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Editorial
Janice Pou, failing to quit, had no further options:
she died
To Janice Pou smoking was very important. She could either quit,
or risk early death; a dilemma, rather
than a choice. She took no serious steps to quit, and died before her
time. Now the courts rule it was not the cigarette maker’s fault. But
was it entirely her fault? Is it the entirely the fault of the 4000
smokers who continue to gamble their lives away each year? Does the
tobacco control community need to review current policies?
Janice Pou was in
that top 5 percent of smokers, who need a cigarette first thing in the
morning and who smoke over 20 cigarettes a day.* Janice Pou was a prime
case of a woman determined to begin to smoke, and to continue to smoke,
and not motivated to quit. The
judge held to the legal principle that an addicted smoker (wanting
redress) should be held accountable to exercise their “free will,
which is fundamental to the individualist philosophy of the common
law.”
If smokers are to be
held responsible for their actions, then what role should the tobacco
control community play?
1)
Continue
to exhort smokers to quit, and continue to demonise the tobacco industry?
And/or
2)
Offer a
wider range of alternative nicotine products, all with informative warning
labels, taxed according to risk, widely available to smokers outside the
health system at shops, and inside it from pharmacies, or by mail and
quitline vouchers, to suit smokers. (The upcoming review of how NRT is
used is a start).
3)
Lobby
to strengthen the Smokefree Environments Act to permit the sale of a full
range of such alternatives.
David Collins QC, John French, and Bruce Corkhill carried out Janice
Pou’s dying wish to seek redress from British American (BAT) for
addicting her to smoking their cigarettes, and they did so with great
dedication and skill. A distinguished array of witnesses gave evidence on
behalf of the plaintiff. Mr Justice Lang found that the fact Janice Pou
continued to smoke cancelled out any liability BAT may have had. She did
not even try to stop smoking he said. Personal responsibility features
very strongly in this judgment, and will contrast strongly with the views
of those trained to give more weight to societal factors.
Smoking control
workers and addiction experts will see her failure to quit as proof of
the severity of her addiction, and may regard the judgment as lacking
insight on this point. The judge listened intently to five weeks of
evidence from both sides. Addiction experts provided hours of post graduate
education to the court on this topic, on the theories, the statistics, on
the clinical assessments and their predictive power with respect to
quitting.
This smoker’s
estate obtained no redress, and anti-smoking groups feel the companies
have not been made accountable. Instead, the smoker has been held
accountable for not quitting smoking their addictive cigarettes.
The judge says,
even after acknowledging the strength of her addiction, that in law the
companies were not responsible for warnings on the packet if the public
generally knew smoking was harmful. In effect, informed consumers are
responsible for what they put in their mouth. Auckland law lecturer Bill Hodge, whose father died
of lung cancer in 1967, agrees the dangers of smoking were widely known
in 1968. This he says was always a major weakness in the Pou case.
___________________________________________________________continued…
* National Research
Bureau, 1996 survey for the Ministry of Health).
Smokeless New
Zealand e-News v.1 no 2, 3 May 2006
Editorial continued.
What to do for the over-4000
smokers annually who like Janice Pou, die before they quit?
To help the most
addicted smokers, we need to increase the pressure to quit, and the
recent increase in TV Quit advertising is welcome. Janice Pou phoned a
help line once but only tried once and the line was engaged. She tried
nicotine patches once from a friend, kept on smoking, then when she got
chest pain, tore off the patch (instead of cutting down on cigarettes).
She did not take professional help. Her attempts to quit were poorly
planned said the judge.
What do we say to smokers who don’t
want to quit or take professional help?
For the rest of her
life she was not even asking for help. She was part of the 90% of smokers
who are not about to quit in the next 30 days. Janice Pou became
depressed and irritable when forced to stop smoking for two days because
she ran out of money. Withdrawal effects were too severe to contemplate
stopping.
We need a way to
stop smoking that smokers like so much they would recommend to other
smokers by word of mouth; something as satisfying as smoking but not as
dangerous.
Many smokers want more nicotine
Patches and gum
together might do it for some. Others recommend using patches and gum
before and during cutting down. Smokeless tobacco can certainly provide
sufficient nicotine to satisfy an addicted smoker.
Janice Pou had
probably never heard of nasal snuff or oral snuff. If she had taken snuff regularly, it
is certain she would not have developed lung cancer. Rothmans (now BAT) in
1968 was making good profits from selling her Pall Mall cigarettes and ignoring the lung cancer
risk. In those days Government did not know about Swedish snuff. In 1987
based on reports of mouth cancer from the USA, New Zealand banned commercial snuff imports from any
country.
If she had switched
to Swedish snuff, Janice Pou’s chances of developing mouth cancer,
an uncommon cancer, would have been decreased 80%, and her risk of dying
from all causes including lung cancer, by 95%.# Customs say some snuff is being
imported for personal use but the duty is nearly $400 per kg (including
GST), the same as for smoking tobacco. There is a case for lowering the
snuff excise in proportion to its death risk, and making it more
affordable for poor smokers.
For many nonsmokers
and health promoters, snuff and snus are tobacco products from the same
firms whose cigarettes kill 4000 annually, and all tobacco products
including smokeless, should be banned. Smokers like Janice Pou, rely on tobacco
companies to provide a lifeline of satisfying nicotine, inhalable on the
hour, even if the inhaled gases eventually
kill them.
We cannot say
whether the late Janice Pou would have ever switched to smokeless. She at
least might have tried smokeless, whereas abstinence from tobacco and
nicotine was always a step too far.
- Murray Laugesen,
chair SmokeLess New Zealand.
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#Levy 2004
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