USA: the Battle for the Bars

6 Tob Control: first published as 10.1136/tc.12.1.6 on 1 March 2003. Downloaded from Newsanalysis......

USA: the battle for The effectiveness of TIM is not in question, yet this new strategy speaks the bars directly of the continued deception There is a growing wave of public sup- associated with the tobacco industry. port for greater restrictions on smok- We followed the development of TIM ing in public venues, but of all the dif- in Albuquerque, beginning with the ferent types, exceptions are often recruitment of clandestine smoking made for bars. The usual arguments “hipsters” who surreptitiously peddle against smoking bans—fears of de- tobacco products to unsuspecting creased profits, the rights of proprie- young adults, and tracked weekly tors to choose whether to permit tobacco industry penetration into the smoking, the rights of individuals to market using a free alternative publi- smoke, for example—can be applied cation. equally to bars as to restaurants. We By the early 1990s tobacco industry believe other forces are at work. executives were under intense pres- Research from a variety of sources sure from anti-smoking advocacy shows the tobacco industry has in- groups. Education efforts had in- creased its use of bars and clubs as creased awareness among consumers promotional venues (see Tobacco Con- about the illusions in traditional to- This front page comment from the Murdoch trol 2002;11:94–104). Smoking restric- bacco product advertising. Facing de- press in New York on Mayor Bloomberg’s clining sales, the industry began look- hard hitting ban on smoking in almost all tions in these areas deprive cigarette public places speaks for itself. makers of critical marketing tools in ing for a new approach. TIM an era when they are blocked from acknowledges: “Shoving products in the face of the consumer is no longer read to follow the trends. These media using most forms of mass market vehicles are a critical part of the advertising. There are economic incen- the successful way to infiltrate this market. Today’s ‘Generation X’ con- network to help the spread of tives for bars and nightclubs, but not trends . . . These free periodicals are sumer is most influenced by what he http://tobaccocontrol.bmj.com/ restaurants, to continue this relation- distributed at most trendy nightclubs ship. or she sees in the hands of friends, not by some stiff riding a horse in a maga- and are found in the stores and coffee- More importantly, the tobacco in- houses that the club crowd fre- dustry collaborates with the alterna- zine advertisement.” The key element of TIM is to quents . . . Aligning Camel with certain tive press to reach young adults who publications by way of advertising frequent these establishments. It is conduct the aggressive promotion cov- ertly. “The minute someone blatantly lends immediate hip credibility to the recognised today that smoking restric- brand.” pushes ‘trendy,’ it’s not. Trend Influ- tions encourage people to quit—or at Most US cities have alternative pub- ence Marketing is underground. For least reduce cigarette consumption. As lications. These tabloid-type newspa- this program to be executed properly, such, public health ordinances present pers are generally free to the public, we as a marketing company will a serious threat to the profit margins widely distributed, and published on a appear almost invisible. Nothing that of tobacco companies, drinking estab- weekly basis. Alternative publications takes place can appear sales-oriented on September 29, 2021 by guest. Protected copyright. lishments, and alternative publica- are willing partners to this public tions. and everything we do will be perceived deception. The Albuquerque publi- Secret internal 1994 documents as cool. The objective is to have cation runs a self promotion claiming from RJ Reynolds (RJR) describe the ‘hipsters’ feel as though smoking their publication is “The Best Paper industry’s strategy to use alternative Camel is their idea, that they started Money Can’t Buy”. Many young publications to manipulate the prefer- the trend.” people under age 18 read the weekly ences and behaviour of American In RJR internal papers, executives editions, as the publication “targets youth. This involves a new marketing emphasised that to reach the hipsters every generation, from the Baby ploy referred to as Trend Influence we must “speak their language, dress Busters to the Baby Boomers. Distrib- Marketing (TIM). TIM abandons their dress, and walk their walk”. The uted throughout Albuquerque, Rio standard advertising campaigns and original RJR strategy is entitled Rancho, Corrales, East Mountain, Ber- jumps directly into the arena of trying “Camel Club”. KBA Lifestyle Market- nalillo, Placitas, Santa Fe and Los to “become the trend-maker”. RJR and ing, which developed the programme, Lunas”. The publication is “available at Philip Morris utilise TIM to increase added: “We will be recruiting our field restaurants, grocery stores, college the popularity of Camel and Marlboro marketing staff from the ‘inside’: campuses, select retailers and various cigarettes, respectively. people who have worked in and downtown locations. Coverage in- around the nightclub/bar business and cludes politics, humor, film, opinion, trendy community.” music, art and the most comprehen- All articles written by David Simpson unless TIM efforts are reinforced by savvy, sive entertainment guide in Nuevo otherwise attributed. Ideas and items for localised alternative media campaigns. Mexico. Arriba!” News Analysis should be sent to David Simp- RJR executives noted: “There are many There are frequently numerous TIM son at the address given on the inside front cover local, national and international news- advertisements per issue. The alterna- papers and magazines that hipsters tive publication has become the home

www.tobaccocontrol.com News analysis 7 base for modern tobacco marketing. fered articles with equally positive and consumers, are still a big part of the Tob Control: first published as 10.1136/tc.12.1.6 on 1 March 2003. Downloaded from Although the health community has misleading titles—Playing it safe, Re- tobacco industry’s marketing plan. succeeded in blocking Big Tobacco’s sponsible production, and Greening Commonly called “power walls”, these encroachment into traditional mar- tobacco, respectively. rows of tobacco products are found in kets, we are falling behind the collabo- How very reassuring, then, to find stores across Canada and in many rative efforts between the tobacco that in Fiji, a country so small that any other countries. These displays are in industry, bar and nightclub owners, big tobacco company might be clear view of children, placed next to and alternative press. tempted to think it could buy its confectionery, and reinforce the idea In the southwest, TIM promotion respectability there with the greatest that smoking must be both very represents an aggressive form of to- of ease, BAT got possibly the most common and socially acceptable. bacco marketing. The “iron triangle” robust and appropriate response of any In June 2001, the province of Sas- formed by the tobacco industry, bar in the world. Health minister Pita katchewan tabled legislation to ban and nightclub lobby, and alternative Nacuva cancelled a meeting with BAT tobacco product displays in public press forms a powerful political oppo- officials, due to include non- areas where young persons are permit- nent. We must recognise this new government organisations and church ted access. threat and confront the growing influ- representatives, accusing the company A group proclaiming themselves to ence of this coalition in the political of unscrupulous advertising and pro- be “poor” retailers mounted an expen- arena. The “Battle for Bars” symbolises motional activities. “I would like to sive campaign urging retailers to op- more than private versus public know whether this implies that selling pose the legislation. Not to be outdone, intervention—it embodies the latest death and diseases is legitimate,” he the provincial health coalition coun- layer of tobacco industry deception mused, a tad rhetorically, one suspects. tered with an information and lobby- where we must fight for the minds and BAT’s local panjandrum described ing campaign of its own. The retailer health of America’s young people. For the cancellation as “disappointing”— group later admitted to being part of a a detailed review of TIM strategy, visit: well, he would, wouldn’t he? Con- tobacco industry coalition. http://www.tobaccofreedom.org/ gratulations minister; you are a model In July 2001 the Tobacco Control Act issues/specials/alibi for public health colleagues world- was unanimously passed by the pro- wide. vincial legislature and became law in SCOTT GOOLD InfoImagination, Albuquerque, New Mexico, March 2002. According to enforce- USA; [email protected] D SIMPSON ment officers, implementation has gone smoothly. Compliance and ac- ceptance are high and there have been Fiji: finger for BAT Canada: no significant problems economically Many readers will have been nause- or otherwise. No tobacco products can demolishing the http://tobaccocontrol.bmj.com/ ated by reports generated from the now be publicly displayed at retail out- publication of British American Tobac- power walls lets in the province, thus ensuring that co’s (BAT’s) first “social report”, part of Traditional forms of tobacco advertis- the availability of these products more its massive self rehabilitation exercise. ing are banned in Canada, and likely to adequately reflects their deadly na- Even the mere linking of a tobacco stay that way after a landmark ruling ture. company’s name to the concept of cor- last December from the Quebec Supe- In May, Rothmans Benson & Hedges porate social responsibility in a glossy rior Court dismissing a constitutional Inc, part of BAT, reacted to the loss of document, while absurd to most challenge from the cigarette compa- this last avenue to market to youth by people, seems enough to fool others nies. However, extensive rows of ciga- launching a lawsuit. The province’s into thinking it has changed its ways. rette packages, in quantities far minister of health, the Hon John On all the issues that really matter, greater than are necessary to supply Nilson, observed: “Our legislation

BAT’s social report is either cosmetic, on September 29, 2021 by guest. Protected copyright. evasive or deceitful, as Clive Bates of the UK’s Action on Smoking and Health commented. “What is shocking is the gullibility of some parts of the ethical investment and corporate social responsibility community. They have blindly lapped up the glossy report and soothing PR without both- ering to test if they are in any way related to BAT’s real-world operations.” One truly emetic response appeared in the UK, BAT’s home country, from the lofty sounding Institute of Busi- ness Ethics. An entire issue of its publication Ethical Performance was de- voted to a company focus on BAT, most of it reading as if penned by the company’s own PR staff. Page after designer polished page of lavishly illustrated articles, under headings such as Safer products, Supply chain monitoring, and Environment, prof- A “power wall” of tobacco products.

www.tobaccocontrol.com 8 News analysis Tob Control: first published as 10.1136/tc.12.1.6 on 1 March 2003. Downloaded from

Students in Thailand pass a no smoking sign.

breaking down the industry’s negative, well funded strategies of negligence, diversion, and delay. In short, the task is confronting and taking apart a complex hidden agenda supported by vast resources. So far so good, but the race is increasingly a case of constantly In this shop, a “power wall” has been replaced by closed cupboards. having to win the next victory, whether on November 8 or other dates must be working if this tobacco com- Control 2001;10:48–54). While a quick each year, despite a continuous stream pany is suing us . . . The Government of survey shows tremendous strides for of obstacles from the tobacco industry. Saskatchewan will defend The To- tobacco control, the tobacco industry bacco Control Act from this attack. We has quietly gained ground in many STEPHEN HAMAN will continue to prevent tobacco com- areas, too. Rangsit University, Bangkok, Thailand; [email protected] panies from displaying tobacco prod- The industry has been able to limit ucts that encourage people, especially Thailand’s efforts to monitor tobacco youth, to smoke.” The legal challenge control indicators, gained policymak- Japan: smoke was dismissed in September, but appli- ing friends and slowed or disabled http://tobaccocontrol.bmj.com/ cation to appeal was granted the important tobacco consumer protec- clouds over the land following month. As with other meas- tion efforts. For example, the ingredi- of the rising sun ures aimed at reducing smoking, the ent disclosure requirements did not To western observers interested in tobacco companies never give up the result in direct consumer disclosure of tobacco control policy, Japan is a fasci- ﬁght. Nor, given the health issues ingredients. While the pictorial health nating anomaly. Despite its extraordi- involved, will Saskatchewan. warnings on cigarette packs are ap- nary achievements in manufacturing The banning of tobacco product dis- proved and will eventually be in place, and technology, coupled with its high plays is a new wave in tobacco control. processes like this are often unneces- levels of education and research, and Similar legislation has been passed in sarily delayed. Tobacco industry docu- an economy that until a recent blip, Iceland, Ireland, the Canadian prov- ments from court actions make it clear probably only temporary, has been a ince of Manitoba, and is being consid- that the transnational tobacco compa-

world leader, its smoking rates have on September 29, 2021 by guest. Protected copyright. ered by other Canadian provinces and nies working in Thailand have been been sky high, with subsequent dis- Australian states. able to gain many allies among politi- cians, circumvent or flagrantly violate ease levels to match. In many ways, to LYNN GREAVES advertising laws, and influence the a westerner it is rather like a Germany Saskatchewan Coalition for Tobacco nature and extent of research on of the East. Reduction, Canada; tobacco, by providing money or sup- Two decades ago, Japan had the [email protected] port to major research institutes and highest male smoking prevalence of influential academics in Thailand. any industrialised country, at around Thailand: victories These three strategies, together with 80%, but an almost negligible preva- corporate sponsorship and philan- lence among women. Then came the and defeats in the thropy, have slowed progress in to- invasion of American tobacco compa- bacco control. nies led by the US Trade Representa- long war A recent newspaper editorial in sup- tive in 1985. Along with Thailand, Tai- November 8 is a date of special signifi- port of tobacco control in Thailand wan, and South Korea, Japan rolled cance in Thailand, as it is both the date challenged tobacco control agencies to over and modern tobacco promotion of official funding of ThaiHealth in do more to achieve a rapid decline in began. Until then, the Japanese to- 2001 and the effective date in 2002 of the total number of smokers. Tobacco bacco monopoly (ironically, in view of new restrictions banning smoking in control advocates and organisations Japan’s high incidence of hypertension public places, including air condi- are seriously pursuing these end and stroke, it was called the Japan tioned restaurants. A previous article points as well as intermediate goals. Tobacco and Salt Public Corporation) has highlighted that the adoption of Nonetheless, building an infrastruc- had been supplying a large and eager the health promotion fund is a crucial ture of positive tobacco control pro- male market but had desisted from milestone for tobacco control (Tobacco grammes takes some time. It requires what must have so attracted the

www.tobaccocontrol.com News analysis 9 foreign invaders—the almost totally the government sells its majority Tob Control: first published as 10.1136/tc.12.1.6 on 1 March 2003. Downloaded from non-smoking female half of the popu- shareholding in JT, something it is lation. A wind of change was in any pledged to do but has put off until the case blowing through Japanese soci- share price, hit by the recent recession, ety, with increasing numbers of young makes a significant recovery. women not only having significant Advertising and promotion has con- disposable incomes—it is still quite tinued to flourish. From the early common for young working women to onslaught by Philip Morris, including live with their parents until marriage, its notorious exploitation of the 1980s usually later than their western Japanese cult for James Bond movies, counterparts—but traditionally strict in which the company’s Lark brand attitudes to women’s behaviour were was contracted into a movie playing to softening. What better way for tobacco sell-out young audiences, tobacco pro- companies to recruit them than by motion has steadily developed, nowa- somehow exploiting this new mood of days with full participation by JT, into liberation? Just as in many emerging, something much more recognisable to fast growing developing countries, the western eyes. Uncannily familiar, in potential to nearly double the market fact—due to Japan’s unique, strong by recruiting women to smoking must cultural traditions, ads for products have been the western tobacco compa- that may be seen as controversial or nies’ dream come true. embarrassing tend to use western Within a decade, smoking rates models. For example, billboard ads for women’s underwear, a fairly essential among young Japanese women had A Japanese advertisement for the Bevel commodity in Japan as elsewhere, shot up, well on the way to those of brand of cigarettes, using a western model. show western women rather than young western women. Then, in 1999, their Japanese sisters. Tobacco ads tar- Japan Tobacco (JT), as it was now bacco is its approach to the Framework geted to women follow the same called, bought the non-US business of Convention on Tobacco Control. The line—about the only sign of any reser- RJ Reynolds. This catapulted the com- ministry representing Japan in the vation by society about the plethora of pany, still two thirds owned by the negotiations has been the ministry of seductive ads clearly designed to ap- state, into the same league as the peal to girls and young women. finance—the health ministry had newly merged BAT and Rothmans, Other forms of promotions to mere observer status on a committee making it second equal in size after women are more subtle, if more assembled to inform the government’s Philip Morris. Added to the existing negotiating position. True, one mem- devious. Last year, Salem ran a promo- http://tobaccocontrol.bmj.com/ high smoking rates—though men tional package of two packs of Salem ber of the committee was a scientist, were beginning to quit—the potential cigarettes, an unmistakably girlie, but he had a track record of research for serious tobacco control was dealt a pocket sized pink powder compact, on addiction for JT. The chairman severe blow, as the government was and a booklet of special offers. It himself was a cardiologist, with no now swung sharply to the side of showed a wide range of household known tobacco connection, but unfor- tobacco. goods, of typically fine and attractive tunately, Japanese tradition demands Japan therefore suffers more than Japanese design, available to those that the independence of the chair is its fair share of that unsatisfactory young women lucky enough to buy the observed scrupulously, so that those dichotomy common to many govern- pack. Not surprisingly, some of the chairing committees cannot make ments, whereby the ministry of fi- same young schoolgirls who can be known their views. Other committee nance, unaware or unconvinced that seen experimenting with make-up as members included a stockbroker, rep- tobacco tax rises can increase revenue they dawdle back home after school resentatives of tobacco retailers and on September 29, 2021 by guest. Protected copyright. while lowering consumption, is by far can now be seen smoking in the street, farmers, and a steel company execu- the most powerful ministry, and resists too. tive. any policy that might reduce con- Perhaps the greatest give-away of Whatever some officials in the sumption. In fact, whatever the fi- the government’s enslavement to to- health ministry might wish to do, nance ministry might want to do, as then, taking a strong lead in tobacco majority owner of JT it is legally bound control is simply not possible while the to defend its huge investment. Con- government remains the majority versely the ministry of health, always shareholder in JT. Non-governmental low in any country’s cabinet pecking organisations (NGOs), however, are order, became relatively lower still, becoming more active. Japan has condemned to a weary cycle of trying always had some active NGOs working to develop policies that might actually on tobacco, as well as a number of reduce future disease levels, then individual activists, but while the watering them down progressively as larger medical charities have tended in the ministry of finance, no doubt the past to stick to safer topics such as advised by its charges at JT, ensures cessation and youth education pro- that nothing that could seriously affect grammes, recent years have seen signs it is ever implemented. Most official of change. The Japan Cancer Society, health initiatives, despite some valiant for example, which in the past mainly attempts, end up with a noticeably soft Salem special offer pack targetted at the concerned itself with screening, is now young female market in Japan, containing “advisory” flavour. The only hope of two packs of cigarettes, a powder compact, moving towards primary prevention. health prevailing over tobacco is when and a booklet of special offers. Half a dozen organisations, including

www.tobaccocontrol.com 10 News analysis cancer and heart charities, founda- mainly physicians and scientists. The Tob Control: first published as 10.1136/tc.12.1.6 on 1 March 2003. Downloaded from tions for maternal and child health, two turned out to be George Leslie, and the anti-tuberculosis association, heavily involved in organising industry have been working together within an sponsored conferences on indoor air NGO council for tobacco control. quality, including some in the Far East; More recently, the Japan Medical and John Hoskins who edited Indoor Association (JMA) and the Japan Air International (now Indoor+Built En- Nursing Association have both become vironment of the International Society much more active on tobacco. Last of the Built Environment) in the days year, for example, the JMA translated when seemingly all the board were Doctors and tobacco, the action guide for industry funded. Will they now be medical associations and their mem- Sri Lanka: With another tobacco promotion penning papers to show that pollution bers, and used it to hold well attended where luxurious prizes beyond the dreams of levels in cities such as London are seminars in several population centres, most ordinary people are offered to smokers, really the cause of much of the disease including one at the headquarters of BAT clocks up a new Hall of Shame entry in Sri Lanka, where this John Player Gold Leaf blamed on smoking? Watch this space. the JMA in Tokyo. It was encouraging in-pack prize scheme to win an Alfa-Romeo to find that much progress has been car was running at the end of last year. D SIMPSON made in recent years by modest yet highly active leaders in the national and regional medical associations. science based public places campaign Hong Kong, China: They have surveyed doctors’ smoking might have been expected. However, return of the butt rates and attitudes, as well as making the politeness for which Japan is so medical association premises smoke- deservedly famous is, for tobacco con- people free. Doctors’ smoking rates, while trol, a two edge sword. On the one There’s something rotten in the Special high for such an advanced society, are hand, it means that when there are no Administrative Region. Having pro- now coming down (from a 1999 level smoking areas, in public transport and gressed from almost zero tobacco con- of around 27% for men, 7% for certain other (though too few) public trol 20 years ago to being a regional women), and there is increasing inter- places, they tend to be scrupulously leader with a comprehensive tobacco est in tobacco control. observed; on the other hand, in terms control policy by the time it was Japan has about 260 000 doctors, of of ordinary members of the public handed back to China in 1997, Hong whom around 60% belong to the JMA. asserting their right to breathe smoke- Kong is beginning to look decidedly Public health, one of the natural pools free air, Japanese people must be vulnerable to the ever present threat of of leadership on tobacco control found among the most reticent in the world, attack by the tobacco industry. Most in other countries, has almost no at the opposite end of the spectrum sinister is the frequent appearance of http://tobaccocontrol.bmj.com/ system for qualification in Japan, even from the non-smokers of the USA people infamous for their previous though it is a recognised medical whose constant and assertive de- service to the industry, in new ap- specialty. So far there is only one mands have proved so potent. pointments not just in government, school of public health, part of Kyoto There are signs that coalitions of but in the health sector. University, which opened two years anti-smoking groups will coalesce into For example, the University of Hong ago. There is a growing demand to get a more powerful force, and there is a Kong’s medical faculty, whose depart- smoking cessation counselling in- growing demand for training. There is ment of community medicine is a cluded among services for which doc- likely to be a record Japanese contin- world leader in research on the effects tors are reimbursed, with all the gent in Helsinki this summer. We must of smoking on health, has accepted related problems of quality control and hope that Japan’s economy allows the free public relations services from government to sell its JT shares, and assurance of the delivery of an effec- Brenda Chow, the former Tobacco on September 29, 2021 by guest. Protected copyright. tive service. As in other countries, begin the serious business of hands- Institute chairwoman and local public many clinicians routinely try to get on, health driven, comprehensive to- affairs director of BAT. The dean of the their patients to quit, and some feel bacco control. medical faculty, Professor Lam Shiu- that their colleagues should do the kum, told staff in a memo that the same whether or not they are reim- D SIMPSON university had invited her to organise a bursed. Meanwhile, in the business series of media workshops, describing world, employers are increasingly real- Where are they Ms Chow as a “renowned and experi- ising the benefits of getting smoking enced PR consultant”, but failing to employees to quit, and making work- now? mention her tobacco industry back- places smoke-free. What happens to scientists and others ground. In Japan’s often smoky public revealed by tobacco industry docu- And he certainly made no mention places, too, there is progress, even if ments to have been agents for the of her being not so much renowned, the most publicised smoking ban brown army? Readers are invited to but notorious in the eyes of most pub- recently, on certain busy Tokyo streets, submit their modern day discoveries of lic health professionals, for a long his- was motivated by people, especially those names familiar to us from the tory of the very worst sort of industry- children, being burned by the glowing tobacco papers. Meanwhile, here’s one speak in the mass media. “Smoking cigarette butts of careless smokers to ponder. At a conference last Decem- may be a risk factor [for cancer], but rushing by. Seeing that the epidemiol- ber to mark the 50th anniversary of that doesn’t mean cause,” she said in ogy of passive smoking and lung the great London smog, two figures 1989. “There’s no point in carrying on cancer began life in Japan, with the were seen huddled together, appar- [with health warnings] when people late Professor Takeshi Hirayama’s 1981 ently reluctant to socialise with the know about it.”She did not neglect the pioneering study, a more sustained, more than 200 other delegates present, more traditional industry mantras,

www.tobaccocontrol.com News analysis 11 such as “Advertising is not a signifi- Tob Control: first published as 10.1136/tc.12.1.6 on 1 March 2003. Downloaded from cant factor in encouraging youngsters to begin smoking”. In 1992, she eulogised about colourful tobacco ads making Kai Tak airport the jewel it then was “ . . .essential ingredients in the local landscape”. In 1997, she greeted the total tobacco ad ban in the final round of legislation of the colo- nial government as “ . . .five steps backwards”. By 2001 she was on to addiction: “If nicotine is so addictive, how come the nicotine patches do not sell? Tobacco is an easy target. People jump on the bandwagon.” She also opposed rises in tobacco duty and government funding for the Council on Smoking and Health (COSH). In short, she seems to be the sort of person who, on the face of it, would be about as welcome in a medical faculty as the proverbial rattlesnake in a lucky dip. In Pakistan, the Agha Khan university in Karachi has been playing an important role in Some months earlier, the govern- educating society about tobacco, in this case, by organising a well attended march, complete with thought provoking posters for World No Tobacco Day last May. ment appointed Sarah Liao Sau-tung as secretary for environment, transport and works. She had been a Philip Then there is the case of Mr Lee Jark- Chow herself. “Smoking is a complex Morris consultant on passive smoking, Pui. He served as executive director of social phenomenon,” it began. “It is receiving an estimated HK$1 million the Hong Kong Tobacco Institute for the government policy to introduce (US$128 000) in 1990 from the largely seven years until 1994, but is currently a tobacco control measures in a step-by- tobacco funded Centre for Indoor Air member of the Hospital Authority step approach . . .”and after a few more Research to study air quality in Hong Board, on which also sits Professor Lam sentences of child level explanation of Kong. Her co-researcher, John Bacon- Shiu-kum. Aside from this apparently government policy, and reiteration of Shone, has also been named as a careless lack of discrimination in public the department’s commitment to edu- http://tobaccocontrol.bmj.com/ tobacco consultant. Both deny know- sector appointments, a succession of cate the public not to buy illicit ing that the tobacco industry was the attempts by tobacco companies to fund tobacco, it ended: “We appreciate the source of the funding, but an industry educational programmes of the “We’ve perception problem you raised and lawyer said he told Ms Liao. Perhaps changed!” variety have been rumbled wish to assure you that we will take she forgot. and in some cases prevented. But that into account when planning our tobacco is a many headed Hydra and no future educational efforts.” Perception doubt other schemes get through, big problem? Is this a new style euphe- and small, before anyone realises their mism from the industry stable? With provenance. government departments like this, An unexpected and singularly inap- what need has the industry of friends? propriate alliance between tobacco and D SIMPSON

the government popped up last Novem- on September 29, 2021 by guest. Protected copyright. ber, when health advocates were ap- palled to see advertisements by the Doctors’ manifesto Customs and Excise department urging In 1951, British researchers Richard the public not to smoke contraband Doll and Austin Bradford Hill began a cigarettes and to shop anyone they study that provided convincing evi- thought was involved in smuggling. Not dence that the great majority of lung surprisingly, COSH ﬁred off a letter cit- cancers were caused by smoking. The ing a review of over 160 reports from subjects of their study were some the media, governmental and other 40 000 British doctors. Now, 50 years sources worldwide on the issue of after that study, there is another tobacco industry involvement in smug- historic opportunity for doctors to gling. It added a clear reminder that if make use of their unique position. an ongoing investigation resulted in In the British Medical Association prosecution of tobacco industry players, publication Tobacco under the microscope, there would be severe embarrassment doctors examine the evidence, identify for the Hong Kong government arising best practice, and set out their mani- from this unhealthy new alliance. festo for global tobacco control. Some Customs and Excise advertisement in Hong Astonishingly, the response from 30 eminent doctors from around the Kong, indicating the dire consequences for the Customs and Excise department, world contributed to the manifesto, anyone caught smuggling cigarettes, which signed by one K Chow (presumably no is jointly supported by the Tobacco Institute and umbrella medical associations (whose logo appears in the bottom left corner relation), was written in terms that whose member organisations repre- of the poster). might have been drafted by Brenda sent more than 10 million doctors in

www.tobaccocontrol.com 12 News analysis

director general of the World Health Tob Control: first published as 10.1136/tc.12.1.6 on 1 March 2003. Downloaded from Organization, reiterated the important role of doctors in tobacco control. “Behind this manifesto lies an enor- mous amount of evidence, of science and of the personal experience of mil- lions of doctors who have watched their patients get ill and die from their tobacco addiction. When a physician speaks, most people take notice. So should policymakers.” By visiting the manifesto website (www.doctorsmanifesto.org) doctors and medical associations can sign up to the manifesto and contribute a state- 117 countries have pledged their sup- misleading claims that some cigarettes ment to the web based document. In port to it. Based on the evidence, it are safer than others; increases in the addition, online postcards can be sent focuses on the ﬁve measures that have price of tobacco through taxation; the on the key issues of tobacco control. proved most effective in the battle to protection of non-smokers from to- curb deaths from smoking, and which bacco smoke; and an end to all forms HELEN FREW doctors would like to see included in of tobacco advertising. SINÉAD JONES the convention: clear and informative Speaking at the launch of the mani- Tobacco Control Resource Centre, UK; pack health warnings; an end to festo, Dr Gro Harlem Brundtland, [email protected] The lighter side ...... http://tobaccocontrol.bmj.com/ on September 29, 2021 by guest. Protected copyright.