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Should plain packaging of cigarettes be tested, first?

Today’s Crikey bulletin has a most informative yarn about Labor’s links to Big Tobacco.

This comes in the wake of publicity about the Liberal Party ties of some of those involved in a tobacco industry-funded campaign against the Government’s plans to introduce plain packaging of cigarettes by 2012.

For those in need of reminding, plain packaging of cigarettes was one of a raft of recommendations from the National Preventative Health Taskforce that are aimed at reducing smoking rates from the present 16 per cent to 10 percent or less.

Meanwhile, health policy analyst Jennifer Doggett is not convinced that plain packaging will have the intended effect, and wants to see it trialled. She writes:

“Plain paper packaging for cigarettes is the sort of policy made for election campaigns. It is easy to explain to voters, it looks like the government (or potential government) is taking action on a serious health problem and it appears to cost voters nothing.

Too bad there is no evidence that it actually works.

Neither supporters nor opponents of the plain packaging proposal have made a case that stands up to any level of scrutiny.

The clumsy attempt by tobacco producers and retailers to argue both that generic packaging would not reduce cigarette consumption yet would seriously harm retailers’ profits is laughable.

No-one could take seriously the argument that stacking plain-label cigarettes on shelves will take $8-an-hour teenage employees so much longer that it will cause the wages bill for corner stores and service stations to skyrocket to the point that the viability of these businesses is threatened or we will all end up paying $5 a litre for milk.

If the ‘masterminds’ of this campaign are indeed ex-liberal party strategists, as reported in the media, Tony Abbott must be eternally grateful that they decided to move on from politics to give the tobacco industry the benefit of their muddleheaded advice.

However, the arguments put forward by supporters of this proposal are not much better.

No country has introduced plain packaging so we don’t actually know what effect it has over the longer term on cigarette consumption. The research cited by supporters to support the policy is usually based on studies where people are asked to compare a packet of cigarettes in plain and branded packaging and asked which they find more appealing (or some variation thereof).

These studies create an artificial situation (given that if generic packaging were introduced consumers would not be given a choice) and make any number of spurious assumptions about how smokers’ behaviour would change over the long term, given their views on cigarette packaging.

This sort of research is useful for academics wanting to publish papers in public health journals but tells us little about real life policy outcomes.

Intuitively, it seems odd that a smoker, not deterred by the prospect of a painful and premature death, would be dissuaded from their habit by unattractive packaging.

It also seems unlikely that a reduction in competition between tobacco companies, through preventing promotional opportunities, would reduce consumption rates (as commonly argued by advocates for plain packaging).

Anyone who lived through or visited the former Soviet Union, where the state had a monopoly on cigarette manufacturing and retailing and male smoking rates approached 70%, would be wary of linking competition within the tobacco market to closely to smoking rates.

It could be argued that, given the serious harms resulting from tobacco use, we should give any harm reduction strategy a go, regardless of whether or not it is likely to reduce consumption rates.

However, this is the wrong approach. It is precisely because of the high levels of harm caused by smoking that we cannot afford to adopt policies which are not based on evidence. We need to ensure that the resources we put into reducing tobacco-related harms deliver the maximum possible benefit and this can only occur if we ensure policy decisions are based on evidence.

Therefore, rather than diving headlong into an untested plain packaging strategy, the Government and Opposition should commit to a ‘suck it and see’ policy trial.

This would involve a number of selected locations, including capital cities and smaller regional centres, around the country with half randomly allocated to sell only plain packaged cigarettes for a defined period. At the end of this time – 12 months would be a decent length – the level of tobacco sales between the two groups would be measured and compared.

A study such as this would give the government the evidence it needs to pursue a generic packaging strategy or allocate resources to an alternative harm reduction strategy.

If the tobacco industry has the courage of its convictions, perhaps it could donate the $5 million it has allegedly pledged to bankroll the election campaign to fund a policy trial of generic packaging and call on both major parties to commit to road-testing the policy.

This would be both smart politics and smart policy and provide a secure evidence-based for future tobacco harm reduction strategies.”

Update: Interesting to see that Mia Freedman has also picked up on this issue at her Mamamia blog. (Which I’m sure is far more widely read than little ol’ Croakey…)

Comments 19

  1. Mike Daube says:

    The history of tobacco control is littered with arguments that new approaches shouldn’t be tried because nobody had done them before – ad bans, decently funded and well run public education, graphic health warnings – even tax increases.

    Just over a century ago, W.H. Cornford wrote in his classic work Microcosmographia Academica, ““Every public action which is not customary either is wrong, or if it is right it is a dangerous precedent. It follows that nothing should ever be done for the first time”.

    If we wanted any evidence that plain packaging would work, the tobacco industry’s desperate efforts to oppose this measure would be enough to convince anybody objective.

    Jennifer Doggett is right in pointing to the unbelievably clumsy way the international tobacco companies have tried to buy in to the Australian election on this issue. But she is wrong to suggest that they should be involved in any measures aimed at reducing smoking – that is the role of governments and health authorities, not an industry with a 60 year track record of trying to oppose and undermine anything that might adversely affect their sales to adults or kids.

    Mike Daube, President, Australian Council on Smoking and Health

  2. Sittting Tall says:

    Question: Why are tobacco companies pouring money into an Australian election campaign?

    Answer: Because they are alarmed at the thought of plain packets for tobacco products.

    Its not rocket science, is it? They are absolutely terrified of the precedent this will set and the fact that other countries will follow Australia’s lead.

    Plain packaging has been on the cards for many years and tobacco companies have been anticipating it with dread.

    I say bring it on!

    I look forward to the day when tobacco is a totally controlled substance that can only be sold to registered nicotine addicts. Then we will be much closer to seeing the end of this industry that profits by killing half of its loyal long term customers prematurely.

  3. annej says:

    Waiting for a truckload of evidence would be ok if tobacco only killed a few score people a year. Since it kills 15,000 Australians and 5 m people worldwide pa, then we have good reason to go with the evidence we already have amassed. The tobacco industry is not so concerned about the Australian market as small and declining – they dont want this policy to domino as thet need tobacco advertising on the packs to suck smokers in from poor countries. When we had no seat belts and several thousand road deaths a year, I dont think the policy advisers sat around for yonks saying we need more evidence before we inconvenience car manufacturers by manadating seat belts.

  4. simon.chapman says:

    Plain packaging is intended as a strategy that will add significantly to the weight of denormalisation of tobacco as just another grocery item, appropriately sold from any corner store, on open display, in boxes thoroughly tested to maximise their appeal to people starting to smoke — ie mainly kids. The idea is to permanently signal that it is an exceptionally dangerous product that is appropriately regulated in the way that products causing such harm should be, short of being banned (as any product invented tomorrow with tobacco’s risk profile would be). Look how we regulate prescribed drugs which are intended to promote health & save lives. You need a “license” to get them (ie a prescription); you get limited supplies; access is controlled by professionals with 4 & 6 year degrees (chemists and drs); they are stored out of sight, and they come in plain packs; and anyone supplying them to someone without a prescription would be struck off and probably gaoled for repeat offences.

    Ask yourself why the industry is spending this money to combat this move. They know its potential to radically change over a generation the way that tobacco products are seen by whole populations. It is not a strategy that anyone is arguing will have rapid impact on adult smokers, many of whom are addicted and “over” brand image. It is about making smoking less intruiging to kids, with the same logic that advertising bans were introduced. Australian kids smoking today is lower than it has ever been recorded, in the total absence of any youth-targetted advertising campaigns. It has happened almost entirely via denormalisation and price.

    The idea that you could setup some dinky little experimental study, with tobacco industry funding no less, which would cough up unequivocal results in 12 months, while the neutral, disinterested tobacco industry sat by with never a thought of how they could corrupt the study by massive cross-border price discounting, viral marketing on social media sites of branded products to make them prestigiuous etc.

    Why molly-coddle this pernicious industry with a strategy that they would seriously work hard to undermine because of the size of the global implications they risked?

    Not a very sensible article Jennifer, sorry. Has the industry put the call through yet?

  5. Becky Freeman says:

    I’ll declare right up front that my published paper on this topic is handily, if dismissively, provided by Jennifer in her post above.

    We already know that graphic health warnings work to reduce smoking. We already know that advertising bans work to reduce smoking.

    We have evidence in the bucket loads to support these two policies – see some comprehensive reviews here: http://www.tobaccolabels.ca/toolkit and http://cancercontrol.cancer.gov/tcrb/monographs/19/index.html.

    Plain packaging simply strengthens and extends this two proven health policies.

    The proposed policy trial sounds like a classic delay tactic and a funding suck. However – wasting time and resources is the least of my worries, let’s just get on with preventing the next generation of smokers becoming addicted.

    Becky Freeman – Tobacco Control Researcher USyd

  6. Becky Freeman says:

    I’ll declare right up front that my published paper on this topic is handily, if dismissively, provided by Jennifer in her post above.

    We already know that graphic health warnings work to reduce smoking. We already know that advertising bans work to reduce smoking.

    We have evidence in the bucket loads to support these two policies.Plain packaging simply strengthens and extends this two proven health policies.

    The proposed policy trial sounds like a classic delay tactic and a funding suck. However – wasting time and resources is the least of my worries, let’s just get on with preventing the next generation of smokers becoming addicted.

    Becky Freeman – Tobacco Control Researcher USyd

  7. Cajela says:

    One thing that I haven’t seen discussed is why we currently ban the e-cigarettes. I’m hearing from several friends in America who have successfully given up smoking tobacco with these devices. While they’re still getting a nicotine fix, at least there’s no second hand smoke and no tar, and (anecdotally) no smoker’s cough. It seems a perfect harm reduction measure, and not so drastically different to the nicotine gum or patches in concept. So why are we opposing it? Are we choosing prohibitionist moralising over harm reduction?

  8. Margo says:

    You could hardly describe this as a made-for-an-election-campaign policy. ‘Generic packaging’ for tobacco products has featured in public health policy considerations, as well as in research (within confines described by others above), in Australia and elsewhere for more than 20 years. Yes, it’s the nicotine (and its enhancers) that cause the physiological addiction. But tobacco brand identity — like branding for other consumer products — is calculated to provides users with constant reminders and reinforcements of ‘belonging’ to the brand. The packaging conveys an image which is supported through other available promotional mechanisms — especially important when there is not a lot to differentiate your little cylinder of toxins from all the other ones.
    As for the alleged burden on retail staff, don’t sell the stuff and you won’t have a problem. Maybe I missed it, but I don’t recall hearing similar protests from pharmacists about their having to deal with thousands of pharmaceutical products sold in very plain packages.

  9. SmokeFree says:

    Good idea. Let us trial it in Australia by making tobacco packaging poo brown with really disgusting health warnings. We could run this pilot in the whole of Australia with all packaging for – say – five years starting on September 1 2010 – and if it doesn’t work no other country need follow it.

    The tobacco industry seem to have no trouble changing their packaging for “special events” like grand prix and other stuff. They should easily be able to do this very quickly.