Eddington played the few seasons but managed to quit during husband of the successful couple, and the third. The series won a 2001 PRISM his screen character was a smoker. But award for accurate depiction of a nico- being an intelligent, thoughtful man tine addiction. with a strong social conscience, and Her downfall in the finale came while realising how inappropriate it was to she was in Paris, where ‘‘everybody portray smoking as part of the good life, smokes’’. It’s hard to miss the glorifica- he asked the writer whether a scene or tion of smoking in this episode. Not only two could be inserted about him giving is her Marlboro Lights pack prominently up the habit. To his pleasant surprise, displayed for long periods, but Carrie’s The ‘‘Sex and the City’’ season finale, in which the writer immediately agreed with him, enjoyment of her first smoke can only the central character Carrie Bradshaw took up and told him simply not to smoke again be described as radiant. smoking again, appeared to glorify the activity. in the part. It was not even necessary to There is a remarkable sequence when refer to it, he said; from then on, the her boyfriend, played by Mikhail addictively sucking on a . character would simply be a non-smoker. Barishnikov, tells Carrie what his ex- Smoking was an integral part of his http://tobaccocontrol.bmj.com/ Eddington, a Quaker, had a long wife thought of her. Carrie has just persona, reflecting his sickness and history of quiet involvement with retrieved a cigarette from her purse despair. He was even known derogato- important causes. When necessary, he when Barishnikov says, ‘‘She found rily as ‘‘cancer man’’. While I think it’s a you…’’ and here’s where the timing is mistake to excuse smoking by villains— was prepared to be a little less quiet, as key: just as the flame touches Carries villains always have great power along when he publicly resigned in protest cigarette and she begins puffing, we with other attractive qualities that can from the board of trustees of the Bristol hear the lines, ‘‘beautiful smart and be associated with smoking—it seemed Old Vic theatre company after it refused chic’’. Barishnikov later takes a puff of to work for this particular character. to end sponsorship from Wills , the cigarette, and even, as he’s getting So how did ex-smoker Davis deal which had a large factory in the city. He into a cab, tells her, ‘‘I like the smoking. with the requirements of his role? was a founder of a high profile group It’s very sexy’’. Being well aware of ’s potential opposing tobacco sponsorship of the

Sarah Jessica Parker, who plays from his own experience, he demon- arts, and helped Action on Smoking on September 24, 2021 by guest. Protected copyright. Carrie, has said she didn’t want to do strated his screen character’s serious and Health (ASH) on several occasions. the smoking scenes, but the writer, nicotine addiction by smoking herbal, Sadly, he did not live to see the UK’s ad Michael Patrick King, apparently not tobacco . After all, it’s well ban—he died of a rare form of skin insisted. ‘‘I told Michael Patrick, I said, accepted that actors don’t have to drink cancer in 1995—but he inspired and oh, please, don’t—must she smoke alcohol or shoot heroin for their roles. enlivened ASH’s work towards it. again?… But he writes great stories He also used something known in the and it’s hard once you read one not to entertainment trade as ‘‘acting’’. see his point.’’ Directors and writers: please, have a Parker dutifully smoked, and soon heart—be kind to your actors. Don’t became hooked once again herself. ‘‘I addict them. There are alternatives to would say I had to smoke for work and the smoking cliche´, and when smoking then I slipped.’’ is absolutely necessary, there are even We hear of this addiction-through- alternatives to tobacco. acting process quite often. An actor is GENE BORIO given a role in which the character must [email protected] smoke, according to the writer and/or director. After the show is over, a little something of the role remains with the UK: acting normal actor, a nicotinic memento—he or she is still smoking. So what can an actor do? without smoking In the case of ‘‘Sex and the City’’, Ms The issue of actors being made to smoke Parker might have chatted with William on stage or screen is not a new one, B Davis, the ‘‘cigarette smoking man’’ but compared to the ‘‘Sex and the of the wildly successful series, ‘‘The City’’ story above, British actor Paul X-Files’’. Davis, the arch villain of the Eddington had more luck 30 years ago. series, was almost never seen without Although he was best known worldwide Actor Paul Eddington: an ASH supporter.

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people at the lower end of the socio- All articles written by David Simpson economic scale, so for its ‘‘Merry unless otherwise attributed. Ideas and Christmas’’ ad, a traditional Guatemalan items for News Analysis should be sent scene, with a starlit courtyard looking to: [email protected] suitably nativity-like for the Catholic Tob Control: first published as on 2 June 2004. Downloaded from audience, was more appropriate. It is all a long way from the total ad ban that is so urgently needed in Guatemala, as in all When the ‘‘Yes, Prime Minister’’ team countries where tobacco promotion is still was considering topics for future epi- permitted. The big question is whether sodes, Eddington suggested they cover the Framework Convention on Tobacco the tobacco epidemic, and telephoned Control, which Guatemala has already ASH to tell them to expect a call from signed, will succeed in banishing ads like the writers. The show’s central charac- these for good—traditional scenes, cow- ter, James Hacker MP, thought he was boys, snow and all. in charge of things but in reality was all too dependent on and manipulated by JOAQUIN BARNOYA civil servants, led by the scheming Sir Center for Research and Humphrey Appleby. Sir Humphrey, Education, University of California, San whose agenda was usually somewhat Francisco, California, USA; different from that of his political [email protected] master, was not immune to being manipulated himself, so the series was a natural for taking a satirical look at Sri Lanka: exploiting one of the greatest scandals of political negligence of our time. the fallen The writers set to work on their It is hard to believe that a tobacco research, including discussions with company, responsible for pushing pro- key public health people, to learn what ducts that cause thousands of prema- went on behind the scenes to try to ture deaths every year, would have the ensure that cigarette sales continued to nerve to sponsor a shrine to those who http://tobaccocontrol.bmj.com/ flourish undisturbed. The ensuing epi- gave their lives for their fellow citizens, sode, ‘‘The Smokescreen’’, broadcast in far less plaster its company logo all over 1986, was as hard hitting as it was it. But British American Tobacco’s hilarious, and can still be found in use (BAT’s) subsidiary in Sri Lanka, CTC, as an entertaining teaching aid in which shares the parent company’s discerning schools of public health the none-too-subtle golden tobacco leaf as world over. At one point, in a robust a logo, has done just that, at the defence of inaction encompassing many National Remembrance Park opened in of the classic argu- Philip Morris ads for two of its brands marketed October 2002 in Kandy district, in the ments and sophistries, Sir Humphrey in Guatemala: snow and cowboys for upmarket centre of the country. Marlboro smokers, more traditional CTC’s name and logo appear not only pleaded with Hacker to recognise the Guatemalan scenes for its local Rubios brand. economic heroism of smokers whose on signs leading visitors to and around on September 24, 2021 by guest. Protected copyright. tobacco tax helped fund the health the park, but prominently engraved for service, but whose early deaths relieved scene with snow is no barrier when posterity on a stone memorial tablet at the state from having to pay their wishing people a happy holiday season the solemn heart of the place, above the pensions: ‘‘We are saving many more from the world of Marlboro. inscription: ‘‘In sincere appreciation of lives than we otherwise could because of However, Philip Morris also makes the those who sacrificed their lives for our those smokers who voluntarily lay down local Rubios brand, smoked mainly by nation so that we may live in peace.’’ their lives for their friends.’’ Incredible though it now seems, it was but a modest paraphrase of what some indus- try briefed politicians were saying at the time. Guatemala: snow stopping ’em Some interesting examples of horses for courses in tobacco advertising were to be seen early this year in Guatemalan newspapers. Snow is about as common in Guatemala as palm trees in Antarctica, but when you are selling a myth to educated people, you can use a wide range of reference points. Philip Morris’s Marlboro brand is mostly smoked by the higher and middle socio- BAT’s golden tobacco leaf logo is prominently displayed on a stone memorial tablet in Sri Lanka’s economic classes, so a pretty cowboy National Remembrance Park.

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country. In a scene reminiscent of a second of time, he went up to the BUGA-UP, that famous group of early country’s president, General Perveiz graffitists in Australia, a young Sri Musharaf, and pointed out that the Lankan protester was captured on film Ordinance issued by him against smok- ‘‘improving’’ one of the signs, as BUGA- ing in public places was being violated Tob Control: first published as on 2 June 2004. Downloaded from UP might have put it. His message, in his presence. He also mentioned his when completed, read, ‘‘CTC kills chil- disappointment that Pakistan had not dren’’. Whether he had in mind children yet signed the Framework Convention who die because of malnutrition due to on Tobacco Control (FCTC), despite the the drain on family income caused by fact that 71 other countries had seen fit their fathers’ addiction, or to future to do so. Next, he approached the prime deaths among the children of today minister and asked him to get the FCTC currently being recruited to smoking, signed by the government—just like the appearance of such protests must be that; as one does. Like the consummate worrying for tobacco companies. advocate that he clearly is, when he got home he wrote follow up letters to the president and the prime minister, with Pakistan: seizing the copies to the federal health minister, moment reinforcing the importance of signing A young Sri Lankan protester ‘‘improving’’ one the FCTC. That’s the way to do it. of the BAT sponsored signs in the Sri Lankan Not many of us have walked up to the National Remembrance Park. The completed head of state of our country and message read ‘‘CTC kills children’’. personally pointed out shortcomings in Australia: a career in the government’s public health policies, with prima facie evidence at hand to cancer promotion? Doubtless the BAT/CTC people respon- back up our case, far less repeated the Last year protests by staff and students sible were sincere in their appreciation process a few minutes later with the at the University of Sydney saw the of the fallen, but a cynic might consider prime minister. But in March, Dr Saeed university senate vote to not endorse the irony that tobacco executives may ul Majeed, president of the Pakistan the chancellor’s appointment of former hold a parallel, sincere appreciation of College of Family Medicine, did pre- state premier and current BAT Australia all those who are addicted to their cisely that. His audacious but exemplary chair Nick Greiner to an advisory posi- company’s products. These customers use of the ultimate lobbying opportunity tion in political science at the university. http://tobaccocontrol.bmj.com/ risk sacrificing their lives by the daily came at a ceremony in the capital, As if to rub salt into Greiner’s public satisfaction of their addiction, in a Islamabad, where he was one of an elite humiliation, the university then advised commercial process encouraged by mas- group being awarded the distinguished BAT that they were no longer welcome sive promotion, so that the executives honour Tamgha-i-Imtiaz (Medal of Dis- to set up a stand at the annual student and shareholders may live in greater tinction), with which the government careers fair and extol the virtues of personal, economic peace than might recognises distinguished merit in the working for a tobacco company—‘‘You otherwise be likely. fields of literature, arts, sports, medicine, get to do lots of great stuff like talking to Interestingly, the exploitation of such and science. government and the media,’’ one stu- an important national landmark by a After the investiture, Dr Majeed dent was told by a gushing BAT staffer. tobacco company has prompted one of noticed people smoking in the hall, in Website checks this March saw BAT the first acts of civil disobedience contravention of Pakistan’s law on poised to woo students at three other prompted by tobacco in a developing smoking in public places. Wasting not Sydney university careers fairs. Alerts to on September 24, 2021 by guest. Protected copyright.

Madagascar: selling dreams. Even in the poorest countries, such as Madagascar, whose more than 15 million inhabitants have an average annual income of around US$250 and a life expectancy of under 60 years, there is always a market for tobacco. Cigarettes usually cost about US$1 for 20, and advertisements such as the one shown above often portray a lifestyle far beyond the reach of most people. Imperial Tobacco of the UK, whose recent takeovers enable it to boast being the world’s fourth largest tobacco company, has been investing there. One of the few links from its website’s home page is to a section dealing with its operations in Madagascar, which it describes as its most extensive in Africa. Last year, Imperial launched its West brand at the Hilton hotel in the capital, Antananarivo, where West’s much vaunted sponsorship of Formula One motor racing seemed about as far as could be imagined from the home made model cars handled by the country’s younger generation.

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guards, managed to get a flavour of the Perhaps, as usual, they will simply try latest company line fed to BAT’s new any and every avenue they can think of. recruits. Lavina, a chirpy media gradu- In the last few years, after all, we have ate, was unfazed by my question about seen a spate of new techniques being whether she felt comfortable working tried, including exclusive invitation only Tob Control: first published as on 2 June 2004. Downloaded from for a company whose products kill parties and nightclub websites aimed at thousands of its customers each year. trend setting young people, and the ‘‘Oh, you can’t say that!’’ she trilled. increasing use of carefully built up ‘‘There are many other things that cause mailing lists. Another practice that has cancer. You just can’t put it down to intensified recently is brand extension, smoking,’’ declining to allow the con- using colours, images, and other asso- versation to be recorded by a radio ciations that are not necessarily a logical reporter. I congratulated her on how development of the original brand, but well she had absorbed her training, and which can reach a new sector of the enquired whether they were any com- market. With around 90% of smokers panies producing legal products for starting to smoke before they are out of whom she would not work. Mercenary their teens in many countries, it is not recruitment agencies, perhaps? ‘‘What surprising that the youth market is the do they do?’’ she asked. ‘‘They pay you usual target. to go to other countries to kill people,’’ I In the USA, for example, Brown & explained. Lavina said BAT was a ‘‘great Williamson Tobacco (B&W), the US company’’. So, I understand, it was said subsidiary of BAT, has introduced a of some of those who supplied slaves to flavoured extension of its menthol America, ran opium out of China, and brand Kool. Called the Smooth Fusions Mr Sigi Butt, who enthusiastically urges students to sign up with BAT to help kill thousands of sent children down mines in the 19th range, flavours include Caribbean Chill, Australians each year. century. All legal activities then. Mocha Taboo, Mintrigue, and Midnight Berry. Take Midnight Berry, which at SIMON CHAPMAN first hearing might be mistaken for [email protected] staff and student bodies saw swift some sort of grim drugs underworld action. The University of Western slang, perhaps for the sort of dark and Sydney reversed its decision to allow USA/Brazil: the slimy blood clot that a terminally ill http://tobaccocontrol.bmj.com/ BAT to participate within hours of a tobacco junkie might cough up in the ’phone call being made. Macquarie flavour of things to delirious, hacking depths of the last University expressed regret that nothing night of this mortal life. In reality, it is a could be done this year to reverse its come? new brand in a highly coloured pack acceptance of BAT, but has said it will As more countries sign and ratify the with an unusual design: it has rounded be the last time. As we go to press, the FCTC, giving the structure for ending all corners and opens out like some of the University of New South Wales is forms of promotion, naturally people are personal digital assistant (PDA) gadgets bracing itself for a rowdy reception for asking how it will really affect the that many get-ahead young people carry BAT led by Mr Sigi Butt, who enthu- tobacco companies. Does the fairly nowadays. Opened out, it holds 13 siastically urges students to sign up with unconcerned image they project mean cigarettes on one side and seven on the BAT to help kill thousands of they have worked out sufficient ways of other. What health campaigners are Australians each year while making lots getting round the national bans that most concerned about, in addition to on September 24, 2021 by guest. Protected copyright. of money. should ensue to keep pushing their this new level of absurd glamourisation Mary Assunta and I accompanied Sigi products, especially to the young, or of an addictive and lethal product, is to the Macquarie careers fair, and before have they done deals with some coun- that the cigarettes’ strong fruit flavour being evicted by some rotund security tries to get bans with built-in loopholes? may mask the retch inducing effects of

Tobacco companies continue to seek new ways of promoting their products to get around the restrictions imposed by the FCTC. Flavoured cigarettes are now being promoted in Brazil (left panel: Carlton Crema and Carlton Mint) and the USA (right panel: Kool Midnight Berry fruit flavour).

www.tobaccocontrol.com 106 News analysis inhalation among first time smokers, taken to court. Its outcome might help especially young ones. seal off one way tobacco companies may B&W says 45% of Kool smokers are think they can get round laws that in African American and 8% Hispanic, and due course should be spawned world- the Fusions range will be targeted at wide by the FCTC. Tob Control: first published as on 2 June 2004. Downloaded from hip, trend setting smokers, more heavily skewed to the Hispanic population, in bars and nightclub venues, with print Malaysia: racing ads appearing in publications such as round the hurdles Playboy and Vanity Fair.AB&W execu- Anyone who visited Malaysia in the tive called Mr Cremers, appropriately 1980s and who turned on the television (see below), was quoted as saying that set in their hotel room was likely to see the response from consumers was that more tobacco promotion than they had ‘‘This is a pack to be seen with’’. That ever seen before in a half hour of sums up much of what underlies health channel hopping. If they were there on officials’ objections, and conversely, is public health business, they had an no doubt why RJ Reynolds, which is in additional shock when they learned that line for acquisition by B&W soon, has Saturation tobacco promotion was very much in the country had banned tobacco adver- evidence at the recent Formula One motor race been trying similar brand extensions. tising on television. Ministry of health in Malaysia. The latest range, Camel Exotic Blends, officials would announce this with has Crema, apparently tasting like sincerity, though some of them would cream; Izmir Stinger, like a cocktail of admit that there were problems of But all that was a long time ago, and brandy and cre`me de menthe; Dark circumvention. Did these stem from now Malaysia has a strictly enforced Mint, chocolate and mint; and cross border television, which can be advertising ban, and frequent, strong Mandarin Mint and Twist, both citrus so troublesome to a tobacco control anti-tobacco rhetoric from government flavoured. It had already launched leader with less enlightened neigh- ministers. So when Formula One nego- Camel Turkish Jade in 2001, with bours? No, the ads were on Malaysian tiated the introduction of this new Mandarin Mint, Creamy Mellow Mint, TV, but were not for cigarettes at all, but spectator sport in Malaysia, with the Light and regular Mellow Menthol for those well known but impossible to construction of a brand new racetrack in blends. obtain products such as Marlboro and Kuala Lumpur, it was bound to be In Brazil, BAT has been even bolder Kent holidays, or Camel clothing. In interesting to see how the health min- http://tobaccocontrol.bmj.com/ with a new extension of its Carlton those days, no tobacco control advo- istry would fare against the tobacco brand. Souza Cruz, its local subsidiary, cate’s conference presentation was com- industry. Could it prevail in preventing has launched Carlton Crema and plete without slides or video clips this most tobacco saturated, adrenalin Carlton Mint, both with flavours, strik- showing how tobacco companies were loaded burst of show business from ing new packaging, and a printed insert. exploiting Malaysia and its innocent undermining its laudable efforts to The insert seems designed to flatter government. educate people about the realities of smokers who would like to be consid- ered sophisticated, with notes on the origins of the world ‘‘mint’’, for exam- ple, and the history of vanilla for Crema. They make ample use of words such as

‘‘refreshing’’, ‘‘perfume’’, ‘‘sweet’’, and on September 24, 2021 by guest. Protected copyright. ‘‘smooth’’. Each insert ends with the slogan, ‘‘Carlton, a rare pleasure’’. The packs also have a semi-clear plastic cover on the outside: on Carlton Mint, it is green with a mint leaf, while Crema’s is cream coloured with a coffee and cream image print. These wrappings also carry the government health warn- ing images—not necessarily the same as the photograph on the actual pack, but frequently one with less impact. For example, in one case, the image on the pack reflected a person being resusci- tated from a heart attack, but that on the plastic wrap showed a couple with problems caused by the smoking man’s bad breath, an image the government has decided to replace because evalua- tion has shown it to be ineffective. Public health authorities in Brazil, the region’s leader in tobacco control, view USA: Life or Death playing Cards in California, USA produces health promotion playing cards the inserts as advertisements circum- containing health messages targeted at young people. Each of the cards features a different cartoon venting Brazil’s legislation, which only character alongside a reason not to smoke, or take drugs—Life Playing Cards and Death Cigarette Playing Cards deal with smoking, and Drugs Playing Cards with drug use. The cards are available permits printed tobacco ads in the to view or purchase from their website (www.deathcards.com), or for a free sample pack contact internal area of points of sale. It is to Life or Death Playing Cards, PO Box 3134, San Luis Obispo, CA 93403, USA; tel +1 805 545 be hoped that if they are right, a case is 9625; fax +1 805 542 0860.

www.tobaccocontrol.com News analysis 107 smoking, and to protect them from trucks, to plinth mounted, spot lit racing US$1 million, he said, and it had taken grossly misleading images about cigar- cars, and even three Dunhill cars to be over the entire Park Inn International ettes? From the outside, at least, it given away, pre-painted in the brand’s hotel for the weekend. But this is small seems that the ministry tried. It was colours, to the lucky winners of a prize money in the scheme of Big Tobacco’s reported to have sought assurances that draw. Entry to the draw was the same as Formula One spending: Marlboro’s Tob Control: first published as on 2 June 2004. Downloaded from there would be no brand promotion, to the party: a form had to be completed Ferrari team is estimated to get around and eventually to have received them. that captured personal information for US$150 million a year, and the others The trouble was, with that old inno- BAT’s future direct marketing. up to another US$200 million between cence in danger of turning into gullibi- A similar price was paid by those them. lity, it believed the assurances. When entering the Marlboro zone. Entry was As for the race itself on the Sunday, the big event, Malaysia’s first on the supposed to be restricted to the usual 18 most notable was an entire stand, Hill Formula One circuit, actually took place, years and over—no doubt the restriction Stand G, which the organisers had filled it was nothing less than a three day orgy of branding to within the events would with students—to get more young peo- of pro-tobacco hype: not a shred of be the companies’ and the government’s ple interested, involved, and able to tobacco promotion had been sacrificed. defence—but witnesses were unani- experience firsthand this new sport. For the tobacco companies, it must have mous in pointing out that ages were Although they probably forgot to men- been a triumphant justification of the never seen to be checked. In any case, tion it to the government, they will also decision of Formula One, which they the promotion was so over the top that have wanted them to experience the effectively control, to pull out of some of any such nuance seemed utterly irrele- lightning fast cigarette packs on wheels those stuffy old countries that had vant. In addition to the large scale driven by young heroes who are the clamped their efforts to push cigarette attractions mentioned above, the events modern day cowboys of tobacco promo- promotion to the ultimate boundaries of were awash with attractive handouts tion—tough, fearless, macho, indepen- possibility. promoting the brands—free coasters, dent, glamorous—you name it, as long Mere words will not convey what eye ashtrays, banners, promotional mobile as it is positive and seductive, and as far witnesses experienced. An atmosphere phone downloads, and competitions as you can get from lung cancer, of excitement, festivity, and celebration offering the opportunity to win branded emphysema, and heart disease. was generated by banners, flags, huge prizes such as computer games, to name So now we know how tobacco com- video screens, music and disco events, a but a few; and there was smoking, panies and Formula One see life beyond plethora of kiosks, all with staff decked everywhere. Almost everyone in the the European Union ban that looms in a out in their brand’s colours, some of events was young, and almost all were couple of years. How it squares with

them students hired just for a day, or a smoking. what ought to be implemented under http://tobaccocontrol.bmj.com/ night—some of the events, such as the Dunhill, Marlboro, West, Lucky the FCTC is unclear; but as the event Dunhill party on the Saturday night, Strike, and Mild Seven—half the had to be approved by the health went on into the small hours of the next Formula One teams are sponsored by ministry, and since there was supposed day. At the ‘‘Regenerate Red Zone’’, tobacco and they were all there, and all to be no direct branding present at the Marlboro’s extravaganza held the same at it, big time. Tobacco companies do event, it seems that what took place did night, Marlboro girls were everywhere, not knowingly throw money away, so not constitute direct advertising and in knee high red leather boots, red the importance to them of this sort of branding under Malaysian law. If this miniskirts, and white Marlboro tank unrestrained promotion can be judged is the size of coach and horses that can tops. At every event, the dominant from what a BAT official told one visitor be driven through one of the more cigarette brand had its vehicles, lots of to the Dunhill party. The one night sophisticated Asian country’s legisla- them—from sports utility vehicles and event had cost the company around tion, it does not bode well for the future. on September 24, 2021 by guest. Protected copyright.

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