As recent editions of Tobacco Control have illustrated, Pakistan has become an adventure playground for young tobacco advertisers. The country has, of course, a long history of cigarette smoking, directly attributable to the strong cigarette industry fostered by its former colonial rulers, the UK. Like so many developing countries, Pakistan now lives under a different form of colonialism, with BAT and other tobacco companies, including some local imitators, greedily exploiting its large population of male smokers, and drooling at the prospect of eventually doubling their sales by recruiting the traditionally non-smoking female population.

Twenty years ago there was little sophisticated promotion and it was largely restricted to the cities. Now, not only the use of cigarettes but their promotion, too, has become much more widespread, even reaching some of the most remote and rugged areas of this large country. The Lakson Tobacco Company, a local cigarette manufacturer, has not been slow to learn the tricks of the international invaders. Far up in the north lies Lake Saif-ul-Malok, considered one of the most beautiful lakes in the world and now a burgeoning tourist destination for Pakistan’s emerging middle class and others who can command the price of the four wheel drive vehicle necessary to reach it. But go to this otherwise almost untouched paradise, surrounded by beautiful mountains capped with snow even in high summer, and you will find that tobacco promotion has got there first. The shelters provided for visitors to sit and inhale the tingling fresh air and gasp at the beautiful scenery promote a Lakson brand called Morven, also the name of several beautiful lochs and mountains in Scotland. There are no hotels in this area of Pakistan, nor electricity, yet refreshment stalls are well stocked with cigarettes; and one recent visitor saw small children smoking their wares.

Meanwhile in September, doctors and other health advocates at the other end of the country received a bitter disappointment. Having been encouraged to think that the government, after some unusually severe prodding in recent years, was actually going to bite the bullet on tobacco control, they found when they saw the long awaited measures that they bore the unmistakeable fingerprints of the tobacco industry. Firstly, the draft legislative proposals turned out to be restricted to the capital, Islamabad, with a straight faced explanation that health was a provincial matter, precluding the government from imposing a law on the provinces, something that may come as a surprise to health workers in other fields of interest. Secondly, tobacco promotion on television, radio and in the print media will continue as before, subject only to clearance from a special committee (an old trick pioneered in Britain).

Tobacco promotion continues to reach the most remote regions of the world—this time, the beautiful surroundings of Lake Saif-ul-Malok in northern Pakistan.

Disappointment in the health community was profound. Doctors gathered at the Karachi Press Club and lodged a strong protest to the government about the proposed ordinance. Their press conference received extensive television and newspaper coverage. While knowing that the proposed measures would be useless as drafted, they did at least have the satisfaction of seeing how large a group they could gather at just a few days’ notice. For these are working doctors, and have to leave their busy clinics and other professional commitments to make their protest. The press conference had the representatives from many academic institutions as well as various professional organisations such as the national chest and cancer societies.

At the opening session of the Third European Conference on Tobacco or Health held in Warsaw in June, the First Lady of Poland, the wife of the country’s President, invested British epidemiologist Professor Sir Richard Peto with the Order of Merit of the Republic of Poland (Officer Cross) for his contribution over many years to the country’s long and successful fight against diseases caused by tobacco.

It should be added that having no budget for this sort of thing, the doctors who organised the meeting each had to pay the equivalent ofalmost US$20 from their own pockets to fund the event, a significant sum inPakistan. To fund anything like this they always try to beg funds from pharmaceutical companies, but usually draw a blank. They say they cannot help noticing that at international tobacco control meetings, world experts talk about the “global war on tobacco”, but that there is still little money available for tobacco control work in developing countries. These people have the courage and motivation to fight against the big tobacco giants, but shortage of money always lets them down. Even the cost of printing any materials comes out of their own pockets. Anyone with a solution can contact the doctors’ network via this journal.

©The New Yorker Collection. Peter Mueller from Cartoonbank.com. All Rights Reserved.