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Abstract
Background In 2017, Indonesia initiated the amendment of its 11-year-old tobacco control regulation (PP 109/2012) to reduce smoking among youth, but the process was stalled. The proposed changes in the regulation include a full ban on tobacco advertising, promotion and sponsorship (TAPS), increasing health warning label (HWL) size and regulating electronic cigarettes (e-cigarettes). This study analysed the arguments and actors for and against the PP 109/2012 amendment in online media articles.
Method Content analysis of 326 online articles reporting on the PP 109/2012 amendment published from 2018 to 2023, retrieved from the Tobacco Watcher platform. We coded articles for statements supporting or opposing the amendment (position statement), content of the arguments used to support (supporting argument) and oppose (opposing argument) the amendment, actors presenting the arguments and tobacco control measures. We iteratively reviewed and coded data and presented the frequency of categories.
Results Of 332 position statements, 53.3% were against the amendment. The main categories of supporting arguments (N=1448) included smoking trends (21.1%), health implications (16.6%), science-based evidence (9.6%) and protecting the population (9.2%). Opposing arguments (N=1413) emphasised the tobacco farmers’ welfare (16.6%), impact on the industry (16.4%) and current regulation is sufficient (11.0%). Supporting actors were predominantly health-related entities and government officials (89.3%), while 62.1% of opposing actors included trade and Islamic groups, the tobacco industry and front groups. HWLs, e-cigarette/heated tobacco product regulation and TAPS were the main (77.8%) tobacco control measures mentioned in the proamendment arguments, while HWLs, TAPS and cigarette sale restrictions were the dominant (79.3%) tobacco control measures in anti-amendment arguments.
Conclusion Indonesia’s tobacco control reform faced opposition by false claims primarily from industry allies, resulting in a 5-year delay in enactment. Future tobacco control media advocacy must address these claims and emphasise the alignment of economic interests with public health goals.
- Low/Middle income country
- Tobacco industry
- Public opinion
- Media
Data availability statement
Data are available upon reasonable request. Data are available upon reasonable request by contacting the corresponding author.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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WHAT IS ALREADY KNOWN ON THIS TOPIC
Evidence from news coverage of tobacco control policies in high-income countries demonstrates a generally positive framing for the adoption and implementation of stronger tobacco control provisions.
A 2016 content analysis of news articles on the implementation of Indonesia’s main tobacco control regulation (PP 109/2012) found that most stakeholders’ arguments were in favour of a better tobacco control policy to protect young people and people’s health.
WHAT THIS STUDY ADDS
This is the first study to systematically examine news coverage of arguments on tobacco control regulation reform in a developing country where the process was stalled.
Online media articles were fairly split statements on supporting and opposing the amendment of Indonesia’s main tobacco control regulation and found new arguments related to the COVID-19 pandemic and e-cigarettes/heated tobacco product issues that were used by both those in favour and against the amendment.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
Because the continued split of health versus economic framing in the media may hinder the strengthening of tobacco control regulation in Indonesia, media advocacy for tobacco control may want to emphasise the alignment of the economic and development agenda with tobacco control goals.
Introduction
Smoking prevalence among Indonesian youth aged 10–18 slightly increased from 7.2% in 2013 to 7.4% in 2023, including the use of combustible cigarettes, electronic cigarettes (e-cigarettes), heated tobacco products (HTPs) and shisha.1 2 E-cigarettes were used by 8.5% of smokers in that age group in 2023.1 Although the smoking prevalence of youth is lower than that of adults aged 20–24 (30.4%), reducing smoking in the 10–18 age group was a priority and set as a national target indicator (RPJMN 2020–2024).1
Since 2012, Government Regulation No. 109 Year 2012 (PP 109/2012) has been Indonesia’s main tobacco control regulation, including provisions regarding tobacco advertising, promotion and sponsorship (TAPS), health warning labels (HWLs) and underage cigarette sales.3 However, it does not meet the WHO Framework Convention for Tobacco Control standards.4 For example, PP 109/2012 requires pictorial HWLs covering 40% of the packaging, allows tobacco advertisements to air between 21:30 and 5:00 in broadcast media, does not ban smoking in all public indoor spaces and does not regulate HTPs, though an excise tax is applied to these products.5
Aiming to reduce youth smoking, the Indonesian Ministry of Health (MoH) has sought to strengthen PP 109/2012 since September 2017.6 Proposed changes include a full ban on TAPS, increasing HWL size to 90%, banning loose cigarette sales and regulating electronic cigarettes (e-cigarettes) and HTPs the same way as combustible cigarettes.6 However, strong opposition led to the Ministry of State Secretariat rejecting the MoH’s request to initiate the revision in November 2021 due to a perceived lack of comprehensive assessment and consultation with stakeholders.7 In response, the Coordinating Ministry for Human Development and Culture led a public hearing on the amendment in July 2022. The amendment process has continued to stall.8
News media coverage can provide insights into the support and opposition towards a public health issue.9 A study on news media coverage of PP 109/2012 implementation from 2012 to 2016 highlighted arguments favouring better TAPS policies to protect youth and public health, while opponents expressed concerns about potential harm to the tobacco industry and reduced government income.10 It is unclear whether these arguments persisted during the amendment process. In high-income countries, news coverage of tobacco control, including plain packaging (Australia; 2008–2014),11 tobacco point of sale (POS) (eg, licensing, density, advertising) (USA; 2007–2014),12 smoke-free areas (USA; 2002–2003)13 and HWLs,14 14 generally demonstrated positive framing for stronger provisions.
However, previous studies only examined news coverage of tobacco policy changes after successful legislative decisions. No research has been conducted on news media coverage where proposed policy changes have stalled. Additionally, none examined a comprehensive tobacco control regulation; previous studies focused on a specific tobacco policy domain (eg, TAPS, HWL). News content on stakeholder arguments remains understudied in low and middle-income countries despite rapid changes in the tobacco product landscape and attempts to advance and safeguard tobacco control policies. This paper addresses these gaps by examining the online news coverage of arguments and actors for and against the amendment of Indonesia’s tobacco control regulation.
Methods
We sourced online media articles from Tobacco Watcher (www.tobaccowatcher.org), a publicly available media monitoring platform that automatically identifies and categorises tobacco news from over 500 000 global sources. Articles met the following inclusion criteria: published in English or Bahasa Indonesia, focusing on the amendment of PP 109/2012, and published from 29 February 2016, following the last search by Astuti et al,10 through 31 December 2023. We performed the search and coding two times: first, in February 2023, we searched for articles, and between February and June 2023, we coded 311 articles; second, from December 2023 until January 2024, we updated the search and coded an additional 15 articles. We used these keywords for searching: ‘amendment’, ‘revision, ‘PP’, ‘legislation’, ‘law’, ‘regulation’, ‘policy’ and ‘Indonesia’. We retrieved and screened 958 articles meeting the inclusion criteria for the following exclusion criteria: irrelevant to the PP 109/2012 amendment (n=326), duplicates (n=194) or inaccessible due to paywalls or broken links/URLs (n=112), resulting a total of 326 articles eligible for analysis.
We categorised eligible articles by article type: news (factual account of issues or events), editorial (opinion of news or columnist) and letters/comments (letters to the editor and readers’ comments sections). Publication date was recorded. We developed an initial codebook based on a previous study concerning news media coverage of stakeholder arguments on TAPS policy in Indonesia10 and other literature regarding arguments and support for tobacco control policies presented in news media articles.11 12 14–16
We initially reviewed 10% of the eligible articles to further develop the initial codes in the codebook. We established the following variables and corresponding codes for the final codebook: position statement (2 codes), argument type (45 codes), actors (12 codes) and tobacco control measures (10 codes). (Codebook is available in online supplemental 1).
Supplemental material
‘Position statement’ refers to an explicit statement supporting or opposing the PP 109/2012 amendment. ‘Argument type’ is defined as the content of arguments to support or oppose the amendment. ‘Actors’ denotes individuals or groups raising arguments. ‘Tobacco control measures’ pertains to the tobacco control domains mentioned in the argument. We further analysed and categorised coded text within the variables based on their tone or slant in favour or against the amendment. For example, if an actor presented a rationale for supporting the amendment but did not explicitly state favouring the amendment, the actor was still categorised as supportive. We identified categories by coding text segments consisting of part or full sentences in the article and used them as the unit of analysis.
Two coders independently conducted three rounds of coding practice, utilising 15 randomly selected eligible articles (five articles in each round). Subsequently, in a fourth round, the Kappa statistic for inter-rater reliability test was 0.91 for 31 articles (10% of eligible articles).17 18 The two coders then single-coded the remaining articles, applying the final codebook using MAXQDA V.2022 software.
Data analysis involved an iterative process of reviewing, organising and reporting categories. For the reporting in this paper, we combined categories into 22 categories for argument type, 10 for actors and 10 for tobacco control measures. We described the volume of articles according to article type and publication date and presented the frequency of each category. We coded articles in their original language (95% were in Bahasa Indonesia), and translated quotations in Bahasa Indonesia into English.
Results
Of the 326 articles, most were news articles (94%); the rest were editorials. Articles were published from 31 May 2018, through 18 December 2023, with the peak publication period being July–December 2022 (23%), followed by January–Jun 2021 (17%) and July–December 2019 (16%). Between 29 February 2016 and 30 May 2018, we found no article reporting on PP 109/2012 amendment.
Position statements and argument types
The position statements presented in online news media were slightly more opposing the amendment (53.3% of total 332 statements), with 20 and 18 argument types used to oppose and support the amendment, respectively (table 1).
Distribution of supporting and opposing arguments, actors and tobacco control measures in relation to the PP 109/2012 amendment in news articles, 2016–2023
The argument types (table 2 and online supplemental 2) used to support the amendment: smoking trend and initiation (21.1% of 1448 supporting arguments), health and safety implications (16.6%), science-based (9.6%) and protecting the population (9.2%). The opposing arguments were predominantly categories of tobacco farmers/workers’ welfare (16.6% of 1413 opposing arguments), impact on the industry (16.4%), and current regulation is sufficient (11.0%).
Supplemental material
Main argument types of supporting and opposing the PP 109/2012 amendment in news articles (2016–2023)
Argument types: supporting the amendment
The ‘smoking trend and initiation’ argument focused on increased youth smoking in Indonesia while there was a global decrease, attributing the main drivers of smoking initiation to TAPS exposure and affordable cigarettes. This argument asserted that the rise in Indonesia’s smoking prevalence occurred despite the COVID-19 pandemic.
The ‘health and safety implications’ argument primarily addressed the harms of smoking, and e-cigarette and HTP consumption. There was an indication of the risk of COVID-19 among people who smoke and the impact of COVID-19 on smoking, such as switching to cheaper tobacco products during the pandemic to save money. Many arguments refuted the claim that e-cigarettes are safer than combustible cigarettes and their effectiveness in aiding smoking cessation (‘harm reduction’). Concerns about product safety and ingredients, including the presence of illicit drugs in e-cigarette products, were also cited.
The ‘science-based’ argument was widely used as the basis of the supporting arguments, such as smoking trends, harmful health effects and TAPS or smoking exposure. Key ‘science-based’ evidence included population-based survey data demonstrating the rise in smoking prevalence, cigarette expenditure in the country and research findings on the harmful effects of e-cigarettes.
The ‘protecting the population’ argument underscored the inadequacy of PP 109/2012 in safeguarding public health, particularly youth, from the hazards of smoking, TAPS exposure and the tobacco industry’s predatory practices. This argument emphasised the country’s legal obligation and national targets for this protection.
Argument types: opposing the amendment
The ‘tobacco farmers’ or workers’ welfare’ argument stressed that the amendment could threaten the livelihoods of those in the tobacco sector, including farmers, factory workers and street vendors, who could face job losses due to the already challenging conditions created by current tobacco control measures. This argument was often presented together with the argument that the labour-intensive tobacco industry significantly contributes to the country’s economy.
The ‘impact on the industry’ argument asserted that the amendment could further burden Indonesia’s tobacco sector, which already faced reduced production due to current regulations. Some called for delaying the amendment, citing the industry’s postpandemic economic challenges.
The ‘current regulation is sufficient’ argument deemed the amendment as excessive, arguing that PP 109/2012 remains relevant, comprehensive and effective in reducing smoking and tobacco production. It stated that PP 109/2012 already included the proposed amendment measures, such as banning cigarette sales to minors. Some argued for prioritising actions like improving implementation, public education and addressing urgent issues like COVID-19 recovery, making the amendment unnecessary.
Actors
More actors opposing the amendment (59.5%) were cited than those supporting it (40.5%) (table 1). The top three actors supporting the amendment included civil society organisations (CSOs), such as groups specific to tobacco control, health and youth/children (40.7% of supporting actors), government, such as MoH and city majors (28.1%), and health professionals (20.5%). International health organisations, such as WHO and the International Union Against Tuberculosis and Lung Disease, were other actors (3.8%) favouring the amendment.
The main three actors opposing the amendment were CSOs, such as Kretek Community, Nadlatul Ulama (Islamic organisation), and the Indonesian Chamber of Commerce and Industry (24.0% of opposing actors), the tobacco industry (eg, tobacco/nicotine manufacturers/entrepreneurs (20.1%)), industry front groups ((eg, Indonesian Tobacco Community Alliance (AMTI) (18.0%)). Although less dominant (16.7%), some government and legislative bodies also opposed the amendment, such as the Ministry of Forestry and Agriculture, Ministry of Law and Human Rights, Ministry of Industry, the People’s Representative Council and regents of districts where tobacco growing is prominent. Academic experts, such as the rector of an Indonesian university and a public policy observer, comprised 9.5% of opposing actors.
Tobacco control measures
More tobacco control measures were mentioned in all proamendment arguments combined than in antiamendment arguments combined (79.9% vs 20.1%, table 1). HWLs, e-cigarette/HTP regulation and TAPS were the top three tobacco control measures discussed in the articles, covering 77.8% of tobacco control measures. HWLs and TAPS were predominant in both pro (48.8%) and anti (59.3%) amendment arguments mentioning tobacco control measures. Another main category of tobacco control measures mentioned in proamendment arguments was e-cigarette/HTP provision (29.0%), while cigarette sale restrictions (20.3%) were another top category for antiamendment arguments. Table 3 shows the main arguments supporting and opposing the proposed tobacco control measures.
Main arguments in news articles (2016–2023) used to support and oppose the proposed tobacco control measures in the amendment of PP 109/2012
Discussion
From 2018 to 2023, online news articles featured slightly more statements opposing the PP 109/2012 amendment than supporting it. A nearly even split between positive and negative framing might partially explain the long delay in the amendment process.1 19 Opponents argued that the revision to PP 109/2012 is unnecessary and could deprive the industry and tobacco workers. Conversely, supporters presented more evidence-based arguments, primarily asserting increased smoking prevalence, health and safety concerns and youth protection.
The 2016 study on news media coverage of PP 109/2012 implementation also identified health and youth protection as primary arguments supporting the amendment, and opposition emphasised harms to the tobacco industry and tobacco farmers.10 Similarly, the proregulation actors were predominantly government officials in health, women and children-related bodies and tobacco control advocates, including doctors and scholars.10 Furthermore, opposition to tobacco control regulation mainly came from tobacco industry alliances, particularly the front groups named as representatives of tobacco farmers and workers.10 19 The Kretek Community, a prominent Indonesian activist organisation, claims to independently defend kreteks (clove-mixed cigarettes) as cultural heritage, opposing tobacco control as ‘foreign threats’ while accepting industry money.20
Mirroring Indonesia’s health tax debate, the opponents from industry-affiliated government institutions, particularly the Ministry of Industry and Ministry of Trade, advocated for fiscal regulations benefitting the tobacco industry, framing it as vital for the domestic sector.21 The inclusion of tobacco companies and the policy to balance commercial interests and health were found to be the main challenges in integrating the whole-of-government approach to tobacco control in the Philippines.22 Since Indonesia has not adopted the whole-of-government approach to tobacco control and non-communicable diseases, it lacks of commitments and robust cross-governmental coordination for tobacco control, with the MoH as the leading sector.23 24 Without the whole-of-government approach, the industry lobbied to exempt e-cigarettes and HTPs from the amendment and donated for COVID-19 recovery, posing as legitimate stakeholders in tobacco control and hindering the amendment process.25 Despite this, the tobacco industry’s conflict of interests was rarely mentioned or denounced by the proamendment groups in this study.
In contrast to former studies in Indonesia, the USA, Australia and South Korea10–16 portraying positive views on tobacco control in printed and digital news, our study shows a slightly negative framing. The disparity may be due to our focus on a stalled amendment, whereas earlier studies centred on promulgated or successful policy measures. News coverage likely mirrored the prevalent policy sentiment.13 Furthermore, compared with previous research,10–12 14 15 21 26 we found a greater number of arguments from both the proponents and opponents, possibly due to the broad tobacco control domains proposed in the PP 109/2012 amendment. Additionally, using text segments instead of the number of articles for category frequency resulted in counting opposing statements as negative, even within an overall positive framing article.
New arguments found in this study were related to the COVID-19 pandemic and e-cigarette/HTP issues. The COVID-19 pandemic argument, under the health and safety category, was also used against the amendment, advocating prioritisation of COVID-19 recovery policies over the amendment. This creates an opportunity to highlight the link between smoking, severe COVID-19 outcomes and the need for integrating tobacco control into pandemic recovery.27–29
Health scientists and experts were divided on e-cigarette and HTP regulation, with five opposing arguments claiming the products to be safer than cigarettes (results available on request). Earlier research also highlighted a positive portrayal of e-cigarettes by academic and research-based institutions in Indonesian news.30 Mixed evidence on the harms of e-cigarettes and HTPs, with industry-funded studies often favouring the products, may contribute to the division.31–33 Claims of ‘harm reduction’ for e-cigarettes and HTPs echoed a policy document analysis from Brazil, which also found that arguments on harm reduction and the potential use of e-cigarettes in smoking cessation were used to oppose a proposed e-cigarette ban in the country.26 The recent embrace of HTPs in Indonesia, exemplified by the inauguration of PMI’s IQOS HEETS factory by the Coordinating Minister for Economic Affairs,34 could influence the government’s stance on the tobacco industry. Moreover, this study revealed a unique science-based category, with more supporting arguments backed by data than opposing claims. Evidence-based supporting arguments can be used against false claims related to tobacco policies.
Categories of safeguarding youth and curbing smoking in supporting arguments align with the primary goals of the amendment.6 High support from youth-related CSOs and the Ministry of Women’s Empowerment and Child Protection in our findings may be due to Indonesia’s national target (RPJMN 2020–2024) aiming to reduce youth smoking from 9.1% to 8.7%.35 News analysis indicates that youth issues are newsworthy and frequently cited as motives for changes in tobacco policy.10 36
Opposing arguments remained dominated by economic claims, focusing on harm to the tobacco industry and workers’ welfare.10 23 These claims implied a positive image of the tobacco industry in the country, disregarding the economic burden of tobacco consumption and the manipulative and exploitative nature of the industry.37–39 The welfare of tobacco farmers and workers narrative has been long used to oppose tobacco policy change in Indonesia10 21 23 and is contradicted by evidence of their economic struggles and low wages regardless of the tobacco control policy.40–42 Opposition from subnational governments, particularly in regions where tobacco commodity was prevalent, reflects the influence of decentralised governance and a complex bureaucratic landscape.43 Nonetheless, counternarratives under the economic impacts category used poverty, and healthcare and societal costs associated with smoking. Similarly, some states in the USA incorporated economic loss as part of their rationale for tobacco control laws, highlighting the financial burdens attributed to tobacco consumption.44
Opponents argued that the current PP 109/2012 was comprehensive and that other measures, such as smoking prevention education, were more important than amending the regulation. This argument tends to divert attention from the need to adopt stronger tobacco control policies. Previous research highlighted a focus on individual-level education rather than policy changes in the news around the issue of youth tobacco use.36 In reality, loopholes, such as the partial TAPS ban, did exist in PP 109/2012, which allowed the industry to exploit them by displaying tobacco products in POS locations and sponsoring education, music and sports events.45–47
We found HWL and TAPS were the most contested tobacco control domains, with the category of e-cigarette or HTP regulation primarily discussed in arguments favouring the amendment. Similarly, the Australian plain packaging policy faced public opposition in online news comments, claiming ineffectiveness.48 Two decades ago, secondhand smoke and tobacco education and cessation were the main issues covered by Australian newspapers,15 demonstrating the shift in importance and popularity of tobacco control measures, possibly due to the change in the tobacco product landscape and tobacco industry tactics.
We did not find discourse on human rights or the environmental impacts of tobacco consumption, topics of increasing global concern.49 50 Additionally, the voices of people who smoke, those directly affected by tobacco consumption,16 were under-represented, accounting for less than 3% of actors identified (under ‘other’ category). Emphasising their alignment with tobacco control goals might help in garnering support for legislative reforms.51 52
This study does not reflect the public’s organic view towards the amendment, which may better be captured in public opinion surveys and social media analysis. Additionally, the study does not account for the reader’s perspective, a factor often revealed through online news commentary, as demonstrated in a study on Australian online news.48 Furthermore, this study does not include paywalled news, nor does it weigh the importance, influence, or readership of arguments and articles, potentially overlooking variations. While we did not find literature on news coverage that presented more negative than positive framing towards tobacco control before the passage of the policy, there is the possibility of publication bias or the absence of study around this negative sentiment.
However, this is the first study to systematically identify news coverage of stakeholder arguments focused on the amendment of a tobacco control regulation in a developing country with a stalled process, offering insights for policymakers and advocates to inform current tobacco policy change efforts. Although the amendment process was stopped, in July 2024, Indonesia passed Government Regulations No. 28/2024 pertaining to Health, which contains a set of strengthened tobacco control provisions, mirroring those in the proposed PP 109/2012 amendment.53 Similarly, the drafting process of the Government Regulations was very slow, lacked transparency and public participation and received strong opposition from the protobacco industry.53
Media advocacy involving CSOs and media collaboration in favour of tobacco control should emphasise the alignment of the country’s economic and development targets with tobacco control goals. Additionally, it is important to expose tobacco industry conduct by broadening the advocacy network and extending the narrative,54 55 such as highlighting the tobacco industry’s violation of human rights and harm to the country’s economy and people’s welfare. Focusing on tobacco industry denormalisation may also protect public health policy from the industry’s vested interests and foster cross-sectoral support within the government.23 Lessons learnt from Australia and the Philippines demonstrate that the whole-of-government approach to non-communicable diseases could advance interministerial coordination and policy coherence and support the incorporation of health considerations in every policy-making process, including tobacco control.22 56
In conclusion, the reform of tobacco control regulation in Indonesia encountered significant contention, with wide-ranging pros and cons arguments presented in online news articles from 2018 to 2023. False claims remained used in opposing the amendment despite strong rationale favouring it, leading to a 5-year delay in enactment. Future media advocacy in Indonesia should use counterarguments to denormalise the tobacco industry and highlight the alignment of economic interests with public health goals to advance effective tobacco control policies.
Data availability statement
Data are available upon reasonable request. Data are available upon reasonable request by contacting the corresponding author.
Ethics statements
Patient consent for publication
Ethics approval
Not applicable.
Acknowledgments
The authors would like to thank Ananta Stokhorst for his contribution as the second coder, Lauren Czaplicki for providing document analysis training for both coders and John W. Ayers for the assistance in data retrieval on Tobacco Watcher.
References
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
X @beladenta, @drayuswandewi
Contributors JEC and BA conceived the study. BA and PASA developed the codebook. BA conducted the analyses. BA wrote the first draft of the article. All authors contributed to the writing and editing of the manuscript. JEC is the guarantor.
Funding This work was supported with funding from Bloomberg Philanthropies' Bloomberg Initiative to Reduce Tobacco Use (bloomberg.org) (47580).
Competing interests JEC is a paid consultant in litigation against a tobacco company.
Provenance and peer review Not commissioned; externally peer-reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.