Health

Wednesday 27 August 2014

James Reilly v big tobacco

In Australia, cigarette packets now bear grisly images of tumours on plain backgrounds, in place of colourful logos. As Ireland prepares to follow suit, Suzanne Harrington asks if it will be enough to stop the next generation getting hooked

Australian cigarette packet

Here are some things a group of six and seven-year-old children said when shown a selection of product packaging: "It stands out"; "it makes you happy looking at it"; it's pretty and girly"; red is my favourite colour"; "it's funky ... fancy... like ice cubes and mint"; "it looks posh"; it reminds me of a symbol in Tinti [bath products]"; it makes you feel like you're in a wonderland of happiness".

The children were talking about cigarette packets. Their responses were complex in terms of decoding visual signifiers at such a young age, yet uncomplicated in that they associated the assorted colours with positive feelings, and identified positive feelings with the graphics and logos, without having a clue what they meant or what the packages actually contained.

The YouTube video (tinyurl.com/84bdlwd) is part of a campaign by Cancer Research UK to sell tobacco products in non-branded packaging, called The Answer Is Plain.

So far, the campaign has not been embraced by the UK government – a spokesperson for David Cameron said in May: "We are still waiting to see how it works in Australia before deciding what to do. There are no plans to introduce it here now."

Ireland, however, is very much on the case, with a ban on cigarette package branding and logos set to come into effect next year. We will be the first country in Europe to do this, and only the second country in the world after Australia.

Down under, cigarettes are now sold in plain, olive-coloured packaging, in same-size boxes with uniform typeface and large health warnings; the only splash of colour comes from some vivid photographs of the effects of cancer.

A rotting mouth is accompanied by the stark warning, "Smoking causes mouth and throat cancer", and a horror-movie eyeball, which is a genuine medical photo, illustrates how "Smoking causes blindness".

Logically, those small kids for whom current European cigarette packaging is a funky wonderland of happiness might have a rather more visceral reaction to the Australian packaging. Such as "yuck", "ewww", "bleugh".

Since the inception of plain packaging in Australia in December 2012, there have been some anecdotal reports of behavioural changes from smokers.

According to Jonathan Liberman, an Australian lawyer involved with the ban on branded packaging, phonecalls to the Australian smoking quitline increased when cigarette logos were replaced with graphic images of what they do to you.

And such is the subliminal power of packaging that Australian smokers reported their cigarettes "tasted different" when in non-logo packaging.

This is the intention – the aim of plain packaging is not to alienate smokers already hooked (given that cigarettes are possibly the most addictive product legally on sale in the world today, it would take more than an eyeball to put off smoking addicts), but to deter future smokers. In other words, kids.

Minister for Health James Reilly refers to current cigarette packets as "silent salesmen" and "mobile billboards".

Here's the thing. Ireland needs to recruit around 50 new smokers a day to keep its smoker rates at current levels. The vast majority of smokers – 78pc – say that they began smoking when still aged under 18. And young people are generally more brand-susceptible.

You don't have to be a genius to work it out – dull packaging with only a blackened lung for decoration is not good news for manufacturers, who have for decades packaged their product in slim gold, chunky masculine red, sophisticated black, elegant silver, reliable blue, light and airy white. Now it's no logo, no special font – just a colour photo of a tumour.

No wonder the tobacco industry is freaking out. In Australia, it launched a television advertising campaign against the plain packaging initiative and appealed to the World Trade Organisation about the ban, all to no avail.

The tobacco industry needs you to start smoking young, despite its insistence that cigarettes are an adult product. This is the same tobacco industry that also insisted for many decades that its adult product was not addictive, while keeping very quiet indeed about its adult product being carcinogenic – a fact known to the industry since 1959.

Yet Ireland already has some of the most stringent anti-smoking legislation on earth. We were the first country in the world to instigate a total ban on smoking in the workplace, in 2004. This workplace ban even includes your house, if someone non-resident – a babysitter, a plumber, a delivery person – is working in it.

In 2009, tobacco products were no longer allowed to be displayed in shops here, while cigarette vending machines were required to use special tokens, and packs of 10 cigarettes were discontinued. Today, a pack of 20 costs almost a tenner. The climate could not be more discouraging.

You would think, therefore, that Ireland is now virtually smoke-free. You'd be wrong. According to an EU report called the Eurobarometer, 29pc of the Irish population smoked in 2006, increasing to 31pc in 2009. The European average is 29pc; the further south you go, the more people smoke – 40pc in Greece, compared with 16pc in Sweden.

According to 2006 figures from the HSE, 15pc of Irish school-age children smoke, but the highest percentage of Irish smokers are aged between 20 and 34.

In Ireland in 2008 there were 36,000 tobacco-related hospital admissions, which cost about €280m. And quite a few deaths – Action on Smoking & Health puts the figure at 5,500, while Health Minister Reilly says it's 5,200.

In Europe, where 700,000 people a year die from smoking, Minister Reilly says that the health cost is €25bn, lost productivity costs €8bn, while the revenue from tobacco is €20bn. "Ireland is strong on tobacco control but has not reduced smoking," says Deirdre Healy, corporate affairs manager at John Player, part of the Imperial Tobacco Group.

While preferring not to comment on her personal views about smoking, or about the ethics of working as a spokesperson for the tobacco industry, Healy says that everyone knows the health risks of the product she represents, and emphasises that this is why it's an adult product.

Prior to becoming a spokesperson for the tobacco industry, Healy was communications manager at the Irish Blood Transfusion Service.

"Those who work in the tobacco industry are happy and comfortable within this industry," she says. "But nobody at John Player wants children to smoke – John Player employees have children, too."

She says that rigorous legislation has resulted in a two-tier tobacco market in Ireland: one legitimate, one illicit.

"Where you see cigarettes advertised is not in any shops, but in places such as Moore Street market, Balbriggan or via leaflets through your door. Twenty-eight percent of cigarettes smoked by Irish smokers are not bought in Irish shops. They don't carry Irish health warnings or pay tax in Ireland."

This is the big beef of the tobacco industry about plain packaging: loss of revenue. The implication is that the tobacco industry is being continuously persecuted, despite being a legal entity.

In a recent radio interview, Healy called the plain-packaging initiative "an absolute boon" to dissident Republican cigarette smugglers.

"The reality is that their supply chain costs have been cut, because you don't have to make a separate pack [for the brands she represents]. They're all going to look the same now, and that means supply chain costs will be cut," she said.

Reilly disagrees with Healy's claims.

"There is absolutely no evidence to support her contention," he says. "Logically, it will make cigarette smuggling in Ireland more difficult. And Revenue don't believe it will make any difference.

"The tobacco industry in Australia fought this [plain-packaging legislation] all the way to the World Trade Organisation. Rather than resist, why doesn't the industry invest in something that doesn't cause such catastrophic effects? It's a no-brainer ethically, morally and economically."

Reilly's claims that cigarette smugglers will not profit from plain packaging is confirmed in a study entitled 'Smuggling, The Tobacco Industry and Plain Packs' by sociologist Luk Joossens, who advises the World Bank, World Health Organisation and European Commission.

"The evidence is that counterfeit producers find all existing packs easy to forge. The overall cost of manufacturing a 20 pack of counterfeit cigarettes is around 10 to 15 pence – of which up to a third is estimated to be on packaging," he says.

"They are typically sold in the UK for around £3 [€4.50 in Ireland]. Counterfeit cigarette packaging is already so cheap to make there is no way that cheaper packaging could have a significant effect on either their retail price or profitability."

It looks, therefore, as if we are at the beginning of a new tipping point, initiated by Australia and closely followed by Ireland, so that by the time the current generation of children are adults, tobacco smoking may be a thing of the past. Like slavery, or snuff.

This is the second tipping point – the first came almost 50 years ago.

On January 11, 1964, the US Surgeon General published a report called 'Smoking & Health', which made the unequivocal link between smoking and cancer.

There had been earlier studies – the Oxford epidemiologist Richard Doll and the US pathologist Oscar Auerbach had both linked smoking with lung cancer and heart disease – but this was the first official declaration by the US government that cigarettes might not be terribly good for you.

The report was published on a Saturday so that it would not cause a distracting earthquake on Wall Street, and would receive maximum coverage in the Sunday papers. In terms of public perception of cigarettes shifting from benign, every day and fashionable to a dangerous legal product responsible for one-quarter of all global cancer deaths, this was the start.

Prior to this report, as anyone who has seen even five minutes of 'Mad Men' will know, it was almost illegal not to smoke. Not smoking was freakish. Everyone did it everywhere, from pregnant women to the elderly, and in public places from hospitals and offices to buses, planes, trains and cinemas. You could smoke anywhere, and everyone did.

Ronald Reagan, pre-presidency, was paid to advertise cigarettes in 1952: "I'm sending Chesterfields to all my friends – that's the merriest Christmas any smoker can have." Rock Hudson, Gregory Peck, Kirk Douglas, Dean Martin, Bing Crosby, Bob Hope, Marlene Dietrich and dozens more also endorsed various brands.

Could you imagine Brangelina endorsing an electronic vapour cigarette today? Not even slightly. (Electronic cigarettes are another story, but given that they are being banned in Mexico, New Zealand and Israel, and France is planning to follow suit, they may not be quite the 'healthy' option we think.)

Intelligence, status, knowledge, power – these tools are of little help to those already addicted to smoking. Barack Obama was probably the world's highest-profile serial relapser, finally quitting in 2011 after 30 years of being a smoker.

Millions are spent all over the world encouraging and supporting people to quit, but the HSE says only about half of all smokers manage to give up properly. And the other half? Half of them die prematurely. As a smoker, you have a one in two chance of early death.

Both the brother and father of Minister Reilly, both of whom were doctors, died as a result of smoking. As a doctor, the Minister's brother knew the dangers, but "was so addicted he couldn't give them up".

Adds Reilly: "And my father was prematurely blind because of a stroke and spent the last 14 years of his life without being able to see. It's not that I have any personal grudge, but I have experienced personally the harm and damage that [cigarettes] do and I don't want other families to endure what we endured."

At a recent press conference, he referred to the tobacco industry variously as "disgraceful", "repugnant" and "indefensible".

The problem with smoking – apart from being addictive and deadly – is its early association with glamour. Think Marlene Dietrich, think classic French cinema, think old-school Hollywood style. Nowadays, smoking is perceived by some demographics as rebellious, edgy, unapologetic, transgressive. Think Kate Moss and Lady Gaga.

In 2011, Kate Moss helped reinforce this image by smoking on a Louis Vuitton catwalk in Paris. Given that it was No Smoking Day, her statement was unlikely to have been accidental. Lady Gaga has also lit up on stage.

Such is its forbidden nature that there are even specialist adult sites online where the kink depicted is not foot fetishism or whatever, but women and girls smoking.

A 2008 study titled 'Adolescent Women, Identity and Smoking: Leisure Experience as Resistance' described how some teenage girls use smoking as a rejection of the 'good girl' female identity. Remember Sandy and Rizzo in 'Grease', archetypes of female 'good' and 'bad'. The tough, unflappable Rizzo smoked while Sandy choked and went green on first inhalation?

Not much has changed, other than our awareness of health issues.

In an article entitled 'Smoke and Minors', published by 'The Guardian' in June 2011, journalist Anne Karpf wrote: "Forget BlackBerrys or wedges: the most desirable accessory for huge numbers of adolescent girls today is a cigarette. There has long been a synergy between the changing self-image of girls and the wiles of the tobacco industry."

And guess what – the tobacco industry is more than aware of this teenage girl misconception that smoking is cool, bad and keeps you thin. According to Philip Morris in 1992, "Throughout all our research, we continue to validate that women are particularly involved with the aesthetics of packaging ... we sense that women are a primary target for our innovative packaging task, and that more fashionable feminine packaging can enhance the relevance of some of our brands".

In 2011, four major global tobacco companies launched girl-oriented cigarettes. Imperial Tobacco, which owns John Player, gave the world a 'slim' cigarette – which, according to 'The Grocer' magazine, had a "stylish pink design" that was "clearly designed to appeal to female smokers".

British American Tobacco offered "the UK's demi-slim cigarette" called the Vogue Perle, Philip Morris launched the Virginia S, and Japan Tobacco International put Silk Cut in a "limited edition" V-shaped pack. You know, like a lipstick or a perfume.

What does this mean – that if you smoke loads of 'slim' cigarettes, your mouth will be too busy to eat and you will be as thin as Kate Moss?

"Young women are obsessed with fashion and staying slim, and this is exactly the message this pack is trying to give," consultant obstetrician Dr Shonag Mackenzie told 'The Grocer'.

"It is young teenage girls who don't yet smoke but are probably experimenting who are most likely to be influenced by this."

In December 2011, 'Retail Newsagent' magazine ran the headline that "slimmer cigarettes will be big money earners".

Minister Reilly is unimpressed. "These new slim packets of cigarettes in nicely packaged colours are aimed at young girls. Seven-hundred thousand people a year die in Europe from smoking and the tobacco industry is replacing them with children. What chance do you have if you are addicted by the time you are 18?

"We're not anti-smoker, we're anti-smoking and anti-tobacco. We are duty bound to protect our minors. Knowledge is power, and we need to protect girls and young women, who have a higher take-up rate of smoking than young men."

Such is the deceptive association for many girls and women between smoking and slimness that one Canadian tobacco industry expert, Professor David Hammond of the University of Ontario, says that in the 1960s there was some experimentation to include appetite suppressants within cigarettes.

"We know the industry explored ways to exploit concerns about weight loss back in the 1960s, because they knew it was an issue that concerned women, who they wanted to recruit as smokers," he said.

"We don't know if appetite-suppressing molecules are still added, because compliance with additive regulations is poor and sensitive internal documents are usually shredded."

Meanwhile, in May 2011, British American Tobacco (BAT) donated £125,000 to the University of Durham to fund the education of four Afghan women – while 5,500 people annually die of smoking-related illnesses in the region of the university, which was widely criticised for accepting the donation. BAT said it made the donation as part of its 'corporate responsibility' policy.

As of next year in Ireland, young people will no longer be influenced by the visual appearance of cigarette packets. Minister Reilly expects the tobacco industry to contest the change, but remains resolute.

"We need to get people off the addiction of tobacco," he says.

"And get governments off the addiction of the revenue that tobacco brings."

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