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All articles written by David Simpson unless otherwise attributed. Ideas and items for News Analysis should be sent to: d.simpson{at}

Austria has long languished in a sort of fantasy never-never land, where health ministers say the right thing, more or less, but don't get round to doing it, unless they want to be sacked. Persistent rumours of the government and some of its advisors being closer to the tobacco industry than to independent health experts once again seemed suspiciously near the mark earlier this year during a period of national debate about smoking in the workplace.

In January, during a discussion on the economic effects of smoke-free legislation involving individuals and organisations representing differing interest groups, a lawyer representing restaurant and café proprietors' ”rights„, Dr Manfred Ainedter, claimed that in Scotland and Ireland, which both have total bans, 1,000 venues had been forced to close, resulting in a loss of 7,600 jobs. This came as a surprise to many present, being so different from what had previously been reported from health sources in those countries. But the figures did seem to ring a bell. They turned out to have been taken directly from a fax bearing the header of the press office of the federal ministry of health. Nothing wrong with that in itself—understandable, even—except that they were familiar to Austrian health advocates from a different source: the website of British American Tobacco (BAT).

The question then arose: who supplied the statistics to whom? Was the ministry getting its data from BAT, or had BAT seized on what appeared to be some nuggets of gold, albeit in a seam as yet unknown to the public health community, mined by the ministry? The Austrian Council on Smoking and Health and other health advocates informed contacts in the press about the coincidence, only to be threatened with legal action.

The parliamentary process duly delivered a disappointing and unhealthy Spanish-type compromise, with the hospitality industry able to designate restaurants and bars to continue allowing smoking everywhere, with a sign at the door to say so, and with their staff and customers—including children—exposed as ever before. Interestingly, preliminary results of breath tests of members of parliament indicate that representatives of the two parties which had blocked progress in tobacco legislation while a previous government was in power were less likely to be smokers than others who argued for health.

This can only worsen the disquiet in Austrian public health circles caused by other uncomfortable developments recently. These include the reported cancellation of the Austrian Cancer League's tobacco prevention programmes—in recent years, nobody from it has participated in a meeting of the smoke-free class competition, the prevention project co-funded by the European Commission. This cannot be on the grounds of cost, as the meetings have been fully funded by the commission. Health advocates have been disturbed by other apparent contradictions in the league's activities, too. For example, its chief executive has argued in public against health warnings on cigarettes, despite being presented with scientific evidence about their effectiveness. And the league has a new board member, too: the lawyer who represented the hospitality industry, Dr Manfred Ainedter.


Mexico: one of the ads run by Mexico City in support of the new smoke-free law

April 2008 will be considered a historic landmark in the global public health movement in Mexico. On 7 April, Mexico City became the most populous smoke-free city in the world, becoming a leader in the Latin American smoke-free movement. Joining Uruguay, some provinces of Argentina, and soon Panama, the legislative assembly of Mexico’s federal district, a city of more than 8 million people, voted 44 to 14 to enact a totally smoke-free policy in all enclosed public places, workplaces, and public transportation, following the recommendations of the World Health Organization. The implementation of the law began with an outstandingly high compliance rate.

The success of the implementation of this policy relies on a strong commitment by local authorities, led by the city’s secretary for health, Dr Manuel Mondragón y Kalb, with persistent effort by tobacco control advocates, as well as international support. This alliance of the city government, civil society and the international movement was very effective in neutralising efforts led by the tobacco industry to undermine meaningful tobacco control in Mexico.

In February, Mexico City legislators approved an amendment to an existing law regulating smoking in indoor areas, which permitted designated smoking areas physically separated with independent ventilation systems. The modification of the law was accomplished in response to increasing public support for 100% smoke-free environments, but also with support from the restaurants’ association, which was concerned about the practical difficulty and high costs of building such smoking areas.

Two educational campaigns, “Se Respira Respeto” (”Breathing Respect„) and “Gracias a Ti” (”Thanks to You„) were launched to support the law. Signs, posters and brochures, were located inside bars, restaurants, discos, public buildings and in the metro, thanking and reminding the public about the positive effects of the new law. Hundreds of volunteers walked through main thoroughfares to promote clean indoor air.

Despite the success of the implementation, a continuing aggressive media campaign has been running since long before the law was approved. Arguments repeat well-known tobacco industry strategies used to block smoke-free legislation elsewhere. These include claims of economic harm to the hospitality industry, discrimination of smokers’ ”rights„, alleged lack of scientific evidence on second-hand tobacco smoke and disease, and difficulty of enforcement.

In addition to this misleading campaign, another parallel controversy has been launched in the media to confuse the public. The very same day that the city assembly approved the 100% smoke-free law, the Mexican Federal Congress passed a national tobacco control law that does allow designated areas for smoking in most enclosed places. The federal law had been watered down during the discussions in the congress since its introduction in 2007.

This apparent contradiction between the two legislations has been identified as a main obstacle in the full and successful implementation of the smoke-free law in Mexico City. Voices from the federal government are calling for the Mexico City law to be turned back to allow designated smoking areas. There is also the continuing co-option of federal and local authorities by the tobacco industry. In a country like Mexico that is home to one of the richest men in the world and a member of the board of Philip Morris (PM) International, it is not surprising. In 2006, the former national secretary of health Julio Frenk signed an agreement with British American Tobacco Mexico and PM Mexico to stop the increase of tobacco taxes, and exclude pictorial-based health warning labels on cigarette packs, in return for some funds. Two years later, once again Mexico is the natural scenario of the tension between the economic profits of the private sector versus the health and social benefits of an entire population. It is clearly in the interest of the entire tobacco control movement that we protect this important achievement.

Ernesto Sebrié

Roswell Park Cancer Institute, USA



Argentina is the only Latin-American country which has not ratified the World Health Organization's Framework Convention on Tobacco Control (FCTC). Furthermore, it has not even passed a national tobacco control law.

Argentina has always served as a test bed for the tobacco industry to try out promotional, communications and avoidance strategies, with many examples such as the educational programme “I Have the Power” and ”The Latin Project„. Currently, the industry is in a special situation in Latin America, as much of the region has severe restrictions for publicity and promotion, including sponsorship. Tobacco companies are therefore trying out new strategies to reach their two major targets: youth and women.

The global conference ”Women Leaders Rising„ took place in Buenos Aires in May, organised by the International Women's Forum (IWF), which promotes female advancement to achieve a more equal society. On 10 May, the ”Women„ supplement Clarin newspaper dedicated a double page to the conference, which was attended by 500 influential women from around the world. The supplement included two interviews, one with Mrs Asma Chaabi, the first female mayor of a Moroccan locality, and the other with Mrs Ester Silver Parker, president of IWF and vice-president of Wall Mart (USA), talking about changes in leadership and female power.

The cover of the supplement featured two young, glamorous women, posing in challenging attitudes, archetypal executive women. The photograph of one of them had a grotesque cigarette drawn onto it. The accompanying headlines translated as, “Women in power: scope of the new leadership”, relating to an article about the IWF conference, and “shocking winter”, relating to fashion colours for the coming winter season. The messages were confusing, bearing no relation to the photograph.

Clarin is the biggest circulation newspaper in Argentina, with 400,000 copies from Monday to Saturday and 700,000 on Sundays. In addition, there is a digital edition with a daily, worldwide readership of around 400,000. The digital edition has no promotion, but the offending image nevertheless travelled around the world.

When asked to explain, the editor of the supplement said it had just been ”a game„ by the article's producer, an answer difficult to accept considering that she had written a book helping people to quit smoking. The question remains as to whether the tobacco industry had a hand in it. Clearly, it has every reason to try to use such indirect publicity to portray smoking as normal in media entering countries where such publicity would be either forbidden or at least unlikely to originate.

Marta Angueira and Elisa Berhman


Argentina: the front page of a women's supplement in the national newspaper Clarin, marking the IWF conference in May.


An ambitious global youth awareness programme has been launched, which aims to gather 10 million signatures, principally from young people, calling for a tobacco-free society. The signatures will be on 6' x 3' (2 m x 1m) cloth banners, to be joined together to form a running banner of about 6 miles (10 km). The idea is to present the banner to the director general of the World Health Organization at next year's world conference on tobacco and health in Mumbai (Bombay), India, where the scheme originated. The project, the brainwave of tobacco control advocate Mr Venkat Regunathan of Tiruchirapalli, Tamil Nadu, is known as G-BAT 10x10 (Global Battle Against Tobacco, 10 million signatures running to 10km). It has already been adopted by the John Tung foundation of Taiwan, which intends to gather signatures from students of more than 165 Taiwanese schools and colleges. In the meantime, it is also hoped to persuade athletes competing in Beijing to add their signatures, too. (Further information from: vregu{at}

India/World: tobacco control advocates and VIPs at the launch of the G-BAT project in Taiwan.


The tobacco industry is advertising slim cigarettes in Lebanon. Virginia Slims was introduced by Philip Morris in the United States in 1968. It was marketed directly to women, promoting and glamorising smoking. In 2008, forty years later, Philip Morris has launched Virginia Slims in Lebanon, the brand is advertised extensively on billboards and in other media, including an insert in the April 2008 edition of the women’s society magazine, Mondanité. Other companies, too, are catching on: recently Gauloise introduced its slim cigarette onto the Lebanese market. British American Tobacco’s Vogue is sold in Middle East duty free shops. The prevalence of smoking among women in Lebanon is the highest in the region. Lebanon continues to allow advertising although the World Health Organization's Framework Convention on Tobacco Control was signed in December 2005; and so far, there has been no legislation adopted to ban such practices.

Rima Nakkash

American University of Beirut, Lebanon


Lebanon: a Virginia Slims billboard in the heart of Beirut. The health warning, on a diminutive white area at the bottom, is barely visible to the naked eye and often obstructed, as in this photograph, by objects in front of the billboard.


From February to April, health advocates in Sri Lanka ran an innovative campaign designed to use modern mobile technology, from which the country's young people are as inseparable as those the world over, to do what the tobacco industry fears most—further downgrade the social acceptability of smoking. In this case, the industry really means British American Tobacco, whose Ceylon Tobacco Company dominates the market.

The campaign was organised by the Alcohol and Drug Information Centre (ADIC), an independent non-governmental organisation (NGO) active in drug demand reduction since 1990. The purpose of the campaign, conducted in Sinhala, Tamil and English, was to encourage the public to use mobile technology in the prevention of smoking by deglamorising tobacco use, reckoned to be particularly effective among the younger generation, reversing the impact of the tobacco industry's image building. At its heart was a competition for the most innovative ideas. It was significant that 1st April was a focus at the final stage, for communicating messages linking the significance of the date with tobacco and those involved with it.

Also, ADIC's choice of medium also capitalised on the fact that mobile users include a wide representation of the various segments of Sri Lankan society, including different ethnic groups, religions, cultures, and social classes. Thus a diverse group of people could be enrolled in a competition that was fun, catchy and at the same time thought provoking and cost effective.

A great deal of support was given by print and electronic media to publicise the event. This was not confined to national media, and ADIC received feedback from all over the world. Media personalities were reportedly impressed that the organisers had used a modern and effective medium to spread the health message.

In planning the competition, several training programmes were held and nationwide campaigns were carried out to publicise the event. ADIC reported that the response was immense, as evidenced by the number of SMS messages received—5,000 in a three-week period.

Entries were judged on originality, appropriateness to the theme and creativity. The final event comprised an award ceremony at a prestigious hotel for the best three SMS texts and the launch of the second round of a digital stories competition. Among the participants were representatives of the World Health Organization, the health ministry, media organisations and NGOs.

Sri Lanka: ADIC volunteers with a banner in Tamil promoting the SMS campaign.


Earlier this year, Philip Morris USA (PM) quietly terminated its heavily-endowed external research grants programme (PMERP). In its time, PMERP funded at least 470 proposals from more than 60 universities and other research units in the USA and abroad, including an unknown number of post-doctoral fellowships. When we analysed the first Request for Application (RFA) issued in 2000, we noted that PMERP’s structure and review process was similar to that of the defunct Center for Indoor Air Research (CIAR), disbanded under the Master Settlement Agreement (MSA) with US state Attorneys General. We also noted that the majority of listed peer reviewers had prior links to PM or CIAR, but few were expert in tobacco research. Our research into internal company documents revealed that the purpose of PMERP was to restore the company’s scientific ”credibility„. Finally, the detailed programmatic description in the RFA seemed to tilt toward eliciting exculpatory evidence in the realm of exposure/biomarkers/dosimetry, epidemiological research, clinical and model systems, tobacco smoke and smoking behaviour.

From an internal management report dated February 2002 (prepared by PM scientist Roger Walk), we analysed the results of the first annual round of funding. Of the 153 applications received by PM, 61 were funded, resulting in 78 publications, most in basic and cellular research, by 2005. By title, two-thirds of the projects related to smoking, tobacco or nicotine. Over half the grantees had received or requested industry funding prior to PMERP, but only about one-third had prior publications related directly to tobacco or smoking. Grant contracts mentioned harm reduction for the first time as an objective. Nonetheless, proposals in the fields of “exposure/risk assessment” and epidemiology were least likely to be funded, while those related to toxicology, clinical disease, neuroscience, and genetics were most favoured. Only 11 of the 78 papers could be obviously considered exculpatory. An internal memo justified PMERP as a way of gaining “credibility…goodwill,” and ”finding young scientists.„

The most recent PMERP research management report, dated December 2004, was authored by a “Research Management Group” that shares the same address as a company calling itself “Center for Indoor Air Resources,” conveniently similar to that other CIAR, the Center for Indoor Air Research, also at the same address. By October 2003, 236 projects had generated 179 publications, similar in scope to the first round. 44 percent of the projects related to smoking, tobacco or nicotine. Only one project, by James Enstrom, appeared to be exculpatory. By 2004, 33 postdoctoral fellowships had been awarded, more than twice the number from 2002.

We cannot know how much value for product development PM gained from the external research programme. By 2006, PM had invested heavily in establishing its own, in-house research centre for product design. In addition, PM has funded specific research in harm reduction and nicotine outside of PMERP.

“Goodwill,” and “finding young scientists” were arguably achieved, however, as illustrated by one postdoctoral fellow’s comment: “As there were no strings attached in the application process I had no qualms in applying for this funding… In retrospect I can say that the whole process was very professional and friendly and that under similar circumstances I would apply for such funding again.”

Norbert Hirschhorn, Stella Aguinaga Bialous and Stan Shatenstein



Tobacco packaging is a critical promotional vehicle for tobacco companies, as well as a powerful medium for communicating public health messages on the risks of tobacco use. For the tobacco industry, packaging provides a direct link to consumers and serves as the cornerstone of industry marketing. The package assumes even greater importance in jurisdictions with comprehensive restrictions on advertising and other forms of promotion.

For governments, packages provide an extremely cost-effective and high profile means of communicating the risks of smoking, as well as promoting smoking cessation services such as telephone quit lines. Indeed, the World Health Organization (WHO) recently identified comprehensive packaging and health warning policies as among the six key measures required to address the tobacco epidemic.

Tobacco labelling policies are rapidly evolving thanks to the WHO Framework Convention on Tobacco Control (FCTC). Article 11 includes provisions in three areas of labelling policy: prohibitions on false or misleading packaging information; mandatory health warnings; and information on tobacco contents and emissions. To date, very few countries have implemented these measures in their entirety. For example, only 17 countries, representing less than 8% of the world’s population, have implemented or have committed to implementing pictorial warnings on tobacco packages.

To promote broader implementation of Article 11, regulators must be provided with better access to the growing evidence base on labelling policies. Priority areas include evidence supporting broader restrictions on potentially misleading information that extend beyond the words “light” and “mild.” For example, what, if any, other terms should be prohibited on packages? What is the likely impact of “plain” or generic packaging, where all colours and symbols are removed from packages? The need for greater evidence is particularly acute in lower and middle income countries – the countries in which these policies are most urgently needed and have the greatest potential for impact. []


UK: staff at the Richard Doll building in Oxford admire the new stone plaque inscribed with some of Sir Richard's summary of his most famous study. Photo: Anna Badley.

A new and lasting testament to some of the work of the pioneering epidemiologist Sir Richard Doll has been installed in the building named after him. Sir Richard's collaborator for more than thirty years, Sir Richard Peto, co-director of his late mentor's former unit at Oxford university, has had some of the conclusion of their fifty year follow-up of their best known study, the British doctors study, inscribed on a large stone plaque. It is fixed to the wall of one of the atria in the light and airy building to which the unit moved shortly before Doll's death at the age of 92 in 2005. The extract summarises much of the extraordinary advances in knowledge and public health achievements in which Doll played such a major part, and presents a realistic target to which every country, if only resources were available, and freedom from commercial pressures were absent, might aspire: “DEATH IN OLD AGE IS INEVITABLE BUT DEATH BEFORE OLD AGE IS NOT.” In previous centuries seventy years used to be regarded as humanity's allotted span of life and only about one in five lived to such an age. Nowadays, however, for non-smokers in Western countries, the situation is reversed: only about one in five will die before seventy and the non-smoker death rates are still decreasing, offering the promise, at least in developed countries, of a world where death before seventy is uncommon. But, for this promise to be properly realised, ways must be found to limit the vast damage now being done by tobacco and to bring home, to not only the many millions of people in developed countries but also the far larger populations elsewhere, the extent to which those who continue to smoke are shortening their expectation of life by so doing.