Bernie Ecclestone's strategy of continuing Formula 1's relationship
with tobacco sponsors at seemingly any cost
is raising the ire of motor racing purists.
As European bans on sponsorship become increasingly likely,
Ecclestone plans to move races from traditional circuits to countries that
have no foreseeable plans to ban tobacco sponsorship.
Rumour has it that among the courses to be axed from the F1...
Bernie Ecclestone's strategy of continuing Formula 1's relationship
with tobacco sponsors at seemingly any cost
is raising the ire of motor racing purists.
As European bans on sponsorship become increasingly likely,
Ecclestone plans to move races from traditional circuits to countries that
have no foreseeable plans to ban tobacco sponsorship.
Rumour has it that among the courses to be axed from the F1 schedule
is the venerable Spa-Francorchamps in Belgium. Wriitng in the Guardian (26
August, 2002), Richard Williams assesses the history of the track and the
reasons for its apparent imminent loss of F1 status.
"Incredibly" he says, "Spa is said to be high on Bernie Ecclestone's
hit-list of circuits that may lose their formula one race in order to
accomodate newcomers to the calendar."
That Spa's loss has less to do with it's inherent quailites than
tobacco sponsorship appears obvious, "Should the worst happen, the
immediate beneficiary is likely to be China, the UAE, Bahrain or Turkey.
Ecclestone's desire to spread formula one to new markets - and preferably
markets with no immediate plans to ban tobacco advertising- admits to no
sentiment or even to a sense of history."
Dear Mr Meyers,
Thank you for your article about the name change of Philip Morris. It is
appropriate that PM should wish to become invisible. In fact, they are
simply backward, so I shall reverse their new name to airtla, meaning
Aberrant Industry in Regular Touch with Legal Attorneys. I hope they
shall hence forward remain named with this backward sign of wrong doing.
Branding, after all, is one of their specialties...
Dear Mr Meyers,
Thank you for your article about the name change of Philip Morris. It is
appropriate that PM should wish to become invisible. In fact, they are
simply backward, so I shall reverse their new name to airtla, meaning
Aberrant Industry in Regular Touch with Legal Attorneys. I hope they
shall hence forward remain named with this backward sign of wrong doing.
Branding, after all, is one of their specialties that we too should
appreciate.
Stephen Hamann
Tobacco Control Policy Research Network
Bangkok, Thailand
Efforts at requiring fire safe cigarettes have been underway for
years, lead by the late Representative Moakley of Massachusetts. Tobacco
industry opposition has always stopped progress. Now that Senator Helms
has retired, Philip Morris has publicly voiced its intent not to oppose
such efforts, and the tobacco industry's public image is lower than ever,
it is time to try again.
Efforts at requiring fire safe cigarettes have been underway for
years, lead by the late Representative Moakley of Massachusetts. Tobacco
industry opposition has always stopped progress. Now that Senator Helms
has retired, Philip Morris has publicly voiced its intent not to oppose
such efforts, and the tobacco industry's public image is lower than ever,
it is time to try again.
New York has passed a fire safe cigarette law, only to have it
attacked and possibly weakened after the fact. On a parallel track, let's
sue the tobacco companies, to force action. Is there anyone pursuing a
class action, or individual lawsuits, against Philip Morris, for over 20
years of 1000 U.S. deaths a year, since PM has known how to make an
acceptable fire safe cigarette in 1982?
I am sorry to say that George Leslie and others who have long worked for
the tobacco industry often end up moving their snake oil solutions to
other areas, for example, Asia. Tobacco control advocates are few here
and scientists who have any experience with research in air quality in the
West are often consulted on problems of air pollution. It is then very
easy for tobacco industry scientists to present themselves as...
I am sorry to say that George Leslie and others who have long worked for
the tobacco industry often end up moving their snake oil solutions to
other areas, for example, Asia. Tobacco control advocates are few here
and scientists who have any experience with research in air quality in the
West are often consulted on problems of air pollution. It is then very
easy for tobacco industry scientists to present themselves as secondhand
smoke experts and "educate" unsuspecting researchers with workshop or
symposium reports designed specifically to sell industry "solutions" on
secondhand smoke exposure and risk. (His expertise appears even in a
respected institutions' newsletter here in Thailand).
In one tobacco industry document, an industry employee reports on his
role as educator of the Minister of Health, "I believe the present
Minister offers us the opportunity to contribute our views and our success
will depend on the degree to which we can educate him and his department
on these issues, without overburdening him with details in which case he
would probably seek clarifiction from our opponents." (Bates
2025593984/3989) And so it goes that tobacco industry scientists offer and
find acceptance of their expertise where they and their so called
"science" poison those struggling to promote meaningful health promotion.
Out of sight for these industry propagandists is unfortunately not out of
action.
Dr. Hughes and Shiffman do their academic best to try and convince
those making worldwide cessation policy decisions that, after 20 years of
NRT research that consumed the lion's share of all cessation research
dollars, a 93% midyear relapse rate demonstrates an "effective" means for
smokers to quit. Rubbish! It's a sad day indeed when NRT researchers
celebrate a 93% failure rate by declaring odds ratio victories over...
Dr. Hughes and Shiffman do their academic best to try and convince
those making worldwide cessation policy decisions that, after 20 years of
NRT research that consumed the lion's share of all cessation research
dollars, a 93% midyear relapse rate demonstrates an "effective" means for
smokers to quit. Rubbish! It's a sad day indeed when NRT researchers
celebrate a 93% failure rate by declaring odds ratio victories over
nicotine doctored placebos. 1
Does anyone truly think it's harder to quit today than it was twenty
years ago or have those marketing NRT simply conditioned smokers into
believing it is? Why have NRT researchers remained silent as millions
upon millions was spent in an attempt to undermine the credibility of cold
turkey (abrupt cessation) quitting in the minds of smokers? Is it
possible that years of bashing self-reliance has had a negative impact
upon cessation expectations?
What Dr. Hughes, Dr. Shiffman and most other NRT researchers continue
to refuse to study is the amazing performance of pre-NRT abrupt cessation
programs that combined varying forms of education, skills development,
counseling, group support and long term reinforcement follow-up while
achieving midyear rates of 30%, 40% and even 50%. Are smokers needlessly
dying because pharmaceutical companies won't profit from behavioral
programs? Have we spent 90% of our research dollars on 10% of the problem
- chemical dependency?
Maybe NRT researchers can be forgiven for not taking the time to
study the world's finest programs before embarking upon their gradual
nicotine weaning magic bullet quest, but how could they ignore the amazing
performance of many of the placebo groups within their own published NRT
studies? How could they fail to notice that the studies in which the
placebo group excelled were often caked in layers and layers of education,
skills development, counseling, group support and reinforcement protocols?
How can Dr. Hughes and Dr. Shiffman sell 7% at six months, when 21%
of the cold turkey quitters (the placebo group) in the 1994 Fiore NRT
study remained nicotine free at six months, 22% in the 1995 Herrera study
were free at ONE YEAR, and when 37% in the 1988 Areechon study, 43% in the
1987 Hall study, and 45% in the 1982 Fagerström study were all still
standing tall at six months?
Should we continue to keep OTC NRT on center stage and continue to
neglect research into refining, developing, deploying and encouraging the
use of proven behavioral programs that we know are capable of delivering
at least a 600% greater chance of midyear freedom?
We don't have to be NRT experts to take our own poll of all quitters
who we know have been off of all nicotine for over one year. How did they
do it? Isn't it time to listen and trust in the long term cessation
evidence surrounding each of us?
John R. Polito
john@whyquit.com
1. Sanderskov J, Olsen J, Sabroe S, et al. Nicotine patches in
smoking cessation, a randomized trial among over-the-counter customers in
Denmark. Am J Epidemiol 1997; 145: 309-18, at 312 "...placebo patches
contained a pharmacologically negligible amount of nicotine."
Over-the-counter nicotine replacement: Rhetoric vs. Reality
Mr. Polito has criticized our recent meta-analysis of over-the-
counter (OTC) nicotine replacement (NRT) that appeared in Tobacco Control
(Vol 12, p 21). Our brief response is below. Readers wishing to respond
to us or obtain citations for our assertions can email john.hughes@uvm.edu
or shiffman@pinneyassociates.com ).
Over-the-counter nicotine replacement: Rhetoric vs. Reality
Mr. Polito has criticized our recent meta-analysis of over-the-
counter (OTC) nicotine replacement (NRT) that appeared in Tobacco Control
(Vol 12, p 21). Our brief response is below. Readers wishing to respond
to us or obtain citations for our assertions can email john.hughes@uvm.edu
or shiffman@pinneyassociates.com ).
The major assumption of Mr Polito’s comments appears to be that
tobacco control is better off sticking solely with intensive behavioral
therapy programs. Both of us helped develop such programs and agree that
they can produce higher quit rates than OTC NRT. (Though Mr. Polito
vastly overstates their efficacy: For example, he USPHS and Cochrane meta
-analyses of such programs report a quit rate of about 15% - not the 50%
cited by Mr. Polito.) Indeed, the highest rates of success are obtained
when smokers combine both behavioral and pharmacological treatment.
The problem is that the vast majority of smokers does not want and
will not use intensive behavioral treatment. Many surveys have shown that
among smokers who try to quit, less than 5% of smokers will attend these
programs. We, like Mr. Polito, would prefer that smokers get all the
treatment they can, including behavioral treatment, but have come to
recognize that smokers do not use intensive behavioral treatment, even in
the developed countries, where it can be made available. In addition,
these programs are costly, which will limit their feasibility in
developing nations.
Thus, we believe a less effective treatment used by more smokers
would do more good than a more effective treatment used by fewer smokers.
For example, in the US, among 1000 smokers trying to quit, about 200 will
use OTC NRT, resulting in about 14 quitters. However, at most 50 will use
behavior therapy, resulting in 7 quitters. In summary, we believe it is
irresponsible to hold out, as a sole remedy, a treatment that only 5% of
smokers will use and assume that this fulfills responsibility to help
smokers who want to quit.
Finally, we would point out that making OTC NRT available does not
mean one should give up on group behavioral therapy. It simply gives
smokers another option for dealing with life-threatening tobacco use.
Some other errors in Mr. Polito’s statements:
Neither of us has suggested that now that we have OTC we do not need
"to explore more effective means of quitting." In fact we have authored
articles urging the development of better behavioral techniques and
critical of the current state of affairs.
Both our own audits and those of the National Cancer Institute
indicate NRT research does not "consume the lions share of all cessation
research dollars;" For example, we estimate less than 10% of US National
Institutes of Health funding for smoking cessation research goes to
testing NRT.
NRT ads are said to "bash… quitting via self-reliance," to convey
that self-quitting is "hard and painful," that quitting with NRT is
"painless" and that OTC NRT is "highly effective." In fact, our view is
that the ads have emphasized the realistic difficulty and discomfort of
quitting without overstating the relief provided by NRT, and have
emphasized the importance of the smoker’s efforts in the quit process;
.e.g, “only for those committed to quitting,” and “You can do it –
Nicorette can help”
Mr. Polito also questions whether it has been getting harder to quit.
Interested parties may want to review two recent meta-analyses by Irvin
and colleagues, which show that success rates have been dropping, for both
behavioral and pharmacological treatments. Many students of this issue
believe that, as smokers who can quit easily do quit, the smokers
remaining are those who have the hardest time achieving success.
Finally, we would note our response above does not a) use comparisons
across studies differing in methods, timing, etc., which are notoriously
misleading b) impugn the motives of the author or c) use ridicule or
sarcasm.
The authors concede that programs offering cessation education,
skills development, counseling and/or group support "on average" produce
quit rates more than double (15%) their meta-analysis OTC NRT finding of
7% at midyear. Although most of us are aware of at least one short term
abrupt cessation program consistently achieving midyear rates in the 30 to
50% range, I thought that confronting the authors with midyear pla...
The authors concede that programs offering cessation education,
skills development, counseling and/or group support "on average" produce
quit rates more than double (15%) their meta-analysis OTC NRT finding of
7% at midyear. Although most of us are aware of at least one short term
abrupt cessation program consistently achieving midyear rates in the 30 to
50% range, I thought that confronting the authors with midyear placebo
group performance rates of 37%, 43% 45%, from their own NRT studies,
would cause them to reflect upon just how ineffective OTC NRT really is.
I was wrong. Instead, they ignore placebo performance when clothed in
behavioral protocols while telling us that 30 to 50% "vastly overstates"
behavioral intervention's realities.
Assume for the sake of argument that there are scores of abrupt
cessation programs around the globe that are today consistently achieving
midyear rates in the 30 to 50% range. Further assume that those
conducting them are willing to share their content, allow us to borrow
their most effective elements, and that we can combine, refine, present
and consistently produce 30 to 50% midyear nicotine cessation using a
laptop, PowerPoint and a scripted presentation. Would the current 5%
behavioral program attendance rate cited by the authors be the best we
should hope for when the product being offered is at least 428% as
effective as OTC NRT?
The authors conclude that the vast majority of smokers [do] not want
and will not use behavioral treatment. I encourage readers to visit the
"how to quit smoking" pages of government web sites or of those health
organizations that you know are receiving large annual NRT pharmaceutical
industry contributions. I submit that smokers cannot want or even be
curious about interventions or effectiveness ratings that are
intentionally hidden from view. I submit that if NRT commercials were up-
front in disclosing OTC NRT's 93% midyear relapse rate that sales would
decline dramatically, and quitters would immediately begin searching for
more effective tools.
Remember when NRT didn't have 5% participation? Imagine the
potential of a government-sponsored cessation marketing campaign that
could honestly declare that a short twelve-hour behavioral program was
affording those in attendance a 428% greater chance of quitting than OTC
NRT products requiring weeks or even months of dedicated use. Could
participation increase to 20%? Imagine teaming up with local businesses
and health care providers to offer donated attendance incentives such as
free temporary fitness center passes, pulmonary function exams,
cardiovascular exams, or tickets to local health related attractions.
Forget about the possibilities for now. Accepting the authors' 15%
behavioral program efficacy concession, in what T.V. commercial are those
pushing the concept of gradual nicotine weaning telling smokers that their
neighborhood abrupt cessation programs are, on average, twice as
effective as OTC NRT? Instead, they condition viewers to believe that
attempting cessation without OTC NRT doubles their chances of relapse.
The authors argue that behavioral programs are more expensive than
NRT. I just visited DrugStore.com where an eight-week supply of Nicoderm
CQ was $192 (U.S.) and Nicotrol was $200. Twenty-four patch quitters
would spend $4,608 on patches while producing just 1.7 midyear quitters,
at a cost of $2,711 per successful quitter. The same funds spent on a
twelve-hour behavioral clinic generating a 30% midyear rate would produce
7.2 success stories, at a cost of $640 per quitter.
My next free two-week clinic commences on the 25th at the College of
Charleston. As usual, there is no pay, and I, along with scores of other
skilled facilitators, would gladly fly anywhere in the world for the
opportunity to help smokers break free while at the same time being
compensated at a rate less than what it costs to produce a single midyear
NRT quitter $2,711).
I know that many researchers have devoted substantial portions of
their lives to the development of NRT only to end up, here, acknowledging
a 93% midyear relapse rate. This isn't a good day for any of us. I
apologize if any researcher feels their integrity is being impugned by my
continuing to seek answers to such questions as the extent of the practice
of placebo nicotine doctoring. But in that the authors declare odds ratio
victories over placebos known to have been doctored, and both authors are
paid consultants for NRT pharmaceutical companies and clearly have access
to those who provided placebo devices for most NRT studies, I must again
ask, how many OTC NRT studies employed placebo nicotine doctoring, what
amounts of nicotine were used in each study's placebo device, and what
studies were undertaken to verify that the practice does not extend the
intensity and/or duration of normal abrupt cessation?
Dr. Pierce's NRT survey published in JAMA on September 11, 2002
concluded that "NRT appears no longer effective in increasing long-term
successful cessation in California smokers." In November 2002, Dr.
Boyle's Minnesota insurance benefit review published in Health Affairs
concluded that the use of NRT did not ....."result in higher rates of
quitting smoking." Is it just possible that out in the "real world"
where surveyed smokers know whether or not they successfully quit last
year, where they have their own understanding of what it means to be quit,
and where they know whether or not they bought and used OTC NRT, that NRT
truly is showing zero value as a cessation tool?
Is it just possible that the study practice of "declaring" someone
still receiving a steady diet of nicotine from the NRT device, as having
already successfully "quit," allowed NRT a natural short-term advantage
when competing against "real" nicotine quitters, that just doesn't get
acknowledged by those being surveyed in the real-world?
Have you ever stopped to reflect upon how the odds ratios in the 2002
lozenge studies would have turned out if abstinence was defined to
commence upon the cessation of all nicotine intake? It's amazing how one
simple study definition - cessation - can create billions worth of
efficacy. Imagine such definitions being used with alcohol replacement
therapy (ART) where you know you're drunk but the researchers keep telling
you that you've already quit.
The industry cries that it's against youth smoking
are a great line of talk; action is of course
another matter. This research finding is a fine
case in point. If the industry were really against
youth smoking, it would respond to this finding
by immediately cutting all advertising and promotion
that portrayed or suggested a connection between
the product and being thin. To do otherwise,
to keep running such ads, would,
in...
The industry cries that it's against youth smoking
are a great line of talk; action is of course
another matter. This research finding is a fine
case in point. If the industry were really against
youth smoking, it would respond to this finding
by immediately cutting all advertising and promotion
that portrayed or suggested a connection between
the product and being thin. To do otherwise,
to keep running such ads, would,
in the light of this finding, be promoting
the product in a way known to appeal to children.
Once again, this industry's cries that it is "against
youth smoking" are not accompanied by action.
I did some investigation comparing the current usage of the term
"environmental tobacco smoke" and its acronym, ETS, and
the usage of "secondhand smoke" and SHS. The results I obtained tend to
support your editorial.
I went first to the WHO web site and typed ETS in the search box. The
first page of results contain 10 entries. All 10 related to tobacco smoke.
I then typed SHS, and out of the...
I did some investigation comparing the current usage of the term
"environmental tobacco smoke" and its acronym, ETS, and
the usage of "secondhand smoke" and SHS. The results I obtained tend to
support your editorial.
I went first to the WHO web site and typed ETS in the search box. The
first page of results contain 10 entries. All 10 related to tobacco smoke.
I then typed SHS, and out of the 10 first hits, only one dealt with
tobacco smoke. I then typed "environmental+tobacco+smoke" in the search
box. This returned 825 pages. Typing "secondhand+smoke" and then
"second+hand+smoke", and I got in total 618 entries. So ETS seems to be
the preferred term on an international basis.
I repeated the experiment on the JAMA site. The acronym "ETS" in the
site's search box produced 27 hits, while "SHS" produced only 2. Looking
at the exact term "environmental tobacco smoke" in the abstracts produced
36 hits, while "secondhand smoke" produced 10 hits, to which one is added
when using the term "secondhand tobacco smoke" So the JAMA score is 36 to
11 in favor of
ETS.
Using the search function on the Tobacco Control web site, the exact
phrase "environmental tobacco smoke" in the abstract returns 36 articles,
while "second hand smoke" returns 9 and "second-hand smoke" returns 5. So
again here the score is 36 in favor of ETS vs 11 in favor of SHS.
It seems that the scientific community has pretty much made its
choice already. Pushing SHS as a new standard might actually create more
confusion than help.
On the other hand, my Collins-Robert English-French dictionary has an
entry for "secondhand smoke", indicating that this is an informal term.
This is confirmed by a world-wide search using Google. Searching for the
exact term "environmental tobacco smoke" gives 47'700 hits, while
searching for "secondhand smoke" gives 121'000 hits. But the acronym SHS
is not well established, while ETS is. Searching for "ETS tobacco" on
Google returns 47,500 entries, while typing "SHS tobacco" returns only
6,560.
The consequence is that, if you address the public at large,
"secondhand smoke" in full is probably a preferable choice to
"environmental tobacco smoke", but if you address the scientific
community, there seems little reason to move away from the already well
established "environmental tobacco smoke" and its abbreviation, "ETS".
Finally, there is another reason why I think one should stick to ETS
and environmental tobacco smoke. This makes searching easier. The problem
with "secondhand smoke" is that the spelling varies from country to
country, British people often write secondhand in two words, with a hyphen
or a space, and other people add the word "tobacco" between "secondhand"
and "smoke", while there does not seem to be any variation of this type
with "environmental tobacco
smoke".
Bernie Ecclestone's strategy of continuing Formula 1's relationship with tobacco sponsors at seemingly any cost is raising the ire of motor racing purists.
As European bans on sponsorship become increasingly likely, Ecclestone plans to move races from traditional circuits to countries that have no foreseeable plans to ban tobacco sponsorship.
Rumour has it that among the courses to be axed from the F1...
Dear Mr Meyers, Thank you for your article about the name change of Philip Morris. It is appropriate that PM should wish to become invisible. In fact, they are simply backward, so I shall reverse their new name to airtla, meaning Aberrant Industry in Regular Touch with Legal Attorneys. I hope they shall hence forward remain named with this backward sign of wrong doing. Branding, after all, is one of their specialties...
Efforts at requiring fire safe cigarettes have been underway for years, lead by the late Representative Moakley of Massachusetts. Tobacco industry opposition has always stopped progress. Now that Senator Helms has retired, Philip Morris has publicly voiced its intent not to oppose such efforts, and the tobacco industry's public image is lower than ever, it is time to try again.
New York has passed a fire safe...
I am sorry to say that George Leslie and others who have long worked for the tobacco industry often end up moving their snake oil solutions to other areas, for example, Asia. Tobacco control advocates are few here and scientists who have any experience with research in air quality in the West are often consulted on problems of air pollution. It is then very easy for tobacco industry scientists to present themselves as...
Dr. Hughes and Shiffman do their academic best to try and convince those making worldwide cessation policy decisions that, after 20 years of NRT research that consumed the lion's share of all cessation research dollars, a 93% midyear relapse rate demonstrates an "effective" means for smokers to quit. Rubbish! It's a sad day indeed when NRT researchers celebrate a 93% failure rate by declaring odds ratio victories over...
Over-the-counter nicotine replacement: Rhetoric vs. Reality
Mr. Polito has criticized our recent meta-analysis of over-the- counter (OTC) nicotine replacement (NRT) that appeared in Tobacco Control (Vol 12, p 21). Our brief response is below. Readers wishing to respond to us or obtain citations for our assertions can email john.hughes@uvm.edu or shiffman@pinneyassociates.com ).
The major assumption of...
The authors concede that programs offering cessation education, skills development, counseling and/or group support "on average" produce quit rates more than double (15%) their meta-analysis OTC NRT finding of 7% at midyear. Although most of us are aware of at least one short term abrupt cessation program consistently achieving midyear rates in the 30 to 50% range, I thought that confronting the authors with midyear pla...
On figure 2D, the number in brackets in front of SEAR B females should be 2% (instead of 61%).
The industry cries that it's against youth smoking are a great line of talk; action is of course another matter. This research finding is a fine case in point. If the industry were really against youth smoking, it would respond to this finding by immediately cutting all advertising and promotion that portrayed or suggested a connection between the product and being thin. To do otherwise, to keep running such ads, would, in...
Dear Editor,
I did some investigation comparing the current usage of the term "environmental tobacco smoke" and its acronym, ETS, and the usage of "secondhand smoke" and SHS. The results I obtained tend to support your editorial.
I went first to the WHO web site and typed ETS in the search box. The first page of results contain 10 entries. All 10 related to tobacco smoke. I then typed SHS, and out of the...
Pages