European Initiatives

BMA/tcrc letter to Commissioner David Byrne on the proposed EU directive on tobacco product regulation

9 November 1999

Mr David Byrne
Commissioner for Health and Consumer Protection
The European Commission
Breydel Building
45 Avenue d'Auderghem
B-1040 Brussels
BELGIUM

Dear Mr Byrne,

Congratulations on your appointment to the post of European Commissioner for Health and Consumer Protection. You will be aware of the above proposal due before the Commission on regulating tobacco products. On behalf of the Tobacco Control Resource Centre, I write to you to urge you to support this important initiative, which represents a landmark in protecting the health of consumers across Europe.

The Tobacco Control Resource Centre
The Tobacco Control Resource Centre (TCRC) is the result of a collaboration between the European Region of the World Health Organisation and the European Forum of Medical Associations, and is supported by the 'Europe Against Cancer' programme of the European Commission. The TCRC supports national medical associations across Europe in their efforts to educate their members, help patients, and inform public policy.

The European tobacco epidemic
Every day, Europe's doctors come face to face with the suffering and death caused by tobacco. In the EU in 1990, more than half a million people died as a result of their tobacco use. Of these, almost half died in middle age and lost, on average, 22 years of life [1]. In addition to the enormous human costs, tobacco places a heavy burden on health services: every year in England alone, around 284 000 admissions to NHS hospitals, 8 million GP consultations and 7 million prescriptions are the result of a smoking-related illness [2].

Tobacco and the European consumer
A responsible industry is expected to act to take all reasonable steps to protect the consumer. Unfortunately, the record shows that the tobacco industry has failed in its responsibilities in this respect. The Commission has a legitimate role in product regulation to protect consumer health, and we believe that regulation of tobacco must reflect the true nature of the risk to the consumer.

Regulation of tobacco products
The aim of any proposed directive should be to correct current regulatory weaknesses that increase the vulnerability of the consumer to tobacco-related harms. In particular, I would like to draw your attention to the need for measures that address the composition of the product.

• Clear limits on tar and carbon monoxide yields. Two major toxic products of tobacco are tar and carbon monoxide. Effective reductions in the yields of these toxins would go some way towards reducing the harmfulness of tobacco products. Clear maximum permissible yields should be established: we support an upper limit of 10 mg for both tar and carbon monoxide.
• Clear limits on nicotine yields. Nicotine addiction is the main motivating factor behind sustained tobacco use. Addiction to nicotine therefore increases the smoker's vulnerability to the harm caused by long-term exposure to tobacco smoke. Effective consumer protection would include a reduction in the addictiveness of tobacco products. To this end, maximum nicotine yields for tobacco products should be established: we would support a maximum yield of 1 mg.
• Accurate independent testing of product yields. In view of the evidence that certain testing systems used by regulatory authorities for ascertaining the levels of tar and nicotine displayed on cigarette packs do not reflect the actual amount absorbed by the consumer [3] it is essential that accurate independent monitoring procedures should be set in place.
• An end to misleading branding and labelling.
  Cigarettes described as low in tar and nicotine were developed in the 1970s by the tobacco industry in an effort to alleviate smoker's health concerns. We would like to see an end to labelling and branding that implies certain cigarettes are healthier. Terms such as 'light', 'mild', and 'ultra-light' are misleading to the consumer, and should be prohibited.
• Disclosure of product composition. More than 600 substances are authorised for use in tobacco products. Additives can be used to modify cigarette smoke to make it more palatable and to increase the dose of nicotine that the smoker receives. The substances added may dilate the airways, increasing exposure to the harmful effects of tobacco smoke inhalation, and may numb the throat, making it easier for novice smokers to persist with experimentation. Full disclosure of the additives used in particular tobacco products, as well as information on their toxicity and biological effects, should be required in the interests of consumer protection.

Manufacturers have a moral and legal duty to ensure that their products are as safe as possible. Unfortunately, despite the scale and nature of the tobacco epidemic, the tobacco industry has mislead the consumer and has failed to co-operate with regulatory authorities. Effective measures are urgently needed. The proposed directive presents an important opportunity for the Commission to protect European consumers from a product that is both uniquely hazardous and readily available.

Yours sincerely

I G Bogle
Chairman of Council
British Medical Association

References

1. Peto R, Lopez AD, Boreham J, Thun M, Heath C. Mortality from Smoking in Developed Countries 1950-2000. Oxford: Oxford University Press, 1994.

2. Godfrey C, Raw M, Sutton M, Edwards H. The smoking epidemic - a prescription for change. London: Health Education Authority, 1993.

3. Kessler DA. The control and manipulation of nicotine in cigarettesTobacco Control 1994;3:362-69.

4. Bates C, Connolly GN, Jarvis M. Tobacco Additives. London: Action on Smoking and Health and The Imperial Cancer Research Fund, 1999.