August 7th, 2009 by Jonathan Foulds, Ph.D. in Better Health Network, Opinion
No Comments »
Now that the US Food and Drug Administration has been given the power to regulate tobacco products, one of its new powers is the right to change the health warnings on cigarette packs in the interest of public health.
So the first question is, are the current health warnings perfectly adequate? The answer to that one is clearly “no”. The boring small text warnings printed on the side of the pack have are almost perfectly designed to be ignored.
The second questions is, can we learn anything from the experience of health warnings in other countries? The answer here is a resounding “yes”. Numerous other countries have been using large mandated pictorial health warnings on cigarette packs for years and there is a growing body of research showing that these are much more impactful then prior text-only warnings. The warnings used in Canada present a good example to follow and can be viewed at:
http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/legislation/label-etiquette/graph/index-eng.php
However, I particularly like the style used in Australia, where they have, since 2006 also added the freephone number of the national stop smoking Quitline to the pictorial health warnings. Graphic images and explanatory messages cover 30% of the front and 90% of the back of the pack. The message “You CAN quit smoking. Call the Quitline 131 848, talk to your doctor or pharmacist, or visit www.quitnow.info.au” is also included on the back of all packs. The Quitline number is also “stamped” on top of the graphic image on the backs of packs.. A recent study by Dr C L Miller of the Cancer Council of South Australia concluded that introducing graphic cigarette packet warnings and the Quitline number on cigarette packets doubled demand for Quitline services, with likely flow on effects to cessation.
Other countries of the world (including the United States) that have not yet introduced large graphic health warnings on cigarette packs or the number to the national quitline should do so as soon as possible.
The research from Australia can be viewed at:
http://tobaccocontrol.bmj.com/cgi/content/full/18/3/235
This post, Should We Put Graphic Warnings on US Cigarette Packs?, was originally published on
Healthine.com by Jonathan Foulds, Ph.D..
July 25th, 2009 by Jonathan Foulds, Ph.D. in Better Health Network, Health Tips
No Comments »
You may have noticed that over the past few years the cigarette companies have been trying to persuade the pubic that they are really nice people trying to make the world a better place. For example, at the start of this decade in the U.S. we saw ads on T.V. showing that Philip Morris tobacco company was bringing bottled water to flood victims or donating to good causes. Why would I be cynical and call this a P.R. stunt? Well for one thing because they spent more money on telling the public about the good deeds than on the good deeds themselves!
More recently companies like Philip Morris have been involved in such odd activities as providing consumers with booklets designed to help them to quit smoking. Of course, if the tobacco companies really did have their customers best interests at heart they would withdraw their products completely. But that isn’t going to happen. The management of these companies have a duty and a responsibility to do their best to help the company make money and provide value to their shareholders. So when it comes to activities apparently designed to help smokers quit, one can be pretty sure that’s not the long term intent. The intent is to provide a PR benefit that will outweigh any effect of helping smokers to quit.
One thing tobacco companies do have control over is the cigarette pack itself. Right now the United States is one of many countries that has inadequate health warnings on the pack. Compare the rather weak and small written health warning on the side of a US cigarette pack with the powerful (and large) pictorial warnings on cigarette packs in numerous other countries. You can view pictorial pack warnings from around the world here.
The new legislation giving FDA the power to regulate tobacco products in the United States provides a new opportunity for the government to regulate not only the product but also the packaging. At the recent UK National Smoking Cessation Conference, Dr David Hammond of University of Waterloo in Canada gave an excellent presentation on the most effective ways to use the cigarette pack to inform smokers about the harmfulness of tobacco and to encourage them to quit. He showed that strong emotional pictures of the harms from tobacco on the pack itself, combined with limiting brand information, adding direct information about help to quit on the pack (e.g. the national quitline number) plus a quit smoking “onsert” added to the pack will all have the effect of encouraging smokers to make a quit attempt.
He made it clear that every country in the world should be much more active in using the cigarette pack as a means of encouraging smokers to quit. The companies themselves clearly won’t do it voluntarily, so governments need to take control of the packs via legislation and require much more effective warnings and quitting information be included on cigarette packs.
You can listen to Dr Hammond’s full presentation and view his slides by clicking on the appropriate icon at the following website.
This post, Advertising On Cigarette Packs May Help Smokers Quit, was originally published on
Healthine.com by Jonathan Foulds, Ph.D..
July 10th, 2009 by Jonathan Foulds, Ph.D. in Uncategorized
1 Comment »
As many of you may know, the famous tobacco control scientist and advocate, Professor Stan Glantz, has over the past few years been focusing on the issue of depictions of smoking in movies. Part of the concern stems from good evidence that young people are highly influenced by movies due to their cultural value and glamorous nature.
The other part stems from a history of use of “product placement” in movies. This refers to the movie producers agreeing to include a specific product in their movie in return for some incentive (typically money). A famous example of this is a letter from Sylvester Stallone agreeing to smoke particular brands of cigarettes in his movies for $500,000. So when one combines the financial power of the tobacco industry with product placement we end up with a hell of a lot more gratuitous smoking in movies than is necessary.
Of course the movie companies and many movie enthusiasts argue about the need for art to imitate life etc., etc. However numerous examples demonstrate that to be a lot of nonsense. Professor Glantz points to depictions of Marlboro cigarettes being dragged around or used by aliens in movies like Men In Black. Is it really true that those aliens prefer Marlboros and so showing the brand was necessary for the movie to be accurate? Mmm….I doubt it.
My favorite example comes from the film “A Beautiful Mind”. The movie stars Russell Crowe in the lead role portraying the (still living and working) Princeton University professor, John Nash. In real life, John Nash suffered from schizophrenia but did not smoke. In the movie he suffered from schizophrenia, but smoked. I’m not sure why the producers changed this aspect of reality or what it added to the movie.
But these are details. Professor Glantz’ main point is that movies made to be viewed by kids do not need to include smoking, and therefore should be given an R rating if they do, just as they are if they depict illicit drug use. Note that an R doesn’t stop people under 17 from seeing the movie in a movie theater. It just means they need to be accompanied by an adult. It also doesn’t ban smoking from movies, it just means that movies with smoking in them will receive an R rating, just as sex, drugs, cursing and certain types of violence will get a movie an R rating. Of course the movie industry is very clear that a large part of its audience is kids and particularly teens. The net effect of the rating changes professor Glantz is recommending would be that gratuitous smoking will be taken out of many movies and particularly those aimed at kids.
I must admit that I didn’t initially pay much attention to this proposal, and my natural inclination was to doubt whether it really was worth the effort. But while I was at the UK National Smoking Cessation Conference in London last week I heard Professor Glantz talk about this idea and I came around to thinking its maybe not as extreme as I first thought. In fact he convinced me that it’s a reasonably sensible idea that would likely result in thousands fewer teens taking up smoking. Sometime soon the full audio recording of Professor Glantz’ presentation will be posted on the conference website along with his slides. I’ll post the link when its available, but for now those interested in this subject may want to check out the following website:
http://smokefreemovies.ucsf.edu/
This post, Should Movies With Smoking In Them Receive An R-Rating?, was originally published on
Healthine.com by Jonathan Foulds, Ph.D..
December 16th, 2008 by Dr. Val Jones in Opinion
2 Comments »
For some reason, people just love to misrepresent the issues underlying the Wyeth vs. Levine case. I have written extensively about this case here and here because I found it so amazing that the media has bungled the story so badly – and that no one is really calling them on it.
In case you don’t recall – Ms. Levine was the victim of medical malpractice. An anti-nausea drug (phenergan) was injected into (or very near) her artery by accident (the potential consequences of such an error are clearly indicated on the drug label). Tragically, the resulting chemical reaction with the oxygen in her artery caused such severe tissue irritation that her arm eventually had to be amputated. Ms. Levine settled out of court for $700,000 with the clinic where the injection occurred. Unfortunately the story doesn’t stop there.
Ms. Levine’s attorney counseled her to sue the drug manufacturer for inadequate label warnings (the potential hazard is in fact mentioned on the label six times – though it does not forbid IV administration of the drug, though it recommends a low dose and slow push). In a precedent-setting judgment, a jury in Vermont decided that the FDA-approved label was inadequate, and that it should have fully contraindicated administration via IV push. The jury awarded Ms. Levine $6.8 million and Wyeth contested the judgment, bringing the case to the US Supreme court in November, 2008. The case has not yet been decided, though it has been compared to deceptive labeling of “light cigarettes.”
How on earth is a drug that has been successfully administered (without harmful side effects and with good efficacy) over 200 million times in the U.S. equivalent to cigarettes (a known carcinogen with no therapeutic value)? It’s an exceedingly poor analogy.
To put it another way, if a nurse took an insulin syringe and injected it into a diabetic’s eyeball, causing blindness, should I say that the insulin manufacturer (because it did not forbid the injection into the eye) was engaging in deceptive labeling and should be at fault for the patient’s loss of vision? The PA who injected the phenergan into Ms. Levine’s artery, and our hypothetical nurse who injected insulin into an eyeball are the ones to blame.
But wait, it gets worse.
The attorney (David C. Frederick) who is arguing Ms. Levine’s case in front of the Supreme Court is being considered by our President elect for the position of Solicitor General of the United States. Yes, this very man who is engaged in a law suit that could potentially set a precedent that would allow all 50 states to set up their own mini-FDAs with the lay public (i.e. juries) deciding what drug label language should say.
The pro-Levine camp argues that a court ruling in favor of Wyeth would preempt consumers from being able to sue drug companies for damages related to incomplete disclosure of risks (such as the Vioxx case) but in reality, the Wyeth vs. Levine case has no bearing on pharmaceutical non-disclosure, since Wyeth did not hide the irritant risks of phenergan from the FDA. They have been known for decades.
So Wyeth vs. Levine is NOT about deceptive labeling or non-disclosure of risks – it’s about whether medically uneducated juries should have the power to set arbitrary drug labeling language standards in order to facilitate litigation against deep-pocketed pharmaceutical manufacturers whenever a patient is harmed in a case of medical malpractice.
I understand that many folks are frustrated with pharmaceutical wrong doing (and there are many cases of it), but this is just not one of them. In America, we are not supposed to bring pre-conceived notions to bear on law suits, but objectively review the facts in each case, separate from our general feelings about those involved. I do think that Wyeth isn’t getting a fair shake in the media because of the general mistrust/dislike of Big Pharma. But everyone has a right to a fair trial. I sure hope they get it.
