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Simon Chapman AO

Monthly Archives: December 2022

New Zealand’s gloves-off smoking policies should see smoking fall dramatically

16 Friday Dec 2022

Posted by Simon Chapman AO in Blog

≈ 1 Comment

On December 13, 2022 the Aotearoa (New Zealand) parliament passed amendments to  the Smokefree Environments and Regulated Products (Smoked Tobacco) Amendment Bill,  making three major changes:

  • reducing the amount of nicotine that is allowed in smoked tobacco products
  • decreasing the numbers of retailers that sell tobacco
  • making sure tobacco is not sold at all to anyone born on or after 1 January 2009.

In doing so, Aotearoa -New Zealand vaulted itself into clear international policy leadership in tobacco control policies likely to drive tobacco smoking to near extinction over the next 20-30 years as fewer smokers start, more quit and inevitably, higher smoking caused death rates continue in the fewer remaining smokers.

However, some important questions of implemention remain when the new legislative rubber meets the road of real life.

Reduced retail outlets

The law will see a maximum 600 licensed tobacco retailers by the end of 2023, down from the present 6000.  The thinking here is that many small retailers such as “dairies” (small mixed businesses which often sell tobacco) will stop selling tobacco, reducing access and “spontaneous” purchases. Smokers will need to plan their purchases to align with visits to the fewer outlets which will be selling tobacco.

New Zealand has no floor price on retail tobacco, so price discounting competition still occurs (eg: https://www.discountt.co.nz/Price+List/Cigarettes+Price+List+2022.html) The tobacco industry has long fought tax increases, knowing what higher prices do to sales. In 2011 a CEO of British American Tobacco told an Australian Senate hearing under oath “What I do believe is that . . . if the objective is to reduce consumption then you would move towards areas which have been evidence based not only in this country but in others around the world –…We understand that the price going up when the excise goes up reduces consumption. We saw that last year very effectively with the increase in excise. There was a 25 per cent increase in the excise and we saw the volumes go down by about 10.2 per cent; there was about a 10.2 per cent reduction in the industry last year in Australia. “

In Australia liquor discount chains like Dan Murphy’s  (owned by the Endeavour Group) and First Choice (owned by the Coles Group) have radically changed the face of liquor retailing via both offering massive product range and significant price discounting. My local Dan Murphy’s this morning advertised 24 330ml Peroni beers for $51.99 while one of the few remaining independent liquor outlets in the same suburb had them at $58.99, 13.7% more.

The sheer buying power of major players in effective retail duopolies drives customers away from small retailers who can’t compete. I’ve yet to read a persuasive argument why the same thing won’t happen by concentrating tobacco retailing when not done within the constraints of parallel floor pricing policy.  Someone retuning to Australia today after being away 15-20 years would find it startling how fewer liquor outlets there are in suburbs and towns. But they would not notice any obvious decrease in drinking. Will the same happen with tobacco retailing?

 No sales to anyone born after Jan 1, 2009

This change in the law will mean that with each year that passes, the minimum age at which it will be legal to purchase tobacco products will rise by a year. For example, by January 1, 2040, you will be need to be over 31 to buy cigarettes legally. Penalties will apply to those who sell, not those who buy.

Minimum age for tobacco purchasing of course  has applied in many nations, often for a long time. In Australia it has been illegal to sell tobacco to minors in NSW (1903), South Australia (1904), Queensland (1905), Victoria (1906) and Western Australia (1917).  But these laws have rarely seen retailers who sell to minors prosecuted or prevented from again selling tobacco. In tobacco control circles, to call for the “strict enforcement” of bans on selling tobacco or vapes to minors is to label yourself a very naïve new kid on the block (or a cynical mouthpiece for the vaping and tobacco industries which also routinely call for such enforcement, hand-on-heart).

It is illegal now to sell cigarettes and vapes to those aged under 18, yet smoking remains widespread as the graph below from ASH New Zealand shows. In 2008, one third of New Zealand kids who smoked purchased their cigarettes, with no change in this pattern since 2000.

So why will New Zealand’s 600 tobacco retailers at the end of 2023 behave any differently than the 6000 do today, with illegal sales to kids being common?

However there is a way that tobacco sales could always be conditional on being linked to an official proof-of-age card. The way prescribed drugs are dispensed shows how this could easily happen. No pharmacist would ever think of selling a prescribed drug to a person without a prescription. To do so would see the wrath of both the pharmacy industry and the government end such a pharmacist’s license to practice.

Every antibiotic, every oral contraceptive, every blood pressure medication, every prescribed drug ever sold is always linkable to a prescription with a named individual with a Medicare record including date of birth. This is used by governments to oversee prescribing patterns including doctor shopping by those trying to stockpile drugs for personal or on-selling purposes,

In this 2012 PLoS Med paper and this 18 minute video, I set out in detail how selling tobacco could be very easily be managed through the introduction of simple swipe card (or these days through a phone app) that linked to an official date-of-birth record. We would not simply leave it to an honour system like those utter joke “are you over 18?” self-declaring barriers to entering on-line tobacco and vape shops.

Trace levels of nicotine

In my view, the absolute towering elephant in the room is the effective de-nicotinisation of cigarettes. With reducing nicotine levels to trace (non-addictive) levels, implementation will be easiest. Since 2020, all manufactured loose tobacco and cigarettes have been  imported into New Zealand, with all importers long having been required to provide  government with full details of the nicotine yields (plus all other additives) of each brand being imported and retailed. It is unimaginable that one of the Big Tobacco importing companies would try to falsify this information or import products which did not match the yield data they had provided the government. This would risk their importer rights and be further catastrophic for their already bottom-of-the-barrel business ethics status.

But critically here, cigarettes with insignificant nicotine to satisfy cravings are likely to be experienced as pointless by most smokers and quickly fade from commerce. So this policy has immense potential to see smokers abandon smoking in large numbers, making the above considerations of price discounting and verifying legal age of purchase all “after the event” of smokers turning right off the only cigarettes which will be legally available. If they won’t want to buy nicotine-tepid cigarettes, few will be bothered looking for price-discounted brands. You can’t put lipstick on a pig.

New Zealand will then need to face the challenges of vast numbers of kids who would have never used nicotine in any form were it not for vaping being addicted to nicotine vapes. Those who have trivialised the health risks and sloughed off people puffing on vapourised nicotine, unregulated flavouring chemicals and glycol 500 times a day may have a lot to answer for as the evidence of health risks mounts.

We are all hoping that New Zealand will boot smoking right out of the park, just as we are excited about Australian Health Minister Mark Butler’s Nov 30 announcement of radical reforms to tobacco and vaping policy in Australia (see his speech here -sorry about the amateur camerawork!)

Very happy to publish and information or civil responses relevant to the concerns above.

Who are the researchers in tobacco control with the 100 highest lifetime citation c-scores?

01 Thursday Dec 2022

Posted by Simon Chapman AO in Blog

≈ 1 Comment

[Updated 28 Dec, 2022]

The scientific impact scholar maven John Ioannidis and his team from Stanford University have recently published an update (Ioannidis, John P.A. (2022), “September 2022 data-update for “Updated science-wide author databases of standardized citation indicators””, Mendeley Data, V5, doi: 10.17632/btchxktzyw.5)  of their 2019 massive ranking of the world’s most-cited authors across all scientific fields.

In their 2019 paper , the Ioannidis group used Scopus to analyse the output and citations of authors in 22 scientific fields and 176 subfields. They looked at citation data during the years Jan 1996-Dec 31 2017 for 6,880,389 authors, being the number who had published at least 5 papers. They presented rankings for the top 100,000 authors (in fact 105,026 were listed), some 1.45% of all who had published 5 or more papers across their career. For the 2019 paper, two searchable supplementary excel tables can be downloaded, one for all 22 years (“lifetime” citations) and the other for citations in the single year of 2017.

The 2022 update

The 2022 update includes the same tables updated with citation data contained from Scopus as at September 1, 2022 (and therefore cited in the 26 years 1998-Sept 2022) for 22 fields and 174 subfields. This time there are 194,983 authors listed in the top 2% of all who had published 5 or more papers across all these research fields. That number would therefore be some 9,749,150 authors (with 5 or more papers)

They ranked authors across all scientific fields “based on their ranking of a composite indicator that considers six citation metrics (total citations; Hirsch h-index; co-authorship adjusted Schreiberhm-index; number of citations to papers as single author; number of citations to papers as single or first author; and number of citations to papers as single, first, or last author). They refer to this as the composite or c-score which “focuses on impact (citations) rather than productivity (number of publications) and it also incorporates information on co-authorship and author positions (single, first, last author).”

As I did in this earlier blog published in Nov 2020, using the Ioannidis c-score I have constructed a provisional list of the top 100 ranked authors who have made substantial lifetime research contributions in the tobacco control field.

Most of these publish almost exclusively in the tobacco field, while others publish more widely, beyond their research in tobacco control. Those  who have published extensively on topics other than tobacco control are shown in italics in the table below. The number after each name shows their ranking based on their c-score. The bracketed figure shows show the percentage change in their c-score ranking between the 2019 and 2022 rankings

There is not a tobacco control research sub-field in the Ioannidis data. I therefore had to manually look up individuals’ c-scores. I started by looking up all those who appeared in my 2020 list. I then used published lists of reviewers for Tobacco Control and other names in my contact lists to I look up the rankings of another 55 authors I thought might have scores high enough to get into the top 100. Many highly productive and influential authors I looked for were not shown in the 194,983 highest ranked authors. Many of these are younger people who are very likely to appear in the list as those with declining citations fall out of it.

If you believe there are authors who should be in this list but are not, please contact me (or better, look them up in the tables here and let me know their scores).

Several things stand out for me in the names that appear below:

  • the huge male dominance (23% are women)
  • an even greater dominance of anglophone authors 90% (USA 65,  UK 13,  Australia  7, New Zealand 3, Canada 2)
  • most of those on the list are older authors, reflecting their aggregated outputs across the 26 years of citation data
  • 37 authors increased their c-scores, with far more reducing theirs

RESEARCHERS IN TOBACCO CONTROL WITH  THE 100 HIGHEST LIFETIME C-SCORES

  1. Neal Benowitz (USA) 344 (+3)
  2. Richard Peto (UK) 443 (-41)
  3. Carlo La Vecchia (Ita) 499 (-12)
  4. Michael Thun (USA) 673 (-69)
  5. Richard Doll* (UK) 929 (-4)
  6. Stephen Hecht (USA) 1044 (-27)
  7. Jon Samet (USA) 1320 (+17)
  8. Jim Prochaska (USA) 1735 (-40)
  9. Saul Shiffman (USA) 1767 (+0.4)
  10. Wayne Hall (Aus) 1885 (-5)
  11. John Hughes (USA) 1886 (+29)
  12. Robert West (UK) 2858 (+31)
  13. Susan Michie (UK) 3685 (+35)
  14. Wayne Velicer* (USA) 4617 (+22)
  15. Stan Glantz (USA) 6050 (-0.8)
  16. Ernst Wynder* (USA) 7140 (-24)
  17. James Pankow (USA) 7228 (-17)
  18. Ross Brownson (USA) 7378 (+10)
  19. John Pierce (USA) 8423 (-20)
  20. Michael Fiore (USA) 8691 (-32)
  21. Karl Fagerstrom (Sweden) 9234 (+71)
  22. Carlo DiClemente (USA) 9510 (-0.4)
  23. Judith Ockene (USA) 9700 (-45)
  24. Srinath Reddy (Ind) 9948 (+36)
  25. Meredith Minkler (USA) 10523 (+40)
  26. Lisa Bero (USA) 10971 (+4)
  27. Jean-Francois Etter (Swi) 12316 (+6)
  28. Nancy Rigotti (USA) 12397 (-8)
  29. Marina Picciotto (USA) 12414 (-17)
  30. Marcus Munafò (UK) 13212
  31. Robert Beaglehole (NZ) 13484 (-22)
  32. Ray Niaura (USA) 15820 (-15)
  33. John Britton (UK) 16,181 (-23)
  34. Frank Chaloupka (USA) 16292 (+14)
  35. David Hammond (Can) 16365 (+41)
  36. Ruth Bonita (NZ) 16452 (-16)
  37. Ron Borland (Aus) 16754 (+5)
  38. Gil Botvin (USA) 16777 (-31)
  39. Simon Chapman (Aus) 16808 (-6)
  40. Steve Tiffany (USA) 16952 (-33)
  41. David Abrams (USA) 16953 (-13)
  42. Caryn Lerman (USA) 17411 (-89)
  43. Martin Jarvis (UK) 17828 (-19)
  44. Cheryl Perry (USA) 17657 (-18)
  45. Ken Warner (USA) 19439 (-10)
  46. Tony Biglan (USA) 19472 (-0.01)
  47. Jodi Prochaska (USA) 20431 (+26)
  48. Mike Cummings (USA) 21501 (-2)
  49. Jennifer Unger (USA) 21881 (+16)
  50. Steve Sussman (USA) 22062 (+5)
  51. Rob Sanson-Fisher (Aus) 23960 (-7)
  52. Gary Giovino (USA) 23923 (-21)
  53. Sue Curry (USA) 24700 (+2)
  54. Emily Banks (Aus) 25853 (+54)
  55. Konrad Jamrozik* (Aus) 24748 (-19)
  56. Wasim Maziak (USA) 27248 (+18)
  57. Robin Mermelstein (USA) 27503 (+1)
  58. Prahbat Jha (Can) 27508 (+22)
  59. Prakash Gupta (Ind) 28230 (-18)
  60. Lynn Kozlowski (USA) 28533 (-0.5)
  61. Riccardo Polosa (Ita) 29278 (+0.1)
  62. TH Lam (HK) 30263 (+0.01)
  63. Steve Schroeder (USA) 30931 (-32)
  64. Mark Nichter (USA) 31011 (+8)
  65. Tom Eissenberg (USA) 31707 (+11)
  66. Hein de Vries (Nld) 33466 (-5)
  67. Karen Emmons (USA) 33607 (-29)
  68. Dorothy Hatsukami (USA) 33809 (-11)
  69. Jack Henningfield (USA) 34723 (-147)
  70. Tracy Orleans (USA) 34790 (-54)
  71. Ovide Pomerleau (USA) 35955 (-48)
  72. James Sargent (USA) 36325 (+17)
  73. Paula Lantz (USA) 36387 (-10)
  74. Mohammad Siahpush (USA) 36523 (+0.5)
  75. Peter Hajek (UK) 37143 (+16)
  76. Joe DiFranza (USA) 37246 (-20)
  77. Michael Russell* (UK) 37437 (-38)
  78. Ellen Gritz (USA) 38835 (-25)
  79. Gary Swan (USA) 38847 (-61)
  80. Tim Baker (USA) 38741 (-0.8)
  81. Tim Lancaster (UK) 39068 (-2)
  82. Ann McNeill (UK) 39099 (+5)
  83. Robert Klesges (USA) 40562 (-44)
  84. Derek Yach (USA) 41874 (+20)
  85. Richard Hurt (USA) 43170 (-44)
  86. David Balfour (UK) 44092 (-19)
  87. Maxine Stitzer (USA) 44627 (-28)
  88. Michael Siegel (USA) 46259 (-6)
  89. Melanie Wakefield (Aus) 47231 (-11)
  90. Tony Blakely (Aus) 47753 (+14)
  91. Hu, Teh Wei* (USA) 47806 (-5)
  92. Robert Jackler (USA) 49015 (-23)
  93. Gerard Hastings (UK) 49682 (+16)
  94. David Levy (USA) 50203 (+10)
  95. Scott Tomar (USA) 52527 (-15)
  96. William Corrigall (USA) 54676 (-48)
  97. Paul Aveyard (UK) 55363 (+18)
  98. Ruth Malone (USA) 58425 (-2)
  99. Alastair Woodward (NZ) 60704 (+6)
  100. Lois Biener (USA) 62227 (-25)

*= deceased

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