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Tobacco
May 2014 |
drinkanddrugsnews
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IF YOU WANTED TO SUM UP THE CURRENT ADVICE ON
TOBACCO CONTROL
it would go something along the lines of
tobacco plain packaging is good, so let’s move ahead with it as
soon as possible, e-cigarettes are bad so let’s surround their
use with increasingly restrictive controls. The Welsh
Government is currently considering banning the use of e-
cigarettes in enclosed public spaces, echoing the similar ban on
smoking instituted in the UK in 2007.
While the ban on smoking in enclosed public spaces made
sense given the evidence of the health harms associated with
second hand smoke, the proposed ban on e-cigarettes is based
on little more than the largely undocumented fear that e-
cigarettes might ‘re-normalise smoking’, particularly among
young people.
It is striking that many of those in public health who are
now cautioning against e-cigarettes are the self same experts
who had previously supported harm reduction in relation to
illegal drug use. Over the last 20 years they supported the
development of needle and syringe exchange services,
substitute prescribing and a host of other harm reduction
initiatives aimed at injecting drug users and others on the
grounds that these initiatives might enable the UK to avoid an
epidemic of HIV infection among injecting drug users, and
largely ignoring the criticism that those interventions might
serve to normalise an illegal activity.
The situation in relation to e-cigarettes could hardly be
more different. E-cigarettes may well be the single most
significant development in harm reduction for smokers but the
trouble is they look like cigarettes and that, it seems, is enough
to surround their use with restrictive control.
In stark contrast to the worries that public health advocates
have expressed in relation to e-cigarettes, there is the
unbridled enthusiasm for tobacco plain packaging. Packaging
tobacco products in plain or standardised form was instituted
in Australia in 2011, and in 2013 the UK government asked Sir
Cyril Chantler to review the evidence on plain packaging with a
view to considering whether similar legislation should be
instituted within the UK. In 2013 an influential group of the
UK’s leading tobacco control researchers expressed their
frustration that the government had not already instituted
laws governing plain packaging in a paper in the
British
Medical Journal
with the title ‘UK government’s delay on plain
tobacco packaging: how much evidence is enough?’
A further indication of the level of academic support for
plain packaging can be gauged from recent research which
involved asking 33 ‘internationally renowned’ tobacco control
experts to estimate what they thought would be the
magnitude of the impact of plain packaging on the prevalence
of smoking among adults and children. All of the experts
consulted were supportive of plain packaging, believing that
this would result on average in a 1 per cent reduction in adults
smoking and a 3 per cent reduction in children smoking.
In April the results of the government review were
published, with Sir Cyril Chantler clearly persuaded of the
benefits of plain packaging: ‘Having reviewed the evidence, it
is in my view highly likely that standardised packaging would
serve to reduce the rate of children taking up smoking.’
Speaking to parliament, Jane Ellison, parliamentary under
secretary for public health, announced that she was ‘minded to
proceed with introducing regulations to provide for
standardised packaging’ and that she wanted to ‘move forward
as swiftly as possible’.
The belief that plain packaging will reduce smoking
prevalence is odd given that there has been hardly any
research that has looked at the impact of such a policy on
actual smoking behaviour. Researchers have looked at the
relative attractiveness of plain and branded cigarettes
packages, the salience of health warnings on plain and
branded packs, and the degree to which smokers infer
information about the harm and strength of tobacco on the
basis of pack design and colour. What they have not done is to
measure how much the prevalence of smoking and the
number of cigarettes smoked actually reduces once cigarettes
are packaged in plain form.
The lack of evidence that plain packaging reduces smoking
prevalence was conceded recently when the Mexican
government asked the Australian government for the evidence
on which they had based their plain package policy. The health
minister, Nicola Roxon, responded: ‘Well this is a world first. The
sort of proof they’re looking for does not exist.’ Cyril Chantler
also seemed to concede the lack of evidence on the impact of
smoking prevalence in his review when he commented:
‘Although I have not seen evidence that allows me to quantify
the size of the likely impact of standardised packaging, I am
satisfied that the body of evidence shows that standardised
packaging in conjunction with the current tobacco control
regime is very likely to lead to a modest but important
reduction over time on the uptake and prevalence of smoking.’
So why are the public health advocates who supported
harm reduction measures in relation to illegal drug use so
enthusiastic over plain packaging and yet so cautious over e-
cigarettes? The difference here is that when harm reduction
measures were being considered in relation to illegal drug
users it was the greater fear over the possible spread of HIV
that led to the enthusiasm for developing needle exchanges
and other interventions. In relation to tobacco, there is no fear
greater than that over smoking-related health harm, and no
priority greater than the priority of subjecting tobacco to
increasingly restrictive control.
As a result, the harm reduction inclined public health
advocates find themselves urging the government to get on and
implement tobacco plain packaging while worrying darkly that
e-cigarettes might re-normalise smoking and advocating that
their use should be subject to increasingly restrictive control.
Neil McKeganey is director of the Centre for Drug Misuse
Research, Glasgow
COMMENT
QUICK, QUICK, SLOW...
The latest moves on UK tobacco control are leading us a merry dance, says
Neil McKeganey
‘The belief
that plain
packaging will
reduce
smoking
prevalence is
odd given that
there has
been hardly
any research
that has
looked at the
impact of
such a policy
on actual
smoking
behaviour.’
NEIL MCKEGANEY