SELLING DEATH NICELY PACKAGED

Rima Nakkash, DrPHFaculty of Health SciencesAmerican University of Beirut

Spread of the epidemicIn the 20th century, the tobacco

epidemickilled 100 million people

worldwide.

During the 21st century, it could kill

one billion.

WHO, MPOWER 2008

…Tobacco use is unlike other threats to global health. Infectious diseases do not employ multinational public relations firms. There are no front groups to promote

the spread of cholera. Mosquitoes have no lobbyists.

—Thomas Zeltner, MD, David A. Kessler, MD, Anke Martiny,PhD, Fazel Randera, MD1

The Dwarves-video

“Nicotine is addictive. We are, then, in the business of selling nicotine…” (Addison Yeaman from Brown & Williamson, 17 July 1963)

Tobacco company CEOs declare, under oath, that nicotine is not addictive (1994)

Lots of toxic chemicals!

What is in tobacco and cigarettes?

Carbon Monoxide-auto exhaust, gas chambers Carbon Dioxide Carbonyl Sulfide Benzene (1) Toluene-industrial solvent, in explosives

Formaldehyde (2)- body tissue preserver Acrolein-aquatic herbicide=burned glycerol Acetone-poisonous solvent, nail polish remover Pyridine-poisonous solvent Methylpyridine-insecticide solvent Vinylpyridine Hyrogen Cyanide-rat poison, gas chambers Hydrazine-rocket fuel chemical

Ammonia-poisonous, cleaning agent for toilets and floors Methylamine-tanning agent Dimethylamine-tanning accelerator Nitrogen Oxides Nitrosodimethylamine Nitrosodiethylamine Nitrosopyrrolidine Formic Acid-caustic solvent Acetic Acid-caustic solvent Methyl Chloride-poisonous refrigerant Butadiene Particulate Matter-animal carcinogen Nicotine-insecticide, cockroach killer Anatabine Phenol-toilet bowl disinfectant

Catechol-tanning, dyeing agent Hydroquinone-photographic developing agent Aniline-industrial solvent Toluidine-agent in dye manufacture Napthalamine-mothballs Aminobiphenyl Benz(a)anthracene Benzo(a)pyrene Cholesterol Butyrolactone Quinoline-specimen preservative Harman Nitrosonornicotine NNH Nitrodiethanolamine Cadmium Nickel Zinc-anti-corrosion coating for metals Aluminum-metal Titanium-metal Copper-metal Mercury-metal

Silicon-metal Silver-metal Gold-metal Polonium-210-radioactive element Benzoic Acid-tobacco curing agent Lactic Acid-caustic solvent Glycolic Acid-metal cleaning agent Succinic Acid-agent in Lacquer manufacture PCDDs and PCDFs –dioxins, dibenzofurans Hexamine-barbecue lighter Stearic Acid-candle wax Cadmium-rechargeable batteries Arsenic-poison Butane-cigarette lighter fluid Propylene Glycol-antifreeze

What’s in a cigarette Video

SPIKE MY CIGARETTE VIDEO, Is big tobacco evil ?

Tobacco Industry uses a variety of tactics

• They target youth and special populations such as women, different cultural groups

and low income people.• They reassure concerned smokers by linking tobacco with healthy images.• They use advertising and promotion to publicize their product.• They launch “prevention” campaigns that have been shown to actually encourage

youth to smoke.• They pretend to be concerned “corporate citizens” by donating money to various

causes.• They challenge the decisions of governments to control tobacco.• They use their networks to influence politicians.• They create “front groups” to express their opinions.• They create controversy about the health effects of smoking.• They deny scientific evidence.• They deny that second-hand smoke is dangerous, even though it has been proven

to be harmful.

Other tactics Flavored products:  Cigarettes, smokeless tobacco, and so-

called “little cigars” have been introduced in many candy, fruit, and alcohol flavors that mask the harshness of the products and make them appealing to children.

Novel smokeless products:  New smokeless tobacco products, some in teabag-like pouches and even in dissolvable, candy-like tablets, have been marketed as ways to help smokers sustain their addiction where they cannot smoke.

Targeted products and marketing: New products and marketing, such as R.J. Reynolds’ Camel No. 9, are aimed at women, girls and other populations.

Unproven health claims:  To discourage smokers from quitting, and possibly entice new or former smokers, increasing numbers of products have been marketed with unproven and misleading claims that they are less harmful than traditional cigarettes.

Undisclosed product designs: The report also details how tobacco manufacturers control nicotine delivery to maximize addiction, while using flavorings and other additives to make their products milder,

• Are you really more of a man if you smoke? What girl is going to kiss you with that stinky breath?

The tobacco industry as disease vector

The tobacco industry plays a key role in the tobacco epidemic.

Industry voluntary or self-regulatory measures have not been proven to be effective.

Release of internal tobacco industry documents (TIDs).

Framework Convention on Tobacco Control

 Adopted in May 2003 by the World Health Assembly (WHA).

Ninety days after the 40th country ratified the treaty, the FCTC became legally binding in February 2005.

Anti smoking media campaigns

Non price measuresBan tobacco advertising in all its forms

Advertising to women ……

….and youth

Faraya Skiing Event Mika concert downtown Beirut

Tobacco advertising increases consumption:

Encourages children to experiment Encourages smokers to smoke more Reduces motivation to quit Encourages former smokers to resume Discourages full and open discussion of the

hazards of smoking as a result of media dependence on advertising revenues … dependence of organisations receiving sponsorship from tobacco companies

Creates through in which tobacco use is seen as familiar and acceptable .

Tobacco Industry Resistance Voluntary codes in existence for decades, but

consumption is growing

A 1989 Philip Morris International Memorandum states that:

“The general argumentation used by the industry is beginning to look extremely weak… This is best illustrated in the advertising bans and consumption argument, where the industry argues that ‘advertising does not increase total market size’, yet we are presented with a dilemma in developing markets where the total market is growing and advertising expenditure is rising accordingly. How can we reconcile this?...”

Branding Marlboro Classics clothing, camel boots

and accessories, Gauloise cars

Sports Sponsorship

Music Sponsorship

Iran Brazil

Health Warning Labels

Jordan: Courtesy of Dr. Hiba Ayoub

السجائر علب على الصحية التحذيراتالعربية مصر جمهورية في

Graphic labels on tobacco products

Graphic Warnings “Large, graphic warnings on cigarette packages

are an effective means of increasing health knowledge among smokers [and] may also help to reduce the disparities in health knowledge by providing low-income smokers with regular access to health information.”

Hammond and colleagues also found that smokers in countries where a warning depicts a particular health hazard of smoking are much more likely to know about that hazard and smokers who reported noticing warnings were 1.5 to 3 times more likely to believe in each health hazard.

Hammond et al.,2001

73 percent of smokers approved of them

54 percent had changed their opinion on the health consequences of smoking

67 percent said the new warnings made them want to quit.

The impact was particularly strong among less educated, lower income people.

Industry Arguments and Rebuttals Expensive and technically difficult Larger warnings or the use of pictures will not be

more effective than existing warnings. Smokers already know the health effects of

smoking. Mandatory health warnings constitute an

expropriation of the tobacco industry's Packages and trademarks spoiled The warnings ‘demonize’ smokers and make

them feel like outcasts. If the government wants to put out those

messages, it should use billboards or TV commercials.

Dangers of second hand smoke

The debate is over!

The Surgeon General’s 2006 Report on The Health Consequences of Involuntary Exposure to Tobacco Smoke secondhand smoke causes cancer, heart

disease and serious lung ailments. Former Surgeon General Richard Carmona

stated when releasing the report, "The debate is over. The science is clear. Secondhand smoke is not a mere annoyance but a serious health hazard."

Secondhand smoke contains over 4,000 chemicals, including at least 69 that cause cancer, including arsenic, ammonia, formaldehyde, and polonium 210.

Studies show that children, the elderly, and people with respiratory illnesses are especially vulnerable to secondhand smoke.

For example, children exposed to secondhand smoke are more susceptible to bronchitis, asthma, eye and ear problems, and other ailments.

Bans on Smoking in the Workplace and Public Places

Previously “SECRET” Tobacco Industry Documents:

“Total prohibition of smoking in the workplace strongly affects industry volume. Smokers facing these restrictions consume 11%-15% less than average and quit at a rate that is 84% higher than average…If smoking were banned in all workplaces, the industry’s average consumption would decline 8.7%-10.1% from 1991 levels and the quitting rate would increase 74% (e.g. from 2.5% to 4.4%).”

Such measures need to be strictly enforced in order to be effective.