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.