WHY DOES A CIVILIZED SOCIETY TOLERATE A PRODUCT THAT KILLS >5 MILLION PEOPLE

Transcription

1 The End Game: The Beginning of the End of the Cigarette Epidemic Richard D. Hurt, M.D. Professor of Medicine Director, Nicotine Dependence Center Mayo Clinic

2 WHY DOES A CIVILIZED SOCIETY TOLERATE A PRODUCT THAT KILLS >5 MILLION PEOPLE EVERY YEAR?

3 Star Wars Theme 1977 Composed by John Williams

4 In 1492, Columbus sailed the ocean blue and thus began the globalization of tobacco--- sad but true. Glynn T, et al, CA Cancer J Clin 60:50, 2010

5 Early Cigarettes Allen & Ginter contest for mechanical cigarette roller James Bonsack won contest. Roller produced 120,000 cigarettes/day James Buchanan Buck Duke obtained rights and in 1884 Bonsack machines went on line in Durham, NC 1889 American Tobacco Company formed

6 James Buchanan Duke

7 American Tobacco Company 1898 Acquired R. J. Reynolds plug tobacco company 1899 Controlled 93% of cigarettes, 80% of snuff, 62% of plug tobacco, and 59% of pipe tobacco in USA 1903 Deal with Imperial Tobacco Company of Britain created British American Tobacco 1906 Duke successfully lobbied with newly formed FDA NOT to regulate tobacco

8 Stages of the Cigarette Pandemic WHO website:

9 The Cigarette Death Epidemic in Perspective in the USA No. (000s) Annual smoking 440,000 Secondhand smoke 50,000 World War II 416,000 Vietnam War 58,000 Annual auto accidents 33,000 AIDS Annual 18,000 Annual murders 15,000 Annual heroin, morphine & cocaine deaths 14,000 CP

10 Endgame in New Zealand by 2025 Drs. Richard Edwards and Hayden McRobbie

11 The problem Slow decline in smoking prevalence Tobacco control advances are incremental and subject to industry tactics; Delay Neuter Block Challenge and repeal

12 A non-endgame approach Vision The vision for this tobacco control plan is for New Zealand to be a country where smokefree lifestyles are the norm. Goals The goals of this tobacco control plan are: to significantly reduce levels of tobacco consumption and smoking prevalence to reduce inequalities in health outcomes to reduce the prevalence of smoking among Māori to at least the same level as among non-māori to reduce New Zealanders exposure to second-hand smoke. Clearing the Smoke: A five-year plan for tobacco control in New Zealand ( ). Wellington: Ministry of Health, 2004.

13 Elements of the endgame Zero (or near-zero) smoking prevalence Zero (or near-zero) uptake of tobacco Zero (or near-zero) supply of tobacco, e.g. prohibition, no commercial supply Full denormalization of tobacco use i.e. smoking seen as an undesirable and abnormal behaviour, unacceptable for children Zero (or near-zero) tobacco-related morbidity and mortality Time limited

14 Endgame overarching strategies Needed to achieve endgame goals within reasonable timeframe Examples: Regulation of nicotine content Sinking lid on tobacco imports Progressive reduction in retail supply Rapidly escalating tax and duty on tobacco products

15 The moral and ethical case for action 1. Tobacco is a uniquely hazardous product: Major cause of ill health, premature death and health inequalities Tobacco is highly addictive most smokers want to quit and regret starting but only about 2% per year quit successfully spontaneously max quit success around 20% at 1 year with support Secondhand smoke (SHS) is a significant acute and chronic health risk for non-smokers (inc children) Tobacco products are legal only due to historical accident

16 The moral and ethical case for action 2. Smoking starts mainly among children and young adults: Hardly anyone starts smoking as a mature adult Children do not (cannot) make informed decisions about smoking 3. Protecting children from known hazards is generally viewed as a moral imperative and is a societal responsibility.

17 Analogy with alcohol Sixteen-year-olds are in no position to assess the dangers of binge-drinking. Fifteen, 14 and 13-year-olds even less so. If the industry cannot find a way to keep alcohol out of the hands of children, society must. Dominion Post editorial (response to death of James Webster, aged 16); 13 th May 2010

18 Dynamic Sequence of Gray Matter Maturation Over the Cortical Surface Source: Gogtay, Nitin et al. (2004) Proc. Natl. Acad. Sci. USA 101, Copyright 2004 by the National Academy of Sciences

19 Maturation starts at the back of the brain... and moves to the front Cerebellum Physical coordination, sensory processing Nucleus Accumbens Motivation Amygdala Emotion Judgment Notice: Judgment is last to develop! Prefrontal Cortex

20 NZ Recommendations - DO NOW Further tax increases Ban retail displays- To be implemented in large stores in UK in 2012 & all retailers 2015 Tobacco sellers > 18 years Compulsory reporting of additives by brand Prohibit covert sponsorship Action to enforce illegal sales laws

21 NZ recommendations - DO NOW[cont] Ban vending machines NRT available at all tobacco retailers Pharmacists -> Quit Card providers Ban or restrict duty free imports

22 NZ Recommendations - Future Plain packaging- Australia to implement 2012 Tobacco industry funds all treatment support including pharmacotherapy Regulate nicotine and additives Explore alternative (safer) nicotine delivery systems Control retailer numbers, density, and proximity

23 NZ Recommendations Future (cont) Reducing tobacco imports progressively New social marketing campaigns and communications media Better treatment support and targeting New tobacco control strategy (+ Authority), including Māori focused strategy

24 Plain Packaging Proposed In Australia

25 Summing up We need: to switch to endgame thinking a clear vision and a defined time period to achieve it a comprehensive endgame strategy to achieve the desired rapid reductions in smoking prevalence health professionals support

26 Endgame in Singapore Deny access to tobacco for citizens born in or after the year 2000 Gradual phase out less disruption Aligns with tobacco industry assertion We do not want children to smoke Affixing to easily identifiable year facilitates identity checking 70% of Singaporeans support the proposal Khoo D. et al Tobacco Control 19:355, 2010

27 Global Bridges Mission Create and mobilize a global network of healthcare providers and organizations dedicated to advancing effective tobacco dependence treatment and advocating for effective tobacco control policy. 27

28 Global Bridges Regional Partners Latin America Region Gustavo Zabert, MD Regional Director Middle East Region Africa Region Feras Hawari, MD Regional Director Lekan Ayo-Yusuf, BDS, MPH, PhD Regional Director 28

29 Global Bridges Goals 2012 Continue to expand in Latin America, Middle East and Africa Develop distance learning in collaboration with U Toronto Center for Addictions and Mental health Extend educational activities to complement existing in Europe Develop plans for Asia and South Asia 29

30 GB Accomplishments Summary Since April 2011, Regional Partners have trained over 1360 HCPs from 51 countries Over 14,500 person-hours of training, impacting thousands of patients Presented at national, regional, and global meetings with combined attendance of over 18,000 launched in 6 languages 645 members have joined via website Active collaborations with ATTUD, treatobacco.net, Global Nurses Network, American Academy of Pediatrics, Global SmokefreePartnership, Hong Kong Deptof Health, INWAT, American Association of Anesthesiologists, and others 30

31 WHY DOES A CIVILIZED SOCIETY TOLERATE A PRODUCT THAT KILLS >5 MILLION PEOPLE EVERY YEAR? WE DO NOT HAVE TO AND WE SHOULD NOT!

32 December 2007 September 2009 We owe it to our grandchildren BUT WE OWE IT TO THEIR CHILDREN AND GRANDCHILDREN, TOO!

33 21st Century-1 Billion Deaths 20th Century-100 Million Deaths

34 No matter how innocent they appear, the tobacco industry CANNOT BE TRUSTED!