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Press releases Saturday 11 February 2006

(1) CONCERNS OVER INFLUENCE OF TOBACCO FIRMS IN LOW INCOME COUNTRIES

(Mexico and the tobacco industry: doing the wrong thing for the right reason? )
http://bmj.com/cgi/content/full/332/7537/353

(British American Tobacco’s erosion of health legislation in Uzbekistan)
http://bmj.com/cgi/content/full/332/7537/355

(Editorial: The tobacco industry in developing countries)
http://bmj.com/cgi/content/full/332/7537/313

This week’s BMJ raises serious concerns about the influence of global tobacco companies when they invest in low income countries.

For example, in 2004 the Mexican government agreed on tobacco control measures with the tobacco industry in return for contributions to a public health fund. The terms of the agreement included abandoning tax increases and restricting health warnings on cigarette packages. It also provided the industry with a tax subsidy worth $50 million.

These elements conflict with the World Health Organisation’s antismoking treaty, the Framework Convention on Tobacco Control (FCTC), which Mexico ratified days before the agreement with the industry was announced.

The agreement comes with considerable future costs, warn the authors. It binds the fund to industry sales and makes it difficult for Mexico to enact stricter controls in future. It also provides the industry with an opportunity to improve its public image.

“We are concerned that this agreement is yet another example of industry efforts to seek voluntary agreements rather than endure effective government legislation as required by the FCTC,” say the authors. “We urge Mexico to reconsider its pact with the tobacco industry and caution other nations against following its example.”

Another article analyses British American Tobacco’s erosion of health legislation in Uzbekistan. Using corporate documents, the authors show how BAT overturned legislation that banned advertising and smoking in public places as part of its investment conditions.

After the deal, tobacco advertising in Uzbekistan became ubiquitous, they write. Tobacco consumption has reportedly increased by 7% to 8% annually, primarily among young people, and cigarette sales rose by over 50% between 1990 and 1996. By 1999, BAT had achieved a market share of over 70%.

Documents suggest that such policy influence has not been confined to Uzbekistan. Safeguards are needed to prevent transnational tobacco companies influencing health policy when investing in low income countries, they conclude.

These experiences, as well as those in other developing countries, show that the tobacco industry has adapted to changing circumstances with ever more sophisticated strategies to protect its profits and forestall meaningful tobacco control legislation, argue Professor Stanton Glantz and Ernesto Sebrie in an accompanying editorial.

Seductive deals like the one in Mexico are incompatible with the FCTC, yet the WHO has not said whether the agreement violated the treaty. Failing such action, the multinational tobacco companies will replicate the Mexican agreement elsewhere, creatively using the Framework to consolidate their position and undermine global tobacco control, they warn.

BMJ Editor, Fiona Godlee adds: "It is depressing to hear from Ernesto Sebrie and Stanton Glantz that WHO has been silent about countries that fail to honour its framework convention on tobacco control. WHO took a brave stand a few years ago in facing up to its own tobacco links. Now is the time for WHO to speak out again."

Contacts:

Jonathan Samet, Chair, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
Email: jsamet@jhsph.edu

Anna Gilmore, Clinical Lecturer in Public Health, European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK
Email: anna.gilmore@lshtm.ac.uk

Editorial: Stanton Glantz, Professor of Medicine, Division of Cardiology, Department of Medicine, University of California, San Francisco, USA
Email: glantz@medicine.ucsf.edu

(2) WORST OFF WILL BE MOST AT RISK UNDER PARTIAL SMOKING BAN

(Letter: Partial smoking ban would worsen health inequalities)
http://bmj.com/cgi/content/full/332/7537/362

A partial as opposed to a full ban on smoking in public places could put those living in the most socially deprived areas of the country at most risk, warn doctors writing in this week’s BMJ.

The letter comes as MPs prepare to vote next week on Government proposals for a part-ban across England - a move which would worsen health inequalities say the authors, a Director of Public Health and colleagues working in South London.

A part-ban would mean that smoking would be banned in pubs and bars serving hot food, while those not serving food would be exempt, and customers could continue smoking.

In a snapshot survey of nearly 500 pubs selected randomly, the authors found there was a strong, direct correlation between wealthy areas and pubs selling food - which would be smoke-free under the proposals. In the richest areas as many as 88% of pubs and bars would come under the ban, protecting staff and customers against the effects of smoking and second-hand smoke, say the authors.

But in the poorest areas, far less pubs - less than half (46%) - sell food, so far fewer pubs would be subject to a ban on smoking. This would mean that some of the most deprived people in the country would be left most exposed to the risks of passive smoking.

This is direct evidence of the likely affects of the Government's proposals, say the authors. There can now be no doubt that the health gap between the most affluent and the worst off in society would be exacerbated by a partial ban, they conclude.

Contact:

Geraint H Lewis, Specialist registrar in public health, Department of Public Health, Croydon Primary Care Trust, Croydon, UK
Email: Geraint.lewis@nhs.net

(3) INTIMATE KISSING QUADRUPLES RISK OF MENINGITIS IN TEENAGERS

Online First
(Risk and protective factors for meningococcal disease in adolescents: matched cohort study)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38725.728472.BE

Intimate kissing with multiple partners almost quadruples a teenager’s risk of meningococcal disease, finds a study published online by the BMJ today.

Meningococcal disease is a life threatening condition with two incidence peaks: in early childhood and in adolescence.

The incidence and fatality rate among teenagers in England and the United States rose dramatically during the 1990s, but little is known about the risk factors for this disease in adolescents.

The research team examined potential risk and protective factors in 15-19 year olds who had been admitted to hospital with meningococcal disease in six regions of England from January 1999 to June 2000. Each case was compared with a matched control. Blood samples and nose and throat swabs were taken and data on potential risk factors were gathered by confidential interview.

Intimate kissing with multiple partners, a history of preceding illness, and being a student conferred higher risk of disease, whereas recent attendance at a religious event and meningococcal vaccination were associated with lower risk.

Despite some study limitations, these findings imply that changing personal behaviours could reduce the risk of meningococcal disease in adolescence, say the authors.

Although behaviour based health promotion messages might have a small role in reducing the risk of disease, such campaigns are unlikely to have a major impact. The development of further effective meningococcal vaccines therefore remains a key public health priority, they conclude.

Contact:

Professor Robert Booy, CoDirector, National Centre for Immunisation Research & Surveillance, Children’s Hospital Westmead, Sydney, Australia
Email: r.booy@qmul.ac.uk

(4) NO EVIDENCE THAT MELATONIN IS EFFECTIVE IN TREATING JET LAG

Online First
(Efficacy and safety of exogenous melatonin for secondary sleep disorders and sleep disorders accompanying sleep restriction: meta-analysis)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38731.532766.F6

There is no evidence that melatonin is effective in treating secondary sleep disorders or preventing jet lag, finds a study published online by the BMJ today.

Sleep disorders are a widespread problem and place a burden on society through their negative impact on quality of life, safety, productivity, and healthcare utilisation.

Complementary and alternative therapies, such as melatonin (a hormone that is thought to play a part in controlling daily body rhythms) have been used increasingly to manage sleep disorders.

Researchers at the University of Alberta, Canada analysed trials of the effects of melatonin on people with secondary sleep disorders (sleep problems associated with medical, neurological or substance misuse) and sleep disorders arising from sleep restriction, such as jet lag or shiftwork disorder.

They found no evidence that melatonin is effective in treating secondary sleep disorders or sleep disturbance in people with jet lag or people with shiftwork disorder, say the authors. There is evidence that melatonin is safe with short term use, but further studies are needed to determine its long term safety, they conclude.

Contact:

Nina Buscemi, Research Associate, Department of Pediatrics, University of Alberta, Edmonton, Canada
Email: nina.buscemi@ualberta.ca

(5) PATERNALISM NOT TO BLAME FOR FAILURE TO IMPLEMENT RESUSCITATION POLICIES

Online First
(Barriers to implementing a policy not to attempt resuscitation in acute medical admissions: prospective, cross sectional study of a successive cohort)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38740.855914.BE

Many seriously ill patients admitted to hospital cannot discuss resuscitation in line with current guidelines, finds a study published online by the BMJ today.

The results suggest that paternalism is not driving the failure of implementing effective hospital resuscitation policies.

Current guidelines on resuscitation advocate explicit discussion of resuscitation with all competent patients within 24 hours of admission. However, it has been shown that this is not happening, and the presumption has been that this is due to time constraints and doctors’ reluctance to cause patients anxiety.

To investigate what prevents patients from being questioned about their views, researchers identified 374 seriously ill patients admitted to the emergency department of a London hospital.

Only 74 (20%) patients agreed to discuss resuscitation and accept an information sheet about it. Of the remaining patients, 80% could not discuss resuscitation within 24 hours of admission. (half could not be approached for practical reasons and almost one-third refused to discuss this aspect of their care).

Of the 74 patients who read the leaflet, 88% reported having little or no prior knowledge about resuscitation, 95% understood it, and 78% preferred that resuscitation decisions were discussed with them. Fifty-five patients (74%) did not mind discussing resuscitation and these patients showed an overall decline in anxiety after this discussion.

“It is unfair to assume that paternalism is driving the failure of implementing a policy not to attempt resuscitation,” say the authors. “We must ask our patients if they wish to be involved, and until they feel well enough, health professionals continue to carry the responsibility for decisions on resuscitations.”

Contact:

Helen Fidler, Consultant, Department of Gastroenterology, University Hospital Lewisham, London, UK

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