Editor's Choice | This Week in BMJ | Press releases



BMJ No 7106 Volume 315

Press Releases Saturday 23 August 1997


Embargoed: 00.01 Hrs 22 August 1997 UK time

Tobacco - time for action at home and abroad
Sharp rise in number of elderly with dementia
Obesity - time to chew the fat
Diuretic withdrawal can do more harm than good

Tobacco - time for action at home and abroad

[Tobacco marketing: shackling the pied piper]

Banning tobacco advertising can only form part of our response to the tobacco industry's efforts to attract and retain customers, says an editorial in this week's BMJ. What is needed is a broader focus on the increasingly sophisticated business of tobacco marketing, and its appeal through branding, to the young.

The editorial goes on to make three points: that young smokers are vital to the tobacco industry; that branding is the key tool they use to attract new smokers. It provides them with important social and psychological props that ease the process of starting to smoke; and that all aspects of marketing - product development, pricing strategy, promotion and distribution - are used to develop and hone brands, and all these activities therefore need to be controlled.

"Perhaps the easiest way forward is to tell tobacco companies what they can do rather than what they can't," they suggest. "Ideally, they should be allowed simply to produce and sell plain packs of low tar cigarettes and communicate about these only by approved letter in response to specific inquiries from retailers or the public. Brand names in standard fonts could be permitted, but only on the pack. These should be the limits of tobacco marketing. Only with such stringent and wide ranging measures can we hope to limit seriously the tobacco marketers' ability to attract the young to smoking," they conclude.

Contact:
Professor Gerard Hastings

Strathclyde University
Glasgow

Tel: 0141 552 4400
Fax: 0141 553 4118
email: gerardh@market.strath.ac.uk

Availability: Fri 22-23 Sat

Newton Hotel
Hong Kong

Tel: 00852 2807 2333
Fax: 00852 2807 1765

Sun 24-28 Thr

Beijing Continental Grand Hotel

Tel: 0086 10 6491 5588
Fax: 0086 10 6491 0106

[The challenge for Beijing: the 10th World Conference on Tobacco and Health]

Tobacco control must be seen as a global issue, not just a national concern, says an editorial in this week's BMJ. The proposed settlement in the US, negotiated by the tobacco industry and state attorney generals is problematic, says the author, with some leading figures in the health field arguing that the industry should be controlled by legislation and not negotiation.

The US settlement will do nothing to help developing countries, argues the author. "If anything it will accelerate the global spread of smoking."

In developing regions over half the men are current smokers and cigarette consumption is rising. With a quarter of the world's smokers smoking a third of the world's cigarettes, China has become the major tobacco control battleground.

The Beijing conference on tobacco and health which takes place this month is concentrating on the themes of developing countries and women, and a record number of developing country delegates will attend. Developing countries are most vulnerable to the tobacco industry, says the author, who calls for a unified approach based on the best national strategies to accelerate the trend towards a smoke-free world.

Contact:
Professor Robert Beaglehole

University of Auckland
New Zealand

Tel: 0064 9 373 7599 xtn 6722
Fax: 0064 9 373 7503
e-mail: a.lole-taylor@auckland.ac.nz

[Test sales do not have impact on prevalence of smoking by children]

A letter reports a survey carried out in two schools in Gateshead in May 1995 and May 1996. In 1995 in school A 39% of girls aged 14-15 were regular smokers and 26% of boys. In school B, 24% of girls and 14% of boys were regular smokers. Altogether 95% of children who were regular smokers bought cigarettes from shops at least once a week. Only 2.5% in 1995 and 6% in 1996 reported ever having had someone refuse to sell them cigarettes.

The local trading standards office carried out test sales - in which a child attempts to purchase cigarettes while being observed by a trading standards officer - in shops around school A. No test sale purchases were made, and hence, there were no prosecutions, despite the ease with which the children were able to buy cigarettes in local shops. The study suggests that test sales may not be a useful measure of the availability of cigarettes to children, and it may not be justified to continue them in their current form, say the authors.

Contact:
Dr Mark Bagott

University of Newcastle

Tel: 0191 477 6000
Fax: 0191 477 0373

Sharp rise in number of elderly with dementia

[Cognitive impairment in elderly people; population based estimate of the future in England, Scotland and Wales]

The number of elderly people with dementia in the UK will increase steeply over the next few decades, predicts a paper in this week's BMJ. The prevalence of cognitive impairment increases with age, say the authors, and they predict that the increase in numbers of elderly people with such problems will outpace the increase in the elderly population as a whole.

In 1996, 41% of elderly people with cognitive impairment were estimated to be aged 85 and over, but according to the authors' model this will rise to 45% by the year 2006 and 52% by 2036. Ageing has important consequences, since the risk of living in an institution rises sharply with age.

This will have important implications for policymakers, say the authors, since "financing long term institutional care for elderly people is a contentious political issue".

Contact:
Dr David Melzer

University of Cambridge

Tel: 01223 330 332
Fax: 01223 330 330

Obesity - time to chew the fat

[An "ecological" approach to the obesity pandemic]

The prevalence of obesity in many countries is now so high that it should be considered a pandemic. says a paper in this week's BMJ. One estimate suggests that over the past decade the average Australian adult has been adding one gram a day to his or her bodyweight.

Although there is increasing knowledge and awareness about obesity, nutrition, and exercise, the inexorable rise has continued, say the authors, who suggest that a new way of tackling obesity is needed.

Dietary fat and energy intake have not fallen as fast as energy output and the result is a large energy imbalance leading to obesity, they say. But large reductions in the fat content of the modern diet seem unlikely, as do large scale increases in high intensity exercise.

Obesity has become a normal response to an abnormal environment, and the challenges this poses are not currently being met, say the authors; "Hence it is important to re-examine the paradigms on which treatment and prevention programmes are based."

The driving force for the growing prevalence of obesity is environmental rather than an increase in metabolic defects of genetic mutations within individuals, they say, and this knowledge should inform a wider public health approach to the obesity pandemic.

Contact:
Professor Garry Egger

Deakin University
Melbourne
Australia

Tel: 0061 2 9977 7753
Fax: 0061 2 9976 2957
e-mail: eggergj@ozemail.com.au

Diuretic withdrawal can do more harm than good

[Withdrawal of long term diuretic medication in elderly patients: a double blind randomised trial]

Withdrawal of diuretics in elderly patients without heart problems or high blood pressure frequently leads to the emergence of heart failure symptoms or a rise in blood pressure, says a paper in this week's BMJ.

Diuretics are among the most commonly prescribed drugs in Western society, say the authors, with about 20% of elderly patients using them long term. There is, however, doubt about the necessity of such large scale usage. The authors carried out a randomised trial to assess what proportion of elderly people could be withdrawn from diuretic therapy, and found that the potential adverse effects of stopping treatment were such that about 50% of patients needed to go back on the medication within six months.

Withdrawal of diuretic therapy does more harm than good in most patients, they conclude, and extensive monitoring of attempts to withdraw from such treatment is essential.

Contact:
Dr Edmond Walma

Erasmus University Medical School
Rotterdam
The Netherlands

Tel: 0031 10 408 7621
Fax: 0031 10 436 0717


Embargoed: 00.01 Hrs 22 August 1997 UK time


NB: Due to the UK public holiday on 25 August, next week's BMJ press release will be issued on Wednesday 27 August.

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