A New Regulation On Big Tobacco

By Chuck Dinerstein, MD, MBA — Feb 23, 2017
Beginning in May of this year, all cigarettes sold in the UK must be packaged to standards regulating material, size, shape, opening mechanism and more importantly with plain packaging. And by plain packaging, I mean a "mud-green box" stripped of all branding. Like this:         

Beginning in May of this year, all cigarettes sold in the UK must be packaged to standards regulating material, size, shape, opening mechanism and more importantly with plain packaging.

And by plain packaging, I mean a "mud-green box" stripped of all branding. Like this: 

 

 

 

 

The tobacco companies argued that plain packaging was ineffectual. But as the Financial Times notes

"The argument that plain packaging was ineffectual was largely dismissed by the UK appeal court judge, who noted that “research found that the designs and branding upon cigarette packaging and upon the tobacco products themselves exerted a causal effect upon consumer behaviour and encouraged smoking.” 

An additional argument was that this form of packaging violates trademark law -  removing their intellectual property without compensation for their loss. And there are now plans underway for a similar plain packaging program for alcohol raising a troublesome concern about a slippery slope. A court that finds this valid when it comes to a hot-button issue like cigarettes may impact similar efforts about things like snack foods, or any behavior that people in power are convinced they should penalize based on an epidemiology paper published in a journal.

Here is a recent small meta-analysis of plain packaging for tobacco. All four studies were of low quality but here is a bit of a synopsis:

  • "plain cigarette packs were rated as significantly less appealing than branded packs."
  • For some of the people surveyed "plain packaging would make pictorial warnings effective" for others brands had differing health risks and finally, "socioeconomically disadvantaged Australians still believe health messages are exaggerated" [So at best a draw]
  • "smokers using cigarettes in plain packaging reported decreased product quality, with quality and taste decreasing, although at the same time they reported that the plain packaging was not likely to impact their established smoking behaviour."
  • "Purchase intentions were reduced with plain packaging and this was consistent within the studies that assessed for intentions." [Italics added]

Two conclusions. It makes sense that plain packaging would have less appeal, advertising is a business for a reason, and it is obvious that plain packaging with nothing but a picture of a lung cancer patient would be a deterrent, but this is where a law may be in violation of intellectual property rights. And the second conclusion is that because plain packaging research is limited, its actual effectiveness is unknown. Instead, we rely on surveys for whether or not people would buy a cigarette with a plain package.

One final quote:

"...India had a high proportion (70%) of participants who supported the introduction of plain packaging. This is similar to information coming out of HIC [high income countries], such as in the UK, where 62% support plain packagingand up to 80% support it if plain packaging made packs less appealing to children and youth, and Australia, where 49.9% of smokers support plain packaging. This suggests that in general, there is community support for introducing plain packaging across both HIC and LMI settings alike."

There is no doubt that smoking is bad for your health. Period. And there seems to be widespread support for plain packaging. But I do not see the scientific evidence that backs up that claim. Rather than tie these up in courts with limitations on intellectual property and freedom of speech that would not survive if it were almost any issue besides smoking, why not just ban them if that's what they majority wants? Do you think health policy should be evidence-based or what the population 'demands?' More importantly, do you think the politician policymakers are more attuned to the public or science?

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Chuck Dinerstein, MD, MBA

Director of Medicine

Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.

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