The New Straits Times, August 20, 2000
By Prof Dzulkifli Abdul Razak
Lat week, the 11th World Conference on Tobacco or Health in Chicago came to a close. It was the largest conference of its kind, with about 5,000 participants from more than 130 countries.
Many new findings and ideas were exchanged during the four-day meeting of the minds. Below are some highlights.
From the very first day the message was clear. Dr Gro Brundtland, director-general of the World Health Organisation, in her keynote address, underscored that "tobacco disease" is a global epidemic.
She likened it to the HIV epidemic, which in public health terms has serious implications on innocent lives, the health systems and economic productivity.
While some countries in the developed economics have shown signs of decreasing overall smoking figures, global mortality is likely to rise 'from about four million deaths a year in 1998 to about 10 million in 2030'.
More than 70 per cent, that is over seven million, of the deaths will be in the developing countries, where tobacco companies are using the same 'brutal marketing tools' that they had to give up decades ago in the US and Western Europe.
The irony is, developing countries are the ones that 'need all their resources to build their social and physical infrastructure. They have no money to spend on the unnecessary costs of a man-made epidemic' she added.
According to the Global Youth Tobacco Survey, to date, of the 50,000 children aged 13 to 15 in 12 developing countries, 24 per cent had tried smoking and nine per cent said they were current smokers. A quarter of the smokers said they started before they were 11 years old, and about 70 per cent said they wanted to kick the habit.
This phenomenon was partly explained on the second day, notably that tobacco use can lead to 'nicotine addiction' - an inescapable effect on the brain of smokers.
'People start smoking because they like what nicotine does to their brains' said Dr Alan Leshner, director of the National Institute on Drug Abuse.
'Pictures' of part of the brain that could be activated or stimulated by nicotine inhaled from cigarettes provided evidence for the statement.
The activated areas cause a release of brain chemicals called dopamine, much like that of other drugs of abuse - cocaine, ganja as well as methamphetamine, a close cousin of Ecstasy.
Hence a smoker is no less a drug addict - the drug being nicotine.
According to Leshner, 'more than 50 per cent of people who smoke daily will become addicted. Furthermore, 32 per cent of those who merely try the substance will become addicted, compared with 23 per cent for heroin, 16 per cent for cocaine and 15 per cent alcohol.
That's because these drugs 're-wire that brain'. It's almost as if there is a switch in the brain that is thrown and transforms you from a voluntary drug user to a compulsive drug user, he added. Once the switch is on, the user becomes an addict.
On the third day of the conference, the participations were treated to a number of true stories from a group of 'whistle blowers' - consisting of former tobacco industry researchers, lobbyists and spoke-persons. They have been instrumental in the success of many legal battles waged against the tobacco industry.
Among them were Dr Paul Mele and Dr William Farone, ex-research scientists at the biggest tobacco company.
Both provided invaluable 'inside' information in the recent Florida case where the jury handed down a record US$146 billion (RM555 billion) verdict against the tobacco industry (NST, Poison Control, July 30).
According to Farone, 'There was no question that tobacco companies knew the dangers associated with their products. They were looking for a new nicotine delivery system to replace the supposedly doomed cigarette.'
Unfortunately, it turns out that 'the only goal of tobacco companies was to keep people smoking', Mele added.
Yet another 'secret' of the industry was also revealed on the following day.
In a session entitled 'Smuggling: Who Really Benefits?' many were shocked to learn the extent to which the tobacco companies are actually 'involved in the smuggling process' (NST, Poison Control, April 16).
The participants were shown documents from the industry outlining activities ranging from establishing front companies that serve as smuggling clearinghouses to actually timing product launches for the smuggling market, in addiction to the legal market.
While the industry has argued that higher taxes (as recommended by WHO) are the primary motivating force behind smuggling, the presenters revealed statistics showing that, in fact, countries with higher taxes have lower smuggling rates.
Seemingly 'organised smuggling' has been designed to subvert the move to increase tobacco prices especially in places where the level of anti-smuggling enforcement is poor.
Finally, on the last day of the conference, participants were again reminded that 'tobacco and truth just do not seem to mix'. This was the underlying message in the session on 'Setting the Record Straight - Responding to Tobacco Industry Misinformation'.
The session moderator recalled the fact that for the past 50 years, the tobacco in industry came up with a three-pronged strategy in the attempt to 'defend' its deadly products.
First, 'they attempted to disprove science', then 'they attempted to remove the toxins' in their products, and finally 'they put all their energies in aggressive public relations campaigns'.
The tobacco game plan includes: denying that smoking is harmful or trivialise the issue, argue that everything causes cancer, and divert debate away from health to economics and civil liberty issues.
At the same time, in another session, it was revealed how tobacco companies' strategies undermine tobacco control activities at WHO (NST, Poison Control, Aug 13).
'The attempted subversion has been elaborate, well financed, sophisticated and usually visible,' reported Dr Derek Yach of WHO.
In summary, the conference has provided ample evidence as to why and, more importantly, how the tobacco epidemic must be stopped from continuing to cause harm to the innocent population.
Dr Brundtland, reiterated in her speech 'a few well-tested and effective measures'. They include 'increases prices, a total ban on tobacco advertising and sponsorship, strong counter-advertising, better access to quitting methods, smoke-free areas and controls on smuggling'.
It is worth noting that Malaysia was cited in the WHO director-general's speech. Indeed, Malaysia has taken some of the above-mentioned measures - but it still has to work on the more difficult ones if we want to see decreasing trends in smoking.
There are increasing the price of tobacco, a total ban on tobacco advertising and sponsorship, as well as a strong effort towards counter-advertising.
Perhaps it is a coincidence that the world conference opened on Aug 6 - the very day the bombing of Hiroshima took place some 55 years ago. But the comparison to the latter is most apt.
While people continue to die due to the effects of the bomb, the numbers somehow pale when compared to those who continue to die due to the ill effects of tobacco.
This year, another 5,021 names were added to the list of the dead, marking the 217,137 people who have been victims of the bombing since 1945.
But the toll caused by tobacco-related disease in 1998 alone is at least 16 times more, and will be 40 times more by 2030.
If the violation of human lives in Hiroshima is a deadly nightmare, that of tobacco is beyond any comparison.
We therefore urge all the Ministries in the Government to move forward in the direction of WHO's suggestions in the shortest possible time in combating the burden of this vicious man-made disease. We must stop the tobacco violence today!
