Leading Australian Tobacco expert, Dr. Nigel Gray once said, “The single reason for the dominance of the tobacco problem is that someone is selling it, whereas no one is selling diphtheria or tuberculosis.”1 We should therefore be investigating, developing and implementing tobacco control solutions which break the power of the industry.
This week one of the biggest international news media networks in the world, Al Jazeera English, ran a television story on the proposed idea for a SmokeFree generation in Tasmania. That is, to not permit sales of tobacco products to any person born this century. This would mean a phased in cessation of sales of cigarettes. Smokers would not be penalised, only the sellers. Minister Michelle O’Byrne explains it well and the children from Campbell Street School in Hobart are well informed and thinking about these issues. See the Al Jazeera website and story here. http://www.aljazeera.com/news/asia-pacific/2012/09/201291663731567939.html
We all know tobacco kills many Australians, far more than illicit drugs, traffic deaths, homicides, suicides, fires, other injuries, and alcohol put together. We know that it maims people, who may not die, but endure daily blindness, amputated limbs due to gangrene, emphysema, cancers, infertility, impotence, heart conditions, bad teeth, gastric ulcers, osteoporosis, fractures, sleep disturbances, diabetes, asthma or pain, all of which smoking either is linked to or aggravates2.
Smoking is a paediatric disease. 3It is taken up by children, they become addicted and find it hard to quit as adults. Adults rarely start smoking. Smoking is therefore not a “choice”, it is an addiction acquired when the developing brain is unable to properly understand those “choices”. 4Even children who smoke infrequently show signs of dependence, and difficulty in quitting5.
We spend a lot of money, as do the makers of nicotine replacement therapy, on helping adults to quit. Children and adolescents, do not realise they will become addicted, and about 70% think they will not be smoking next year. Most of them will.6 We need to try harder to prevent children and teenagers from taking up smoking. Plain packaging with gruesome warnings will help, but will not wipe out smoking.
The solutions are simple. First we pass legislation that no person shall be sold tobacco that was born this century. These are children now aged 12, who could not be sold cigarettes when they turn 18 years old. This would impact in 2018. Note that they would not be penalized for smoking; the retailers just would not be able to sell them the product7.
This method of eliminating an addictive legal recreational drug has been tried and succeeded in the past. Formosa and Ceylon (now Sri Lanka) both eliminated or reduced opium over a number of years early last century by phasing out sales. In Formosa an 80% reduction in 15 years, and in eradicated within 35 years8,9.
We continue social marketing of graphic TV ads, raising tobacco excise, and cessation support services. We set a date for the phase out of the sale of tobacco products. We remove all additives and flavourings and nicotine from tobacco products, raise the pH above 8 10, eliminate vented filters,11 and reduce the number of tobacco retail outlets over a five year period, 2014 to 2019. Then in 2020 to 2025 we prohibit the general sale of tobacco products and provide heavily addicted smokers with tobacco under a licensing scheme12, 13.
Additional cessation support services would be provided to groups such as pregnant women, people with mental health problems, prisoners and those with high smoking rates in particular communities.
This is a managed phase out, not prohibition, would avoid black markets developing and would provide support to those who are simply unable to quit. No smoker would be “criminalised”, nor would they lose any “rights”, it would only be the tobacco pushers and dealers who would be prohibited from selling.
The lethal tobacco industry which has been found guilty of racketeering in the USA and misleading and deceptive conduct in Australia would be eliminated in this country, no longer able to market its product and kill our citizens14.
This generation of children should be protected from the depredations of the tobacco industry, and our current smokers helped to quit.
References
1. Nigel Gray, Chapter 37 Global Tobacco Control Policy (Boyle et al., 2004)
2. Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and Issues. Third Edition. Melbourne: Cancer Council Victoria; 2008. Available from: http://www.tobaccoinaustralia.org.au http://www.tobaccoinaustralia.org.au/chapter-3-health-effects/3-8-infant-health-and-smoking
3. Kessler Journal of Pediatrics April 1997 page 518
4. http://www.tobaccofreesingapore.info/
5. Elpidoforos S Soteriades, George Spanoudis, Michael A Talias, Charles W Warren, Joseph R DiFranza Tob Control 2011;20:201-206 doi:10.1136/tc.2010.036848 Research paper Children’s loss of autonomy over smoking: the global youth tobacco survey http://tobaccocontrol.bmj.com/content/20/3/201.short
6. ASSAD secondary school surveys all Cancer Councils in Australia (including SA) conduct surveys every three years.
7. http://www.tobaccofreesingapore.info/ and http://www.tobaccofreesingapore.info/wp-content/uploads/2010/11/tobacco-control-article.pdf
8. Report of the Prohibition Commission (Ceylon,1957) Willoughby (Johns Hopkins, 1925)
9. Professor Jon Berrick. Presentation to the Menzies Research Institute Tasmania, University of Tasmania 11/5/2012.
10. Dr. Matthew Peters http://www.ashaust.org.au/pdfs/EndgamePeters1208.pdf Further reading Robert Proctor “Golden Holocaust” which explains the history of tobacco industry manipulation of pH of cigarettes. Tobacco above pH of 8 is virtually uninhalable, and the original tobacco 19th Century was like this.
11. Kozlowski et al “……the banning of filter vents, coupled with low maximum standard tar, nicotine, and carbon monoxide yields, would contribute to making cigarettes much less palatable and foster smoking cessation or the use of clearly less hazardous nicotine delivery systems. “ http://tobaccocontrol.bmj.com/content/15/3/262.abstract
12. As proposed by Professor Simon Chapman. http://www.smh.com.au/opinion/politics/dont-ban-tobacco-license-it-20110524-1f1xn.html
13. Australian Competition and Consumer Commission (ACCC) chairman Graeme Samuel said legal advice was clear the tobacco companies were breaching the Trades Practices Act with packaging and promotion of the cigarettes. “That legal advice … has advised us that the tobacco companies have, in their representations both on tobacco packaging and promotion of light and mild, have been engaging in misleading and deceptive conduct,” Mr Samuel told reporters in Adelaide. http://www.smh.com.au/news/Health/Mild-labels-on-cigarettes-misleading-ACCC/2005/02/15/1108229998504.html
14. US Judge Gladys Kessler in the tobacco RICO case http://www.reuters.com/article/2011/06/01/us-tobacco-court-idUSTRE75079R20110601
