NSW Health is in turmoil. Major hospital changes were suggested with disguised cuts to the overall budget and hospital sales. After massive public pressure, Minister Dr Andrew Refshauge 'found' another $34 million and no cuts were necessary for the time being. But NSMA has reason to suspect that NSW Quit will face budget cuts. The review of the Tobacco Advertising Prohibition Act has been also delayed a year by Dr Refshauge. Last year NSW spent $1 Million on the Quit campaign- a very low amount even by Australian standards. Public health has had its budget cut 20% over 2 years, and some areas such as mental health and community health are unlikely to be cut.

Professor Stanton Glantz, a leading US smoking and health campaigner recently toured Australia as a guest of the Heart Foundation and said that the state of California spent 50 million US dollars a year on Quit campaigns which were much harder hitting than any seen in Australia, and painted the industry as the cynical crooks that they are. The campaign lowered the Californian smoking rate from 25% in 1988 to 15%. California has a population of 33 million. Using these figures, the equivalent amount that NSW should spend per population is at least 7 million dollars annually. Even within Australia, NSW does not match other states.

In Victoria, Quit's annual budget is $2.8 million and Western Australia with its much smaller population designates $1.2 million yearly for Quit campaigns. It is clear that the NSW Government is not pulling its weight in helping lower the prevalence of smoking . 17 people die in NSW per day from smoking caused illnesses and child recruitment is rising so it is crucial that the NSW Government increases the funding for Quit programs. At the moment the government is cutting these preventative services, so as political noise saved the hospitals, it must be used to save Quit.

NSMA is seeking to use the Freedom of Information Act in order to obtain information on the campaign history and future of Quit NSW. Hopefully, this will provide further information as to the effectiveness of Quit NSW, and why

Unfortunately NSW Health Minister Dr Andrew Refshauge and most of his staff smoke, so there is a real failure at the top. Shadow Health Minister, Jillian Skinner quit when she got the job and has been quite supportive of smoking programmes, so there is some hope there.

Action Point

Write to Premier Bob Carr or Shadow Health Minister Jillian Skinner and demand that Quit be maintained at least Victorian levels of funding. Parliament House, Macquarie St, Sydney NSW 2000

Federal Govt Rejects Tax Changes

The Federal Government has declined to remove the tobacco tax anomaly that encourages larger pack sizes. It ignored pressure from the AMA and a number of other health groups, who asked that tobacco tax be levied by the number of cigarettes, not by the weight of tobacco. The decision was despite the so-called $8 billion budget black hole and that the fact that the change this would gain them $100 million more revenue. Clearly tobacco industry has powerful friends in the Liberal government, and the voices of health such as John Herron and Brendan Nelson have not had much effect.

On a brighter note, the Queensland government has increased state excise to 100%, the same as all other states, so there is now uniform excise. Some work will be lost at Wills in Queensland where cigarettes were made for 'export' south, and an 'organised crime' network that distributed 'cut price smokes' on which lower excise had been paid will come to an end.

Action Point 2

Write to Treasurer Peter Costello, or Shadow Health Minister Michael Lee, or Democrat Health spokesperson Meg Lees to get tobacco taxed by the number of sticks. Parliament House Canberra ACT 2600

The Annual General Meeting is at 6.30pm on Wednesday, the 9th of October, combined with a social dinner at 7.30pm at BJ's Eatery at 99 Glebe Pt Road, Glebe.

Details and Agenda enclosed.

TIA Author Elected NSW AMA President.

The recent election of Dr Julian Lee as President of the NSW branch of the Australian Medical Association (AMA) has caused much controversy. It is likely that few AMA members were aware that in 1994, Dr Lee headed a group of specialists in order to produce a report on passive smoking funded by the Tobacco Institute of Australia (TIA). Furthermore, in 1993, Dr Lee received $64,500 to appear on behalf of Burswood Casino defending itself against a claimed breach of the Western Australian Health, Safety and Welfare Act, a case that, if successful, could have led to smoking bans in all workplaces in Western Australia.

NSMA President, Dr Arthur Chesterfield-Evans wrote to the National President of the AMA, Dr Keith Woollard calling for Dr Lee's resignation, and to the President of the Thoracic Society of Australia and New Zealand, Dr Charles Mitchell. NSMA pointed out the potential conflict of interest in Dr Lee's position as NSW President of the AMA, an organisation with a strong history of smoking and health campaigning, and the role he has played for the TIA. The same argument applied to the Thoracic Society.

NSMA wrote, "We do not deny that Dr Lee may take a scientific or political position that is at variance with the majority of scientific opinion, and may take remuneration from whoever he chooses to write up his opinion. However, we understand that the AMA has a policy position to refuse tobacco sponsorship, and if this is so, Dr Lee's dual role of working for the AMA and the Tobacco Institute of Australia is inconsistent"

The NSMA is yet to receive a reply from the AMA, but the President of the Thoracic Society of Australia and New Zealand (TSANZ) Dr Charles Mitchell replied, "The Thoracic Society of Australia and New Zealand takes a very strong position on tobacco sponsorship, but as these two mentioned members accepted their remuneration as individuals, and at no time did they represent the TSANZ, our Society does not feel that they have breached any of the rules of our Society."

This reply conveniently ignores the problem that when the debate over smoke-free indoor air legislation starts, the Tobacco Industry can trot out Lee's documents, and when the health groups say that Lee's opinion has no credibility, the Industry will ask- "Then why is he head of your society?" Lack of action over this inconsistency may cost the health forces important legislation.

Action Point 3

Write to the Federal AMA President, Dr Keith Woollard asking that the AMA consider the position of Dr. Lee in NSW in view of his stand on tobacco. POB E115 Queen Victoria Terrace, Parkes ACT 2600

Florida Goes For Gold!

A Florida jury has awarded $US 750,000 ($965, 000) to Mr Grady Carter who got lung cancer after smoking Lucky Strikes for 44 years. Damages will be paid by Brown & Williamson tobacco, the first time a tobacco company has had to pay damages, and the first case to use incriminating documents from the company which were made public by a whistleblower in 1994 (probably Merrell Williams). These documents revealed the company's awareness of the hazards and dangers of smoking. Mr Carter began smoking at 17 and smoked Lucky Strikes until 1972, when he cut down and switched brands. Brown & Williamson are hoping to have the ruling reversed on appeal. But the decision has caused tobacco shares to plummet in Britain, Europe and the US. What does this mean for Australia? Commentators believe that the inclusion of the documents showing tobacco companies' awareness of the addictive properties of nicotine as crucial to the decision. This will soon be tested in a case in Victoria. Mrs Phyllis Cremona, who is terminally ill, is suing the Tobacco Institute, Philip Morris and Rothmans for damages. Regardless of the outcome of the Australian case, legal actions are finally making progress.

NEWS IN BRIEF

Mr Brendan Brady, Executive Director of the TIA has resigned due to internal divisions in the industry. Wills has not to renewed its membership and relations still remain strained between Rothmans and Phillip Morris due to the price war that ensued last year, causing profits to be reduced by $200 million. Fin Rev 12/8/96 (It is not clear whether the TIA will continue to check for bugs after each meeting).

Congratulations to the City of South Perth Council who have banned their workers from smoking near council property or projects. The council also has a social conscience, paying for Quit programs for workers. Herald Sun 6/7/96

The AMA and the Royal Australian College of General Practitioners has called for a new movie classification S for Smoking after a survey found that 57% of parents felt the portrayal of smoking by actors influenced their children to take up the habit. Tobacco companies are paying to get product placement in Hollywood movies. Examples are Beverly Hills Cop, Rambo: First Blood, Primal Fear, Who Killed Roger Rabbit? and Superman 11. The Brown and Williamson documents have shown that Sylvester Stallone was paid $500,000 to smoke in 5 movies! Aust. 23/7/96

Clinton Calls for Nicotine to Be a Drug

Following President Bill Clinton's declaration that the nicotine in cigarettes was an addictive drug the AMA and ASH have called on the Australian Government to follow suit, claiming that it was the Government's "ethical responsibility". In Australia, nicotine is listed on the poisons schedule except in tobacco. According to Dr Woollard, if this exemption were changed governments would have full control of the packaging and contents of cigarettes, forcing cigarette packaging to be uniform and have health warnings regulated. Canberra Times 25/8/96

Editorial Opinion - Let's Stop the Nonsense

There are three major errors being perpetrated by the Smoking and health campaign currently.

1. Concentrating on children. It is politically easy to concentrate on children. Everyone does not want children to smoke, smokers, non-smokers, publicly even the tobacco industry! So it is nice and easy to 'do something' there. But children smoke because they can be persuaded it is 'grown up' So as long as the issue of adults is ignored, the kids will be recruited. The industry knows this, so is quite happy to let soft education campaigns roll on, knowing it can out-point them. We have to take the harder road!

2. Concentrating on ETS (environmental tobacco smoke) or 'passive smoking. As Richard Kluger put it, "By stressing the risk of ETS exposure, the smoking control movement was effectively trivialising the risk form direct smoking, which was 30-40 times greater. It was an incendiary, ineffective and questionable tactic for those on the side of the angels". The whole debate as to whether passive smoking kills or worse, how many people it kills assumes that it is OK to pollute peoples' air as long as it does not kill them, and that using smoke-free air legislation to discourage smoking and improve health is irrelevant. As such the whole medicalisation of the argument is fighting on the Industry's terms. Smoking should be actively discouraged by government because it is unpleasant and because this will improve public health. How many people are actually killed by ETS is of interest, but is not crucial for the argument.

3. Thinking the Battle is won. Governments, Health Charities and Colleges like to stress how much they do in the tobacco field, and how fast progress is being made. This is nonsense. Child recruitment is rising. Government legislation is minimal in the areas that matter. The Health charities spend only a tiny amount on health advocacy, compared to large sums on research which in tobacco's case is never implemented. This reflects the composition of their board's rather than a serious analysis of what is needed for health. The Colleges do very little apart from maintain medical standards, which is often hard to distinguish from maintaining cartels for their members.

There is a lack of resources and a lack of will in all areas that needs to be changed if lives are to be saved.

A new British study has found that babies who die from Sudden Infant Death Syndrome (SIDS) are most likely to have slept on their tummy and have mothers who have smoked both during pregnancy and after it. The team undertaking the study commented that smoking in the same environment as a pregnant woman was as unacceptable as drinking and driving. West Wimmera Advocate 14/8/96.

The Australian Musicians' Union has called for smoke free performance venues after it had received complaints from members saying that their health was being affected by the pubs and clubs they were forced to play in. The AMU called for smoke free environment legislation in line with restaurants and other workplaces. Sun. Tasmanian 14/7/96

According to an Australian review of international lung cancer research, women smokers are more likely to develop lung cancer than male and appear to need fewer cigarettes to do so. In addition, women also find it more difficult to quit smoking than men do. China Daily 16/8/96.

According to a new survey, Australian workers are getting healthier on the job because of the smoking ban in most office workplaces. Office workers, unable to smoke at work are gradually discarding the habit. 90% of Australian offices have a smoking ban, but in NSW this figure drops to a mere 83%. Andrew Refshauge take note! Daily Tele. 18/8/96

A taskforce on passive smoking has been established in Western Australia to report to the State Government in 12 months. Both the NSMA and the AMA believe that this is too much time for a taskforce to simply recommend way of restricting smoking in public places and is yet another example of Governments establishing committees simply to postpone decision making and action. West Austn 26/8/96

Tobacco company Phillip Morris has withdrawn its 3 million dollar sponsorship to Alan Jones "Pack Leader" in Australian Touring Car Racing. Some say it is due to subtle pressure from the Federal Government who had noticed that it looked very similar to the Peter Jackson car. More cynical people think that Philip Morris have felt it is not enough publicity for the money. Daily Telegraph 13/7/96

Tweed Heads Clubs Call for Smoking Bans.

Tweed Heads Combined Clubs have called on the Federal Government to initiated a smoking ban on licensed premises following the changes to the Occupational Health and Safety Act in New South Wales. Under changes to the Act, penalties have been doubled to allow for a maximum fine of $500 000 if workers suffer from ill health from passive smoking. This puts pressure on clubs to ban smoking from their premises, but Tweed Chairman, Geoff Provest is concerned about the economic dangers of implementing a ban in one club and not others. He feels that only if there is legislation banning smoking can clubs be protected. Gold Coast Bulletin 24/8/96.

It is now only a matter of time until bar staff lodge a successful action against a pub or a club and then we will see a speedy ban of cigarettes in licensed premises- but when?!

The Taskforce on Passive Smoking will give legislative options to NSW Parliament in February 1997- quite a wait!

The AMA will hold a Summit on Passive Smoking ini Canberra on 21st October. Details (06) 270-5400

In New Zealand Helen Hughes-Smith has obtained a ruling in the Family Court that her ex-husband, Bill Hughes may not smoke in the presence of their children in his own home. He is appealing the decision in the High Court.

Due to the success of tobacco litigation in the US more states have joined the growing list seeking to recover the hundreds of millions of dollars for the costs of treating smoking related illnesses. Kansas, Arizona, Michigan and Oklahoma have filed suits and New York City received the recommendation to sue from their Public Advocate. Daily Telegraph 22/8/96

A new nicotine patch has been invented by U.S. scientists that blocks the effects of nicotine and changes the taste of tobacco. The patch is designed to rob smoking of its rewards. Northern Territory News 15/8/96.

TIA Sues the N.H. and M.R.C.

The Tobacco Institute of Australia is taking legal action against the National Health and Medical Research Council (NHMRC) because of its landmark draft report into the health effects of passive smoking. The report, claims that passive smoking increases the risk of a heart attack by 30% and as 25% of adults are exposed to Environmental Tobacco Smoke this translates into a 7 per cent increase in the number of heart attacks. The TIA are taking legal action because they allege that the NHMRC did not consider all the relevant material when compiling the report. SMH 21/8/96. NSMA feels this is a monstrous attack on a scientific body to try to silence it, or reduce the impact of its report.

Books Reviews

Two new books on smoking have been published recently.

The Cigarette Papers by Prof. Stanton Glantz, John Slade, Peter Hanauer & Deborah Barnes. This is very readable analysis of the Brown and Williamson tobacco company documents, which show how much the tobacco industry knew and when about the effects of smoking on health, and what they conspired to do about it in their public statements. As Stephen Weinberger puts it " it is one thing to know your spouse is having an affair- - it is another to actually catch them in bed". No one believed the tobacco industry's denials, but this evidence is compelling reading! The documents are also at http://www.library.ucsf.edu/tobacco.

Ashes to Ashes by Richard Kluger is being hailed as the definitive history of the tobacco industry. It looks at perceptions of the industry, as immoral in the early 1900s, to a soldier's friend in WW1 and a symbol of female emancipation in the 1920s. It also track Philip Morris corporate success, especially targeting arts sponsorship as a route to social acceptance and powerful friends. Kruger criticises aspects of the health campaign, but patiently builds his case against the tobacco companies so that his conclusion is inescapable- they are guilty.

Smoking Partners Break Hearts!

People whose partners smoke have an average 20% higher risk of dying from coronary disease according to findings from a study of passive smoking. The study concluded that passive smoking might account for 35-40, 000 heart disease deaths in the US each year. According to the National Heart Foundation of Australia, smoking accounted for 17% of heart attacks in 1994. Sydney Morning Herald 21/8/96

Did you know that Thomas Edison refused to employ anyone who smoked? Ashes to Ashes

Office News

For those members who would like to get more involved why not come along to the meeting and maybe even nominate for the committee. We would love to see some fresh, enthusiastic faces each month!

I have been very busy working alongside Arthur trying to find out what is happening to Quit NSW. The other big news is that Brian Robson, our resident computer genius, has been busy connecting the computer so that we can get online and more importantly, put a homepage on the Internet! This looks like happening in a few weeks so if anyone has any suggestions as to what they would like to see on the homepage write or give me a call (Wednesdays only). Suggestions so far have been a history of the NSMA, the newsletter and information about passive smoking and the law etc.

Strangely, I have been dealing with a lot of complaints about smoking and sport! While the West Coast Eagles and the Fremantle Dockers have taken the initiative in banning smoking at their home games it seems as if community sport has a long way to go. Spectators, in particular, are the source of much ire. I have received complaints from both indoor sports participants in games such as volleyball and darts, as well as outdoor sports such as soccer. The problem seems to be that common sense is not prevailing and, furthermore, the sporting bodies do not have laws or by-laws to ban smoking either at their meetings or at the games. If you are having problems with any sporting bodies that you are involved in the easiest solution seems to be to simply write them a letter pointing out your concerns. You may also like to know that the NSW Cancer Council has a pamphlet "Smoke-Free Sport- Guidelines for Sporting Organisations" which will give authoritative advice. Failing that, give me a call and I will consider further action.

I look forward to meeting members at the AGM on Wednesday the 9th of October. Katherine.