This letter responds to misrepresentations in a recent article by
Daniel Stevens and Stanton Glantz (1). In the article, Stevens and Glantz
question my integrity based on some questions during a 4-day deposition
which I gave in 2014 in a legal proceeding against my employer. These
writers cite snippets from the 1,000+-page transcript of that deposition,
relating the text of a facetious note that I h...
This letter responds to misrepresentations in a recent article by
Daniel Stevens and Stanton Glantz (1). In the article, Stevens and Glantz
question my integrity based on some questions during a 4-day deposition
which I gave in 2014 in a legal proceeding against my employer. These
writers cite snippets from the 1,000+-page transcript of that deposition,
relating the text of a facetious note that I had sent to my boss almost 20
years ago in 1996. The writers use a small portion of that note, together
with my answers to other deposition questions, taken out of context, to
infer that I gave questions from the open-book examination for
recertification to my co-workers to answer for me.
It is well-understood that recertification candidates must complete
the self-assessment examination themselves (2), which is precisely what I
did in both 1992 and 1996. Period. I stand by my sworn testimony that I
did not provide questions from either my 1992 or 1996 recertification
examinations to anyone to answer for me, and that my examination responses
were my own work. This is made clear in the deposition transcript and I
refute this attempt by Stevens and Glantz to suggest otherwise.
I am taken aback by the willingness of Tobacco Control to accept the
sort of "scholarship" pursued by Stevens and Glantz. These authors advise
special scrutiny of my work, with specific mention of my lead authorship
of the Industry Menthol Report that was written at the request of the FDA
(3). I stand by the scientific integrity of and conclusions in that
report, as well as by the comments provided to FDA on the recently-voided
TPSAC menthol report (4), and on FDA's own Preliminary Scientific
Evaluation of menthol (5).
Jonathan Daniel Heck, Ph.D., DABT, ATS
References
1. Stevens D, Glantz S. Tob Control Published Online First: May 12,
2015, doi:10.1136/
tobaccocontrol-2015-052271.
2.http://www.abtox.org/Candidates/ABOT_recertification/ABOT_recertification_policy.aspx
(accessed May 19, 2015)
3
http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/TobaccoProductsScientificAdvisoryCommittee/UCM249320.pdf
(accessed May 19, 2015).
4
http://www.lorillard.com/pdf/fda/Comments_to_FDA_on_TPSAC_Report.pdf
(accessed May 19, 2015)
5. http://www.lorillard.com/wp-content/uploads/2013/11/PSE-
Response_Lorillard_Final.pdf (accessed May 19, 2015)
Conflict of Interest:
I am a full-time employee of the Lorillard Tobacco Company. I have been asked on occasion to provide testimony in litigation involving my employer. I have done so from time to time, and receive no payment for this beyond the normal salary and benefits of my employment
NOT PEER REVIEWED This comment summarizes, but mischaracterizes the
findings and conclusions of our study. Our analyses and interpretation are
based strictly on the letter of the Family Smoking Prevention and Tobacco
Control Act (FSPTCA) and its requirements, including Section
911(b)(2)(ii), which bans "the use of explicit or implicit descriptors
that convey messages of reduced risk including 'light', 'mild' and 'low',
o...
NOT PEER REVIEWED This comment summarizes, but mischaracterizes the
findings and conclusions of our study. Our analyses and interpretation are
based strictly on the letter of the Family Smoking Prevention and Tobacco
Control Act (FSPTCA) and its requirements, including Section
911(b)(2)(ii), which bans "the use of explicit or implicit descriptors
that convey messages of reduced risk including 'light', 'mild' and 'low',
or similar descriptions in a tobacco product, label, labeling or
advertising".
The findings demonstrated that manufacturers did not simply remove
descriptors, to be in compliance with the law, but introduced new color-
coded brand name descriptors which smokers were able to recognize and
easily identify the formerly labeled "lights" brands. We did not examine
the use of colors themselves, which may be protected by the First
Amendment, but rather the use of color terms.
The marketing materials examined make explicit the fact that the use of
substituted color terms in brand names is similar to the dropped
"descriptors, so that consumers will continue to recognize these brands as
"lights". The National Cancer Institute previously found that filter
ventilation has been used by manufacturers to delineate the misleading
"lights" categories, which are now color-coded, and which conveyed
messages of reduced risk resulting in increased initiation and reduced
cessation.
Our conclusions are stated in conservative terms that manufacturers appear
to have evaded this critical element of the FSPTCA, which is intended to
protect the public health.
Research on waterpipe smoking, also called hookah, is still emerging,
and research on second-hand hookah exposure is still in its nascent
stages. However, after reading the review on the various effects of second
-hand waterpipe smoke exposure by Kumar et al recently published in
Tobacco Control1, we noted several major issues in its execution and have
serious reservations about th...
Research on waterpipe smoking, also called hookah, is still emerging,
and research on second-hand hookah exposure is still in its nascent
stages. However, after reading the review on the various effects of second
-hand waterpipe smoke exposure by Kumar et al recently published in
Tobacco Control1, we noted several major issues in its execution and have
serious reservations about the potential of this review as a tool in the
development of public health policy.
First, the authors failed to synthesize all available research on the
topic into their review, by utilizing only two electronic search
databases. When a search was conducted in CINAHL, we found one more
relevant article that could have been included in this review2. However,
we are unable to judge as the authors don't present the inclusion criteria
for the review. Furthermore, we found another systematic review on this
topic and found that the amount of nicotine absorption resulting from
daily hookah use was similar to that of daily cigarette use3. This is
concerning because the authors did not include the older systematic review
in the narrative nor did they derive information from it; consequently,
calling into question the relevance of the current review. In addition,
the authors were unclear regarding their methodology. They only provided a
list of search terms and failed to specify any inclusion criteria, making
it impossible for anyone to replicate their review.
Second, the authors did not seem to have assessed the scientific quality
of the included studies, negatively affecting the transparency of the
review process. Thus, readers cannot properly assess its quality as a
comprehensive review of the current body of literature or assess the
validity of the findings that were included in the review. They also
failed to assess publication bias, which would have been a relevant issue
as they only included published studies. Given that a number of reporting
guidelines for reviews have been produced, these issues are almost
unjustifiable.
Although the authors examined an important, often overlooked public health
issue, their review suffered from major methodological flaws that could
not be ignored. Unfortunately, the review's weaknesses prevent it from
being a proper synthesis of the current body of research on the effects of
second-hand exposure to hookah smoke and a useful tool for assisting
decision-making in public health policy.
REFERENCES
1 Kumar SR, Davies S, Weitzman M, Sherman S. A review of air quality,
biological indicators and health effects of second-hand waterpipe smoke
exposure. Tob Control. 2015; 24: i54-i59. doi: 10.1136/tobaccocontrol-2014
-052038
2 Aydin A, Kiter G, Durak H, Ucan ES, Kaya GC, Ceylan E. Water-pipe
smoking effects on pulmonary permeability using technetium-99m DTPA
inhalation scintigraphy. Ann Nucl Med. 2004; 18(4): 285-289. doi:
10.1007/BF02984465
3 Neergaard J, Singh P, Job J, Montgomery S. Waterpipe smoking and
nicotine exposure: a review of the current evidence. Nicotine Tob Res.
2007; 9(10): 987-994. doi: 10.1080/14622200701591591
Frederieke S. van der Deen and Nick Wilson (on behalf of the other
authors; both from the University of Otago, Wellington, New Zealand)
This electronic letter aims to give readers an update on the smoking
prevalence projections to 2025 and beyond in New Zealand (NZ) that were
provided in the paper by Ikeda et al. NZ is now one of four nations with
an official smokefree goal (others are: Fin...
Frederieke S. van der Deen and Nick Wilson (on behalf of the other
authors; both from the University of Otago, Wellington, New Zealand)
This electronic letter aims to give readers an update on the smoking
prevalence projections to 2025 and beyond in New Zealand (NZ) that were
provided in the paper by Ikeda et al. NZ is now one of four nations with
an official smokefree goal (others are: Finland, Scotland, and Ireland).
In NZ, this goal is generally interpreted as achieving a smoking
prevalence under 5% by the year 2025.
The modelling work by Ikeda et al aimed to explore the feasibility of
achieving this goal under current annual trends in smoking uptake and
cessation (ie, business-as-usual (BAU)). Smoking prevalence data from a
regularly conducted NZ health-related survey between 2002 and 2011 were
used to provide information on recent annual trends in smoking uptake and
cessation as input for future BAU smoking prevalence projections. However,
since this modelling work was first published (as an e-publication in
2013), smoking prevalence data from the 2013 Census has become available.
A larger than expected fall in smoking rates in the general NZ adult
population, but especially in Maori (indigenous population), was observed.
It was therefore decided to update the future BAU smoking prevalence
projections that were provided in the Ikeda et al paper by using smoking
prevalence data from the 2013 Census.
The updated future BAU projected smoking prevalence in 2025 was 8.3%
and 6.4% for non-Maori (Ikeda et al: 10.7% and 8.8%), and 18.7% and 19.3%
for Maori men and women, respectively (Ikeda et al: 30.0% and 37.3%).
Although the updated projections are more favourable from a public health
perspective (especially for Maori) than the previous modelling work, a
smoking prevalence below 5% by 2025 is still not attained by any
demographic group. Achieving the 2025 smokefree goal will most likely
require implementation of more intense existing tobacco control strategies
or potentially even entirely novel measures (eg, major changes in the
tobacco retail environment as per the Tobacco Control themed supplement
for March 2015 'The Pack and the Retail Environment').
Updating the previously published smoking prevalence projections
proved to be a feasible and relatively easy exercise. Projecting and
regularly updating future BAU smoking prevalence projections with most up-
to-date smoking prevalence data, in NZ and in other nations, may assist
policy makers in planning how much more intense tobacco control measures
may need to be to achieve smokefree goals. For more detail around the
methods of updating the previous modelling work by Ikeda et al, we would
refer readers to the recently published paper that describes this work
[1].
Reference
1. van der Deen FS, Ikeda T, Cobiac L, Wilson N, Blakely T (2014)
Projecting future smoking prevalence to 2025 and beyond in New Zealand
using smoking prevalence data from the 2013 census. N Z Med J 127 (1406):
71-79. http://www.otago.ac.nz/wellington/otago083774.pdf
We refer to the article, "Did the tobacco industry inflate estimates
of illicit cigarette consumption in Asia? An empirical analysis" Chen J,
et al. published in Tobacco Control on November 25, 2014 (Tob Control
2015;0:1-7) and concur with the important points raised in this article.
While the article focuses on Hong Kong, other countries in South East Asia
also faced a similar experience.
The...
We refer to the article, "Did the tobacco industry inflate estimates
of illicit cigarette consumption in Asia? An empirical analysis" Chen J,
et al. published in Tobacco Control on November 25, 2014 (Tob Control
2015;0:1-7) and concur with the important points raised in this article.
While the article focuses on Hong Kong, other countries in South East Asia
also faced a similar experience.
The authors revealed that the tobacco industry-funded study on the illicit
trade of cigarettes in Asia, "Asia-11 Illicit Tobacco Indicator 2012" by
the International Tax and Investment Center (ITIC) and Oxford Economics
(OE) inflated the extent of illicit consumption in Hong Kong by 133-337
percent. Similarly, other scholars have also questioned the methodology
applied in this report. For example, Dr. Frank Chaloupka, Distinguished
Professor of Economics at the University of Illinois at Chicago,
criticized the reliability of the study's estimates in using an
inconsistent approach and the lack of details about the empty pack
surveys, the main source of data for the estimates.
In June 2014, the South East Asia Tobacco Control Alliance (SEATCA)
released a critique of the "Asia-11 Illicit Tobacco Indicator 2012"
showing how its estimates are being used to rescind tobacco tax policies.
As illustrated in Hong Kong's experience, the SEATCA critique revealed
that the ITIC-OE report overestimated the total illegal consumption in
other countries in South East Asia. In the case of Vietnam, it claimed
that in 2012 about 103.3 billion cigarettes consumed in Vietnam were
illegal, which amounted to 19.4% of total cigarette consumption. The
estimate was based primarily on the data of a tobacco industry group, the
Vietnam Tobacco Association (VTA), and the full details of the
methodology were not disclosed. The report admitted that data were
collected only in urban areas, but it failed to mention that 68.3% of the
Vietnamese population live in rural areas. This means that the findings
are not representative of the Vietnamese population and are very likely
biased since illicit cigarettes consumption is concentrated in big cities
and near borders.
Unfortunately, as in Hong Kong, the glossy ITIC-OE study took its
toll on tobacco tax policy in Vietnam. The Government of Vietnam
considered the results of the study and opted for a less than ambitious
tobacco tax rate increase. When the Ministry of Finance proposed a rather
moderate tobacco tax roadmap in March 2014 (an increase from 65% to 75% in
July 2015 and to 85% in January 2018), they noted that their decision was
influenced by the illicit cigarette issue. The scope of illicit cigarettes
consumption and the associated government revenue loss continued to be
highlighted both in the press and during the policy debates until November
2014, when the National Assembly adopted an even weaker excise tax law: an
increase to 70% in Jan 2016, and to 75% in 2019. Since these taxes are
based on ex-factory price, and the tobacco industry is in full control of
that price, the full impact on cigarette retail prices and tax revenue is
likely to be minuscule. The average real retail cigarettes prices are
expected to increase by less than 1% per year in the period from 2015 to
2020 (5.8% in 6 years), which, given the 5-6% annually per capita real
income grows, is insufficient to prevent cigarette consumption from
rising.
In summary, the Asia-Illicit Tobacco Indicator 2012 report was as non-
transparent in Hong Kong as it was in Vietnam and nine other countries
covered by the report. It was used to undermine a pro-health tobacco tax
policy supported both by public health advocates as well as the general
public. We thank Tobacco Control for publishing the findings of Hong Kong
colleagues, which successfully challenged the invalid evidence and
arguments supported by the tobacco industry. We hope that other countries
in Asia and elsewhere will follow Hong Kong's initiative and expose the
tobacco industry's tactic to undermine pro-health tobacco tax policies
that signatories to the WHO FCTC are committed to under Article 6 of the
Convention.
Thank you
Sincerely,
Son Dao , Hana Ross and Sophapan Ratanachena
NOT PEER REVIEWED I commend the authors on a significant effort involved in conducting
this rather insightful research.
Having conducted qualitative research on FCTC implementation in the
Pacific, I can provide comment in relation to the Cook Islands which may
explain why MPOWER measures mentioned here did not achieve decreases in
prevalence (at least in the figures obtained in this study).
NOT PEER REVIEWED I commend the authors on a significant effort involved in conducting
this rather insightful research.
Having conducted qualitative research on FCTC implementation in the
Pacific, I can provide comment in relation to the Cook Islands which may
explain why MPOWER measures mentioned here did not achieve decreases in
prevalence (at least in the figures obtained in this study).
Firstly, the Cook Islands Tobacco Control Act was introduced in 2007
and accompanying regulations in 2008, and stakeholders informed me that
compliance to these regulations was not strictly enforced until 2009 -
hence their implementation on the ground may not have been felt until the
latter period of or after this data was collected.
Secondly, accurate, timely, comparative data on prevalence is
extremely difficult to obtain in many small island nations such as those
in the Pacific. I am unsure of the exact calculations behind the MPOWER
reports and how these figures were extrapolated, but they are likely to be
an estimation that is rather different to what other (national) studies
suggest. The Cook Islands Census suggests a decrease in prevalence from
29% in 2006 to 20% in 2011. The Cook Islands GYTS (limited to those aged
13-15) suggests a decrease from 45% in 2003 to 35% in 2008, indicating the
trend in prevalence is contrary to the statistics obtained in MPOWER.
These potential limitations are duly noted in your study, but I
thought this additional information would (a) be of interest and provide
some context to these issues, and (b) serve to caution anyone who may
suggest that MPOWER measures have not been effective in the Cook Islands
(or elsewhere).
Of course it would also be great to see further points of data
collection beyond 2009, which would also give a better indication of
trends over time.
NOT PEER REVIEWED
We welcome the timely review published by Hill et al. [1], and agree
that more research is needed to assess the equity impacts of tobacco
control interventions. The results of the review indicated that "increases
in tobacco price have a pro-equity effect on socioeconomic disparities in
smoking", but that "evidence on the equity impact of other interventions
was inconclusive [...]". The inconclusiveness o...
NOT PEER REVIEWED
We welcome the timely review published by Hill et al. [1], and agree
that more research is needed to assess the equity impacts of tobacco
control interventions. The results of the review indicated that "increases
in tobacco price have a pro-equity effect on socioeconomic disparities in
smoking", but that "evidence on the equity impact of other interventions
was inconclusive [...]". The inconclusiveness of findings with regard to
smoking ban policies may be partly due to date limitations for the
database searches, which included evidence from January 2006 through
November 2010. It may also be partly due to the assessment of equity in
outcomes that related only to active smoking. Although a benefit of
smoking ban policy implementation may be a reduction in active smoking,
this outcome is dependent upon an individual's personal response to the
intervention. However, the primary purpose for implementing comprehensive
smoking ban policies is to reduce secondhand smoke exposure among the
population through environmental change. It is therefore important to
assess whether the successful implementation of smoking ban policies has
pro-equity health effects.
Our previous research indicated that the national smoking ban policy
in the Republic of Ireland was associated with immediate reductions in all
-cause and cause-specific cardiovascular, cerebrovascular, and respiratory
mortality, and that these mortality reductions were primarily due to
reductions in population exposure to secondhand smoke [2]. Our subsequent
assessment of the socioeconomic differentials of these mortality
reductions in the Republic of Ireland suggested that inequalities in
smoking-related mortality were immediately reduced following smoking ban
implementation [3]. Furthermore, given the higher rates of smoking-related
mortality in the most deprived group, even equitable reductions across
socioeconomic groups resulted in decreased inequalities in mortality [3].
Partial smoking ban policies do not fully protect health [4], and are
likely to yield negative equity effects as a result of policy exclusions
for workplaces and hospitality venues located in more deprived areas [5].
In contrast, comprehensive smoking ban policies provide equal protection
for all against secondhand smoke exposure. Indeed, previous studies have
indicated that comprehensive smoking ban policies are effective public
health interventions for reducing both exposure to secondhand smoke and
other indoor air pollutants [6-11], the benefits of which are experienced
by all employees and patrons of restaurants, bars, and other public
places, regardless of individual socioeconomic group. Therefore, we wish
to highlight that the evidence for pro-equity effects of comprehensive
smoking ban policies may be more conclusive when additional health-related
outcomes are considered.
References
1. Hill S, Amos A, Clifford D, Platt S (2014) Impact of tobacco
control interventions on socioeconomic inequalities in smoking: review of
the evidence. Tob Control 23: e89-e97.
2. Stallings-Smith S, Zeka A, Goodman P, Kabir Z, Clancy L (2013)
Reductions in cardiovascular, cerebrovascular, and respiratory mortality
following the national irish smoking ban: interrupted time-series
analysis. PLoS One 8: e62063.
3. Stallings-Smith S, Goodman P, Kabir Z, Clancy L, Zeka A (2014)
Socioeconomic differentials in the immediate mortality effects of the
national Irish smoking ban. PLoS One 9: e98617.
4. Tan CE, Glantz SA (2012) Association between smoke-free
legislation and hospitalizations for cardiac, cerebrovascular, and
respiratory diseases: a meta-analysis. Circulation 126: 2177-2183.
5. Lewis GH, Osborne DC, Crayford TJ, Brown AC (2006) Partial smoking
ban would worsen health inequalities. Bmj 332: 362.
6. Fong GT, Hyland A, Borland R, Hammond D, Hastings G, et al. (2006)
Reductions in tobacco smoke pollution and increases in support for smoke-
free public places following the implementation of comprehensive smoke-
free workplace legislation in the Republic of Ireland: findings from the
ITC Ireland/UK Survey. Tob Control 15 Suppl 3: iii51-58.
7. Connolly GN, Carpenter CM, Travers MJ, Cummings KM, Hyland A, et
al. (2009) How smoke-free laws improve air quality: a global study of
Irish pubs. Nicotine Tob Res 11: 600-605.
8. Goodman P, Agnew M, McCaffrey M, Paul G, Clancy L (2007) Effects
of the Irish smoking ban on respiratory health of bar workers and air
quality in Dublin pubs. Am J Respir Crit Care Med 175: 840-845.
9. Mulcahy M, Evans DS, Hammond SK, Repace JL, Byrne M (2005)
Secondhand smoke exposure and risk following the Irish smoking ban: an
assessment of salivary cotinine concentrations in hotel workers and air
nicotine levels in bars. Tob Control 14: 384-388.
10. Valente P, Forastiere F, Bacosi A, Cattani G, Di Carlo S, et al.
(2007) Exposure to fine and ultrafine particles from secondhand smoke in
public places before and after the smoking ban, Italy 2005. Tob Control
16: 312-317.
11. Eisner MD, Smith AK, Blanc PD (1998) Bartenders' respiratory
health after establishment of smoke-free bars and taverns. JAMA 280: 1909-
1914.
NOT PEER REVIEWED Tobacco is an interesting consumer product. It is legal, toxic and
dangerous. It kills people when used as intended. There is a global
initiative to reduce use of this product opposed heavily by those
profiting from it, tobacco industry stockowners. Industry has successfully
blurred consumers, health professionals and policy makers over the years
with false science, modulation of product and misleading m...
NOT PEER REVIEWED Tobacco is an interesting consumer product. It is legal, toxic and
dangerous. It kills people when used as intended. There is a global
initiative to reduce use of this product opposed heavily by those
profiting from it, tobacco industry stockowners. Industry has successfully
blurred consumers, health professionals and policy makers over the years
with false science, modulation of product and misleading marketing,
product manipulation and new nicotine devices. In the 1970's the first anti-
smoking movement was followed by the "light cigarette"- concept, in the 1990's
when carcinogens entered public health discussion with environmental tobacco
smoke, the industry came out with "less carcinogen" concept. Now the focus is
finally moving to the pure addictive compound of tobacco, nicotine as we
see the rise of "pure nicotine" -concept with electronic devices for
inhaling nicotine in aerosols. So basically this industry has modified its
very toxic product as we public health people have been responding to
these new products, but really seeing, that old products remain available.
In comparison with the petrol industry, which has faced similar
challenges, for example high amount of lead needed in motors being
environmental health threat. Reaction of the petrol industry was similar to the tobacco
industry: developing new products, both cars and fuels. However, there is
one distinct difference. These high-lead fuels are no longer on the market,
but cigarettes are. So, if we have no courage to ban nicotine, why not
follow the pattern of population protection strategies and ban the most
harmful products first and then gradually move into nicotine free time.
Taxing may help, but a gradual shift is worth thinking about, isn't it?
In this rejoinder, we will address the recent response by Mary
Assunta to our article, "Complexities at the intersection of tobacco
control and trade liberalisation: evidence from Southeast Asia." To be
sure, we believe that trade policy remains a very important issue for
public health both in Southeast Asia and globally. Before addressing the
specific concerns raised by the reader, it is worthwhile to restate the
ove...
In this rejoinder, we will address the recent response by Mary
Assunta to our article, "Complexities at the intersection of tobacco
control and trade liberalisation: evidence from Southeast Asia." To be
sure, we believe that trade policy remains a very important issue for
public health both in Southeast Asia and globally. Before addressing the
specific concerns raised by the reader, it is worthwhile to restate the
overarching argument, goals and approach in the original article. In
brief, we argue and demonstrate empirically that over the last 15-20
years, sometimes considerable changes in trade policy have not
systematically undermined tobacco control in Southeast Asia. Moreover, we
also posit that penetration of the region by large international tobacco
firms through investment is likely playing a much larger role in affecting
public health policy. We do not discount trade entirely and largely agree
with the reader that it has had some specific important effects, but these
incidents do not undermine our general thesis.
We completely concur with the reader's first concern that trade
liberalization should be conceptualized as more than tariffs. This indeed
was exactly our concern and largely motivated the research. In previous
research and in discourse at international meetings, we observe too much
emphasis on the more elementary aspects of liberalization and not enough
on some of the areas that the reader, too, points out as important. The
reader appears to have overlooked particularly both the abstract and the
conclusion, which raise concerns with critical issues such as intellectual
property rules and investor-state dispute settlement. We wish for the
focus to be the right one, too, and it seems that we are on the same page
for this goal.
On the second major point, it appears that the reader is suggesting
that transnational tobacco corporations use tariff reduction as a
springboard into seeking further non-tariff liberalization. We would not
dispute this contention, but we would also like to see much more
compelling and rigorous evidence of this dynamic. The Philip Morris
International (PMI) submission to the Transpacific Partnership (TPP) cited
by the reader does not really make this connection sufficiently, in
particular because the included passage is still really about tariffs or
closely-related ancillary policies.
The reader's third concern revolves around a purported dismissive
treatment of the findings of Chaloupka and Laixuthai (1996), and Honjo and
Kawachi (2000), particularly on the advertising dynamic. When we wrote,
"Tobacco control policies were mostly nonexistent in these contexts too,
so there was no obvious policy-based counter-force to the sudden changes
in the tobacco marketplace" (which the reader cites almost verbatim in
their critique), we were referring to the lack of these types of
restrictions. We do not and would not dispute the important role that
increased marketing played in re-shaping these contexts - it was
undoubtedly an important part of the increase in imports and subsequent
consumption. But our broader conceptual point is that the context in most
countries now is different than it was in East Asia in the 1980s. First,
most countries are already highly liberalized both in terms of trade and
of investment. In most if not all of Southeast Asia, multinational
tobacco firms are already firmly entrenched in terms of trade, investment
and marketing (Vietnam is a partial exception because of tariff walls and
the market constraints on multinational firms in their joint ventures with
the state-owned tobacco enterprise). Thus, in many markets, firms have
already been marketing for years and further liberalization in the
classical sense is likely to make little difference strictly speaking.
There is also good news in the contemporary era quite different than the
1980s in that some countries have strong marketing restrictions in place.
The fourth concern in the response focuses on affordability. The
reader's primary concern is that their data do not match ours. We re-
checked our data and calculations, and remain confident in them. We are
using the most up-to-date market data from proprietary sources such as
Euromonitor and ERC (these services frequently update old data rendering
older versions obsolete). While these sources are far from perfect, most
in the tobacco control sub-field believe that they remain the best
available for these types of data. It is critical to stress that we are
using the cheapest brand (typically, a local brand, though not necessarily
the most popular) for our calculations with the explicit logic that we
want to explore barriers to consumer market entry (i.e. what is the least
amount of money that it would take for someone to smoke regularly). Many
other articles on tobacco affordability use prices of the most popular
brand and/or an international brand such as Marlboro to calculate
affordability. As we explain in the article, these choices are simply not
theoretically suitable for our purposes. When we run cursory analyses with
these other prices, we do note some of the differences that the reader
points out; however, such differences are not relevant to our discussion.
In response to the reader's concern about our interpretation of
Figure 3, we appreciate the correction about Myanmar. The reader is
correct that we erroneously indicated Myanmar when we meant, instead, to
include Singapore in this list of countries with noticeable decline. As
the reader rightly points out, Myanmar stayed about the same. In the
process of writing the manuscript, we re-did this figure several times -
ironically largely because we thought that the Singapore and Myanmar
results were not accurate - with updated data (see the discussion above -
sometimes we observed reversals in country-level trends after receiving
market data updates) and unfortunately failed to update the text
completely.
We should also clarify the reader's misconception in Figure 3's
interpretation about our apparent confusion around Indonesia and Vietnam.
We actually split them apart in our narrative in order to draw attention
to each of them. As we suggest, the broader contexts and dynamics in the
two countries are quite different, but we wanted to highlight the
similarity in outcome (increased consumption per capita) in two quite
different scenarios. More broadly and importantly, the crux of the figure
is the inconsistency across countries. Even our tiny descriptive error
outlined in the paragraph above does not change this important
characteristic in any way.
In terms of the reader's very minor concern about our description of
Vietnam as being "closed," please refer to Table 1, which discusses tariff
rates. We do not purport to make a broader interpretation of openness (or
"closedness" as the case is here) than the straightforward one that we
clearly lay out. We also cite the joint venture activity that the reader
seems to suggest as new and excluded information (see Table 4).
We appreciate the reader's interesting discussion on affordability in
Malaysia. We are very interested in the possibility that tobacco firms
operating in Malaysia were able to keep prices down by importing cheaper
leaf. However, the reader's discussion focuses on the delay of the
prohibition of selling "kiddie" packs, conflating the actual causal
relationships. Specific to the dynamic of tobacco leaf prices, it is also
important to note that FAO price data suggest that these prices are
increasingly global with limited cross-country variation (FAO STAT 2014).
Moreover, leaf comprises only a surprisingly small part of the overall
"cost" of a cigarette, so changes in leaf prices are unlikely to have
enormous impact on affordability.
In many ways, the complexities that the reader points out with the
kiddie packs only strengthen our overall argument that the broader
political economy of tobacco control is much more complex than changes in
trade policies. That the tobacco industry is devious and employs many
tactics only reinforces the important notion that the public health
community has to keep the broader context in mind. Like the brief
discussion above about one aspect of the complexities of measuring
affordability (Which cigarette price should we use? Lowest? Most popular?
Most commonly collected? Recognized international brand?), the dynamic
that the reader describes raises another complexity - the definition of
pack size for the calculation. Alas, this discussion about the vagaries
of measurement in affordability - though very important - is beyond the
purview of our brief study about trade liberalization.
We thank the reader for pointing out our reversal of the dates for
the investments in Malaysia and Indonesia. We appreciate the reader's
keen sense of accuracy, but our main point remains unchanged:
transnational tobacco firms are highly active investors in the region.
Investment is almost certainly more important than trade liberalization in
terms of affecting the dynamics that we discuss, including affordability
and relevant policies.
In the Philippines-Thailand dispute at the World Trade Organization
(WTO), the reader appears to confuse the basic tenets of Article 5.3 of
the World Health Organization's (WHO) Framework Convention on Tobacco
Control (FCTC). One of the key goals of Article 5.3 is to ensure that the
tobacco industry is excluded from direct participation in making tobacco
control policy. The article also presses for transparency when
governments deal with the tobacco industry more generally, but the FCTC
does not ask governments to cease all relationships with the tobacco
industry. Elsewhere, the authors and colleagues have examined in
considerable depth (e.g. Chavez et al 2014; Drope et al 2014) the lack of
irrefutable evidence that the tobacco industry did anything that is not
permitted - in the FCTC or otherwise - to get the Philippines government
to pursue the dispute at the WTO. That the industry helped to pay some of
the legal costs (incidentally, we failed to obtain confirmation of this
scenario in our on-the-ground research) is neither illegal nor unusual.
Firms in many other industries in other countries have behaved similarly
at the WTO and it is not expressly prohibited. Perhaps the reader
believes that pursuing such a case is tantamount to an incentive, which
Article 5.3 does identify as not permissible, but the case for such a
dynamic remains to be made. While we personally feel that governments
should not pursue these cases on behalf of the tobacco industry, it is
clearly in trade ministries' mandates to act to protect their
constituents, of which the tobacco industry is one.
Rather than relying on anecdotal and often unverified media accounts,
we formally interviewed dozens of the key official and unofficial players
involved in this and related dynamics in the Philippines and we did not
find any "smoking gun" evidence of corrupt behavior. What the public
health community considers "bad" or undesirable behavior does not
necessarily qualify as corruption. Finally, we never suggested that civil
society had to produce the evidence - as researchers, we should not care
from where the evidence comes. We should, however, care deeply about the
quality of the evidence, and be able to gather it and evaluate its
validity and reliability with considerable objectivity.
Finally, in regard to the referenced Joint Memorandum Circular (JMC),
it is worth noting that there are internal struggles within the
Philippines as the domestic tobacco control legislation (RA 9211) and the
FCTC remain in some or even considerable tension. Many government
departments point out that the FCTC has never been properly domesticated
with enabling legislation as the political and legal structure in the
Philippines requires (see Magallona 2013 for a discussion of how this
works). So, in the eyes of many, the JMC does not have the force of law
(see Lencucha et al, forthcoming).
In regard to the concern about regulatory chill, we do not purport at
any point that regulatory chill does not exist; rather, the actual dynamic
that we examine in the article is that chill is a very difficult
phenomenon to identify unequivocally. To take the reader's example of New
Zealand, our colleagues (officials in governments) have explained to us
that there is limited political support for plain packaging beyond
Minister Turia and some in the Maori Party and the Green Party. In brief,
our sources suggest not only that the minister lacks support from many
other key actors (including particularly in the minority government's
coalition-leading National Party), but that blaming regulatory uncertainty
("chill") is a thinly-veiled and convenient excuse to avoid pushing the
legislation that a number of officials simply do not want. The scenario
in New Zealand seems likely to be precisely the dynamic that we are
discussing in this article. Incidentally, the dynamic that we examine may
be just as or even more problematic to the public health community than
basic "chill." We cannot speak to what is happening in this area in
Malaysia as it was not part of our research - perhaps it is regulatory
chill in the truest sense - but it has to be demonstrated rigorously.
From personal perspectives, we are quite concerned about regulatory chill,
and particularly for low- and middle-income countries that rightfully fear
costly litigation, but as we state clearly and for which we make a
compelling case, as a scholarly community we simply do not yet understand
well the actual dynamics of regulatory chill. Clearly, it is a much
needed avenue of future research.
After the discussion of regulatory chill, the reader reiterates one
of our key conclusions - which we do not seek to prove empirically - that
investment almost certainly plays a significant role in affecting the
tobacco control outcomes examined in this research. Our discussion is
fully congruent with the reader's observation that investment in countries
like the Philippines and Indonesia is surely having a significant effect
on tobacco control and related efforts. Again, we are advocating not only
more systematic research on trade policies' effects on tobacco control,
but more broadly, to expand research focus to the dynamics around
investment in the tobacco sector.
Finally, on the issue of a tobacco carve-out in the TPP, we would
suggest that typical dynamics of the international system - well developed
theoretically and substantiated empirically - suggest that the prospects
for a Malaysia-style proposal are likely to be rather dim (for a broad set
of relevant theoretical discussions, see, for example, Baldwin 1993).
First, international agreements are deeply affected by state power and in
the TPP scenario, Malaysia is a relatively weak actor, while several of
the other much stronger states have stated an explicit preference for an
alternative arrangement (the US) or have intimated that a carve-out is not
likely to be acceptable (Japan). Second, and intrinsically related to the
first dynamic, in an international trade negotiation like the TPP, all
parties must agree, so the prospect of total agreement on a complete
tobacco carve-out is currently not strong. It is possible that other
countries will use the Malaysia proposal as a foil in order to find some
middle ground, which might still work out well for public health. It is
also possible that because the proposal is so unpopular with some key
actors that negotiating parties might choose ultimately to exclude it
entirely from the negotiation (much the same way that trade has thus far
been excluded from the Framework Convention on Tobacco Control). Finally,
we highly doubt that Malaysia will withdraw from the TPP if it does not
get its way on tobacco, which suggests strongly that it is probably not
the most important issue on its trade ministry's negotiating agenda.
The dynamics above also apply to the re-negotiation of the thousands
of existing agreements that the reader suggests is attainable with some
hard work. Unfortunately, both theory and recent experience suggest a
genuine struggle to negotiate trade agreements more broadly. For example,
the WTO's Doha round was essentially stuck for more than a dozen years and
the supposed breakthrough in 2013 was eventually about the relatively non-
controversial area of trade facilitation and ignored the many other
pressing issues that have contributed to the long gridlock (WTO 2013). It
is also important to consider that many international economic agreements
do not come up for renegotiation naturally or will not expire for many
years. Any enthusiasm for re-negotiation may eventually be tempered by
the sheer size of the endeavor. We do agree, however, that a TPP that
enshrines health in a way that protects and promotes tobacco control and
public health is a crucial set of goals for the global community.
It is also important to consider that the idea of a tobacco carve-out
is mostly untested. We fear that it will not be the panacea that many
advocates suggest. Tobacco exclusion may even be detrimental in some
circumstances by perpetuating market structures that serve strong pro-
tobacco interests - for example, by preserving the market share of
politically-strong tobacco firms (this dynamic is somewhat similar to a
scenario where under certain conditions marketing restrictions can also
serve to preserve market share for powerful incumbent firms). In two
recent major international economic agreements, the Pacific Island
Countries Trade Agreement (PICTA) and the South Africa-European Union
Trade, Development and Cooperation Agreement (TDCA), it was a major
transnational tobacco firm operating in favorable domestic conditions
pushing governments for a tobacco exclusion policy (personal communication
with a South African treasury official).
A final and more crucial point is that the international trading
system has rules that seek to tackle the complexities of making policies
across sectors (e.g. public health and economic policies). As Drope and
Lencucha (2014) discuss, the seminal Thailand - Cigarettes case at the
General Agreement on Tariffs and Trade (GATT) actually laid a reasonable
foundation for how to make good public health policy that integrates
successfully with world trade rules and goals (see for example, paragraphs
77-78 from GATT 1990). In some ways, the slightly bizarre U.S.-Clove
Cigarettes case also generated some similar proactive discussion from the
WTO wherein the panel was explicit about permitting the banning of tobacco
additives as long as it was not discriminatory (see McGrady 2011 for a
discussion). The panel reports demonstrate these dynamics clearly (see
WTO 2011, 2012).
As a broader community - i.e. beyond tobacco control - we suggest
that we need to develop a world trading system that can accommodate many
other important health-related issues such as unhealthy foods, alcohol and
access to medicines (to name only a few) that sit squarely at the nexus of
public health and economic policymaking. Re-working or tweaking some of
the rules of the world trading system might be a good place to start. But
we are unwilling to throw out all of the existing rules and are suggesting
that they have even sometimes served to try to integrate health and trade
meaningfully in ways that do not necessarily undermine health (see the
examples in the paragraph above). Another recent case worthy of
consideration is the Philippines - Distilled Spirits dispute at the WTO,
which ultimately was the primary catalyst for the recent successful
tobacco excise tax reform in the Philippines (see Chavez et al 2014; Drope
et al 2014). We underscore in our article, and reinforce in this
rejoinder, that the international economic system is complex, but it is
not without opportunities to promote public health.
In regard to the quote from a Philippine trade official about a lack
of support for a tobacco carve- out in ASEAN, it is important to reiterate
context. First, the official was speaking about the AFTA, not the TPP,
which is to what the reader is referring. Second, returning to the
original interview transcript, the official also stated that no
influential trade official that s/he knew of was in favor of a carve-out.
Whether the Malaysian proponents prove to be sufficiently influential to
include a tobacco exclusion in AFTA still remains to be seen. Finally,
this was a key informant interview of an influential actor in one country
in this regional agreement - these are not our views necessarily and we do
not at all purport that these are the only views. Moreover, we do not
suggest anywhere in the research that the tobacco carve-out discussion is
only occurring in Southeast Asia. We set up our case study justification
for Southeast Asia by acknowledging the regional discussion, but this does
not suggest that there is no discussion of carve-outs elsewhere in the
global community.
In sum, the key argument in our article that trade policy has not
systematically undermined tobacco control in Southeast Asia remains
strongly supported. Moreover, the reader appears to concur with us that
investment is a key variable in the political economy of tobacco control
in the region. In many ways, it appears that we and the reader are simply
coming from entirely different epistemological and methodological
traditions. We are seeking to identify and explain broader patterns across
time and space (in this case, countries in Southeast Asia) and learn from
them, where in contrast the reader seeks to focus in large part on the
exceptions to the patterns that we are underscoring. We acknowledge the
complementarity of research that seeks an approach focused on important
exceptions and identify some effective recent articles in this research
vein (see endnotes 24 and 34-38), but it is important to recognize that
each approach offers distinct utility. In an important research topic and
moral cause - such as the health-trade nexus - we need to take great care
not to prematurely dismiss others' rigorous and transparent work, and
exploring a wealth of different approaches can only be good.
REFERENCES
Baldwin R. (ed.) Neorealism and Neoliberalism: The Contemporary
Debate, Columbia University Press, 1993.
Chaloupka F, Laixuthai A. U.S. Trade Policy and Cigarette Smoking in
Asia [Internet]. National Bureau of Economic Research; 1996 Apr. Report
No.: 5543. Available from: http://www.nber.org/papers/w5543.
Chavez JJ, Drope J, Lencucha R, McGrady B. The Political Economy of
Tobacco Control in the Philippines: Trade, Foreign Direct Investment and
Taxation 2014. Quezon City: Action for Economic Reforms and Atlanta:
American Cancer Society.
Drope J, Chavez JJ, Lencucha R, McGrady B. The Political Economy of
Foreign Direct Investment: Evidence from the Philippines. Policy and
Society 2014; 33: 39-52.
Drope J, Lencucha R. "Evolving Norms at the Intersection of Health
and Trade." Journal of Health Politics, Policy and Law 2014; 39, 3: 591-
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FAO STAT. Tobacco leaf - world price and export unit value. 2014.
General Agreement on Tariffs and Trade (GATT). Panel Report: Thailand
- Restrictions on Importation of and Internal Taxes on Cigarettes 1990.
BISD DS10/R-37S/200. Geneva: GATT (November 7).
Honjo K, Kawachi I. Effects of Market Liberalisation on Smoking in
Japan. Tob Control. 2000;9(2):193-200.
Lencucha R, Drope J, Chavez JJ. Whole-of-government approaches to
NCDs: The case of the Philippines Interagency Committee on Tobacco.
Forthcoming, Health Policy and Planning.
Magallona, MM. The Supreme Court and International Law Problems and
Approaches in Philippine Practice. 2013 Philippine Law Journal 85(1, 2).
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APPROACHES-IN-PHILIPPINE-PRACTICE-Merlin-M.-Magallona.pdf.
McGrady B. Tobacco Product Regulation and the WTO: US - Clove
Cigarettes. O'Neill Institute Briefing Paper - 12 September 2011.
Washington DC: Georgetown University.
Pacific Island Countries Trade Agreement (PICTA). Nauru, 2001.
World Trade Organization (WTO). Panel Report: United States -
Measures Affecting the Production and Sale of Clove Cigarettes 2011.
Geneva: WTO (WT/DS406/R).
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- Measures Affecting the Production and Sale of Clove Cigarettes 2012.
Geneva: WTO.
World Trade Organization (WTO). Agreement on Trade Facilitation. 6
December 2013. See https://mc9.wto.org/system/files/documents/w8_0.pdf.
I would like to respond to this paper by Drope J and Chavez JJ whose
analysis focuses on cigarettes, not tobacco leaf production and trade, and
seeks to question the "conventional wisdom" that "trade liberalization
naturally leads to lower prices for tobacco products, increased
consumption and decreased levels of regulation." The authors use
theoretically guided empirical research to demonstrate there is little
cause for...
I would like to respond to this paper by Drope J and Chavez JJ whose
analysis focuses on cigarettes, not tobacco leaf production and trade, and
seeks to question the "conventional wisdom" that "trade liberalization
naturally leads to lower prices for tobacco products, increased
consumption and decreased levels of regulation." The authors use
theoretically guided empirical research to demonstrate there is little
cause for concern on the negative impact of trade liberalization on
tobacco control policies. They have focused on Southeast Asia as an "ideal
most likely case" because the region has experienced recent trade
liberalization regionally and multilaterally, and because the "tobacco
control proponents from the region continue to voice loud concern about
the issue suggesting that it is perceived as a genuine threat," and
conclude their proposal to carve out tobacco from trade agreements is "sub
-optimal". The authors omitted and overlooked some crucial evidence,
details, and developments on tobacco, trade and tobacco control on the
ground which I will address in this response. There are also some errors
which need to be corrected.
Firstly, trade liberalization through new free trade agreements are
not just about eliminating tariffs, but includes addressing "non-tariff
barriers" such as national legislation, product standards, services,
investment, intellectual property rights, government procurement and
environment which may be just as important or even more important than
tariffs for regional economic integration. In the Trans-Pacific
Partnership (TPP) to which the authors refer, only 5 chapters of the total
29 chapters actually deal with traditional trade issues while the rest are
about dismantling non-tariff barriers to trade. There is the real threat
that corporations are using trade agreements to get special benefits that
they would find much more difficult to get through the standard
legislative process. Trade agreements' impacts on tobacco control, among
others, include challenging clean indoor air rules, controls on sale and
distribution of tobacco products, cigarette content regulation and bans on
tobacco advertising and promotions. It is in this context that the impact of
trade liberalization on tobacco control should be seen and not limited to
the narrow scope of tariffs alone.
Secondly, transnational tobacco companies (TTC) themselves have
traditionally supported the lowering of tariff barriers to tobacco both
historically and continue to support it even now for the added value it
brings them to influence non-tariff barriers. Philip Morris International
(PMI), for example, in its submission to the TPP said, "The negotiations
should be comprehensive and lead to the complete elimination of all
tariffs on all goods. There are tools - such as longer phase-out periods
and temporary special safeguards - that can be used to mitigate the impact
on products deemed "sensitive" by participating national governments."
Trade liberalisation -
The authors are rather dismissive of previous studies on trade
liberalisation and tobacco control in East Asia such as papers by Honjo
and Kawachi, and Chaloupka and Laixuthai as being limited to a narrow set
of market conditions since they involved state-owned tobacco monopolies,
where tobacco control policies were mostly non-existent and there was no
obvious policy based counter-force to the sudden changes in the tobacco
marketplace. The Honjo and Kawachi study actually provides clear evidence
that the opening of Japanese markets to the TTC "stalled a decline in
smoking prevalence" and the contributing factors to opening of the market
included removal of non-trade barriers such as the actual elimination of
restrictions on advertising and promotion on tobacco products, which saw an
increase of marketing and promotion by these companies. This is also
consistent with strategies revealed in the internal industry documents
which suggest that besides tariffs elimination the American companies also
wanted: "(b) access to all retail outlets. (c) Eliminate advertising
limitations. (d) Allow us to do effective market research and product test
marketing."
Affordability -
The data of the authors show the RIP (relative income price) of only
Brunei, Cambodia and Philippines have reduced. However according to the
data of the Southeast Asia Tobacco Control Alliance, the RIP of
cigarettes also decreased for Lao, Indonesia and Vietnam, besides
Philippines and Cambodia, meaning that overall, cigarettes became cheaper
across many countries in the ASEAN region following the introduction of
AFTA.
The authors refer to Figure 3 to illustrate changes in consumption
per capita, demonstrating mixed results, though not precisely in the same
pattern they observe with affordability. They point out the most
pronounced declines have occurred in Malaysia, Myanmar and Cambodia, and
that the only clear upward trend is in Indonesia. However this description
does not match data in Figure 3 accordingly. For example Figure 3 shows
Myanmar's per capita consumption has remained unchanged (around 200
sticks), while the decline in Singapore has been reversed as of 2006.
After identifying Indonesia as the only county with a "clear upward trend"
the authors go on to say Vietnam is the only ASEAN country with a "strong
upward trend".
They describe Vietnam as the only country that continues to have a
"closed tobacco sector." It is unclear what exactly this means as the
state owned Vinataba has joint-venture agreements with both British
American Tobacco (BAT) and PMI.
Change in affordability - The authors make considerable reference to
Malaysia, indicating it has experienced the greatest change with
substantial imports, prices, policies and the tobacco trade. The authors
point out when the government increased specific excise taxes from RM28
per kilogram to RM220 per 1000 sticks by 2010, cigarettes became less
affordable. What has been omitted is the tobacco industry gained by
importing cheaper leaves and mitigated the cigarette price increases by
successfully lobbying to delay the implementation of regulations banning
kiddie packs (less than 20 sticks) which was passed in 2004 but only
implemented in 2010. The tobacco industry kept cigarettes affordable
through the sale of kiddie packs. Contrary to the graph in Figure 2
showing cigarettes becoming "dramatically less affordable" in Malaysia,
another study conducted by the International Tobacco Control Project,
found affordability to have increased by 1.9% over the four years (2005 -
2009). These findings show that tobacco taxes and prices did not increase
at a rate high enough to offset income growth, and cigarettes became more
affordable to consumers.
Using small packs to keep cigarettes affordable particularly to the
young is further confirmed in the internal tobacco industry documents on
Malaysia. PMI for example, in their internal documents say, "...As the
total outlay for a pack of 20's became too prohibitive for our younger
adult smokers we should consider smaller packings. Currently we plan to
reduce the price of our 14's pack from M$2.40 to M$2.20. Should this move
not yield the desired results, we will launch a 10's and 7's packing in
this strong growth segment."
An error that needs correction is about the PMI factory in Malaysia.
According to the authors, "PMI opened a new US$40 million plant in
Malaysia in 2005, while purchasing remaining shares in Sampoerna
Indonesia, which they had partly purchased in 1995." In actual fact PMI
opened its manufacturing facility in Malaysia in 1995, which was its
first plant in Asia. Ten years later in 2005 PMI purchased PT HM Sampoerna
in Indonesia.
The authors refer to Thailand and Vietnam as being the "only
countries with a WHO MFN rate of 60% or greater" - this is a typographical
error for WTO as the WHO does not offer any MFN status to any countries.
In February 2008, the Philippines government filed a complaint to the
WTO, claiming a bias against imported cigarette brands in Thailand. The
authors claim that while tobacco control civil society groups in the
Philippines have expressed concern that the case is a violation of FCTC
Article 5.3 because tobacco firms in the Philippines, particularly Philip
Morris-Fortune Tobacco, might have exerted inappropriate pressure on the
Philippine government to pursue the case, the groups have
not produced unequivocal evidence of an Article 5.3 violation. Firstly,
the authors have failed to recognise that there are many newspaper reports
indicating that the case was filed by the Philippines government on behalf
of Philip Morris which cannot be ignored and warrant an
investigation to ascertain if there is indeed an Article 5.3 violation.
Secondly, the authors have not clarified why it is civil society's
responsibility to provide the evidence and not the government's to
facilitate an investigation when in the Philippines there is a mechanism
to implement Article 5.3 through the Joint Memorandum Circular (JMC) 2010-
01 of the Civil Service Commission and Department of Health.
Regulatory chill -
On regulatory chill the authors claim it is difficult to identify such
incidents definitively because there can be "multiple explanations for
governments' policy choices". It appears the authors may be ignorant of
tobacco control activities on the ground. In the case of New Zealand which
has started legislative process on plain packaging of tobacco and seen
first reading in Parliament, the legislators won't pass it into law "until
legal action in Australia has been settled". BAT and Imperial Tobacco,
which sued the Australian government, have threatened to take similar
action if plain packaging is introduced in New Zealand. The New Zealand
Prime Minister said they decided not to take a chance in breaking any
trade rule, that it would be too expensive for New Zealand to face a legal
challenge from tobacco companies. Similarly the Malaysian Health Minister
has said Malaysia will watch the legal outcome in Australia on plain
packaging.
The authors are dismissive about regulatory chill in the context of
the developing nations being studied. If it is too expensive for New
Zealand to fight such legal challenges, the reality is even more stark for
low and middle income countries which simply cannot afford protracted legal
battles. This is illustrated in Uruguay's experience of being unable to
afford legal costs in meeting PMI's challenge and seeking assistance from US
philanthropies. The challenge launched in 2010 is still ongoing.
Uruguay's President has now made an appeal to the US President for
assistance in stopping PMI from annulling their tobacco control
legislation.
The authors' conclusion that the very mixed results across key
aspects of the trade and tobacco nexus suggest that there is no clear-cut
link between trade liberalisation and a decline in tobacco control and/or
an increase in tobacco consumption in Southeast Asia must be seen in the
context of the errors and omissions pointed out above. While the authors
need not address all aspects, such as ways in which the TTC benefited from
AFTA beyond tariff reductions and conducted efforts to thwart tobacco
control measures, they could have mentioned them in the limitations.
Indonesia and the Philippines are the two countries where the TTC have
consolidated their presence by acquiring or merging with local companies.
BAT which exited the Philippines has since returned in 2012 and has
benefited from the recent tax hikes through what it calls a more "level
playing field".
Tobacco carve-out -
The authors claim that simply arguing trade liberalisation is bad for
tobacco control and that excluding the tobacco sector from economic
agreements is the solution is a "suboptimal" strategy. The authors have
attributed this call for a tobacco carve-out to "tobacco control
proponents from the region" as in a proposal limited to a specialised
group. The authors' doubts about the political viability of excluding
tobacco from such economic agreements have already been contradicted by
the Malaysian government's formal tabling of just such a provision in the
TPPA in August 2013. Malaysia's proposal received wide media coverage.
The complete carve-out proposal is based on the recognition that tobacco
products are uniquely harmful and the global consensus that nations must
act to reduce tobacco use, according to the WHO Framework Convention on
Tobacco Control (FCTC).
In reality the call for a tobacco carve-out is not confined to just
"tobacco control proponents from the region" but is echoed by public
health advocates, medical groups, academics and lawyers from New Zealand,
Australia, the US and Peru. Additionally in January 2014 the
Attorneys General of 45 states in the US urged the US Trade Representative
to exclude tobacco from the TPP entirely, stressing that "there is no
policy justification for including tobacco products in agreements that are
intended to promote and expand trade and investment generally." Needless
to say these Attorneys General are not from Southeast Asia.
Malaysia's proposal to the TPP was submitted by officials from the
Ministry of International Trade and reiterated by the Minister
contradicting the authors' claim that there is a "gap between trade and
health practitioners". This also lays bare the authors' quote from a
Filipino high-ranking trade official that "no key trade or finance
officials in ASEAN countries are openly supportive of this proposal
(tobacco exclusion)".
The authors say tobacco exclusion may even be problematic and advise
tobacco control proponents to counteract aggressive marketing by the
tobacco industry by being more prudent and pursuing FCTC-compliant bans on
tobacco advertising, promotion and sponsorship. If the authors simply
recognized the fact that Australia plain packaging was challenged despite
"being prudent" then they would realize that their recommendation for
prudence has no basis and is not an alternative to the so-called
suboptimal solution. The Australian plain pack example also clearly
explains the regulatory chill effect in other countries that the authors
dismiss.
In questioning the political viability of tobacco exclusions, the
authors focus on the challenges of the broader task of affecting trade
negotiations successfully but not on the benefits. Of course, nothing in
tobacco control was achieved easily, more so in trade agreements. They
have all been hard fought battles and we continue to fight them in
developing countries.
The authors refer to the "additional burdens of returning to hundreds
of previously negotiated economic agreements" but they should know that
the practical solution is when these agreement expire and/or come up for
renewals, to address tobacco then. Hence it is vital to secure a tobacco
exclusion in the TPP, touted to be the 21st Century free trade agreement
to provide the standard for future agreements.
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This letter responds to misrepresentations in a recent article by Daniel Stevens and Stanton Glantz (1). In the article, Stevens and Glantz question my integrity based on some questions during a 4-day deposition which I gave in 2014 in a legal proceeding against my employer. These writers cite snippets from the 1,000+-page transcript of that deposition, relating the text of a facetious note that I h...
NOT PEER REVIEWED This comment summarizes, but mischaracterizes the findings and conclusions of our study. Our analyses and interpretation are based strictly on the letter of the Family Smoking Prevention and Tobacco Control Act (FSPTCA) and its requirements, including Section 911(b)(2)(ii), which bans "the use of explicit or implicit descriptors that convey messages of reduced risk including 'light', 'mild' and 'low', o...
NOT PEER REVIEWED Dear Editor,
Research on waterpipe smoking, also called hookah, is still emerging, and research on second-hand hookah exposure is still in its nascent stages. However, after reading the review on the various effects of second -hand waterpipe smoke exposure by Kumar et al recently published in Tobacco Control1, we noted several major issues in its execution and have serious reservations about th...
Frederieke S. van der Deen and Nick Wilson (on behalf of the other authors; both from the University of Otago, Wellington, New Zealand)
This electronic letter aims to give readers an update on the smoking prevalence projections to 2025 and beyond in New Zealand (NZ) that were provided in the paper by Ikeda et al. NZ is now one of four nations with an official smokefree goal (others are: Fin...
NOT PEER REVIEWED
We refer to the article, "Did the tobacco industry inflate estimates of illicit cigarette consumption in Asia? An empirical analysis" Chen J, et al. published in Tobacco Control on November 25, 2014 (Tob Control 2015;0:1-7) and concur with the important points raised in this article. While the article focuses on Hong Kong, other countries in South East Asia also faced a similar experience. The...
NOT PEER REVIEWED I commend the authors on a significant effort involved in conducting this rather insightful research.
Having conducted qualitative research on FCTC implementation in the Pacific, I can provide comment in relation to the Cook Islands which may explain why MPOWER measures mentioned here did not achieve decreases in prevalence (at least in the figures obtained in this study).
Firstly, th...
NOT PEER REVIEWED We welcome the timely review published by Hill et al. [1], and agree that more research is needed to assess the equity impacts of tobacco control interventions. The results of the review indicated that "increases in tobacco price have a pro-equity effect on socioeconomic disparities in smoking", but that "evidence on the equity impact of other interventions was inconclusive [...]". The inconclusiveness o...
NOT PEER REVIEWED Tobacco is an interesting consumer product. It is legal, toxic and dangerous. It kills people when used as intended. There is a global initiative to reduce use of this product opposed heavily by those profiting from it, tobacco industry stockowners. Industry has successfully blurred consumers, health professionals and policy makers over the years with false science, modulation of product and misleading m...
In this rejoinder, we will address the recent response by Mary Assunta to our article, "Complexities at the intersection of tobacco control and trade liberalisation: evidence from Southeast Asia." To be sure, we believe that trade policy remains a very important issue for public health both in Southeast Asia and globally. Before addressing the specific concerns raised by the reader, it is worthwhile to restate the ove...
I would like to respond to this paper by Drope J and Chavez JJ whose analysis focuses on cigarettes, not tobacco leaf production and trade, and seeks to question the "conventional wisdom" that "trade liberalization naturally leads to lower prices for tobacco products, increased consumption and decreased levels of regulation." The authors use theoretically guided empirical research to demonstrate there is little cause for...
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