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The Tobacco Companies: Remember Rope-a-Dope?

by Dr. Len July 14, 2006

As I sat through two related sessions on tobacco company marketing behaviors yesterday afternoon at the 13th World Conference on Tobacco OR Health, I couldn’t help but think of the analogy between the behavior of the tobacco companies and Muhammad Ali’s tactic of bobbing and weaving to avoid his opponents’ punches.


Whether you consider the tobacco companies immoral or just amoral, the reality is they are in business to produce a product that is designed to kill or injure when used as directed.


That fact then begs the question of how companies making profits from death and illness can survive in a socially responsible, moral society.


For Ali, his tactics included something called the “rope-a-dope.”


The riddle: How are the tobacco companies’ strategies to remain viable in a moral society similar to the tactics of a boxer?


The answer: they both are well-honed practitioners of a technique called “rope-a-dope.”


What, you may ask, is “rope-a-dope?” 


Here is the definition taken from Wikipedia, the online encyclopedia:


“Rope-a-dope is a boxing fighting style used most famously by Muhammad Ali in the Rumble in the Jungle against George Foreman.  The idea is for the boxer to lie on the ropes of a boxing ring, conserve energy and allow the opponent to strike him repeatedly in hopes of making him tire and open up weaknesses to exploit for an eventual counterattack.”


That sounds suspiciously similar to the tactics used by the tobacco companies in fighting tobacco control efforts, and in their efforts to paint themselves as socially responsible organizations.


The message from the sessions I attended was clear: you must always be alert for the real substance and purpose of the companies’ efforts, for they never are what they appear to be.


One of the companies put under scrutiny yesterday was British American Tobacco, and their corporate social responsibility program, or CSR.


CSR programs are not unique to BAT.  Many companies use these programs to provide socially useful, valuable and effective programs for their communities and their customers. 


These programs are usually well constructed, implemented and audited, with agencies actually retained to audit them and provide public reports.


It isn’t a long leap to understand that tobacco companies, with their tarnished images and poor reputations, would seek to benefit from these types of programs.  These programs are especially important in developing countries, and in fact the World Bank has been encouraging companies to create such programs worldwide.


But for the beneficiaries of these tobacco company efforts, is it worth it?


There were reports recently about a local fire department that received a rescue truck through one of these programs, and there was considerable community dissent as to whether this truck should be retained by the community, the need notwithstanding.


For the tobacco companies, according to one of the speakers, they are twisting the terms, intentions and spirit of CSR.  They do not behave ethically or responsibly.


It isn’t lost that CSR programs are put in place in developing countries who are desperately in need of expertise, money and investment and are the same countries where the transnational tobacco companies are looking for their next big growth phase.


For example, in Malawi, as was pointed out to the audience, there was a serious issue regarding child labor abuse in the tobacco trade.


The International Labor Organization (ILO), which is part of the United Nations, was concerned about child labor.  BAT saw an opportunity, and became part of the effort.


The net results? 


For a small amount of money, BAT gained a foothold in the country.  It had the ear of the government, and made the case that tobacco growing was profitable for the country (which produces 6.6% of the world’s burley tobacco exports, which in turn accounts for 70% of the country’s foreign earnings).


The impact on child labor?


The BAT corporate reports do not say they have reduced child labor, according to the presenter.  A researcher noted that, in fact, child labor and abuse of child labor appears on the increase.  The company links other indirect measures of success to their efforts, but don’t give the hard data about the core issue.


What they end up doing is pursuing CSR rather than accept responsibility for eradicating child labor according to his research.


Sound like bobbing and weaving/rope-a-dope to you?  It sure does to me.


In trying to make some sense of this, a financial analyst speaking about BAT at the same session said that the only thing that will get the attention of the financial community with regard to the CSR debate is if someone can demonstrate that they have lied on their audited reports regarding CSR.


What?????  A company can make a product that deliberately kills, but the financial community only cares if the company lies on an audited report???


That doesn’t make a lot of sense, does it?


But the real rope-a-dope action came out in the second session which focused on Philip Morris.


Here is a company that has worked long and hard to change its image.  It has admitted “guilt”, but yet it continues to produce and profit mightily from cigarettes.


Using techniques such as placing ads on WebMD (which recently removed the ads in question) give the company credibility.


They give money to charitable causes, and in times of great need such as tsunami relief.


They are philanthropists.


They promote youth smoking prevention programs that in fact target smoking parents.


They reframe the arguments: 


  • Smoking is an adult choice. 
  • It is peer pressure—not advertising—that entices kids to smoke. 
  • Those anti-tobacco advocates are “crazies”.  You don’t want to be associated with them.


The company cloaks its anti-smoking efforts with respectability, including very scientific looking documents and advisory boards with medical school professors.


They are part and parcel of the “We Card” program, which touts not selling cigarettes to children under 18.  In fact, these programs are known not to be effective, insofar as they create the image of a “forbidden fruit,” and if anything—according to the lecturer—they encourage youth and teen smoking.


They give grants to respectable community organizations in need, including the 4H clubs (some of whose members protested accepting the money), Boys and Girls Clubs, Big Brother and Big Sister among others.


They say they don’t mix their marketing and youth smoking prevention program data and staff, but they do according to the experts on the issue.


But, according to the panelists, Philip Morris has no business in running youth programs, and it has no business gathering any data on youth smoking behavior.  There is a need to separate Phillip Morris and the tobacco industry from legitimate health programs.


At one point recently, the company embraced tobacco control legislation and regulation by the FDA.


But they wanted certain concessions, including a request that cigarettes not be considered medical devices and that there be no automatic ban on selling cigarettes.  They also wanted Congress to take charge of the rules creating “reduced harm” tobacco products.


As part of this effort, they engaged in a massive public relations program, to make them seem more “friendly” in communities around the country.


The legislative efforts failed, we were told, but the image damage was done.  Their favorable ratings rose significantly in polling data.


Another speaker focused on their website, and the disconnects between what they claim and what they say.


They acknowledge that tobacco causes disease, but yet they still sell it.


There is no evaluation of the effectiveness of their youth smoking prevention initiatives.


They don’t mention addiction in their smoking cessation materials.


They don’t talk about the harms and dangers of tar and nicotine.


And they don’t mention death, according to the speaker.


The company takes blame for its poor reputation through their spokespeople.  They say the products they produce are controversial, ignoring the fact that there is no controversy about their lethality.  They spent years trying to divert the debate from the obvious.


Sowing doubt is the key to their strategy, and that is unlikely to change noted the speaker.


The final speaker noted that social acceptability is vitally important to the company, and that much of their actions are directed in a way to improve their public image.


In the process, she noted that they tried to work proactively with tobacco control advocates while at the same time they wanted to control the agenda and the debate.


The research she completed showed that the company’s sense of “fair play” included, among other strategies:


  • intensifying research on organizations
  • exacerbating conflicts between anti-tobacco groups
  • seek to diminish funding to tobacco control efforts
  • weaken the credibility of anti-tobacco groups and individuals


In conclusion, she noted that their makeover is not just public relations.  It is calculated to undermine the tobacco control movement by crating conflict in organizations, and thwarting “industry delegitimization” as a tobacco control strategy.


The final quote in the program from the records of Philip Morris:


“This is a long term project. It will take a serious effort of interdependent actions and plans and initiatives.  It is a reweaving of the fabric of social acceptability.”


Sounds like rope-a-dope to me.











Filed Under:

Prevention | Tobacco

The New Bold Idea In Tobacco Control:Are We Ready?

by Dr. Len July 14, 2006

Bold new ideas may be the next necessary step in the fight against tobacco. 


And bold doesn’t begin to describe the suggestion of one presenter at this morning’s plenary session at the 13th World Conference on Tobacco or Health now in its third day in Washington DC.


What was clear from the discussions I heard this morning is that we can make progress doing what we are already doing and what we know to do, but that in fact there are inevitably going to be limits to what those strategies can accomplish.  We need new ideas. 


Taxation, smoke-free communities, smoking cessation assistance, marketing restrictions and advertising bans are among those strategies that for some time have been the underpinnings of our tobacco control strategies.


As more than one speaker noted, in the United States these are the strategies that have been implemented by various communities and states around the country.


But, the United States is noted for its lack of a national strategy. 


In fact, the one federal effort that was made to effectively control tobacco products, namely the declaration by the former FDA commissioner David Kessler many years ago that the FDA would regulate tobacco products, was ruled unconstitutional by the Supreme Court. 


Subsequent congressional efforts to legislatively direct such regulation have not been successful in Congress.


What today’s speakers made clear is that the fight against tobacco will continue to evolve, and it is difficult to see a day when that fight will be over.


As tobacco control strategies evolve, so will the industry’s efforts to thwart them.


And some long held beliefs, such as restricting sales of tobacco through taxation for example, will not be successful in an internet age when the “public” price becomes prohibitive for too many people.


One speaker, Ron Borland from Australia, actually suggested we more or less embrace industry efforts to develop and promote less damaging tobacco products.


“The biggest problem in tobacco control is the industry and the cigarettes they produce and the immoral ways they market them to consumers,” were his opening remarks.


He went on to say that we can no longer avoid the harm reduction agenda, and we need to realize that some forms of smokeless tobacco are much less harmful than cigarettes.


He asked why we wouldn’t want to have people use a safer form of smokeless tobacco, which “only” kills one in twenty users, compared to one of every two people who currently smoke cigarettes.


But it was David Thompson from Vancouver, Canada who provided the truly bold new idea that captured the attention and enthusiastic support of the audience (if applause is any indication of such support).


Thompson, who is a lawyer and apparently has been active in environmental issues, challenged the audience to think differently about the entire concept of tobacco control.


 Losing 5 million people every year worldwide to tobacco related illnesses should make us think long and hard about why we haven’t had more success in our tobacco control efforts.


He got a response from many in attendance with his description of what he called the “Four L’s” of the tobacco industry strategy:


  • Lobbying
  • Litigation
  • Lying, and
  • Lawbreaking


But even given those less than desirable characteristics, he told us that understanding the industry is the key to managing it.


He also reframed the question about the motives of the industry, acknowledging that they are doing exactly what for-profit corporations are supposed to do, which is to maximize profits.  That is what they are required to do by law, in his words.  So, in simple terms, it is not about tobacco—it is about profits.


Thompson also shifted the debate about the companies from “immoral” to “amoral.”


They are more like machines than people, and they will always do their job to maximize profits.  To that end, he noted, they will never stop interfering with tobacco control, and continuously optimize and shift their tactics.  The industry will always be successful in his opinion.


So how to change the big picture?


Thompson showed a graph, where he portrayed the difference in smoking related deaths in a for-profit environment, and a not-for-profit environment.  The rates of death were substantially less in the not-for-profit model


Removing the profit in cigarette manufacturing and marketing results in a difference in what he called the “death increment of profit” which he defined as “the number of additional deaths we have as a result of having a for-profit tobacco industry, and the number of lives we could save if we eliminated the profit incentive.”


That is a concept I have not heard previously, but as I sat in the audience I thought this actually was making some sense.


A grand plan—purchasing the tobacco companies, making them a public utility, and taking a number of other steps that were outlined--actually is an approach that has some appeal. 


On the surface, it does not appear to be too dissimilar to what happened to Johns-Manville, a former large asbestos maker that was turned into a “social responsibility” type of corporation to compensate the victims of asbestos injury.


Thompson knew there would be skepticism about his plan, but he anticipated the arguments and offered solutions.


To do this would require a non-profit business model that would supply tobacco products and help reduce demand in a socially responsible manner.


  • There would be no changes for the tobacco farmers or tobacco company employees, at least initially. 


  • Research departments at tobacco companies could be shifted to harm reduction, and marketing departments could be shifted to working on the issues of demand management. 


  • For consumers, cigarettes would still be available but so would smoking cessation assistance.


There would also be an end to the “4 L’s.”  Industry could no longer block tobacco control initiatives.


The result?    A reduction in the death increment in tobacco industry profits.


Thompson noted that governments have the legal authority to purchase companies and property through eminent domain (although one of the panelists later in the program pointed out that the government record in this area hasn’t been particularly good, and provided the example of the Tennessee Valley Authority as a major polluter).


Future profits could finance the purchase, and the costs of purchase would be far outweighed by the reduction in medical costs now spent on treating tobacco related illnesses.


The major question remained to be answered: Is it wrong for us to get “involved” with tobacco, even if we save lives?


His response was simple and direct: It is no longer possible NOT to be involved.  Citizens in a democracy are responsible for their institutions.  And, in a point not lost on many of us, our mutual funds, pension funds and other investment vehicles are already involved in the ownership of these companies.


“Clean hands are a moral luxury, and actually a moral irrelevance when lives are at stake.”


Thompson concluded his remarks by outlining how to move forward in getting this done.  He likened the effort to other successful major social change initiatives.


By getting people, organizations, and government involved in collaboration we can be successful in this effort.  After all, look what has happened with other social programs, such as the campaign against drunk driving.  Focus the message, keep it consistent, and repeat it often and you can be successful.


The 4 minute mile, the end of apartheid, putting a man on the moon, and the fall of the Berlin wall are all examples of what can be accomplished if people have the will and see the way.


Crazy? Insane? Maybe. 


As Thompson pointed out, Einstein once said, “Insanity is doing the same thing over and over, and expecting a different result.”


But of all the new ideas I have heard discussed at this conference, this is the one that has really made me think. 


I hope it will make you think as well.



Filed Under:

Lung Cancer | Prevention | Tobacco

The Tobacco Treaty: What It Means To The World

by Dr. Len July 13, 2006

The Framework Convention on Tobacco Control (FCTC) is certainly a topic that is on the minds of many of the attendees at the 13th World Conference on Tobacco OR Health here in Washington DC.


This morning’s plenary session was devoted to a discussion of that treaty and its potential to control the worldwide tobacco pandemic.


Also not far from the thoughts of the folks who attended the session was the fact that the United States, although having signed the treaty, has not yet begun the process to ratify it.  The barbs thrown our way were sometimes subtle, and sometimes not so subtle.


The introductory speaker, Yumiko Mochizuki-Kobayashi from Switzerland, noted that ending the epidemic in the United States didn’t come soon enough for millions of Americans who lost their lives to tobacco.   As a result of various interventions in the US, cancer mortality eventually started to decline in the 1990’s.  But it did take substantial efforts over a prolonged time to achieve this result, and the work is still not done.  


The speaker listed an important series of steps that one needs to keep in mind to achieve success in tobacco control, in the context of the myriad conditions that are specific to countries and communities throughout the world.


These include the need to:


  • Personalize
  • Socialize
  • Galvanize
  • Medicalize
  • Regularize
  • Penalize
  • Fiscalize
  • Politicize
  • Globalize


The Framework convention is providing the global solution. In developing countries, where much work is needed in tobacco control there is also the greatest potential to stem the epidemic.  These countries also need to understand the link between tobacco control and economic and political development.


It is also clear in developing countries that tobacco control will not occur in a vacuum.  Once again, tobacco control needs to occur in context, as part of broader strategies to achieve important goals.


To this end, developing countries will need to:


  • Eradicate extreme poverty and hunger
  • Achieve universal primary education
  • Promote gender equality and empower women
  • Reduce child mortality
  • Improve maternal health
  • Combat HIV, malaria and other diseases
  • Ensure environmental sustainability
  • Develop a global partnership for development


We need to change the pattern of the epidemic, noted the speaker.  We need to nip the epidemic in the bud where it has not yet taken hold.  The tobacco companies are spending more money, knowledge and resources to accomplish their goals.  Yet we must remain optimistic that we can prevail.


She concluded with the emphasis on the fact that we are dealing with human lives, and we need to prevent future generations from the effects of tobacco.  We need to make our dreams a reality, and must share our vision and our future.


The next speaker was Patricia Lambert from South Africa.  Ms. Lambert is an advisor to the minister of health in South Africa.


She started her advocacy at age 5, when she vomited in the car and blamed her parents smoking for her ailment.   She has been an advocate ever since.


Her comments were personal and at times hard hitting.  She pulled few punches in criticizing the process through which the FCTC came to life and how it almost met is demise.


Ms. Lambert was passionate in her thanks to “all the epidemiologists and other scientists, to the health professionals, the civil society organizations, the lawyers, the politicians national and local, the policy advisors, the government workers, the diplomats and the leaders and members of international organization, as a citizen of an increasingly fractious and fragile world, I thank you for your efforts.”  The statement brought tears to her eyes.


“What you have done benefits us all, and most importantly the children today, and the children and adults tomorrow, tomorrow and tomorrow.  A tobacco free world is no longer impossibility. The FCTC will be a cornerstone of a tobacco free world.”


She was asked to present her view of the FCTC from the viewpoint of a personal critical analysis.


She described the treaty as a milestone in public health law.  The convention sets up most of the internationally accepted public health standards for public health and tobacco control.  If ratified, the standards become binding.


She described the document as a miracle.  Whether it is a large or small one remains to be seen, she noted.


Ms. Lambert commented further that it wasn’t easy to survive the long hours of discussion and negotiation.  The draft document was feeble and virtually meaningless, leading to shock and dismay.  It ignored 5 previous rounds of negotiation.  Her disappointment at the first draft was clear through the next several comments, with the feeling that many of the commitments that had been negotiated were subjected to political considerations and considerably weakened.


First, despite evidence that advertising bans have dramatic effects on tobacco consumption and childhood addiction, the draft called only for restrictions.  The advocates believed that restrictions were weak and would help the tobacco industry.


For another example, she said that the draft was silent on the issue of tobacco trade, another area of intense interest.  Too difficult, said the chairman.  We need to be aware of what is possible, not what is desirable.


But there were protests from many participants.  International measures were needed to curb the pandemic.  Compromise is a necessary part of any negotiation according to Ms. Lambert.  But the context of compromise is just as important, and each context is different.


In the case of tobacco control, compromise can be damning.  Horse-trading about life itself is not acceptable.  The strongest possible treaty was needed.  It is NOT just another product and the industry is not just another group of companies.  Trade cannot be more important than health.


She could not personally compromise.


Greater shocks were to follow, Ms. Lambert continued.  


The World Health Organization (WHO) Director General gave her unqualified support to the watered down text.  The participants had thought the WHO would have asked for the strongest possible controls, but they did not.  The DG should never have reversed her stance, and it smacked of political expediency.  “We had been looking to WHO for leadership, and many developing countries shared anger and disillusionment.  Trust had been broken,” said Ms. Lambert.


These issues are no longer relevant, since many were resolved.  There is one reason to discuss them today.  In her opinion, to ignore them would endanger the treaty we worked so hard to get in the first place.


Some of the greatest challenges in implementing the FCTC have their roots in the text as it presently stands and the relationships that were fractured.


There is an unquestionable political dimension to the entire process of the treaty and tobacco control in general. “Underlying the politics of tobacco control is always the question of money,” Ms. Lambert said, repeating, “Power and money.  Money and power.”


The FCTC is a miracle and a diamond. It is the jewel in the crown of tobacco control and international public health.


The treaty succeeds at many levels.  It condemns tobacco company interference, and places priority on the needs of developing countries and women.   We cannot let the forces of money and power to undermine the work we need to do and that we have already done.


The document sets the floor for control and not the ceiling.  The FCTC is the lowest threshold that a ratifying country needs to achieve.  Any country can do more to achieve the best possible tobacco control.


She commented that the fractured relationships are healing and will continue to heal.  She pointed out that success is based on the need for close, meaningful collaborative, working relationships.  They are vital for the successful implementation of the treaty. 


She then took on the issue of the United Nations, with several episodes of applause from the audience. 


“The entire UN system is under attack.  Unfortunately, the United States is at the forefront of the attack,” she said. 


There is criticism from the developing world which does not agree that the United States should have more influence in the United Nations because it pays more money in support.  “No single country, no matter how powerful, should have undue influence over international bodies,” she said.


She concluded with the observation that we have to protect the treaty in every way that we can.  We need to be alert to the combined influences of money and power.  We need to work with vigor and energy alongside the WHO to make the treaty a success.  “It is, after all ladies and gentlemen, a matter of life and death.”


The final presentation of the session was by the minister of public health from Uruguay, Dr. Maria Munoz.  Uruguay is the first country in the Americas to become smoke free.  It was a fascinating story.


Uruguay ratified the FCTC in September 2004.  It was a matter of economic necessity, in their view.


There was a tobacco epidemic in Uruguay.  32% of the population used tobacco.  25% of young people smoked, and 27% of the medical doctors were smoking.


3 million people live in Uruguay.  Almost 5000 citizens died every year from tobacco related diseases.  About 10% of all health care expenses—about $170 million--were associated with tobacco related diseases. 


The need to turn around this very serious reality was crucial to the decision to adopt the Framework. 


Since 2005, tobacco taxes were increased 70%.  This increased prices from $1.16 to $1.45 in US dollars, a substantial amount in a country with a large portion of the population living with low incomes.  She stated that this year Uruguay intends to add a 33% value added tax, from which cigarettes had been exempt previously.


A complete smoking ban in all indoor places went into effect in March 2006.


The result of these efforts is that Uruguay is the first smoke free country in the Americas.


There is progress in other areas as well.  A partial advertising ban is a prelude to preparation for a total tobacco advertising ban.


There is now a warning on every pack of cigarettes which occupies 50% of the cigarette pack surface.  One of these warnings is a picture of a pregnant woman’s belly smoking a cigarette.  Others are too graphic to describe here.


They have also offered free treatment of tobacco dependence including NRT and medications, have trained health professionals, and developed public sensitization campaigns.


Dr. Munoz noted this has been a long process. 


To succeed, she noted the need government and political will as well as having the will and commitment of the society as a whole.  Smokers and bar owners supported the decree, and there is an 80% public support level.  Civil society commitment was critical in implementing and enforcing the ban.   “La casa invita. Ambiente sin humo de tabaco” is a sign sitting on a restaurant bar in an advertisement shown to the audience.


To Dr. Munoz, a smoke free Uruguay is a citizen entitlement and a democracy entitlement.


Dr. Munoz stated her final message: “We encourage to the other states and governments to ratify, implement and enforce FCTS and join to this global public health movement that the FCTC is.”


 The moderator of the session concluded with what she described as a few final thoughts:


  • It is vital to keep this momentum going.  You have to use it to keep it alive.
  • Don’t go for the bare minimum; interpret the treaty to the maximum.  Otherwise it would simply not be enough.   
  • Those that have not ratified the treaty: you are in the minority, and that needs to change fast. 
  • The primary objective of the treaty is to reduce consumption.  That gives us the marching orders for its implementation.

 I have written previously how key global tobacco control is to the efforts to control the world cancer pandemic. 


This session provided insight into how the world views the first public health treaty to embrace this cause, and which has the potential to save millions of lives.


But to get to the goal, we have to take actions and be participants in the world stage.


The United States has not ratified this treaty.


To me, the rest of the world is making it pretty clear that they are looking for our leadership.  The time to act is now.




For more information about international tobacco control efforts and the Framework Convention on Tobacco Control, please visit our website.












Filed Under:

Lung Cancer | Prevention | Tobacco

Taking The Fight Against Tobacco To The World

by Dr. Len July 12, 2006

Today I joined thousands of my colleagues attending a symposium hosted by Larry King and Dr. Sanjay Gupta from CNN.  The subject was international tobacco control. The session was a combined program of the UICC World Cancer Congress and the 13th World Conference on Tobacco OR Health, which starts today.


As I entered the hall at the beginning of the program, the words uttered in the opening video gripped my attention. 


An airline attendant who is active in tobacco control efforts talked about “tobacco rape” as she made the point that you can’t step outside an airplane at 35,000 feet to get away from tobacco smoke.


The participants in the program covered a number of aspects of the tobacco control issue, and the battles that have been fought and the needs that have to be addressed worldwide.  Some of the panelists that appeared during the 90 minute program are well known to many of us, others not so well known.


The emphasis was on the global control of tobacco, and what must be done throughout the world to stem the scourge of the forthcoming epidemic.


The importance of the Framework Convention on Tobacco Control was also front and center on the agenda of this session...  It was pointed out several times that this is, after all, the first worldwide public health treaty that is intended to stop the global pandemic of preventable disease and death.


Tobacco is the worst public health threat facing the world today. 1 billion people will die this century, if we don’t intervene according to Dr. Seffrin, Chief Executive Officer of the American Cancer Society.  He went on to say that we know all we need to know about the tobacco epidemic.  The moral imperative requires our intervention now.


Dr. Seffrin noted that 133 countries have signed on to the FCTC treaty, which is the most rapidly adopted treaty in UN history.


The tobacco epidemic has four major stages, according to Dr. Seffrin.  Each country can be placed on a graph, which shows where they fit in the progress of the epidemic over 100 years.  Most countries in the world are still in the earliest stages of the pandemic, when intervention can produce the greatest benefit in terms of saving lives.


If nothing is done, tobacco deaths will soar over the next 50 years.


Everyone is concerned about bird flu, which is an immediate health threat.  Why not the same attention and care about tobacco?


People need to be aware that the cigarette companies are in fact engaged in child abuse, according to Dr. Seffrin. As markets mature in the United States, the transnational tobacco companies move to the other parts of the world where the rules allow the companies to exploit children and create new tobacco addicts.


According to an official of the World Health Organization, 200 million deaths can be averted by 2050 if actions are taken now.


The next presentation was by Dr. Nora Volkow, who is director of the US National Institute on Drug Abuse.  Dr. Volkow discussed the impact of nicotine on the brain.


By increasing dopamine levels in the brain, nicotine in cigarettes leads to the addiction process. 


Dr. Volkow pointed out that nature has provided a mechanism in the brain to ensure that we engage in behaviors that are important to our survival, such as eating.  When we engage in these necessary behaviors, the dopamine levels in our brain increase and we identify those activities as “pleasurable”.


Nicotine works through the same mechanism but is much more potent than other triggers.  In essence, nicotine results in a perversion of a life-sustaining reaction in our brains. 


We also know that drugs of abuse, such as nicotine, by themselves are not sufficient.  Some people become addicted, but others do not.  So other factors such as social situations that stimulate smoking can increase the risk of addiction.


Genetics may influence 50% of the vulnerability to nicotine addiction. 


The stage of your life when you start smoking is also important in determining whether or not you will become addicted.   The process of addiction is, in fact, established before age 25 and in many cases before 21.


Why are children so vulnerable? 


Their brains are still developing, says Dr. Volkow.  When brains are developing, they respond more vigorously than in older people.  The brains of children are also much more “plastic,” which means they can learn much more rapidly.  The net result is that it takes much less stimulation by nicotine to affect children than adults, when it comes to the process of tobacco addiction.


The impact of nicotine actually can start during fetal development.  17% of smoking women still continue to smoke during pregnancy, which leads to developmental defects in their unborn children.  And, yet, this problem has not received the attention it deserves.


The nicotine not only goes into mother’s brain; it also goes into the brain of the fetus where it affects the development of the brain.  In fact, nicotine receptors are much more prevalent in the fetal brain.


And it is not just nicotine that produces effects on the human body. 


Some of the other chemicals in cigarette smoke also have effects on the brain.  One substance in the brain, MAO, is reduced by 30 to 40% in the brains of smokers.  MAO is also present in the heart lungs kidney and spleen.


Smoking—or not smoking—in Ireland was next on the agenda.


Through a satellite link, Larry King spoke with the deputy prime minister of Ireland, Mary Harney.


As you probably know, Ireland is now smoke-free in its public places, including its legendary pubs.


Has the change been welcomed by the people in Ireland?  The PM responded if smoke- free can happen in Ireland, it can happen anywhere.  Compliance is 95%, and 80% of smokers support the ban.  A number of smokers have actually quit smoking because of the ban, and she noted that was “fantastic.”


For us it was a no-brainer, she said.  Smokers can damage their own health if they wish, but they do not have the right to damage the health of others.  The air quality of Irish pubs is 91% better in Ireland than in Irish pubs in other parts of the world.


The Irish government is also putting efforts into reducing the incidence of smoking among young people.  They are working on banning sun beds for people under age 16.  So it is not tobacco alone.  Cancer control is the key focus, noted Ms. Harney.


Our workplace and pub environments are fantastic, she said.


The next panel included some people well known to many of us.


Dr. C. Everett Koop, the former Surgeon General, Henry Waxman, a member of the House of Representatives who has long been active on tobacco issues, Dr. Yussuf Saloojee who is executive director of the National council Against Smoking in South Africa, and Dr. Thomas Frieden, Commissioner of Health in New York City joined Dr. Gupta on stage and were greeted with a standing ovation.


Nationally, we have made enormous strides noted Mr. Waxman.  We still have a long way to go: too many people smoke, children remain the targets of the tobacco industry, and they die early as a result of those efforts.  Mr. Waxman emphasized his amazement that the tobacco executives lied in their presentations to Congress in the past.  (“What a surprise”, was Larry King’s response to Mr. Waxman’s comment.  “But they aren’t politicians,” said Mr. Waxman.)


The science against smoking and cancer is seamless, noted Dr. Koop.  He took on tobacco because he had to—it is legislatively required.  He called the big tobacco folks the “sleaziest bunch of people.”


Dr.  Saloojee commented that South Africa started tobacco control much later than other countries.  Despite that late start, the country has achieved a40% reduction in tobacco consumption over the past 10 years, and the numbers of children who don’t even take a puff of tobacco have decreased. 


It wasn’t that they did anything unique or fancy.  They achieved their results by applying the basic principles of tobacco control. 


An interesting comment from his discussion was that it was only liberation from apartheid that permitted tobacco control legislation to be passed, since the tobacco executives sat on the secret group that previously had controlled the government.


Dr. Frieden, who is in no small part responsible for the remarkable success of New York City in implementing its smoke-free law, pointed out that tobacco, the leading cause of death in this country, is a man-made product.  Taxation, education, restricting tobacco advertising, and supporting people who smoke who want to quit are all key to success in this fight. 


Why not ban tobacco?  Prohibition didn’t work for alcohol and it won’t work for cigarettes said Mr. Waxman.   He continued that if we can postpone the starting age, we will be far along the way to preventing children from becoming addicted.


Mr. Waxman shared with the audience the fact that he had been a smoker in the past.  He admitted it wasn’t easy to quit.  He also said he hoped we would do more to provide smokers the tools they need to help them quit.


Dr. Koop noted that the tobacco industry had a budget of $4 billion, and then that doubled, while his office had only $1 million dollars to work with—and that had to cover all of the issues his office had to deal with, not just the fight against tobacco abuse.


Through collaboration with the American Cancer Society, the American Heart Association and the American Lung Association,  he was able to use their “volunteer armies”, to use his words, to take the anti-smoking message to every corner of this land. 


The US has signed the Framework treaty, but the Senate hasn’t received it for ratification, noted Dr. Gupta.  So, we are not bound by the treaty.  To much applause, he said we should be a leader in this treaty, not dragged kicking and screaming to the signing table.


The South African minister observed that the African countries are sitting on a ticking time bomb, and the time to defuse it is now.


Dr. Frieden noted that a tax increase decreased the number of smokers.  He recommended that we should make the tax o cigarettes as high as we can make it, since it is clear from the evidence that the single most effective way to decrease tobacco abuse is to increase the cost of the product.   We need bold moves to move the needle, and get tobacco use down.  We are now stalled in our tobacco control efforts in this country.


Tobacco control advocates were the next guests for the session.  Six experts from around the world were introduced to the audience.


The comments from these panelists were enlightening, and sometimes frightening.


  • In India, 47% of adult males and 14% adult women use tobacco in one form or another.  The tobacco industry in India has used every trick of the trade to get children addicted to tobacco. 


  • In Czechoslovakia, the tobacco companies advised the government it could save $1227 every time a smoker died and that would save the government money, implying that tobacco deaths are good for the country’s economy. They also suggested that money could be used for other purposes, such as housing for the elderly.


  • An expert from Guatemala noted that smoking by physicians is still high in many parts of the world.  He commented that we are not asking our patients about smoking during their visits, and we are not referring them for cessation help.  Doctors and their professional associations need to become involved.


  • A doctor from Zimbabwe noted the deceptive ways the industry uses to get their product to young people.  They offer scholarships and put their logos on backpacks.  The challenge is to communicate to the young people that they should have nothing to do with tobacco and the tobacco industry.


  • In Eastern Europe, the tobacco epidemic is just unfolding about 20 years behind the United States.  In the past, under the totalitarian regimes, tobacco was a sign of freedom. 


  • Women are the next market target in India, noted one audience member.  Women are a large potential market.  Weight control and special packaging are among the ways the industry are pitching their products to women. 


  • A flight attendant in the audience pleaded that every doctor ask their patients about how much secondhand smoke they have been exposed to in their lifetimes.  She pleaded that hospitals and doctors take one day to ask their communities and their cities to become smoke free, and end what she called this “diabolical crime against humanity.” 


Why not take the fight against smoking to the tobacco farmers, asked an audience member?  The companies say that growing tobacco is good for the community.  It is not good for the economy, said one of the panelists.  The economics of tobacco growth is not what the industry has made it out to be.  Governments need to know that tobacco growing is not economically viable.


The program concluded with a call to action. 


Dr. Franco Cavalli, the new president of the UICC noted that the UICC is very concerned about the increase in the number of deaths from tobacco related causes worldwide.  We need to step up the fight for a smoke-free world, and we need to convince all countries to sign the treaty for tobacco control.  Already 80% of the world’s population lives in countries that are parties to the Framework treaty.


The United States has signed it, but not ratified it.  Dr. Cavalli urged the government to do so as soon as possible.  He similarly pleaded for the Russian federation to become parties as soon as possible.


Everyone should help the UICC fight for a smoke free world and cancer will become a less scary reality than it is today.


Dr. David Bristol, president of the St. Lucia Cancer Society, is a surgeon who ended the program.  His country ratified the treaty last November.  His message was that the tobacco industry needs to hear continued, clear messages that we are going to sound the death knell for their product.  


Breathing clean air is about a right.  Not the right of smokers pushed by a relentless transnational tobacco industry, but the basic human right to live a normal, healthy human life span according to Dr. Bristol.


Dr. Bristol exhorted the audience to see its responsibility to be sure that no one in the world is forced to breathe someone else’s tobacco smoke.  We need to make smoke free environments a reality.  Curb tobacco use, and you will prevent many of us from premature deaths.


The messages of this symposium were loud and clear. 


We need a coordinated international effort on many fronts to defeat the tobacco industry.  Working one country at a time simply won’t work.


If we are successful, there will be gains for humanity.  If we fail, there will be countless lives lost over the next century.  The reality is that there are many examples of success that can be emulated elsewhere.


There are no mysteries here about what works.  What we need is the resolve to make it happen—everywhere.


After all, if you can be smoke free in Dublin and New York, why not the rest of the country and the world?




Ask President Bush to send the landmark Framework Convention on Tobacco Control to the United States Senate.  Visit our website for more information. 




Filed Under:

Lung Cancer | Prevention | Tobacco

A World in Need: The Cancer Epidemic

by Dr. Len July 12, 2006

Today is a day of transition at the international cancer meetings in Washington, DC.


As the UICC 2006 World Cancer Congress draws to a close, the 13th World Conference on tobacco OR Health is beginning, bringing over 4500 tobacco control researchers and advocates to sessions running through this coming Saturday.


This morning, the focus was on cancer prevention and the cancer control issues faced by countries throughout the world. 


The highlight of the session was the premier presentation of the 2006 World Cancer Declaration  (posting of the actual declaration was pending at the time this blog was published) where the participants in the Congress, from 139 countries, put in place a statement intended to focus attention on the world’s growing epidemic of cancer and what needs to be done now to stem that epidemic.


During that session, Dr. John Seffrin, the Chief Executive Officer of the American Cancer Society, highlighted what he called the “seven facts of life” for effective cancer control:


Fact #1: Cancer is a global problem and tumor burden is increasing worldwide.


Fact #2: The amount of information to control cancer is unprecedented.  By doing what we already know, half of cancer cases could be prevented. The quality of life of cancer patients could be improved worldwide.


Fact #3: The opportunity to save lives and reduce suffering is truly extraordinary by any measure


Fact #4: Even though the World Health Organization and the UICC recognize that well organized cancer plans can save lives, most regions do not have such plans.


Fact #5: Due to inaction, the gap is actually growing between what is known and what is done to control cancer globally. Most human suffering from cancer in the world today is needless.


Fact #6: Cancer is potentially the most preventable and treatable disease on the planet today.


Fact #7: We must take evidence-based action to make cancer control happen, and to make it a new reality for all people everywhere.  This is what the UICC and collaborating organizations are trying to accomplish.


Dr. Seffrin has emphasized a theme he has stated previously: We know a lot about what causes cancer, how to prevent cancer, how to treat cancer and how to support those whose lives are touched by cancer.  But what we are not doing is translating that knowledge into effective action.


In fact, several speakers today have repeated the comment that we already know enough about what to do to reduce cancer deaths.  Not that new knowledge and research is not important—it most certainly is—but we need to use what we already know.  Making that commitment could have an immediate, global impact.


We also can’t forget that death with dignity, controlling pain, and dealing effectively with end-of-life issues is an important part of our mission, according to Dr. Seffrin. 


Without access to state of the art cancer care in many parts of the world, we need to remember that access to comfort at the end of life, including adequate pain medication, is still beyond the reach of many people. 


He concluded his remarks with what he called “great news, the really important news.”  I can’t help but agree with his observation that if we do the right things we know how to do right now, these gaps between knowledge and action can be reduced and then eliminated.  And, if we can accomplish that, it will be the greatest victory in public health history.


But how to make this happen remains an elusive goal.


An official of the World Health Organization pointed out there were 7.6 million cancer deaths worldwide in 2005, and there will be over 9 million deaths from cancer in 2015.

70% of those cancer deaths occur in low and middle income countries. 


We are facing a major and growing health crisis, and much of the world is being left behind as we try to solve the problem.


Dr. Julie Gerberding, director of the Atlanta-based Centers for Disease Control and Prevention, challenged the audience to combat complacency, build capacity for real cancer control, and create connecting networks of organizations and governments that produce real results.


Working across organizations effectively is rapidly becoming a necessary set of skills if we are to be effective in our mission of reducing the burden and suffering from cancer in the United States and worldwide. 


She concluded with the observation that comprehensive cancer control is a measure of how these three challenges are met.


The session concluded with the presentation of the 2006 World Cancer Declaration.


Although contributions were made by many individuals and organizations up until the moment the Declaration was drafted, the actual writing of the declaration was accomplished by 40 world leaders in the fight against cancer.


This was not meant to be a window-dressing, feel-good type of document. 


The declaration is actionable, and progress will be measured and reported at the next World Cancer Congress, scheduled for 2008 in Geneva.


The preamble of the declaration describes a “new vision of the world cancer control community” as “a world where cancer control knowledge and competencies are equitable, shared and accessible, where new scientific findings are transferred to clinical settings, where disparities in prevention, early detection, treatment and cure of cancers are systematically reduced and eventually eliminated, and where all cancer patients receive the best cancer care.”


The document goes on to outline several specific action areas, including the need to invest in health, develop adequate cancer control planning, create cancer registries and implement vaccination programs with HPV and hepatitis vaccines. 


Tobacco control is a key area of interest, with the Declaration highlighting the need to increase the number of countries implementing strategies that have been identified as being successful in the WHO Framework convention on tobacco Control, such as:


  • increase the number of countries who implement effective tobacco control strategies, including price and tax measures


  • protection from exposure to tobacco smoke


  • regulation of tobacco products


  • tobacco use cessation, restriction of tobacco advertising, promotion and sponsorship


  • strengthening tobacco product packaging and labeling


  • controlling illicit trade of tobacco products and


  • banning sales of tobacco products to and by minors.


The Declaration’s goals are ambitious, to say the least. 


Having attended this conference over the past several days has been a significant learning process for me and I am certain for many of my colleagues as well. 


There is no doubt that there is a substantial amount of passion surrounding the discussions and presentations of the past several days, and a tremendous commitment to the spirit and the letter of the Declaration.


We tend to become somewhat complacent in this country when we view the issues we face in the prevention and early detection of cancer and the treatment of cancer relative to the rest of the world. 


We are so far ahead of many other countries that we tend to overlook the value of the lessons we have learned and how far we have come over the past several decades.


But we cannot overlook the needs of so many others throughout the globe.


Cancer is indeed a worldwide problem, and one of the lessons of the conference is that we are in the midst of a worldwide epidemic that demands action.


We can no less ignore the worldwide cancer epidemic and the specter of a world confronted by increasing tobacco abuse and its consequences than we would ignore an epidemic of an infectious disease that kills a fraction of the people who die from cancer every year.


We look forward to measuring our progress of how we meet the challenges set forth here in Washington over the past five days.


Katie Couric: A Very Special Day

by Dr. Len July 10, 2006

I had a remarkable experience today.


As I have written in my entries from the past couple of days, I am presently attending the international cancer conferences in Washington DC.


Last week I received a call from the folks in our Florida division, who asked if I could attend an event for the following Monday in Tampa.  Today was the day for that event.


Katie Couric was making a tour of six cities in the United States as part of her new responsibilities with CBS, which includes hosting their daily evening news program.


My American Cancer Society colleagues in Florida wanted to take advantage of that opportunity to kick off their $25 million, 5 year campaign to raise awareness of colorectal cancer screening.  Since the Society was the local focus of Ms. Couric’s trip to Tampa, they realized this was a rare opportunity to announce and kick off this campaign. 


I was asked to join them and welcome Ms. Couric to their city and their state.  As a result, I took a detour from my Washington duties to head off to Tampa, Florida to participate.


I will admit upfront that I am not a big celebrity fan.  I am, however, a “news junkie” and have a great deal of respect for Ms. Couric and her professional accomplishments.


I was also aware of what she has done for colorectal cancer awareness throughout the United States and the world.


I knew she had lost her husband tragically at a young age from colon cancer, and I knew about the impact she had on colorectal cancer screening when she made the incredibly bold move to have a screening colonoscopy live, on the air, as part of a Today show segment.


But I was not prepared for what I experienced today. 


I can honestly say that Ms. Couric is one of the most special and impressive people I have met.  To have the degree of talent and celebrity that she possesses is one thing.  To be as warm and human to others is quite another.


She spent individual time with each of the colon cancer survivors who were able to attend the event.  She listened to their stories, and remembered their names.  She let them know that she cared.


And then there was the speech.  I really don’t think “speech” is the right word to describe what she did this morning.  What she did was talk from her heart, with humor and emotion that can only come from the very personal experiences that she has had with cancer in her family.


Ms. Couric talked eloquently and passionately about what happened in her life with her husband, and how she has coped since his death.  She described her commitment to her efforts to defeat colorectal cancer in a way that touched the hearts of everyone in the audience.  She shared herself and gave of herself to all of us, in a way that cannot be simply described in words.


You may not be aware of what we in medicine call the “Couric effect,” which is used to describe the significant increase in interest and the actual number of colorectal cancer screenings that occurred after her television procedure.  The increase in screenings was real, and unprecedented.  There is no question that her commitment today is no less than it was when she “exposed” herself for all to watch.


Today, I was part of a unique and wonderful experience.  The media was present in large numbers, so you may have an opportunity to get a glimpse of a very special person doing something extraordinary, touching the lives of every person in the room.


Katie, the American Cancer Society wishes you well in your new venture with CBS and thanks you for what you did for us today. 


More important, we wish you well in life.


You have given of yourself, and there are people alive today because of you, your calling and your commitment.  You have saved lives, and you have saved worlds.


We are in your debt, and we are in awe of your accomplishments.


Can The Rest of The World Keep Pace?

by Dr. Len July 10, 2006

I attended a session yesterday which quickly grabbed my attention when I walked in the room and the speaker said, “We have been crawling and now we can fly.”


He was referring to the fact that the pace of developments in research and the practical, meaningful applications of those developments to patient care has increased so substantially as to be beyond comprehension.


The speaker, Dr. Andrew von Eschenbach, who is currently the acting Commissioner of the Food and Drug Administration, was outlining the changes that are occurring in cancer research and cancer treatment, and the implications of those changes in many areas of medical practice.


He referred to a process where we are moving from macroscopic care, to microscopic medicine, and now finally to molecular medicine.


Where we used to treat patients with their cancers, we are now treating the actual cancer cell itself.   Research has opened the era where we now understand how the cancer cell works, and what avenues are available to reverse those changes and push the cell back into normality.


The impact of these developments will make our treatments more predictable, and perhaps avoid the long and costly process that we currently have to grapple with to get medicines from the laboratory bench to the patient bedside.


But this new era also means new collaborations and partnerships, new means of educating everyone involved in health care from the doctors to the universities and medical schools to industry to the patients.  It will take unprecedented effort to make all this work, and to assure the world that we will move this process forward as expeditiously and efficiently as possible.


That, my friends, is a huge task.


But other speakers at the same session echoed Dr. von Eschenbach’s thoughts, although perhaps in more defined ways.


The prediction that within ten years we will have inexpensive, accurate molecular probes available to measure 2000 proteins in the blood that will serve as markers of changing cellular patterns predicting the onset of disease is astounding to me. 


It is far beyond where I thought we were in the development phase, and the impact of patients measuring their blood test every six months at home, and having the data analyzed and reported to their physician, who will be able to effectively treat a disease before it becomes visible or detectable by currently available means is almost beyond my belief and comprehension.


Yet that is what was said, repeatedly.


What we now consider our newest technology and treatments will soon be outmoded and “ancient.”  The pace of change will require adaptations that do not exist at the present time.


There is a maxim in medicine that it takes 17 years for a new idea to take hold and become part of standard medical practice.  There is another maxim that half of all medical knowledge is outdated every five years.


We can agree that both of these statements are, at times, not reflective of what actually happens.  But the essence of these thoughts is that change is constant, yet acceptance and dispersion is slow.


What is going to happen if the cycle of discovery and drug development shortens from ten years to two?  Will we be able to keep pace?  Will doctors be able to absorb the new information and new technologies?  How will the medical education and medical care systems deal with rapid change as a constant?


I am still skeptical that this will happen so quickly, but I must admit that I would like to be proven wrong in my doubts.  The opportunities are simply too exciting to contemplate, and the sooner we get to this goal, the healthier we are going to be as a country and as a world.


Especially tantalizing is the thought presented at the session that this new medical paradigm in fact will be less expensive and reduce medical care costs dramatically.  That’s another goal that I hope is real, for I have trouble contemplating that this new technologic reality will be able to reduce medical care costs.


Then there is the proverbial “other side of the coin.”


What about underdeveloped countries?  How will they be able to respond to this brave new world?


One of the speakers at the session, who followed Dr. von Eschenbach and two other scientists who painted a very vivid and very real picture of the new order, was from India.


She spoke eloquently of the decisions that have to be faced on a daily basis in countries too poor to contemplate the medical care that is generally accepted in the Western hemisphere.


Doctors in these countries less fortunate than ours are very much aware of the value of evidence based medicine.  They are aware of the results that can be obtained with targeted therapies.  They know the value of screening for cervical, colorectal and breast cancer.  They know that participation in clinical trials is important.  They realize that they need to develop an infrastructure of cancer registries in order to move forward with more effective cancer control and cancer care.


But they can’t afford it. 


They are faced on a daily basis with decisions that many of us are not familiar with.


Do they immunize or do they treat?  Do they use new therapies or older treatment regimens?


As the speaker noted, these countries are caught in a situation where they have to grapple with outcomes and benefits every day.


I have heard this before. 


For example, we take mammography for granted in this country.  Breast cancer is diagnosed in many women before a lump is felt.  We treat early stage disease, with outstanding results.  We provide hospice care and pain relief for people who are suffering.


These poor countries can’t do that. 


I spoke with a physician from Montenegro not too long ago who told me of his struggle to get doctors to stop smoking in the hospital.  He recounted the difficulty of getting a mammogram machine into the country and instituting an effective breast cancer screening program.  He recounted how he is trying to build a nascent non-governmental cancer organization to promote the various messages needed to change people’s behaviors.  And he needed funds to get this work done.


As the developed world moves on and creates technologies not even dreamed about a couple of years ago, we cannot lose sight of what has to be done worldwide to provide people in less fortunate circumstances access to first rate medical and cancer care.


That is a very tall order.  But if we don’t accomplish that, then the gap between the “haves” and the “have nots” will continue to widen.


As one of the speakers pointed out, good health is part of good economics.  If a country does not have good health and good health care, it suffers economically. 


Systems put in place in Singapore, according to this scientist, allowed it to deal effectively with the SARS epidemic and actually resulted in a boost to its economic ratings.


Poor countries cannot remove their dependence on others unless they have infrastructures in place that allow their people to have adequate food, shelter and health, among other basic requirements.


What many folks are not aware of is that the American Cancer Society has made it part of its commitment to provide aid and assistance to these countries, to help them organize their own cancer societies and strengthen their national programs.


I spoke to a group from Jerusalem who work with Palestinians, and the appreciation in their eyes and their words was a testament to the success of our international efforts.


We are certainly not going to be able to do it alone, and our contribution is a small one in global terms.


But it is an investment in people that we hope will spread the doctrine worldwide that we can accomplish much for the care of people, including those in countries less fortunate than many, where difficult decisions have to be made every day.


Getting cancer care on the political and social agendas of these countries will hopefully give them the focus and opportunity to be able to take advantage of the many exciting research and medical care developments that are primed to make this a very different world to live in.


Once again, we can do no less.




We are also doing audio blogs from the UICC conference.


If you are interested, the blogs are posted at the following URLs:





We plan on posting additional blogs this week during the course of the conferences.

Filed Under:

Cancer Care | Prevention | Research

Report from the UICC: What The World Needs Now

by Dr. Len July 09, 2006


This week marks the occasion of several internationally important cancer meetings in Washington DC.


Last evening, the International Union Against Cancer (UICC) opened its quadrennial international cancer meeting, bringing together cancer experts from 139 countries.


The UICC is the only international non-governmental organization dedicated exclusively to the global control of cancer, with a vision of a world where cancer is eliminated as a major life-threatening disease for future generations.


The American Cancer Society is proud of the fact that our Chief Executive Officer, Dr. John Seffrin, has served for the past four years as president of the UICC.  The Society is the host organization for this year’s conference, which is attended by over 2200 experts in cancer research, cancer treatment and cancer control.


The opening sessions highlighted presentations by Dr. Seffrin, and former President George Herbert Walker Bush and his wife Barbara, among others.


It stands to reason that we spend much of our attention and focus on what impacts cancer in the United States.  How we improve prevention and early detection, and how we assure patients with cancer have access to the best available care—no matter where they live or what their economic status—is a goal many of us work towards every day at the American Cancer Society.


But what may be the primary cancer-related issues here in the United States are certainly not the primary cancer-related issues in other parts of the world. 


For economically developed countries, cancer is certainly on their health agendas.  But for countries that can be considered “developing,” attention to cancer related issues is not at the top of their priority list.


That was one of the messages sent loud and clear from the podium last evening:


Cancer is a major cause of death worldwide, and not only in economically developed countries.  And it is not just a disease of wealthy countries.  If we are to improve the economies of developing countries, we need to be aware of the impact of cancer on those economies, and we need to take steps to address our approach to cancer in those countries.


As Dr. Seffrin mentioned, 7 million souls have been swept from our midst by cancer this year.  That is more than HIV, tuberculosis and malaria combined. Yet, despite this huge toll, cancer is not even on the G8 cancer agenda.  The toll will increase each year unless we do something now, said Dr. Seffrin.


And the influence of tobacco has not yet even begun to be felt worldwide, as noted by Dr. Seffrin. One out of every five people in the world use tobacco today, and the tobacco industry has to recruit 5 million new smokers to replenish its base.


Since the United States is no longer the fertile ground it once was for new tobacco smokers, the companies must look elsewhere.  It is a plan that is implemented in various countries around the world.  First, the boys and the men, then the women and the girls.  Twenty years later, the lung cancer rates start to rise, and then the deaths begin to become epidemic.


That in short is what the world has to look forward to as the tobacco companies export their deaths elsewhere in the world.  One half of all people who smoke will succumb to a smoking related illness.  When you take into consideration a country the size of China, that toll begins to mount into the millions of people.


Dr. Seffrin noted that as a direct result of tobacco use, 650 million people alive today including 300 million children will die from tobacco related disease, and at a time in their lives when they are likely to be most productive.


Infectious diseases are another area of concern if we are going to decrease the global burden of cancer.  Infectious agents are responsible for 1 out of 5 cancers worldwide, and one out of 4 cases in poor and underdeveloped countries.


Overweight and obesity, once the province of the more developed countries, are now becoming endemic in poor countries as well.  We are not only exporting our Western lifestyle, we are also exporting our Western diseases.


The comments of former President Bush and his wife were especially heartfelt, given the fact that they had lost a young daughter to acute leukemia, something that many in the audience were not aware of. 


For the Bush’s and their family, this fight is personal.


The Bush’s deserve special thanks for their efforts devoted to cancer research and treatment, including their involvement in the M. D. Anderson Cancer Center in Houston, Texas and their founding role in the development of C-Change, a national collaboration of organizations devoted to cancer treatment and research.


Mrs. Bush recounted her involvement in speaking for effective cancer treatment for children worldwide, and made a pledge that they will not consider their job done until children can survive cancer worldwide.


The President made proposals describing what we need to do to make cancer control a reality throughout the world.  He cited the need for cancer registries where they currently don’t exist.  We need data and information that is accurate and current if we are to move forward in the global fight on cancer.  We need funding proportional to the threat that cancer raises in every country.  Five percent of the budget is simply not enough when talking about dealing with non-communicable diseases such as cancer, mental health and auto accidents.  Cancer has to be recognized as a priority by governments and others throughout the world.


He concluded his remarks by saying that we need nothing less than a truly remarkable international cancer community driven by common goals, and that is coordinated and energized and able to accomplish great things.  We need worldwide unity and advocacy in this effort, backed up by real substance.


He said that we will not consider cancer a conquered disease until every single person in every corner of the world has access to cancer treatment and cures.  We need to emphasize cancer prevention.  “This is one fight we can win, will win, must win.”


So what does all of this mean?


We certainly have issues we need to address here in the United States.  But, as outlined above, we cannot accomplish our goals if the rest of the world is devoid of hope, access to prevention and early detection, and effective cancer treatment.


How we approach cancer, its control and its treatment may be different depending on what part of the world we live in.  Infectious causes may be a priority in one part of the world, while early detection of breast cancer may be important in another.


But we will not be able to achieve audacious goals if we don’t think big, and if we don’t think about the basic blocking and tackling that needs to be accomplished to get movement started towards these goals. 


What sounds simple—like creating effective, inclusive cancer registries—in fact requires adequate funding and coordination in all parts of the world.  Then w will have a basis of information on which to move forward in a rational manner


We can’t be fragmented in our approaches to the common causes of cancer, including tobacco, overweight and obesity and infection. We can’t ignore the fact that what tobacco companies can’t do here they can do with ease elsewhere.


Yesterday I had the opportunity with my wife to visit the Holocaust Museum here in Washington. I am not ashamed to say that I was emotionally distraught when our tour was complete. 


My wife and I both cried, and asked, “Why?  How did it happen?  Why did people let it happen?”


Now I ask the same question of the tobacco companies.  We know the dangers of tobacco.  We know it kills when used as intended.  We can see the statistics of mounting deaths worldwide and the promise of millions to come. 


Yet despite that knowledge, we stand by and let the scourge continue.  We in the United States have failed to ratify the treaty where we commit to the global anti-tobacco alliance in a real and meaningful way.


And I ask, “Why? How is this happening? Why are we letting it happen?”


When millions upon millions of people are dying, why do we think that transporting these deaths offshore is humane or ethically justifiable?


We have to think globally in many ways today.  As the book title says, “The world is flat.”  And we do have to be concerned about what happens elsewhere.


We cannot be silent. To do so is to know that we stood by why we let these things happen.


It may not be dramatic, but the loss of so many lives cannot be ignored.  And we should not be able to stand back and let history ask why we didn’t do more.


To me, that is the meaning of this conference.  By acting together and thinking globally, we have the opportunity to impact lives—millions of lives—throughout the world.



About Dr. Len

Dr. Len

J. Leonard Lichtenfeld, MD, MACP - Dr. Lichtenfeld is Deputy Chief Medical Officer for the national office of the American Cancer Society.