Under the terms of an ambitious government regulation now being drafted, all cigarette packs will have to carry graphic warning labels and will be prohibited for sale to minors. Bambang Sulistomo, the health minister’s adviser for health policy, said on Tuesday that although the tobacco industry was opposed to the requirement for graphic warnings, the ministry was adamant that they should be printed. “Some of them have proposed that the pictures only cover 10 percent of the pack’s surface area, but we want 50 percent,” he said.

The regulation was supposed to be passed in 2010, but it continues to be stalled because of tobacco-friendly opposition. Bambang said the Health Ministry hoped to finish it sometime this year.

He said that in addition to the graphic warnings, the regulation would require that cigarettes not be sold to anyone under the age of 18 and would prohibit the selling of cigarettes per stick.

It is now illegal to sell to minors, but the law is not regularly enforced. The regulation would help strengthen enforcement.

However, the regulation does not address the thorny issue of tobacco advertising. Indonesia continues to have one of the most liberal tobacco advertising climates in the world, whereas other countries have banned most forms of such advertising. In the United States, for instance, tobacco ads were barred from TV in 1972.

Bambang said the problem here was that tobacco advertising was already regulated under the 2002 Broadcasting Law, meaning that any attempt to curb it would require amending the law.

Nevertheless, he said he was optimistic that once issued, the tobacco control regulation would prove effective.

“It will definitely have teeth. Hopefully we can finish it this year. It’s just a matter of getting all stakeholders in line,” he said.

Mardiyah Chamim, co-author of “A Giant Pack of Lies,” a book that seeks to uncover the marketing and lobbying practices of the country’s powerful tobacco industry, said it was clear that the tobacco industry’s advertising strategies in Indonesia had been successful.

He said they included questionable strategies such as failing to be completely honest about the health impacts of smoking, as well as ads equating smoking with manly characteristics, similar to the Marlboro Man ads from the 1950s and ’60s.

R.T.S. Masli, from digital advertising consultancy Pressmart, said tobacco advertising in Indonesia was highly pervasive and the required health warnings tacked onto them were often too small or fleeting for people to read.

“They’re very persuasive and they give no information,” he said. “And they’re very strong. The companies’ advertising spending is huge.”

According to the American Cancer Society, 70 percent of smokers want to quit, but fear of failure keeps them from following through. For the 45-million Americans addicted to smoking, there is good reason why it is so hard to kick the habit. “Cigarettes have what are called monomineoxidase inhibitors,” says Dr. Sameet Kumar, a psychologist who treats addiction, “and they boost levels of all the neurotransmitters so it can be harder to quit cigarettes than a drug like cocaine or heroin or methamphetamine even.”

Because cigarettes are addictive on multiple levels, experts say slapping on a patch, or chewing some gum, may not be enough to kick the habit. Along with nicotine replacement, health experts recommend supportive counseling, relaxation techniques like yoga and meditation, and the oral medications Zyban and Chantix. “What they’re doing is working on the reward centers activating dopamine in small doses,” says Kumar, “which is usually enough to get by managing small cravings.”

One therapy showing promise is auriculotherapy, which stimulates nerve centers in the brain without the use of drugs. “Auriculotherapy, as I use it, is designed to stimulate your brain to produce it’s own chemicals, ” says Dr. Maritza Paz, “those chemicals that are missing when you’re depressed or anxious.” In the procedure, a hand held device delivers micro-currents to points on the ear which Paz says helps generate “feel good” chemicals in the brain. “When you’re in a better place, you can handle the craving when it comes, ” she says, “you can talk yourself through it.”

For Ron Everdij, auriculotherapy succeeded when all else had failed, helping him quit a 30-year habit in 2009. “I haven’t touched a cigarette since,” he says, “it’s amazing because I though for sure ‘give me a week and I’m going to smoke again’ .” Ron is now addicted to healthier pursuits, and spending time with his son. He says it’s likely that quitting smoking may have added 10 years to his life. Experts say the benefits of quitting start 20 minutes after your last cigarette, with a measurable reduction in blood pressure and heart rate.

Should drug stores be selling cigarettes and other tobacco products? If Middleboro Youth Advocates is successful, you won’t be looking at Marlboro and Parliament displays as you pay for your vitamins and tooth paste. MYA, a consortium of youth and adults whose mission is to encourage young people not to smoke, drink or abuse drugs. is targeting the sale of cigarettes in pharmacies as its project for this year. During a presentation Monday night to the selectmen, who also act as the town’s Board of Health, two articulate and earnest young women made the MYA’s case for a ban on all tobacco products in the local Rite Aid, CVS and Walgreen’s, as well as other health care institutions.

The selectmen have scheduled a public hearing for March 12 on amendments to the town’s tobacco control bylaws that also include a proposed ban on the sale of cigarettes from vending machines.

I confess that I haven’t given a lot of thought to the issue of drug stores selling cigarettes. As a former smoker, I’m not happy about anyone smoking anywhere. There is no one more militant than a former smoker. But in general, I tend to be opposed to what my friend calls “Mommy Government” — restrictions on people’s behavior that assumes we are not quite bright enough to know what’s good for us and what isn’t. I also tend to agree with the notion that businesses don’t need a whole lot more restrictions than they already have to deal with, particularly restrictions that impact their ability to make money.

There’s no question that it seems pretty hypocritical for a drug store to be selling cigarettes. It’s true, as the young women said Monday night, that drug stores otherwise promote healthy behavior. If you think about it, it’s fairly disconcerting to see those cigarette displays in a drug store, albeit at the opposite end of the store from the pharmacy itself. And according to the director of the regional tobacco control program, who spoke Monday night, the major pharmacy chains have not protested efforts to ban tobacco sales in the 70 or more Massachusetts communities that have approved the bans.

Based on the overwhelming evidence that smoking cigarettes is a lot like playing Russian roulette with even worse odds, cigarettes should be banned altogether. But at the present moment it’s legal to produce them and legal to sell them. How can it be appropriate to take a legal revenue source away from one class of business, hypocrites or not?

And the argument that young people will be more likely to start smoking if they see cigarettes being sold in drug stores, because they believe drug stores only sell things that are good for them? I guess we ought to consider barring pharmacies from selling soda, potato chips, candy …

The MYA has raised an interesting issue, perhaps fodder for debate at the March 12 hearing. It’s likely the ban will be approved, but it’s considerably more complex than it appears.

The Missouri Petroleum Marketers and Convenience Store Association takes issue with the Tribune’s recent editorial supporting Rep. Mary Still’s misguided effort to increase the state tax on cigarettes by an outrageous 424 percent, from 17 to 89 cents per pack or from $1.70 to $8.90 per carton, and to use the revenue generated to support K-16 public education. What follows are seven of the many reasons House Bill 1478 and other similar proposals are a bad idea for all Missourians, smokers and nonsmokers alike.

First, a statewide problem such as funding public education requires a statewide, broad-based solution. All Missourians benefit from core government services such as public education, and all Missourians should pay their fair share and have “skin in the game.”
Trying to solve a statewide problem such as funding public education by the majority increasing taxes on an ever-decreasing funding source and minority population such as smokers is bad public policy that lacks serious leadership, reeks of political desperation and does not generate nearly enough revenue to solve the problem.

Second, the outrageous 424 percent tax increase proposed by HB 1478 is fundamentally regressive and unfair and thus will have the greatest negative financial impact on the poor and the middle class. It’s always confusing and disappointing when some politicians want to increase taxes on those most vulnerable and least able to bear the additional financial burden.
Third, this might be heresy to some, but low state taxes are actually a very good thing — whether it’s a low sales tax, low income tax, low business tax, low fuel tax or low tobacco tax. Low taxes encourage cross-border sales from our higher-taxed border states, which drives economic development, creates jobs and generates much-needed local and state tax revenue.
Fourth, the key issue is retail competitiveness with our eight border states. At 89 cents per pack, Missouri retailers, most of which are small-business owners, would be at a competitive disadvantage with retailers in Nebraska, Kansas, Tennessee and Kentucky who, as a result of HB 1478, would have lower cigarette tax rates. In addition, our tax advantage over Illinois and Oklahoma retailers would be all but eliminated. If the outrageous 424 percent tax increase in HB 1478 passes, say goodbye to the local and state tax revenue, economic development and jobs generated by these critical cross-border sales.
Fifth, never forget one fundamental fact: When you pull back the curtain, the ultimate goal of the anti-tobacco zealots is to outlaw all tobacco products in Missouri and across the United States. The anti-tobacco zealots are attempting to achieve this prohibition incrementally by continually supporting the unreasonable taxation and unreasonable regulation of tobacco products. It is both naïve and dangerous to think this nanny-state mentality will stop at tobacco. It’s not a stretch to imagine unreasonable taxation and regulation in the near future on certain foods, vehicles, power sources, health care insurance, medical procedures, alcohol, firearms, etc.
Sixth, calling for a cigarette tax increase disrespects and disregards the will of the people who have voted against similar outrageous cigarette tax increases twice in the past 10 years — the 324 percent tax increase in 2002 and the 470 percent tax increase in 2006.
Finally, it might be surprising, but it’s beyond dispute that cigarettes are currently overtaxed in Missouri. When a consumer buys a pack of cigarettes today, he or she pays 17 cents in state tobacco tax plus $1.01 in federal tobacco tax plus local and state sales tax. Thus, the total tax on a $3 pack of cigarettes purchased in Columbia is at least 46 percent, or $1.39 per pack ($13.90 per carton), and the total tax on a $4 pack of cigarettes is at least 37 percent, or $1.47 per pack ($14.70 per carton).
MPCA can think of no other retail product that is taxed at such a rate. How dare our out-of-touch politicians seriously and publicly argue that a 46 percent or even a 37 percent tax is too low and should be massively increased!

MPCA continues to support a reasonable state tax increase on tobacco products that will allow Missouri retailers to maintain their competitive advantage over our higher-taxed border-states. However, all Missourians, smokers and nonsmokers alike, can agree a 424 percent tax increase is both outrageous and unreasonable.

OU President David Boren’s hopes for designated smoking areas on the Norman campus were extinguished Monday by an executive order from Gov. Mary Fallin. By putting her signature to Executive Order 2012-01, Fallin banned the use of all tobacco products on “all properties owned, leased or contracted” by the State of Oklahoma, including all buildings, land and vehicles owned, according to the executive order.

All OU campuses will be expected to comply with the ban, which will force OU administrators to draft a new smoking policy before the OU Board of Regents hold their next meetings March 28 and 29 in Norman.
When the revised ban is presented to the Regents, it will be the second time in as many meetings that a tobacco ban has been addressed.

The Regents voted unanimously on Jan. 25 at the OU Health Sciences Center to adopt a ban which allowed two designated smoking areas on campus.

With the passage of Fallin’s order, all OU campuses, which fall under the heading of state-owned or state-leased property, can no longer provide the designated smoking areas.

The areas were set to be placed at Lloyd Noble Center and part of the Dale Hall parking lot, according to tobacco ban policy adopted in January.

OU will submit a tobacco policy to the OU Board of Regents that is in line with Fallin’s decision, OU spokeswoman Catherine Bishop said in an email.

When the revised policy is submitted, the change in policy regarding the university’s designated smoking areas will be the only major revision, Gary Raskob said in an email. Raskob is the College of Public Health dean and the former chairman of the university’s advisory tobacco committee formed to help craft the initial policy.

The rest of the policy already approved by the Regents is in line with Fallin’s order, Raskob said.

Fallin has given every state-owned and state-leased property until July 1 before the tobacco ban will go into effect. This is the same time OU’s original tobacco ban would have been enforced.

A new policy will be drafted and submitted to the OU Board of Regents, OU spokesman Michael Nash said.

Northland smokers struggling to make ends meet could give themselves a $100 a week pay rise if they quit the deadly habit, a health worker says. Tobacco products had a 10 per cent tax hike from January 1, the third year in a row the products, which kill 5000 people around the country every year, have had the rise as the Government tries to lower the country’s high smoking rates. The latest price hike has seen the cost of a packet of 20 cigarettes rise by about $2 and a 30g pouch of tobacco by about $4.50.

Already there has been an increase of almost 10 per cent in people seeking to give up smoking since New Year’s Day, said Sarah Woods, spokeswoman for national smoking cessation hotline, Quitline.

Northland Smokefree coordinator Bridget Rowse said smoking had never been more expensive, but there had never been a better time to quit the habit, with plenty of help available.

Ms Rowse said while it was not easy to give up the smoking habit, there were a number of products available, and all with a government subsidy, to help.

She said quitting smoking would be good for the person’s bank balance, their health and the country’s finances as it led to less spending on smoking-related illnesses.

“But the biggest benefit is that there will be fewer children seeing smoking as normal and that makes it less likely they will start smoking themselves. It’s about positive role modelling,” she said.

“Giving up is a great way of saving money at a time when the cost of everything is rising, but wages or benefits aren’t to the same degree. If you smoke a pack a day, that’s around $100 a week, $500 a month, and $5000 a year. You could take a family of four to Fiji and back on that.”

Ms Rowse said there were lozenges, patches and gum available to help people quit with a course of some costing from $3 to $6 a month, far cheaper than the price of one packet of cigarettes.

“Give yourselves a pay rise just at the time you need it most,” she said.

A NOTTS man involved in conspiracies to defraud the revenue out of millions of pounds has been jailed for seven years and four months. Phillip Robinson, 46, of Southfields Close, Kirkby-in-Ashfield, was one of the prime movers in a conspiracy to import cigarettes from Europe. He helped set up an illegal cigarette-making factory – the biggest found by customs in the East Midlands and among the biggest nationally – in a unit at Tapton Business Park, Chesterfield.

Robinson also had another scheme on the go – to dilute 96.4 per cent alcohol and sell it to the public through legitimate retail outlets.

Nottingham Crown Court heard his plans never came to fruition as investigators began dismantling the plots in 2009.

They discovered the cigarette production line as well as a packing machine and packaging for 50 million cigarettes.

Such was the scale of the contemplated operation that a pallet truck was there ready to shift heavy loads.

But it never got off the ground because they didn’t have enough of a vital ingredient – tobacco.

Judge Jonathan Teare told the court as he sentenced Robinson and his associates for the fraud: “What was missing from the tobacco operation was the tobacco.

“Despite prolonged efforts, the principals were unable to obtain tobacco in sufficient quantities to make this operation a success.

“As leading counsel said in opening [the case], ‘this case is all about potentials’. But the potential loss to the revenue was very substantial indeed.

“If the various operations involving tobacco had been successful, the loss to the revenue could have been as high as £150 million per year.

“There were plans to expand the operation even further, so that two more cigarette manufacturing lines could be put in place.”

Three locations were rented for the schemes to take place, including the factory in Chesterfield.

At a unit in Crewe Close, Blidworth, a cigarette machine was being stored for another criminal group. Other machinery and parts were discovered including four hand-rolling, pouch-stuffing machines. In vehicles belonging to conspirators, there were Golden Virginia pouches and tobacco, the court heard.

In a rented barn at Top Farm, Laxton, there was a machine for cutting hand-rolling tobacco set up and ready to use, two pallet loads of Golden Virginia pouches and a forklift truck to move the loads.

Robinson admitted conspiring to avoid paying duty on cigarettes and alcohol.

Derek Lloyd Hickling, 47, of Woodborough Road, Mapperley, and Michael Ray Larcombe, 57, of Coleby Road, Broxtowe Estate, pleaded guilty to being involved in the fraudulent evasion of duty on 5,000 litres of alcoholic spirit.

All three appeared in court alongside seven other men from outside Notts, who received various sentences for their different involvement in the frauds.

After all ten were sentenced, Gary Lampon, assistant director of criminal investigation for HM Revenue and Customs, said the cigarette factory was the biggest found in the East Midlands..

“It’s certainly unprecedented,” he said.

“It was a very professional operation and set up exactly how a professional cigarette manufacturer would have done.

“It had all the machines for cutting tobacco, filling cigarettes and the paper.”

DEREK HICKLING , 47, of Woodborough Road, St Ann’s, was involved in the plan in relation to the evasion of duty on 5,000 litres of alcohol between May 4, 2009, and May 29, 2009. The judge said he fell into the same category as Larcombe. They were involved in the hire of the vehicle used to transport the 5,000 litres.

The judge gave him 12 months in prison, suspended for 12 months, and said he must do 120 hours of unpaid work.

PHILLIP ROBINSON , 46, of Southfields Close, Kirkby-in-Ashfield, was involved in all three schemes. His sentence amounted to seven years and four months. He admitted conspiracy to evade the duty on cigarettes, hand-rolling tobacco and the importation of alcohol. He had two previous convictions for fraud against the Revenue, in 2002 and 2006, the latter involving 135 kilograms of tobacco.

VINCENT WALLER , 47, of Jubilee Crescent, Clowne, Chesterfield, was involved in the conspiracy to avoid duty evasion on cigarettes and hand-rolling tobacco. He was jailed for two-and-a-half years. The judge said he was a “highly active” participant in the activities, subsidiary to Robinson but not far behind him. Judge Teare said: “It is quite clear you were fully aware of his activities in relation to tobacco and cigarettes, assisting him with enthusiasm, and were able to play your own part in negotiating with others.”

ANDRIUS KOCHANANAUSKAS , 30, of Vilnius, Lithuania, pleaded guilty to being involved in the plot to evade duty on cigarettes. He received five months, less 81 days already served in custody. He was involved for a matter of days, helping in the movement of a cigarette-making machine. The court heard he is a football coach and teacher.

PHILLIP HALL , 51, previously of Highland Way, Rugeley, Staffordshire, and Oberon Grove, Wednesbury, West Midlands, was jailed for 18 months consecutively to a five-year sentence he is already serving for a similar offence. He admitted conspiring to evade the duty on cigarettes and the production of hand-rolling tobacco.

CHRISTOPHER BURNS , 34, of Leigh Avenue, Burntwood, Staffordshire, admitted planning to fraudulently evade duty on cigarettes and hand-rolling tobacco. He received 16 months.The judge took into account a doctor’s letter about Burns’ depression at the time. He received a suspended sentence in 2007 for his role as a courier.

DANGIS SULZINSKAS , 41, of London, but originally from Lithuania, pleaded guilty to a role in the plot to evade duty on cigarettes. He received 12 months, suspended for 12 months, and 180 hours of work in the community. He was involved in the fraud for six weeks, and was taken on by Waller to drive one load of cigarettes, which would have evaded some £45k of duty, to Rainworth.

PETER BENT , 44, of George Street, South Normanton, Derbyshire, was given a ten-month prison sentence, suspended for 12 months, after he was concerned in the attempted evasion of duty on the production of alcohol. He was involved with Robinson for three days in the summer of 2009, discussing the plans to bottle substantial quantities of alcohol.

MICHAEL LARCOMBE , 57, of Coleby Road, Broxtowe Estate, was involved in the duty fraud on the booze. He got 12 months in prison, suspended for 12 months, and will do 120 hours of unpaid work. The judge told him and Hickling: “The duty that was going to be evaded was over £100,000, but it was a single transaction as far as you were concerned.”

The partial agonist varenicline (Chantix, Pfizer), which is commonly used as a smoking cessation treatment, may also be effective in treating cocaine dependence, new research suggests. In a small, randomized study of 37 cocaine-dependent adults, those treated with varenicline experienced significantly lower levels of reward effect from cocaine compared w their counterparts treated with placebo.

Participants receiving varenicline also had lower odds of cocaine use, which was the study’s primary outcome measure, but this finding was not statistically significant.

“Because it’s a small-scale study, it was underpowered. But the fact that we did see these effects with such low power suggests that there might really be something there,” lead author Jennifer G. Plebani, PhD, research assistant professor in the Department of Psychiatry and director of the Human Behavior and Pharmacology Laboratory in the Treatment Research Center at the University of Pennsylvania Perelman School of Medicine in Philadelphia, told Medscape Medical News.

Dr. Plebani noted that there are currently no established, proven medications for treating cocaine dependence.

“We have medications for treating opiate or alcohol dependence but nothing for this condition. So we’re cautiously optimistic. Anytime we have an additional tool that might help some patients, it’s worth considering” she said.

“I would tell clinicians that if they have someone who is cocaine dependent, and they are not responding to the treatment options that are currently available, it might be worth thinking about using varenicline. And I would recommend using it in combination with psychotherapy.”

The study is published in the February issue of Drug and Alcohol Dependence.

Cardiovascular, Neuropsychiatric Concerns

A recent meta-analysis published in the Canadian Medical Association Journal in July 2011 and reported at the time by heartwire, a sister publication of Medscape Medical News, raised concerns about varenicline and cardiovascular risk.

Researchers from Wake Forest Baptist Medical Center in Winston-Salem, North Carolina. told heartwire at the time that the results highlighted “how dangerous this drug is” and that it only offers “a very modest benefit.”

On the other hand, another investigator who has conducted research with the medication, Taylor Hays, MD, from the Mayo Clinic, wrote in an accompanying editorial that “the small absolute risk of cardiovascular events associated with varenicline treatment is outweighed by the enormous benefit for reducing cardiovascular morbidity and mortality that can be achieved with successful smoking abstinence.”

In addition, a study published in PLoS One in November 2011, investigators from Wake Forest also reported that varenicline was associated with a significantly increased risk for suicidal behavior and depression compared with other smoking cessation medications.

This was in marked contrast to a review by the US Food and Drug Administration (FDA) published the month before that examined 2 epidemiological studies that showed no differences in risk for neuropsychiatric adverse events between varenicline and nicotine replacement therapy.

However, the FDA also reported that these studies had a number of limitations and that clinicians should continue following the recommendations listed on the physician label and in the patient medication guide — and to carefully monitor use.

Nevertheless, “based on FDA’s assessment of currently available data, the Agency continues to believe that the drug’s benefits outweigh the risks and the current warnings in the Chantix drug label are appropriate,” the organization noted in a release at the time.

Proposals to double the price of cigarettes in the UAE may not be enough to make people kick the habit. The UAE is considering imposing a health tax on cigarettes that would see a 100 per cent price rise on a packet. Smokers told 7DAYS that if proposals to double the price of cigarettes, which are being considered by the government, were given the go-ahead it would not put them off lighting up. Shamsuden Mukhtar, who has been a smoker for 25 years, said: “Cigarette smoking is an addiction and people with a stable income would be more than willing to pay any amount to have a smoke.

The best way to deal with it is to enrol people into programmes to help them quit.”

However, tobacco dealers said they were worried about the business impact on the new proposal so they would consider absorbing a percentage of the new tax to maintain sales.

“Previously, any additional costs have been transferred to the consumer. But in the event where we feel that extra costs are threatening the flow of business, we would explore options of absorbing some of the additional costs in order to keep our business running,” said a cigarette importer in Dubai. However Head of the Tobacco Control Committee, Dr Wedad Al Maidor, is optimistic a severe price hike would work.

“Experience shows that the best way to force people to quit smoking is by making cigarettes more expensive for them,” she said.