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Tobacco company: spouting health while selling harm

On 31 March 2021, Assoc. Prof. Dr. Mohamad Haniki Nik Mohamed, President of the Malaysian Association of Adolescent Health submitted a ‘letter-to-editor’ of the Malay Mail in response to a PMI-supported article the newspaper had published. [See here:] He requested the newspaper give him equal space and publish his letter representing the public health view. This is his letter the Malay Mail did not publish.

Tobacco company: spouting health while selling harm

In a cruel twist, the world no.1 tobacco company is asking, “What about reducing the harm to current smokers?” The public health answer is straight forward – stop selling cigarettes immediately, stop opposing the government’s tobacco control efforts (such as plain packing of tobacco) and compensate for the loss of lives due to tobacco.

But this tobacco company does not plan to take any of these actions. Instead, it is laying responsibility on its customers to quit smoking while simultaneously criticising tobacco control measures as failing to protect public health.

Here are 10 reasons why the government, health professionals and the public must reject any advice on health from a tobacco company and those that further its interest.

  1. No cigarettes recall: This tobacco company sells billions of cigarettes sticks in Malaysia and around the globe which it will not recall despite the overwhelming evidence of its harmfulness and addictiveness. It is brazen to simply mouth cigarettes “release more than 6,000 chemicals, including nicotine, and the smoke is inhaled” when it continues to sell this harmful product and not admit any liability.
  2. Targeted the young in the past: In its past record, this tobacco company targeted young people in Malaysia to sell cheaper cigarettes and in smaller packs if they could not afford the 20 sticks pack: “As the total outlay for a pack of 20’s became too prohibitive for our younger adult smokers we should consider smaller packings.”

Tobacco companies routinely claim they don’t want children to smoke and deny they advertise to minors. In Indonesia, Philip Morris’ local subsidiary PT Sampoerna removed advertising for cigarettes near schools only after being exposed.

  1. Still targeting the young: Tobacco companies have not stopped targeting teenagers and young people. They have been exposed for secretly advertising cigarettes on social media platforms like Instagram, Facebook and Twitter by paying social media influencers as part of a marketing strategy. The Tobacco & E-Cigarette Survey among Malaysian Adolescents (TECMA) 2016 found about 413,000 (between 10 to 19 years) or 11.7% current cigarette smokers among our students.
  2. Regulators cannot keep up with promotion of new products online: Heated tobacco products (HTPs) of this company, IQOS, are sold online via popular e-commerce platforms. One website offers same day delivery, even within 1-2 hours if within Kuala Lumpur and Selangor. There are IQOS Facebook pages even for individual states. Unfortunately, regulators have little capacity to monitor and regulate these promotions and respond quickly to any violations.
  3. Alternate products are all still tobacco products. This tobacco company registered its heated tobacco brand as an ‘electronic’ product and not as a tobacco product to escape applying pictorial health warnings.

Clearly the tactic is to dilute the regulatory powers of the Ministry of Health on HTPs. Tobacco products sold without pictorial warnings will be violating the Control of Tobacco Products Regulation.

The Ministry of Finance appears persuaded into approving non-tobacco tax on HTPs since these products are not registered as tobacco products.

  1. Tobacco use in any form is harmful: According to WHO, all forms of tobacco use is harmful. The tobacco company’s proposal of a “stepping stone towards policies that will help improve the health of all” will only lead to users into nicotine addiction and remain addicted.
  2. Nicotine is a poison: Nicotine is categorised as group C poison in the Poisons Act 1952. Hence applying tax based on nicotine level is a ludicrous concept. To date Johor, Malacca, Perlis, Penang, Terengganu and Perak have banned sales of e-cigarettes. A national ban on e-cigarettes is overdue.

Six countries in the ASEAN region have banned these alternate tobacco products as have about 40 countries globally. They have applied the precautionary principle often used in public health.

  1. Nicotine affects the brains of children: Adolescence is a sensitive period for maturation of brain circuits that regulate cognition and emotion, with resulting vulnerability to the effects of nicotine. The rapidly changing adolescent brain has differing sensitivity to nicotine. Exposure to nicotine during this time can lead to long-term changes in behaviour.

According to the American Academy of Pediatrics the neurotoxic effects of nicotine on the developing brain, is a “gateway” drug for cocaine and other illicit drugs.

  1. Vaping risks during the pandemic: E-cigarettes produce aerosols that contain fine and ultrafine particles which can promote the progression of pulmonary disease. Inhalation of the aerosols is associated with pulmonary events. Tests show e-cigarette constituents induce inflammation and dysregulate anti-microbial responses.

According to WHO, smoking is associated with increased severity of disease and death in hospitalized COVID-19 patients.

  1. Smokers and public pay the health costs: More than 25,000 people die prematurely every year due to tobacco-related diseases. While tobacco companies reap the profits, their customers, the health system and ordinary Malaysians pay the high cost of tobacco use on society.

During this pandemic, the 5 million smokers and 1 million e-cigarette users must quit altogether.

Assoc. Prof. Dr. Mohamad Haniki Nik Mohamed
President, Malaysian Association of Adolescent Health (MAAH)