Tobacco control needs help

Abstract

The tobacco industry is on the march again. British American Tobacco has just signed an agreement with China to build a large plant in the western Szechuan Province. This coup for BAT challenges efforts so far to control the use and spread of tobacco. Countries such as China, with its 300 million smokers, and other parts of the developing world are being targeted by the tobacco industry as stricter controls on tobacco begin to bite in the west. Any advance made by the industry is a serious threat to public health worldwide. About 4 million people die annually from tobacco-related illnesses. By 2030, the estimate rises to 10 million a year, and 70% of those deaths will be in the developing world. Gro Harlem Brundtland, when she became Director-General of the WHO in 1998, declared tobacco control a priority. In May, 1999, the 191 member nations of the World Health Assembly, WHO's governing body, resolved to start a Framework Convention on Tobacco Control (FCTC). Derek Yach, programme manager for WHO'S Tobacco Free Initiative, has described the FCTC as a “defining moment for the global public health community”. The draft framework is wide-ranging. Negotiations will include advertising and promotion of tobacco products, sponsorship by the industry, smuggling of tobacco, smoking cessation, price and tax policies, passive smoking, and duty-free sales. All are considerations known to affect tobacco consumption. But the FCTC is itself under threat. At the second-round meeting in Geneva at the beginning of this month, many thought the convention was too weak (see Lancet, May 5, p 1424). The UK lobby group, Action on Smoking and Health, warned governments and WHO that the convention is in danger of failing. ASH neatly summarised its criticisms: the negotiating text from the chair is weak (such as useless and unenforceable provisions on advertising to under-18s); the European Union is taking a limited stance by preferring Europe-wide measures; President Bush's administration in the USA has positive links with the tobacco industry and scorns attempts at regulation, especially of trade; and the Japanese government, which owns Japan Tobacco, will seek to block parts of the convention. The chair, Celso Amorim, of the inter-governmental negotiating committee, which has the task of making the convention a reality and enforced, is from Brazil. Although the election was by consensus, WHO sends the wrong message by giving the chair to someone from a country that is heavily reliant on tobacco. Amorim says that the negotiating text is realistic, given the lack of political will in many countries to control tobacco, and hopes that negotiations will fill in the gaps. But it is unusual for a draft treaty to start weak in the hope that it becomes strong. Brundtland must step in hard to show that WHO can become a dominant force in this important agenda. Global tobacco control is the only way to stem the epidemic of tobacco-associated disease. Today, May 12, the world's most prestigious general oncology conference, the 37th annual meeting of the American Society of Clinical Oncology, opens in San Francisco. It is timely to look at how tobacco and tobacco control fare at ASCO. The abstract book indexes just three entries for smoking, only one of which relates to tobacco control. The 4-day meeting has just one course on tobacco control, and no main sessions. ASCO's statement on tobacco control has no references after 1994. In an interview in the May issue of The Lancet Oncology, ASCO's president for the past year, Larry Einhorn, missed the opportunity to talk about tobacco control as a cancer prevention policy. ASCO is, however, not silent, having written earlier this year in support of US congressional representatives who are advocating federal regulation of tobacco. Last Monday, the American Medical Association urged the Bush administration to continue the Justice Department's lawsuit against the tobacco industry. Given its influence, ASCO should follow suit by restating its position on tobacco control, starting by using its muscle to counter the influence of the tobacco industry in the Bush administration, and by publicly supporting the FCTC. Larry Einhorn - President of ASCO, 2000–2001Dr Lawrence H Einhorn obtained his first degree from Indiana University in 1965 and then went on to do a medical degree at the University of Iowa. Returning to Indiana University, he did a medicine internship and residency before serving in the United States Air Force for 2 years. He then did a one-year Medical Oncology Fellowship at MD Anderson Hospital and Tumor Institute, before rejoining the faculty at Indiana University, where he has been since 1973. He was appointed as Professor of Medicine in 1979, and as Distinguished Professor of Medicine in 1987. Full-Text PDF