Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Tobacco control legislation has been challanged
- Ediriweera Desapriya (18 February 2006)
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Ban on smoking in UK
- Ediriweera Desapriya (18 February 2006)
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Losing Sight of the Real Enemy
- Mauricio Hernandez Avila (18 February 2006)
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Response of the Mexican MoH´s Officers to two BMJ editorials
- Francisco J. López-Antuñano (4 March 2006)
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Ediriweera Desapriya, Research Associate Department of Pediatrics, Centre for Community Child Health Research 4480 Oak Street V6H 3V4
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Alcohol and tobacco sales control bill, which was presented to Sri Lanka parliament in 8th February 2006, was immediately challenged in court by organizations representing the powerful tobacco and alcohol industries, which provide over 15 percent of the government tax revenues, on the grounds that it violated freedom of expression and free choice and the right to engage in a fair trade. If passed, the legislation will provide for the setting up of a statutory body that would regulate the sale of cigarettes and alcohol in the country. Its aim is to ban the sale of cigarettes and alcoholic products in supermarkets. In Sri Lanka majority of people are Buddhists, but many people have not been heeding the advice given by the Buddha, more than 2500 years ago, on healthy life styles. A recent study has pinpointed alcohol abuse as being at the root of many social problems in this country (1). The poor were affected the most and often male bread winners spend the bulk of their incomes on alcohol and tobacco resulting in domestic violence and crime. Reference: (1) . Bakuen, B., Smarasinghe, D., Alcohol and poverty, 2004. FORUT Colombo Sri Lanka. Free full text of this book is available: http://www.forut.no/index.php/15703-1 Competing interests: None declared |
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Ediriweera Desapriya, Research Associate Department of Pediatrics, Centre for Community Child Health Research 4480 Oak Street V6H 3V4
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In the United Kingdom, smoking prevalence of the adult population is 27% (1). This week British parliament voted overwhelmingly on for a total ban on smoking in indoor public places. Although eminent British scientist Sir Richard Doll was the first to document the health risks of smoking, such as lung cancer, Britain has been slow to prevent workplace and public exposure. However, the evidence is that the British public is very much behind greater restrictions on smoking (2). Smoke-free workplaces not only protect non-smokers from the dangers of passive smoking but also encourage smokers to quit. A recent systematic review by Fichtenberg and Glantz (3) shows that totally free smoke-free workplaces are associated with reductions in prevalence of smoking of 3.8%, and continuing smokers smoke 3.1 fewer cigarettes a day. The combined effects reduce total cigarette consumption by 29%. To achieve similar results through taxation would require an increase in the price of cigarettes of 73%, so that cigarettes would cost £6.59 per pack in the United Kingdom (4). Meanwhile for decades, people with juvenile diabetes have been told that controlling their blood sugar is all they can do to prevent nerve damage that can lead to the amputation of a foot or leg. A recent large British study suggests (5) juvenile diabetes should follow the same advice given to other diabetics: Don't smoke, and watch your weight and blood pressure. These risk factors for heart disease were almost as important as blood-sugar levels in predicting which diabetics would develop nerve problems. REFERENCES: (1). Walker A, Maher J, Coulthard M, Godard E, Thomas M. Living in Britain 2000. London: Stationery Office, 2001. (2). Smoking in Public Places Investigative Committee. Scrutiny of smoking in public places in London. London: Greater London Authority, 2002. (3).Fichtenberg CM, Glantz SA. Effect of smoke-free workplaces on smoking behavior: systematic review. BMJ 2002: 325: 188-191. (4). Smoke-free work places cut smoking. BMJ 2002: 325;0 (5).Tesfaye S, Chaturvedi N, Eaton SE, Ward JD, Manes C, Ionescu- Tirgoviste C, Witte DR, Fuller JH; EURODIAB Prospective Complications Study Group. Vascular risk factors and diabetic neuropathy. N England J Med. 2005:27; 352(4):341-50. Competing interests: None declared |
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Mauricio Hernandez Avila, General Director National Institute of Public Health (Mexico)
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I disagree with Sebre and Glantz´s characterization of the Mexican Ministry of Health (MMoH) in their editorial The Tobacco Industry in Developing Countries. The authors fail to take into account potential positive effects and disregard important accomplishments of the MMoH in the area of tobacco control. Over the past five years, the MMoH, under the leadership of Dr. Julio Frenk, has implemented several noteworthy tobacco control initiatives. A major tax increase on tobacco products reversed an industry-friendly trend set by previous administrations. Restrictions on radio and television advertising have been put into action and an intensive and carefully planned media campaign will be launched in upcoming weeks to discourage tobacco use. Furthermore, the recent development of an efficient system to monitor and evaluate national trends in tobacco-use, especially among young adults, is providing epidemiological data that will be key in guiding mid- and long-term strategies to reduce tobacco consumption. In order to develop and consolidate policies to restrict and control the tobacco industry, constructive action is needed. For example, governmental agencies in Mexico as well as international lobbyists need to provide pressure to support the MMoH along its path towards a more aggressive tobacco tax policy and breaking the barrier that impedes the use of special taxes earmarked for anti-tobacco programs. The MMoH has circumvented such barriers and used funds provided by the mentioned agreement to finance medical institutions directly involved in the treatment of tobacco related illnesses. Activists who issue broad criticisms based on short-term results and brush aside important advances may create pressure in the wrong direction and ultimately benefit the tobacco industry by tarnishing the reputation of an administration that is making long-term progress. A more complete analysis than the limited one provided by Sebre and Glantz would recognize, as Samet et al acknowledges in Mexico and the Tobacco Industry: Doing the wrong thing for the right reason, that Mexico has been a leader in tobacco control. The current minister of public health, Julio Frenk, was an early supporter of the WHO convention and is a champion of tobacco control in Mexico. The bottom line is that the balance of the Frenk administration has been positive and Mexico is making advances towards tobacco control. Competing interests: None declared |
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Francisco J. López-Antuñano, President, Alliance Against Tobacco Calle Monterrey No. 150-206. CP 06700 México DF, México
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The response to two articles (BMJ 2006;332: 313-4 and 353-4) from doctors Mauricio Hernández Ávila, Director General of the National Public Health Institute, and Roberto Tapia Conyer, Under Secretary of Health Programs Development both Ministry of Health (MoH)´s medical officers is, once more, a respectful manifestation of full discipline, unconditional loyalty and complete obedience to Minister of Health Julio José Frenk Mora. From the point of view of the Mexican collective health, Organizations of the Civil Society (OCS) are extremely concerned by the fact that the MoH authorities continue to be victims of the tobacco industry strategies, designed to impose fiscal and health policies in relation to nicotine addiction in our country. Since October 2004 we advised in detail to MoH, the needless to implement The Agreement that could benefit only to the tobacco companies, it could preclude the National Council against Addictions, (CONADIC)’s tobacco control activities and to distract National Commission for Protection against Health Risks, (COFEPRIS)’ functions for tobacco products regulation as a sanitary risk; and above all, it could continue to worsen the Mexican’s health and institutional damage by increasing the sales of tobacco products. Our continuous advise suggested MoH to constitute a task force team to demonstrate the political, scientific, technical and economic feasibility, and to register the evidence of its effects on the health services and the impact on the Mexicans collective health, including the evaluation of relevant conditions and situations both from the point of view of the producers, commercial agents and consumers, and from the MoH´s perspective. We should keep in mind that the main objectives of the tobacco companies are: • to induce socially accepted behaviors, • to secure their future market paid with the money and health of their clients, • to increase their profits selling nicotine addiction, disease, suffer and premature death. Their globalized system for prices and tax control allows them • to generate supportive politicians, scientists. consumers and defenders groups, • to maintain and reproduce their political and economic power, • to block sanitary regulation and • to increase their productivity, We have asked the following questions repeatedly: Is The Agreement • Preventing in any way those diseases attributable to tobacco smoking? • Promoting and recovering the Mexican’s Collective Health by any means? • Controlling by any chance the initiation to smoke tobacco in children, adolescents and women? • Protecting the Mexican people against nicotine addiction and regulating tobacco products as sanitary risks? Is The Agreement requiring respect for diversity (of corrupt practices), for the sensitivity towards the local reality (of policy makers and legislators to impede, difficult or postpone the necessary reforms to the Health General Law) and for adherence to the “unethical” norms and “pseudo philanthropic” attitudes conceived by the social irresponsible corporative? The effective economic global action is the only, transparent and obvious objective of the tobacco industry, who worded The Agreement as it was signed. We made a critical and detailed analysis of The Agreement between decentralized agencies of the MoH and the local tobacco industries British American Tobacco (BAT), Philip Morris (PM) and CIGATAM, and we expressed our great concern to the Mexican Society and to Dr. Frenk Mora (23 January, 2006), through the mass media about the evidence that shows the danger for adopting the strategies promoted by the tobacco companies: (a) Interfering the Framework Convention for Tobacco Control-World Health Organization (FCTC-WHO) implementation, (b) Intervening in health and fiscal policies in the country, (c) Impeding the full efficacy of tobacco control and avoiding the sanitary, economic and environmental consequences of tobacco use, (d) Serving as precedent for the replication of this type of agreement against the principles of the FCTC in other countries of the world. In benefit of the prestige and dignity of the Mexican citizens and Institutions we asked to the Minister of Health of Mexico: 1. To revalue The Agreement signed in June 2004 between CONADIC/COFEPRIS and BAT/PM/CIGATAM because The Agreement: (a) operates against the approval arguments of the Mexican Senate that originate the Presidential Bill supporting the (FCTC-WHO) at full (May,2004); (b) is juridical inexistent since was signed (June, 2004), after FCTC was already approved by the Senate (May, 2004). The Agreement only benefits the tobacco companies, damages health and economy of the Mexican citizens and compromises the authorities, ethically and politically. 2. To convey immediately the National Inter-sectors Commission for the Implementation of the FCTC-WHO, including OCS, for collaborating, together with the Pan American Health Organization/World Health Organization (PAHO-WHO), and the Alliance for FCTC (AFC) in providing´technical cooperation for the construction of initiatives to reform the Health General Law. This endevor will contribute to achieve the Integral Legislation and the strict regulation of tobacco as a sanitary risk, for real protection of the Mexican collective health. Our society should create the juridical bases, expedite mechanisms and social infrastructure to protect all Mexican Citizens, let all of us do it properly without any treaty what so ever with the tobacco companies. Unconstitutionality of The Agreement. It is necessary to excite the Senate for executing his write and duty to advocate for the constitutionality, the Supreme Court will decide about the unconstitutionality of the instrument. Conclusion The Agreement is inexistent. The Agreement should be considered as the “Juridical Nothing”. For constitutional auto protection it is required to be declared by the administrative authority or by means of the external protection process from the Judicial Power thru the Senate intervention and promotion, as been the titular author of the FCTC-WHO approval faculty. We are not questioning the right activities made by the Mexican Government for tobacco control, but we are sure that The Agreement is a serious mistake that should be revalued. To promote, protect and recover the Mexican citizen’s collective health, our society should: (a) count and respect the juridical bases for tobacco smoke elimination, and (b) work on the strengthening of expedite mechanisms for tobacco products strict regulation and on the constructing of the efficient infra-structure for a tobacco integral management system. Francisco J. López-Antuñano, MD, MPH President Alliance Against Tobacco, non profit OCS. Calle Monterrey No. 150-206. CP 06700 Colonia Roma Sur. México DF, México alantu@insp.mx Telephone +52 777 3112463 Competing interests: None declared |
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