Tobacco Control 2002;11:171–175 Tob Control: first published as 10.1136/tc.11.3.171 on 1 September 2002. Downloaded from

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Hong Kong: than pocket sized mini-billboards. circumstances—occupation (teacher), Apart from the health warning, each genetic background, living con- Marlboro tries it on large face was largely covered in ditions—the panel concluded that the images of that universal symbol of disease was at least 80% attributable (the pack) independence who shores up the to smoking. Whenever a government announces morale of PM’s nicotine captives. Building on the traditional approach tobacco control measures which to- Reports from Hong Kong suggest to toxic torts, the panel tried to find bacco companies suspect will be effec- this was a classic trial run. Will they the fingerprint of carcinogens of tive, the companies’ first reaction, at get away with it? They did that time, it tobacco smoke. According to the best least in private, is to work out ways of seems. Will they be back? And if they forensic evidence, these can now be getting round them. Under self regula- can get away with it in Hong Kong, found in the genes of the victim, tion, they implement whatever will they try it elsewhere? Make sure contained in the victim’s cells collected and preserved at the time of hospital schemes they think will most com- your legislation is tightly drafted, then administration. More specifically, re- pletely negate the measures they have sit back and watch this space. just agreed to, and continue for as long cent scientific literature suggests that as they can get away with it. It costs there are different genetic mutations nothing to make a grovelling apology, Italy: court’s expert of p53 and K-ras genes in smokers, after all; and in extreme cases, it can be panel condemns vis-à-vis non-smokers. This might delivered with an air of bewilderment have interesting implications in the that the breach—an isolated lapse tobacco field of mass torts, tobacco as well as non-tobacco related. whose local perpetrator has been se- Stalteri vs. Monopoli di Stato is the verely reprimanded—could ever have The most frequent mutation affect- first tobacco product liability case filed ing smokers or former smokers con- been allowed to happen in the first in Italy (in 1994) and the second one cerns codons 12 and 13 of K-ras, with place. in Europe. On 13 March 2002 a panel the first nucleotides of codon 12 Under legislation too, something ad hoc appointed by the Civil Court of mostly affected (65%) in smokers who similar is seen; they simply try it on, Appeal in Rome released its expert develop adenocarcinoma to the lung. starting with a small tester, working witness opinion on specific causation, That mutation was found in the case of up through repeated violations, until concerning the case of the late Mario the late Mario Stalteri. The three finally the breaches of the letter or the Stalteri, a pack-a-day smoker who quit person expert panel concluded there- spirit of the law become so outrageous smoking in 1987, four years before the fore that “a serious and reasonable cri- that they risk hitting the buffers of manufacturer issued the current terion of probabilistic evidence con- http://tobaccocontrol.bmj.com/ enforcement—legal sanctions that ac- version of warnings. Given the firms that smoking has been a tually hurt. The ideal is to cruise along just this side of enforcement, which in many countries is all too easy to do, either because of the effort required to go to court with a prosecution, or because of the equally tiresome effort of tightening up the legislation. In Hong Kong, China, with a near total ban on tobacco promotion, Philip Morris must have noticed that the on October 1, 2021 by guest. Protected copyright. detailed regulations specifying what has to appear on a cigarette pack had omitted to specify all the things that the government must have intended should not appear. All those positive images linking Hong Kong’s biggest preventable cause of premature death with macho cowboys, for example, whose banishment was the whole point of the ad ban. So it was perhaps no surprise that early this year, a range of Marlboro packs hit the streets of Hong Kong that were nothing less

All articles written by David Simpson unless otherwise attributed. Ideas and items for News Analysis should be sent to David Simp- son at the address given on the inside front cover. Images on packs of Marlboro sold in Hong Kong: “pocket sized mini-billboards”.

www.tobaccocontrol.com 172 News analysis Tob Control: first published as 10.1136/tc.11.3.171 on 1 September 2002. Downloaded from sufficient and adequate causation of as follows: ‘Yes,we agree that smoking The Rodin letter continued: “For the the specific cancer”. cigarettes, including our brands, time being, we are creating a database The next procedural step will be the causes lung cancer and other serious on all national and international pre- decree by which the Court of Appeal diseases in smokers.’” vention projects, more specifically pri- will accept or reject the evidence This seems to be yet another layer of mary prevention and especially to- submitted by the panel. In the Italian the onion that has been removed from bacco prevention among youngsters. legal system the latter event is rare. the game that British American Tobac- The purpose of this scientific research co’s Australian chairman in 1997 once is to give scientific support to other MARCELLO STALTERI described as “a charade”. So what does organisations and federate [sic] initia- Università di Firenze, 50100 Firenze, Italy it mean? Philip Morris and all tobacco tives that fall within the scope of its CARLO LA VECCHIA companies continue to dispute each objectives and raise awareness among Istituto di Statistica Medica e Biometria, and every litigant’s claim on just that: politicians.” Slight overuse of the word Università degli Studi di Milano, 20133 that smoking their company’s brands “scientific” there, one might think, Milano, Italy caused lung cancer or other serious presumably dictated by the urgent diseases in a particular smoker. Yes, need to win the confidence of the SILVIO GARATTINI they agree smoking their brands can letter’s recipients that their replies Istituto di Ricerche Farmacologiche “Mario would be handled in a way that was at Negri”, 20157 Milano, Italy cause cancer in smokers . . .it’s just that they’ve never found a single instance once responsible and beneficial to where they agreed that this ever mankind. No prizes for predicting that PM: “We agree that occurred! Plus ça change, plus c’est la the science would be carried out même chose. according to the tobacco industry’s our brands cause standards, and that the principal ac- lung cancer in SIMON CHAPMAN tivities may closely resemble the well Editor, Tobacco Control known and totally inefficient youth smokers” prevention campaigns favoured by the Following an article I published in an Europe: Rodin’s big tobacco pushers. Australian newspaper in April, I re- ceived a letter from Philip Morris Aus- non-thinker South Asia: the tralia’s spin king Thomas Dubois, Just like CASIN (see “The Circumlocu- scolding me for not drawing readers’ tion Hall of Fame” below), the Belgian party goes on attentions to the company’s latest Rodin Foundation, whose strapline is As we know, international tobacco website position on disease causation “Analysing and taking action”, has companies are hard at work to rein- and smoking. I replied: “Many of my been contacting health agencies active vent their images, particularly in the colleagues understand the message on in tobacco control as if it had no west where people increasingly disap- your website to mean that Philip Mor- connections with the tobacco industry. prove of their activities. At the same ris agrees with the fact that there is Its unctuous approaches even included time, as we also know, their behaviour http://tobaccocontrol.bmj.com/ overwhelming consensus in the medi- a disarming if coy plea for us to make in the new markets of the developing cal and scientific community that allowances for the institutional equiv- world has not changed one iota, except cigarette smoking causes lung cancer alent of the innocence of youth. In a perhaps to intensify with each passing and other diseases. However, we be- letter sent to several organisations in month. lieve that this is no different to (for Europe, the following explanation was Pakistan has already been suffering example) the backpacker serial killer provided. “We are a very young organ- a sustained onslaught of tobacco pro- Ivan Milat saying, with hand on his isation and our activities have just motion clearly aimed at youth for heart, that he agrees that there exists started. We are based in Brussels and many years (see Tobacco Control an overwhelming consensus of evi- are funded by public and private 2001;10:93–4 and Tobacco Control dence that he killed seven young funds.” In fact the Rodin Foundation 2000;9:361, for examples). Have the people. This of course does not pre- has a contract with the tobacco manu- international tobacco companies on October 1, 2021 by guest. Protected copyright. clude him continuing to say, ‘I am facturers in the Belgian market and toned down their marketing recently, innocent of murder’. All he’s doing is will receive 1.85 million Euros in line with the new sense of corporate acknowledging that this consensus (US$1.75 million) annually over five responsibility they claim? Did they, as exists, just as PM is acknowledging the years. Any hint of this funding was perhaps only a hopeless idealist might consensus about smoking and health strikingly absent in the letter. The wonder, think it better corporate ethics among scientists. foundation says it is in favour of the to reduce their barrage of positive “So, to cut to the chase, without more “gentle” approach to tobacco images for cigarettes in view of the nail recourse to the shelter provided by control. As it stated: “Current re- biting, nuclear clouded tension over your company’s frankly robotic ‘desire sponses are of types such as prohibi- Pakistan’s dispute with neighbouring for a single, consistent public health tion, stigmatisation of users and those India over Kashmir, or its struggle to message’ (you’re all told to put this in around them, control measures, penal- house refugees fleeing from war torn these sort of letters, right?) would you ties, social exclusion, etc, while meas- Afghanistan? Of course we know the please answer “yes” or “no” to the fol- ures of assistance, support, assump- answer: absolutely no change at all. lowing question: ‘Does Philip Morris tion of responsibility, treatment and Increasingly, as in other parts of the agree that cigarettes manufactured rehabilitation, as much as they do region, tobacco companies are reach- and sold by Philip Morris cause lung exist, receive much less and increas- ing Pakistan’s adolescents via their cancer in many of those who smoke ingly piecemeal attention and re- heroes. Take Said, for example, a tall, them?’” sources.” Any resemblance to the “re- handsome television and film actor, Back came his reply: “In response to sponsible” Philip Morris approach is, adored by girls and sure to pull a your e-mail dated May 2, our answer is well, not entirely coincidental. crowd—a very young crowd—

www.tobaccocontrol.com News analysis 173 Tob Control: first published as 10.1136/tc.11.3.171 on 1 September 2002. Downloaded from stadium, cheekily embossed with the brand’s name, though executed, like the concept of the promotion, with scant regard for taste. Elsewhere in South Asia, too, the high tide of tobacco advertising has shown no signs of receding. In Sri Lanka, Philip Morris used a new trick in this region, attempting to exploit some of the most familiar, Hollywood friendly icons of grass roots American culture. In a colourful Marlboro pro- motion, entrants stood to win one of five classic American cars, an original Wurlitzer jukebox, the ubiquitous travel bag, or a “classic American” Zippo lighter. Togo: mobile frenzy

BAT has enlisted TV star Said to promote its as Bond goes in for Gold Street brand in Pakistan. the kill wherever he goes. He is known to mil- For most people in West Africa, the lions through his starring role in one thought of owning any sort of hi-tech of the country’s most popular televi- luxury goods is little more than a pipe- sion drama series. What a catch, then, dream. A competition to win one of 50 for British American Tobacco (BAT), mobile telephones, complete with an whose Gold Street cigarettes he has initial call charge credit, was therefore Marlboro promotional campaign bound to be a hit in Togo, a small been helping to promote. Interestingly, advertisements in Sri Lanka, in which entrants the brand bears a remarkable resem- could win a classic American car. country wedged between Ghana and blance to the colours and design of the Benin above the Gulf of Guinea, where company’s Benson & Hedges brand, a mobile telephone costs more than a using the same gold background to- image, everything on a Gold Street third of the average annual per capita gether with a similar font for the pack is in English—except for the gross domestic product. name. And in keeping with the inter- Urdu health warning. Earlier this year Godfrey Philips, a http://tobaccocontrol.bmj.com/ national companies’ use of western Not to be outdone, Red and White subsidiary of ever crafty Philip Morris, references to present an upmarket brand, made by a Philip Morris sub- came up with a promotion for its Bond sidiary, has run ads featuring a verita- Street cigarette brand, which exploited ble Alladin’s cave of desirable con- a popular misunderstanding. The sumer goods to tempt the would-be name Bond has near legendary status upwardly mobile—a sleek BMW among children, even those who do sports car, ultra slim laptop computers not attend school, thanks to the popu- and mobile telephones, as well as the larity of the James Bond adventure ubiquitous cigarette lighters—all to be movies. His special agent’s number 007 won in a promotion in February. Ads is to be found everywhere, especially appeared in journals such as The Crick- on children’s toys. Apparently, many on October 1, 2021 by guest. Protected copyright. eter, which covers the country’s most children mistakenly believe that any- popular sport, whose most ardent fans thing called Bond is associated with are teenage boys. No doubt Philip their hero. Morris would say that it was only tar- Just as Bond the agent always gets geting “young adults” who are, of the girl, played by an actress who was course, fully informed about the risks somewhat easy on the eye, so Bond of smoking. They could even point to Street the cigarette ran ads showing the health warnings on the promo- young men looking so happy, they tional ads, situated in the bottom left- must have just won either a phone, or hand corner of the ad shown here. the affections of the glamorous young Even in the original, it is so small as to woman beside them, or possibly both. be almost illegible. As with 007’s women, the models in Later in the year, to capitalise on the ads looked European, not African, World Cup soccer fever, Diplomat just as many other African tobacco ads brand, also from Philip Morris, linked feature Americans or Europeans. itself to the familiar range of toys for Entry to the draw was simple, and boys. In addition, for the three luckiest all over the country people rushed to Philip Morris ads for its Red and White winners, there was a whole kilogram brand, which appeared in the Pakistan sports buy the required pack of Bond Street. journal The Cricketer—a popular magazine of gold, not just your regular ingot, but Entrants were not just the young for teenage boys. a model of the World Cup soccer people who seem to have been the

www.tobaccocontrol.com 174 News analysis Tob Control: first published as 10.1136/tc.11.3.171 on 1 September 2002. Downloaded from I wrote to CASIN’s Danielle Ecoffey about the FCTC process. They are thor- asking, “Your letter to tobacco control oughly networked and nearly all be- NGOs fails to mention your connec- long to Globalink and the Framework tion with the tobacco industry. This Convention Alliance. Hardly a recep- significant omission is plainly decep- tive market for an expensive report tive and unethical. Would you care to about each other’s activities. So who, make any comment on this prior to my we might wonder, is likely to be the journal running an item on your market for CASIN’s report? activities in a forthcoming issue [of Freymond provides an oblique hint. Tobacco Control]?” “The research studies aim at assisting Ecoffey replied on 16 April, “I policy-makers, negotiators, senior understand well your concerns. They public and private managers in search are legitimate” but by the end of a page for policy options in relation to the of soothing words said nothing about smoother functioning of the who was paying for the research. I international system and international immediately wrote back suggesting societies. The nature of the issues that a clerical error in her office must covered compels the Programme to surely have resulted in the wrong enter into relation with various actors letter being sent to me, and followed involved in the issues... In this con- this up with individual emails to the text . . .the NGO programme and not CASIN board of directors, asking the CASIN as such has had, and has— since the late 1980s—occasional Ads for a competition promoting Bond Street same question. cigarettes in the West African country of On 24 April Ecoffey replied with a professional contacts with the tobacco Togo: contestants stood a chance of winning weasel worded explanation, now short industry.” a mobile phone. listed for the Hall of Fame of Circum- Tobacco Control understands that very locution: “The study we plan to launch few NGOs replied to CASIN’s request. main target: according to one report, on the multilateral negotiation of the Their report promises to be as compel- even the poorest women who eke out a WHO FCTC is in no way meant for the ling as The complete guide to Swiss naval living by selling produce in the mar- tobacco industry.” “It will be under- bases. kets flocked to buy a pack, in the hope taken in total independence and will SIMON CHAPMAN of winning their own mobiles. No be public.” “The tobacco industry, as Editor, Tobacco Control doubt Philip Morris, which is spending you know, has used the Programme’s millions of dollars to persuade the services occasionally”, and “Insofar as world it has changed its ways, would the work corresponded to the provi- Smoke in the have answers to the obvious questions sion of a service, it has been billed . . . machine: industry’s the competition raises about the ethics In no case has the Programme worked http://tobaccocontrol.bmj.com/ of promoting an addictive, lethal prod- on behalf either of the tobacco indus- nervous puff over uct to people locked in a daily struggle try or of its agents.” for the barest essentials of life. For So let’s get this straight. “In no case” Tobacco Control increasing numbers of them, cigarettes has CASIN worked for the tobacco report will turn out to be the barest essentials industry. But CASIN has billed them In the June 2001 issue of Tobacco of an early death. for the “work” and “service” it has Control, Stella Aguinaga Bialous and done for them. It is now doing a report Derek Yach presented a paper entitled The Circumlocution on tobacco control NGOs, but this “Whose standard is it, anyway? How report is not meant for the industry. the tobacco industry determines the Hall of Fame: and Such lack of ambiguity will I’m sure International Organization for Stand- inspire huge confidence in CASIN’s ardization (ISO) standards for tobacco on October 1, 2021 by guest. Protected copyright. the winner is... independence. and tobacco products” (Tobacco Control In March, many of the world’s tobacco CASIN’s chairman Jean Freymond 2001;10:96–104). Using tobacco in- control organisations received corre- also replied a month later and was dustry documents, the authors “de- spondence from a Geneva based much clearer: “ . . .the study was not scribe the extent of the tobacco indus- organisation named CASIN (Centre initiated at the request of, nor in- try involvement in establishing for Applied Studies in International tended for the tobacco industry, nor of international standards for tobacco Relations). CASIN requested infor- or for anyone related to the tobacco and tobacco products and the industry mation on organisations’ roles in the industry. It is neither financed nor influence on the [ISO].” Evidently, Big WHO’s Framework Convention on supported in any way by the tobacco Tobacco was not amused. Tobacco Control (FCTC), annual re- industry or by anyone associated with Offering only “light and mild” ports and newsletters, explaining it the tobacco industry . . . This . . .is praise for the authors, the tobacco had “taken the initiative of launching therefore a completely independent industry has lavished king size atten- a study on the negotiation” of the study.” tion on their paper, with editorial rein- FCTC. Smelling the deep fragrance of This is interesting. Who would be forcements recruited from companies wolf in sheep’s clothing, a quick search the market for such a study, which spread across four continents. The revealed that CASIN had supplied would plainly involve considerable heightened display of interest is a sure Philip Morris with information on costs needing to be recouped? Tobacco sign that a nerve had been hit by Bial- tobacco meetings in 1993 and 1996, NGOs have any number of ways of ous and Yach, the Executive Director, and was listed as an agency serving knowing about each other and are Noncommunicable Diseases and Men- Philip Morris in 1997. nearly drowning in a sea of emails tal Health Project Manager at the

www.tobaccocontrol.com News analysis 175 Tob Control: first published as 10.1136/tc.11.3.171 on 1 September 2002. Downloaded from World Health Organization (WHO), tobacco products standards”. Instead, ance on smoking machine readings, and who also manages WHO’s Baker provides a detailed history of the and the consequent “low-tar myth”. Tobacco-Free Initiative. Clearly, issues development of FTC (Federal Trade Worse, he states, apparently in earnest, of international measurement stand- Commission), CORESTA (Paris-based that to his knowledge: “no overt state- ards and product regulation are of Cooperation Centre for Scientific Re- ment has ever been made by the critical importance to global cigarette search Relative to Tobacco), and ISO tobacco industry to the public (con- marketing strategies. standards for cigarette smoking ma- sumers or the scientific community) In the February 2002 edition of Beiträge chines and, in passive-aggressive that smoking a low ‘tar’ cigarette is a zur Tabakforschung (Contributions to prose, challenges the Tobacco Control safer form of smoking.” This, despite Tobacco Research), a journal spon- authors’ integrity. the fact that one of the Bialous and sored by the Verband der Cigarettenindus- With almost endearing condescension, Yach references is to an earlier Tobacco trie (German Association of Cigarette Baker says he’s “sure that Bialous and Control paper (Leavell N-R. The low tar Industries), Richard R Baker, of BAT, Yach wrote the paper with the objec- lie. Tobacco Control 1999;8:433–7) that delivers the industry’s response, and it tive of presenting an unbiased view of details just such “overt statements”. is an industry wide rejoinder, not the development of the subject”, but A key message of Bialous and Yach’s merely the work of BAT. Though Baker, immediately follows with a challenge analysis is that the ISO standards have senior principal scientist of BAT Re- to their concentration on “selected served the industry’s interests by “pro- search & Development, is listed as sole quotes from internal company docu- viding the impression of legitimacy to author of “The development and sig- ments, taken out of context”. In one industry claims that cigarettes with nificance of standards for smoking- such quote, from a 1993 Philip Morris lower levels of tar and nicotine yield machine technology” (Beiträge zur Europe research and development let- were less harmful”. Baker ultimately, Tabakforschung 2002;20:23–41), he ac- ter, CORESTA is described as “100% and notwithstanding his own “objec- knowledges the assistance of no less controlled by the industry” and the tive of presenting an unbiased view”, than 20 “colleagues” at BAT’s competi- relevant ISO technical committee to be reiterates that specious claim. Less tar tors Philip Morris, RJ Reynolds, Impe- “made of approximately 80% Indus- makes more sense than more tar but, rial Tobacco (UK), and others for this try”. Baker tries to diminish the where measurements fail to truly first person, sometimes folksy 19 page significance of this fact by saying that reflect smoking behaviour, less can effort. tobacco companies comprise only 44% sadly be more. Smokers who stop Despite all those industry minds at of the membership, but it turns out the puffing consume no tar at all. Those work, they never mount a charge that rest of the members come almost who take false reassurance from ma- could topple the main conclusions of exclusively from industry partners and chine ranked tar yields do need to Bialous and Yach that “ISO’s tobacco suppliers. know whose standard it is, anyway. and tobacco products standards are While hoping, with little or no success, STAN SHATENSTEIN not adequate to guide tobacco prod- to find trivial errors in the Bialous and Editor, Lighter Side, ucts regulatory policies, and no health Yach paper, Baker more importantly Montreal, Quebec, Canada claims can be made based on ISO’s ignores the catastrophic impact of reli- [email protected] http://tobaccocontrol.bmj.com/ on October 1, 2021 by guest. Protected copyright.

©Jenny Coopes and The Australian Financial Review.

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