Untitled Document

v. 1: 10. 31 October 06 Full printable version: www.endsmoking.org.nz/enewsOct06.pdf

This newsletter can be referred to any time at www.endsmoking.org.nz under News.

Politics

“Smoking – a scourge the world can do without” – Prime Minister Helen Clark

Addressing the WHO Western Pacific region meeting in Auckland on September 18, Helen Clark, a former New Zealand health minister, stressed how tobacco control can improve a country’s overall health. “Smoking causes utterly preventable death, disease and disability,” she said. It cheats our people of the good health to which we all have a right. It is a scourge the world can do without.”

Obesity, tobacco scourge of Pacific. New Zealand Herald September 19, 2006.

Tobacco product displays to be investigated: Damien O’Connor

Damien O’Connor Associate Minister with responsibility for reducing smoking, promised nothing new in his speech to the National Smokefree Conference on September 16. Health warnings were on their way, he said, but these have been promised for some time. The Minister explained the need to spend the $30 million tobacco control money in the best way possible, acknowledging the dedicated and passionate workers in the sector. But he emphasized the need for effectiveness. His office said that point of sale displays of tobacco products would be “investigated.”

Absence of Maori Party and other politicos at the National Smokefree Conference – editorial comment

Under MMP, small parties have increased importance in launching radically new developments, which Damien O’Connor the responsible Minister, is not about to do. Yet no other politicians or political parties were represented at this conference.

Labour for these last many years has led a minority government. Minority parties have limited numbers of MPs to cover all issues. Yet the the Greens, which played an important role in securing the smokefree bill, were not represented. And the Maori Party, which has publicly backed its MP Hone Harawira on the need for ending tobacco sales within five years, was not represented. Nor was its clarion call formally discussed. Hopefully by the Oceania conference in Auckland in 4-7 September 2007, the Maori challenge will be formally picked up and examined in a full Conference session.

Enforcement, health promotion, law change

Dr Janine Paynter of ASH explained how a “powerwall” of packet displays works like a point of sale advertisement. Medical students at Wellington School of Medicine in a presentation to the National Smokefree Conference, had shown up widespread breaches of the current rather complex law surrounding product displays, which represented a deal behind closed doors between NARGON the grocers organization, and the then Minister of Health Annette King in 2003, to permit these displays to continue. This deal was concluded before the health groups could give evidence against tobacco product displays to the Health Select Committee in 2003.

Dr David Booth of Public Health South showed how much dedicated work by smokefree officers is necessary to obtain industry compliance at retailer level to the law as it stands.

Dr David Collins QC, before he became solicitor general, advised ASH that this problem was best addressed by a change to the Act, rather than in regulations alone. Perhaps an amendment inserted into a private members bill with cross reference to the Smokefree Environments Act, would achieve this objective.

- Bringing down the powerwall. A review of retail tobacco displays. Paynter J, Freeman B, Hughes B.

Smoking cessation

Nicotine rather than snuff likely to lead improvement in smoking cessation

Freed-up guidelines for more liberal use of nicotine patches and gum, and new research on faster-acting NRT products, will lead the changes in smoking cessation over the next year or two.

Ministry of Health has commissioned the updating of the NRT guidelines, and University of Auckland researchers are working on faster nicotine products.

Nicotine Replacement Therapy

Current guidelines on the use of nicotine as a stop smoking aid, if revised, would likely favour nicotine patches and gum being used in higher dose and for longer than is currently the case.

Nicotine gum and patches are useful but designed to be unappealing. They don’t “do it” for smokers who want an nicotine fix. Recreational nicotine is sold but only as cigarettes for smoking. Nicotine, however, is also being researched as a recreational replacement for inhaled smoke.

Snus to treat individual smokers with intractable addiction to smoking

Snus can be recommended on a one to one basis by doctors to very addicted smokers – for example those with COPD (emphysema) (some of whom face certain death in ten years), according to Professor Yves Martinet a chest specialist of Nancy, France at the 2006 SRNT Europe conference, speaking on harm reduction.

Until more effective NRT Is available, SmokeLess believes doctors will increasingly suggest that smokers with emphysema, if unable to quit by conventional means, should order snus individually by internet.

Second hand smoke

Smoking in cars pollutes a child’s airspace

Best tobacco research news story this month:

Dr Richard Edwards of Wellington School of Medicine measured particulates (smoke particles) in outside air and in cars where one or more adults was smoking.

Fresh air in Auckland on a very smoggy day 35-40 micrograms per cubic metre of air
Air in a car with an adult smoking, window down 199 micrograms per cubic metre of air
Air in a car with an adult smoking, windows up. 2926 microgrames per cubic metre.

These measurements follow a medical school survey of 16,000 cars in the Wellington region had shown that 4% of drivers smoked, and in a quarter (1% ) smoking occurred when other passengers were present. Smoking may have been underestimated. A law change was advised.

- Sunday Star Times October 29, 2006, p. A3.

End game policies

Pharmac type agency to reform the tobacco industry gets a fair hearing

Martin Johnson, health reporter at the New Zealand Herald, elicited “an interesting idea” response from Dr Ashley Bloomfield Chief Public Health Advisor at the Ministry of Health, with respect to a separate agency, similar to, but separate from Pharmac - which already controls the sale price of most pharmaceutical nicotine sold - to enable tighter controls and eventual phasing out of cigarette nicotine. However the Ministry is not investigating the scheme.

This proposal was the topic of a paper at the National Smokefree Conference in Wellington on 17 October by Dr Nick Wilson and colleagues at the Wellington School of Medicine, when they discussed the end game for cigarette sales in this country.

Susan Jones British American Tobacco’s new public affairs spokesperson said “It smacks of state intervention on an unprecendented scale, which is unusual because we have got extensive regulation in place.”

- Martin Johnston. Radical anti-smoke plan. NZ Herald 21 October, 2006. www.nzherald.co.nz

Research

Clinical trial of fast acting nicotine to begin early 2007.

Drs Hayden McRobbie and Simon Thornley of the Clinical Trials Research Unit, School of Population Health, University of Auckland, have applied for permission to conduct a stage 3 trial of oral fast acting nicotine products on over 80 subjects. Assuming permission is obtained, the actual trial is slated to begin early 2007.

Reviews and research

ASH and Smokefree Coalition are bringing out a lengthy report on snus and cigarette regulation shortly, commissioned from Gravitas, an Auckland consulting firm. The European Union is bringing out a report on snus in the next few months.

For its part, the Ministry of Health is taking care to foster an evidence base, commissioning a report on snus from the Health Technology Assessment Group in Christchurch, due out soon, and has granted permission to bone fide researchers to import snus for use in properly approved research projects.

Certainly, research is urgently required to elucidate a number of issues:

- How effective is snus as an aid to stopping smoking. A randomised controlled trial is needed.

- How acceptable is snus to New Zealand smokers in this regard, including Maori smokers. This will be researched during 2007 by Professor Julian Crane at Wellington, but more studies may be needed.

- How effective will faster acting NRT be? This is being researched in Auckland. (see below).

- Will it be able to more safely replace snus as a stop smoking aid? Professor Julian Crane has applied for funds to carry out research comparing the effectiveness of snus and fast acting NRT.

The clinical trial to watch for

If fast nicotine proves better than standard NRT in aiding smokers to stay quit, then the randomised clinical trial to watch for, will be a trial of snus against the best candidate product based on nicotine alone, such as a fast acting nicotine, conducted over a least a one year period.

Smokeless tobacco

Sweden

Male smoking falls to 13%, and female smoking to 15%.

Daily smoking age 18-84 years, percentages

Among men Among women

2004 2005 2006 2004 2005 2006

14 13 13 19 17 15

Snuff use

Among men Among women

2004 2005 2006 2004 2005 2006

22 22 21 3 4 4

In Sweden in men, daily smoking fell from 14% in 2004 to 13% in 2006. In women smoking prevalence fell from 19% in 2004 to 15% in 2006. The daily use of snus in men fell from 22% to 21%, and in women rose from 3% to 4%. The use of tobacco of any kind in 2006 was 32% in men versus 19% in women. The tax policy of the Finance Ministry of the Swedish Government is to raise tax on snus more than cigarettes to reduce smuggling of manufactured cigarettes.

- Margaretha Haglund, Swedish Institute of Public Health. www.fhi.se 30 October 2006, and ESPN newsletter.

New Zealand

24.5% of men (almost twice as many as in Sweden) smoked in 2004. Snus is banned except for import for personal use .

With Maori Smokefree Coalition, ASH and Cancer Society opposed, the current legal ban on import and sale of snus is likely to stay meantime. Others have reserved their position, and the opposition expressed could melt away if a randomised controlled trial showed snus was better than the best NRT available in helping smokers to quit, and smokers demanded access to taste and see what worked best for them.

Maori smokefree coalition launches its Tupeke Kore (tobacco free) brand: smokeless opposed

Shane Bradbrook director of Te Reo Marama, the Maori Smokefree Coalition, in an impassioned address to the National Smokefree Conference in Wellington this month said his organization aimed for Maori to be tobacco free. He also opposed lifting the ban on (the import and sale of) smokeless tobacco, regarded as another addictive drug. He cited recent successes such as the ten percentage point falls in smoking prevalence among Maori youth between 2000 and 2005. Health, economic and cultural benefits would flow as Maori became tobacco free.

Shane urged equity of funding at every turn to reduce the health inequities in smoking and health between Maori and non-Maori. Apart from this, no new policies were suggested for becoming tobacco free.

Addiction science

Why tobacco may be more addictive than nicotine alone

Drugs, such as nicotine, cocaine, heroin, and alcohol, food, and sex all release dopamine the ‘happy’ drug into the brain. Monoamine oxidase, (MAO) an enzyme in the brain that oxidases and thus destroys dopamine, is inhibited or dimmed by about one third in smokers brains, by known substances in tobacco smoke. When this happens dopamine accumulates to reinforce the addictive effect of nicotine in smoke. These MAO inhibitors in smoke have an effect that takes at least a week to wear off. This makes the addiction to tobacco potentially more powerful than can be obtained from nicotine by itself. Research on this topic is planned by Penny Truman at ESR and Victoria University of Wellington.

Note: MAO has mainly been studied with respect to tobacco smoke, but tobacco leaves and hence smokeless tobacco may also have MAO inhibitory and nicotine potentiating powers, making snus more addictive than pure nicotine of any kind. This remains to be elucidated by further research.

Personal

Becky Freeman leaves ASH

Best wishes to Becky Freeman who steps down in a week or two from two and a half years as director of ASH NZ.

She goes to Sydney and to enrol in a PhD course at the University of Sydney. ASH has already advertised the vacancy in NZ and through Globalink.

Dr Murray Laugesen QSO editor SmokeLess New Zealand cell (0274) 884 375

Dr Murray Laugesen QSO chair; Prof Ross McCormick, Sir John Scott KBE, Trish Fraser MPH, Dr Marewa Glover, Trustees