In the last days of the old Parliament, MPs agreed that from May next year cigarettes may only be sold in plain packaging. Dr Peter Mackereth congratulates politicians for their willingness to stand up to the tobacco industry, but warns the companies are fighting back.
Almost a quarter of children aged 11 to 15 in England have experimented with smoking, while 4% smoke at least one cigarette per week, according to figures produced by Cancer Research UK. A child in England who is a regular smoker will on average smoke 36 cigarettes a week.
These are the tobacco industry’s new recruits – needed because half of all smokers will die as a result of their habit. Consequently, engaging with the children of adult smokers via ‘glamorous’ packs and branding is now the main platform for attracting a new generation of consumers.
So our politicians are to be congratulated that in the dying days of the last Parliament they approved new legislation that from May 2016 will – all being well – require all cigarettes to be sold in plain packaging. This is on top another new law that requires all retailers to hide cigarette displays from April 6 this year.
I say the branded packaging will be banned from next year ‘all being well’ because the industry is unlikely to accept the new laws without a challenge. The UK is not the first country to ban packaging that promotes cigarette branding. Australia introduced a ban in 2012, while Ireland passed legislation earlier this year for implementation in 2017. Three tobacco companies have just announced that they will use the courts to challenge Ireland’s new laws. We have yet to find out if they will do the same in the UK.
Legal challenges to the new legislation will cost the tobacco companies a lot of money. They already spend vast sums on designing and producing fancy packs that are typically pulled out of a smoker’s pocket or handbag 20 or more times a day, sit on tables and are propped up on dashboards. Films, videos and television often include smokers pulling cigarettes out of glamorous packets; yet I doubt if we will see in close-up on contemporary dramas the replacement drab brown packets with diseased lungs.
The need to cut the high numbers of children on the route into tobacco addiction is obvious to those at the sharp end of treating those suffering ill-health from long-term smoking.
Across the Greater Manchester area approximately 37% of the population smoke; this is much higher than the national average in England of 20%. At The Christie our audits indicate that 40% of patients are smoking at the point of cancer diagnosis – sometimes they increase usage and argue that this is the wrong time for them to stop. Many of our patients are unaware that toxic chemicals found in the smoke interfere with the efficacy of chemotherapy and radiotherapy. Specifically, carbon monoxide – a colourless gas found in smoke – increases anxiety, nausea and breathlessness, while impairing circulation.
Additionally, the tar and other chemicals interact with and reduce the effectiveness of drug treatments and increase side-effects. Smoking cessation is a an essential component of evidence based cancer treatment, extending survival times and lowering the risk of new primaries and metastatic disease across a range of cancers.
At The Christie nurses and senior management have embraced our smoking-cessation (SC) services, with funding in place for skilled heath advisors. Our SC package includes smoking assessment, provision of nicotine replacement therapy (NRT), motivational interviewing, stress management techniques and clinical hypnotherapy. As lead for tobacco control my role includes maintaining a smoke-free site, engaging nursing and medical staff to become champions for early referral and linking the gains from going smoke-free to cancer treatment.
In addition, our SC team works with carers and staff to assist them in becoming smoke free. Over the last few years I have been invited to engage in debates on plain packaging, smoke-free sites, and smoke-free cars for children and have engaged in discussion on television, radio and in the press. Some commentators have used social media to label my arguments as those of a ‘nanny state’, but others have said ‘it’s time we see smoking for what it is – a harmful and damaging addiction that compromises the health of adults and children’.
Arguments against plain packaging by the tobacco industry focus on the potential for driving up the illicit tobacco trade and reducing users’ ability to distinguish brands, so damaging the industry’s trade. But counterfeit cigarettes are already here and those who smoke them will also buy the big brands to maintain their addiction.
Health and wellbeing care is unavoidably a political and social activity. Compassionate care requires nurses to see beyond appeasing addiction. Would we allow alcohol and recreational drug use on site at a hospital? I believe plain packaging is a necessary step towards de-normalising smoking.
There was a time when many UK hospitals were funded by the tobacco industry, now we have around 4,400 admissions a day and 79,000 deaths a year due to smoking. Over 200,000 children aged 11-15 years old will start smoking in the next 12 months with the majority of lifetime smokers starting as teenagers.
Plain packaging is the next brave step for the UK towards tobacco-free futures for both current patients and future generations – and MPs are to be congratulated for taking it. Their actions could extend the lives of many thousands of ‘would have been’ smokers.
This blog is an amended version of a comment article published in the British Journal of Nursing, 2015, Vol 24, No 5.