FDA Releases Selection of Graphic Warnings

The FDA released Tuesday their final selection of 9 graphic warnings to be placed on all cigarette packaging and advertising by September 2012. These warnings will replace the ubiquitous black and white labels that have been in use for the past 25 years. The Federal Trade Commission found in 1981 that they had little deterrent effect. The new warnings will cover 50% of packaging and 20% of advertising.

CDC research conducted in 14 foreign nations has shown that graphic warnings spur smokers to think about quitting. However, there remains question as to the efficacy in a society as literate as the U.S. Are there really individuals that do not know tobacco will kill you? One of the critiques of youth focused prevention is that young persons do not grasp the same concept of long term health risk. Will these graphic warnings actually penetrate this worldview and prevent initiation?

One of the most unique criticisms of graphic warning labels comes from Martin Lindstrom author of the book Buyology. Lindstrom’s book is an analysis of the effectiveness of marketing tactics involving MRI and EEG brain scanning technologies called nueromarketing. His findings were that graphic warnings on cigarette packaging did little to inhibit craving and promote cessation. In an interview on NBC’s Today show in 2008 he remarked,

“We couldn’t help but conclude that those same cigarette warning labels intended to reduce smoking, curb cancer, and save lives had instead become a killer marketing tool for the tobacco industry.” The crux of his argument is that visual stimuli, like the graphic warnings, over time becomes associated with cigarettes as effectively as any overt branding.

None of the marketing reforms called for in the Family Smoking Prevention and Tobacco Control Act go to the lengths of eliminating branding and advertising called for in the WHO’s Framework Convention on Tobacco Control. Limiting advertising to black on white as well as a preclusion from claiming that a tobacco product was FDA approved were almost immediately held up by litigation. The judicial history of commercial speech in the U.S. may place significant obstacles to ratification in this country.

Perhaps the most positive aspect of these new warnings is the inclusion of the 1-800 QUIT NOW national quit line number. Getting a minimum of social support and counseling to smokers can only act as a prompt for cessation that did not exist previously.

Fayetteville Battles On

On June 7 the Fayetteville City Council failed to pass a comprehensive clean indoor air ordinance that would have protected bartenders, servers, and musicians from secondhand smoke. The vote required a super majority because it amended a popular vote in 2003.5 voted positively with 3 siding with the tobacco industry. And in this is the real story. The expected 6th vote to pass would have come from a former board member for the American Lung Association. Alderman Mark Kinion failed the people of Fayetteville and embarrassed himself and the Lung Association. This is reprehensible. Yet again evidence of the tremendous influence of the tobacco industry in Arkansas.

For your amusement, my presentation to the City Council is below.

Handsel Art

7 June 2011

contact J.R. Few

handselart@marioncounty.com

http://handselart.blogspot.com/

or 870-427-1365

ADDRESS TO THE FAYETTEVILLE, AR CITY COUNCIL

Thank you for the opportunity to speak this evening.

My name is J.R. Pinky Few. I’m Creative Director for Handsel Art and Advertising. I’ve been a tobacco free advocate for about a decade. In 2006 I was recognized by the Coalition for a Tobacco Free Arkansas with the Trailblazer Award. The National Public Health Information Coalition cited my work in print media w gold and silver medals in 2007. In 2009 I was invited to speak on effective rural media at the ASH Wales conference in Cardiff, Wales. I currently work as a volunteer w the Arkansas Cancer Coalition on the Communications Committee and act as co-chair of the Lung Cancer Work Group.

I have to ask why a public health issue as evidence based as smoke free air is even being debated. The Surgeon General Richard Carmona’s report in 2006 stated that there was unequivocally no safe exposure to secondhand smoke. Surgeon General Regina Benjamin’s 2010 report, “explains beyond a shadow of a doubt how tobacco smoke causes disease, validates earlier findings, and expands and strengthens the science base.” She adds,” Armed with this irrefutable data, the time has come to mount a full-scale assault on the tobacco epidemic”. So why are we here?

George Santayana is quoted that those who do not learn from history are doomed to repeat it.

In 1954, responding to growing epidemiological evidence relating tobacco to disease, the tobacco industry took out a full page ad in 400 of the largest newspapers in the country. Titled a “Frank statement to cigarette smokers”, it promised to work closely with public health officials to understand the ‘speculation’ about tobacco and disease. This spawned the creation of the Tobacco Industry Research Committee. That developed into the American Tobacco Institute and marks the beginning of decades of deceit, pseudoscience, and manipulation of our laws and public opinion. In 2006 a Federal Court convicted the tobacco industry of Racketeering and Fraud. In her final opinion Judge Gladys Kessler notes,

“These public promises were intended to deceive the American public into believing that there was no risk associated with passive smoking and that Defendants would fund objective research to find definitive answers. Instead, over the decades that followed, Defendants took steps to undermine independent research, to fund research designed and controlled to generate industry favorable results, and to suppress adverse research results.”

We are here because this historic fraud was, and continues to be, so very successful. The industry created, funds, and manipulates hospitality groups and smokers clubs to create the illusion that there was any question about the science or rights behind clean indoor air. Smoking is a privilege. Breathing is a right.

We hear concerns about lost business revenue when there are no legitimate, peer reviewed studies of tax receipts that do not show clean indoor air to be revenue neutral or advantageous to smoke free businesses. The only business that loses money with clean indoor air is the tobacco business.

I’ll warrant you’re hearing the same pro tobacco arguments today that you heard in 2003. The forecast economic doom didn’t happen then either. And in fact since 2003 research has shown that comprehensive smoke free space significantly reduces deaths from cardiovascular disease. In 2003 the study in Helena, Montana showed a 42% reduction in area heart attacks after a comprehensive law. This was replicated in Pueblo NM, in CA, in NY, in Italy. The National Academy of Sciences concluded from 11 key studies that comprehensive smoke free air in public spaces reduced heart attacks from 6% to 47% . These results were often seen almost immediately. This makes sense because we know that even brief exposure to secondhand smoke compromises the cardiovascular system.

Because of the lag time between exposure and the onset of cancers we have not seen the reduction among cancer deaths caused by tobacco smoke yet. However, the California EPA has classified secondhand smoke as a Toxic Air Contaminant and as such subject to regulation even out of doors. This finding was the result of research showing a causal relationship between adult asthma, pre-term deliveries, and a significantly increased risk of breast cancer among primarily younger pre-menopausal women. This is pertinent today because so many young women work in bars before they start a family.

The risk of death from heart disease or cancer should never be a condition of employment or patronage.

100 years ago infectious disease was the leading cause of death. Simple sanitation, clean water and hand washing, saved millions of lives. Today tobacco is the leading cause of death and second hand smoke is the third leading cause. 100 years ago we did not have multinational corporations hiding behind rhetoric minimizing the risks to public health and claiming personal liberties. Today we do. We don’t force this rhetoric on sanitation or hand washing requirements. We don’t carefully weigh an individual’s right to build unsafely, to drive drunk or faster than the speed limit. Why should we phrase the question about clean indoor air as one of personal liberties? The fact is we shouldn’t. Smoke free air is a matter of public health. The only place that rights come into play is a human right to every opportunity for health and safety.

Clean indoor air requirements are simple and will save lives. Smoke free air protects nonsmokers, helps smokers quit, and is the example to young people that tobacco is never appropriate, desirable, or normal.

The data and ethics are straightforward and clear. It is well past time for a comprehensive clean indoor air ordinance. That is why we are here.

Thank you.

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Menthol? What Menthol?

Earlier this year the FDA Tobacco Products Scientific Advisory Committee , entrusted with investigating menthol in cigarettes, stopped just short of a recommendation that menthol be banned. The report noted that, “removal of menthol cigarettes from the marketplace would benefit public health in the United States.” This diplomatic missive, or cowardly depending on your perspective, recognized that menthol may not actually be harmful. But in cigarettes certainly causes harm.

Last week Congress threw another variable into the works when Montana Republican Denny Rehberg’s amendment to an appropriations bill was approved by the House Appropriations Committee. The amendment, in short, would preclude “consumer behavior” as a variable in determining whether a product was safe. Hence the fact that the Advisory Committee had noted that even though menthol played an integral part in the ease of youth initiation to nicotine addiction, and difficulties in cessation, it could not play a role in the decision on whether or not to ban menthol in cigarettes.

A release from Tobacco Free Kids, and others, notes that of the 29 to 20 committee vote, those voting in favor received 20 times the campaign contributions from tobacco companies than those opposing the amendment.

The moral here is a brief lesson in just how bad the passage of the Family Smoking Prevention and Tobacco Control Act was.

It is no secret that the major public health groups, led by the Campaign for Tobacco Free Kids, snuggled up with Phillip Morris to pass the FSPTC. Having the majority market share in the U.S. PM knew they had a good chance that the other tobacco companies would immediately file suit to block any problematic marketing reform. (They did, blocking black and white advertising and restrictions on claiming FDA approval of cigarettes, almost immediately.) While the Act did remove fruit and candy flavored cigarettes,( small cigars and spit tobacco were unaffected). Menthol was the deal breaker for PM because, some menthol is in all tobacco, and they knew they had legislators already paid for in Congress.

The first guiding principle for the World Health Organization's Framework Convention on Tobacco Control is that the interests of the tobacco industry and the public health are incompatible. In the U.S. some of us are learning hard lessons about the veracity of this guideline. Unfortunately, the rest of us will pay for it.

Disciplined Language

On May 6 the Arkansas Cancer Coalition posted a disturbing op ed online written by Billy Parish their Community Outreach person. The editorial is disturbing primarily because it frames the issue of tobacco prevention in language tobacco companies use and questions the limits to tobacco prevention. Ostensibly the piece asks how we will get more Arkansans to show support for tobacco control policies. That question seems to have been rhetorical because my response disappeared from both the comments section on their website and the ACC FaceBook profile page, where I first linked to the editorial. For your amusement, my response, and answer to his question, appears below.

Handsel Art

6 May 2011

FOR IMMEDIATE RELEASE

contact J.R. Few

handselart@gmail.com

or 870-427-1365

“How we frame the question usually leads to an answer.”

The fact that you question the pandemic of tobacco related disease as some sort of libertarian issue about smokers tells me you are still under the thrall of industry propaganda. We don’t ask these kinds of questions about sanitation or hand washing requirements. We don’t carefully weigh an individual’s right to drive drunk or faster than the speed limit. Why should we phrase the question about tobacco prevention as one of personal liberties? The fact is we shouldn’t. Tobacco prevention is a matter of public health. And the only place that rights come into play is a human right to every opportunity for health and safety.

The tobacco industry loves it when we phrase the issue as a matter of personal choices made by smokers because it distracts from the much more appropriate focus of allowing, even subsidizing with our permissive laws, a predatory rogue industry responsible for an obscene majority of the death and disease on this planet. A tobacco free advocate has very little interest in interfering with anyone’s decisions. Tobacco free advocacy challenges the perception that this kind of tolerance for tobacco related disease is not and does not have to be a normal part of our lives. It is not the tobacco free advocate that blankets our parking lots with advertising. It is not the advocate who makes sure that every time a child enters a convenience store they will pass eye level logos and at every check out look up at a colorful wall of tobacco. It is not the advocate who manipulates the nicotine in their product to enhance addiction to a product so flawed that it will eventually kill half of all users because they were unable to quit. It is not the advocate spending millions challenging public health legislation to reduce tobacco use. It is not the smoker doing this either. It is the multi-national corporations whose sole aim is to profit and profit at any cost. This is the focus of tobacco prevention.

The tobacco free advocate seeks to de-normalize tobacco use in our society to the point where no one ever wants to smoke enough to become addicted, to change the social norm to where no addiction can support the demand for profit the industry needs to survive. We create tobacco free spaces not merely because secondhand smoke is deadly but also because it helps smokers quit and is the example to young people that tobacco is not normal or appropriate. We place significant taxes on tobacco not merely to offset revenue losses from tobacco related disease but also because it makes tobacco more expensive and less accessible. We regulate marketing for the same reasons, to de-normalize tobacco use.

In 2006 the tobacco industry was convicted in Federal court of racketeering and fraud for 50 years of deceit and manipulation of our laws and public opinion. To confuse tobacco prevention with something we are doing to smokers and even suggest that there is a question about the limits tobacco free advocacy should accommodate demonstrates just how effective this fraud has been and continues to be.

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World No Tobacco Day Celebrates Global Treaty

The World Health Organization (WHO) will celebrate the annual World No Tobacco Day on May 31. The 2011 theme calls attention to the Framework Convention on Tobacco Control(FCTC). The first global treaty initiated under the auspices of the WHO, the FCTC has been in force since 2005 with over 170 signatory parties to date reaffirming “the right of all people to the highest standard of health and new legal dimensions for cooperation in tobacco control.”

The United States signed on as a non-party in 2004. The Senate has yet to ratify the treaty. There had been concern that the U.S. would try to weaken provisions and doubts about the possibility for implementation. In fact, the Family Smoking and Tobacco Prevention Act of 2009, giving limited authority over tobacco to the FDA, contains provisions allowing non-voting participation by the industry on a scientific advisory panel. This compromises Article 5.3 of the FCTC conflicting with the first guiding principal of the treaty that, “There is a fundamental and irreconcilable conflict between the tobacco industry’s interests and public health policy interests.” This seems to have been ignored when major public health groups in the U.S. collaborated with Philip Morris to pass this law.

Additionally, the treaty recommends that all tobacco advertising be banned. While other nations are proposing plain packaging and have products hidden behind counters this promises difficulty in the U.S. Unlike many countries, U.S. courts have upheld a doctrine of commercial speech for tobacco companies. Given the recent Citizens United decision, it is not clear how sympathetic the sitting Supreme Court will be to compelling public health concerns about tobacco.

The strength of the FCTC, despite the influence of the tobacco industry in this country, is a recognition of the extent and potential for harm caused by multi-national tobacco corporations. Writing in the August, 2006 Human Rights Quarterly, on The Emerging Human Right to Tobacco Control, Dr. Carolyn Dresler notes,

“In the developed world, the health effects of tobacco on the individual are well established, as are its effects on society. However, only predictions based on experience of the established tobacco consuming markets are available to warn of the impending epidemic of tobacco related death and disease that will disastrously affect individuals and society in the developing world.”

It is only with global initiatives like the FCTC can we begin to meet this challenge.

FDA Given Opportunity to ban Menthol

Handsel Art

20 March 2011

FOR IMMEDIATE RELEASE

contact J.R. Few

handselart@gmail.com

or 870-427-1365

Panel Releases Report on Menthol

On March 19 the FDA’s Tobacco Products Scientific Advisory Panel (TPSAP) released a draft of its report on menthol in cigarettes. Advocates had feared that the narrow scientific restrictions of the investigation would find that the menthol in cigarettes was relatively benign. But the panel, while failing to actually make the recommendation that menthol in cigarettes be eliminated, found for the larger concept of menthol’s harm in cigarettes. The panel found that menthol’s cooling effect made addicting youth easier and quitting more difficult. Virtually all tobacco products contain some menthol.

The report states, “The availability of menthol cigarettes in the marketplace could adversely affect public health through two consequences: (1) increasing the risk for the diseases caused by smoking cigarettes; and (2) increasing the number of people who smoke.” It goes on to conclude, “Removal of menthol cigarettes from the marketplace would benefit public health in the United States.” Unfortunately, the TPSAP did not make any specific suggestions on how to limit the harm to the public health.

The 2009 Family Smoking Prevention and Tobacco Control Act, giving limited authority over tobacco to the FDA, banned fruit and candy flavoring. But a political compromise charged the TPSAP to report on the public health impact of menthol in cigarettes. Many advocates opposed the compromise because 80% of African American smokers smoke menthol.

A statement released by the Campaign for Tobacco Free Kids applauded the report saying, “We urge the FDA to implement the committee's recommendation in a way that maximizes the public health benefits.” Tobacco Free Kids led several of the major public health groups in negotiations with tobacco giant Philip Morris to see successful passage of the Act.

American Legacy Foundation Distinguished Professor of Tobacco Control at UCSF, Dr. Stanton Glantz, noted that the most significant finding was that menthol, “has a complex pharmacological interaction with nicotine that affects the addictive potential of cigarettes.” He added that, “The question at this point is whether the FDA and the Obama Administration will have the backbone to ban menthol in all tobacco products (or, at least as a first step, all smoked tobacco products, which is more than just cigarettes) and whether the major health organizations will unambiguously press for such a ban.”

If the stock market is any prediction tobacco companies still have little to worry about. Lorrilard, maker of Newport, the leading menthol cigarette, saw its stock value rise 3.4% as drafts of the report were released.

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