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View the Paper (HTML) - March 1, 2004 Tell a colleague about it.

ABSTRACT:
The meeting was held in response to a call by Dr Gro Harlem Brundtland, Director-General, WHO for scientific evidence that could be used as the basis for regulating tobacco products. During the opening addresses, the Norwegian Minister of Health, Mr Dagfinn Hoybraten, and the WHO Regional Director for Europe, Dr Marc Danzon, both emphasized the need for sound evidence to be used as the basis for decisive action against tobacco. Mr Hoybraten stressed the need for complementary national and global actions and urged that the output of the meeting be of use to the development of a product regulatory component of the Framework Convention on Tobacco Control (FCTC) and possible protocols. The objectives of the meeting were based on an acknowledgement that comprehensive tobacco control policies and strategies were needed in all countries. The specific objectives of the meeting were to: A review of the epidemiology of tobacco and health, and current approaches to tobacco control was presented by Derek Yach. Tobacco kills 4 million people annually worldwide and will kill 10 million a year by the 2020s. The epidemiological evidence highlights the need to assess the ultimate impact of control strategies on total mortality. A review of these strategies by Dr Tapani Piha stressed the need for comprehensive national approaches that use effective measures able to reach all sectors of the population. Sustained investment in tobacco control over decades is required before results become evident. Reporting on a recent meeting on tobacco product regulation held in Finland, Jack Henningfield stressed that within a comprehensive approach, product regulation should play an increasing role. Product regulation should not undermine but rather should complement prevention and cessation strategies. He highlighted several areas where agreement is emerging: Judy Wilkenfeld highlighted the need for regulatory agencies to be able to evaluate and respond to changes in tobacco product design, and assess their health impact. The difficulties in doing this were outlined by Don Shopland who also showed how public perception of risk was influenced by terms such as "low tar". There was little evidence of real health gains from such products. The intimate link between product design and smokers' behavior was highlighted. This link explains why product design changes have failed to yield health gains (through compensatory mechanisms). Clive Bates, Bill Rickert and David Sweanor all highlighted major difficulties with existing testing methods when these are used to characterize smokers' exposure. Studies have shown that smokers adjust their smoking behavior according to the availability of nicotine in smoke in order to achieve their desired dose. This effect, known as "compensation" is not emulated by any standardized smoking regime, such as the Federal Trade Commission (FTC) and International Organization for Standardization (ISO) methods. Testing methods able to evaluate the biological impact of existing and novel products are urgently needed. Channing Robertson urged that testing methods be kept simple and not try to cover thousands of constituents of tobacco. He provided evidence demonstrating that cigarettes are designed to deliver optimal doses of nicotine masked by natural and added taste elements. Further, he believes that the onus of showing health gains from new products should be placed on the tobacco industry. The range of new and novel products, already at an advanced stage of development by the tobacco industry, was described. Some attempt to provide very low levels of tar, nicotine and side-stream smoke. Mitch Zeller reviewed the need for regulatory agencies to proactively evaluate the challenges posed by the ongoing debate surrounding exposure and harm reduction. He raised the potential unintended consequences of certain policies and urged that they be carefully considered prior to adoption. David Sweanor recommended that a future regulatory framework should encourage wider use by smokers of "cleaner" forms of nicotine and disfavor the use of "dirty" forms. exchange scientific information about tobacco product design and manufacture needed for regulation define public health goals of regulation of tobacco products and how the concept of harm reduction fits within such goals identify priority research areas required to advance regulating tobacco products recommend whether a protocol on regulation should be developed as part of the FCTC.