Kill the tobacco industry, or it will keep killing

This month in Rio de Janeiro, the global tobacco industry's annual conference features a special session on what many are seeing as its Armageddon: plain, generic packaging. All packs are identical except for the brand name, printed in standard font. No colours, no logos, no box variations. Nothing but the brand and the health warning.

The British Government has released a consultation paper on the idea. Morgan Stanley advised its clients recently that "homogenous packaging" would "significantly restrict the industry's ability to promote their products". Tobacco Journal International, the industry's main trade journal, had as its latest cover story a warning: "Plain packaging can kill your business." That's the whole idea, ladies and gentlemen.

The World Health Organisation's Framework Convention on Tobacco Control, now ratified by 160 nations, is rapidly accelerating a long overdue regulation of the tobacco industry. Plain packaging has not happened in any nation yet, but the race is on. Here is why it is the most important next step in reducing Australia's leading cause of death.

When you take a doctor's prescription to a pharmacy for a drug designed to prolong life, relieve pain or symptoms or in some way promote health, radically different things happen than when you buy a packet of cigarettes.

First, the pharmaceutical company making the drug will have spent a small fortune trialling it to see if it does what it is meant to do - such as act as an effective contraceptive or lower blood pressure - and that it does not cause adverse reactions that are so severe as to radically alter the cost-benefit ratio of the drug (for example, chemotherapy for cancer often causes nausea but may prolong life).

Tobacco companies, by contrast, have to meet no standards for their products and can add any legal substance that will, for example, get nicotine to your brain faster or mask the astringent, choking sensation of smoke. While Philip Morris once withdrew its salmonella-contaminated Kraft peanut butter from shops because it might have harmed customers, it is relaxed and comfortable about half of its best customers dying from using its tobacco products in the intended way.

Next, your prescription will be made up by a pharmacist with a minimum four-year university degree, while your cigarettes will be handed to you by someone who may have left school at 15. You will get a limited supply from the pharmacist and have to go back to your doctor if you want a repeat prescription.

With cigarettes, you can buy as many as you like. If a pharmacist supplied drugs to someone without a prescription, they would be fined, perhaps jailed and almost certainly struck off the register. If a store supplies cigarettes to a child, hell would freeze over before they were caught or any serious action taken n the pharmacy, prescribed drugs are not on open display but stored in the dispensary. Until now, cigarettes have been on open display, sending the message that they are profoundly ordinary products, no different from sweets, soft drinks and groceries.

Verity Firth, when she was the minister for cancer, prepared a raft of reforms that will have their final reading in State Parliament on Friday. The most important "denormalising" proposal will see all tobacco products stored out of site, as occurs in Canada, Thailand and Iceland.

The final difference between tobacco and prescribed drugs is packaging. When you pick up your next prescription, check out the plain, dull box. It is not designed to express the product's "personality" or to confer prestige or some other desirable attribute in the user. It simply states the drug's name, dosage and any contraindications. Tobacco products, by contrast, are the result of ongoing market testing to ensure they are as attractive and beguiling as possible, particularly to what the industry euphemistically calls "starters" or "young adult smokers".

Research released this week by Professor Melanie Wakefield, from the Cancer Council Victoria, shows how smokers feel about plain packaged cigarettes. When shown regular packaged brands and the dull, generic packs, the 813 smokers rated the dull packs as much less attractive and popular, and those who would smoke them as much less stylish, outgoing and mature than smokers of the original pack. They inferred that cigarettes from the plain packs would be less satisfying and of lower quality.

The federal Health Minister, Nicola Roxon, has repeatedly put prevention front and centre of national health policy. By making Australia lead the world - by taking a step that the history of tobacco control suggests is inevitable - she could start global dominoes tumbling, and save millions of lives. If the tobacco industry thinks plain packaging will kill its business, no stronger recommendation is available.

http://www.usyd.edu.au/