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Tobacco is a “weapon of mass destruction”. Should western countries be invaded for that?
  1. P Chaturvedi
  1. Department of Surgery, Tata Memorial Hospital, EB Road, Parel, Mumbai 400 012, India;

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    The western tobacco industries, with declining tobacco consumption in parts of the west, are now targeting Asian and eastern European markets intensively.1 This part of world is fast approaching a “tobacco holocaust”. The following staggering statistics call for an urgent action on this weapon of mass destruction.

    (1) Tobacco kills more people than AIDS, alcohol, cocaine, homicide, suicide, motor vehicle crashes, and fires combined. It has already killed 70 million people since 1950. Annual global tobacco related deaths are about 3 million (one third in developing nations) and is expected to rise to more than 10 million by the 2020s.2,3 By 2030, 70% of all deaths due to tobacco will occur in developing nations (presently it is 50%). Tobacco related diseases are responsible for one in 10 adult deaths worldwide.4

    (2) With current patterns, about 500 million people alive in the world today will eventually be killed by tobacco use (nearly a half will be today’s children and teenagers).2 If tobacco control is extremely successful and adult tobacco consumption is cut to half by 2020, there will still be over 250 million people dying of tobacco consumption.

    (3) Seventy percent of Chinese men smoke and, if they do not change their habits, a third of them, now under 30 years (more than 50 million), will eventually die of smoking. Tobacco is predicted to account for 13% of all deaths in India by 2025. In Thailand, 250 million children alive today will eventually die from tobacco if they take up smoking at the present rate.5

    (4) In a developing country with a per capita gross domestic product of $2000, effective tobacco prevention costs approximately $20 to $40 per year of life gained. Lung cancer treatment costs $18 000 per year of life gained.4 For the USA, direct health care costs related to tobacco were estimated in 1980 to be US $16 billion (7% of national health care costs) and indirect mortality and morbidity costs were US $26 billion.

    (5) Approximately five trillion cigarettes (1000/human on earth) are produced annually. In 1999 the tobacco industry spent $8.24 billion a year on marketing. This amounts to $22.5 million a day—nearly $1 million an hour!

    (6) Philip Morris, Japan Tobacco and British American Tobacco, the world’s three largest cigarette companies, now own or lease plants in at least 40 countries each.6 In 1998, they had combined tobacco revenues of more than $88 billion, a sum greater than the total gross national product of Albania, Armenia, Bahrain, Bolivia, Botswana, Bulgaria, Cambodia, Cameroon, Estonia, Guyana, Honduras, Jamaica, Jordan, Laos, Latvia, Madagascar, Moldova, Mongolia, Nepal, Nicaragua, and Togo combined.

    We need an international coalition that could address tobacco issues that cross borders. We also need to create an international coordinating agency to reduce and monitor tobacco consumption. Key areas for action include facilitating international agreements on smuggling control, discussions on tax harmonisation to reduce the incentives for smuggling, and ban on advertising and promotion involving the global communications media.