Tobacco control in Canada and Australia

Michael Blaese (US Institutes of Health) and National Peter Stambrook (University of in New Delhi UICC cancer Cincinnati), provides an example of It would have been easy to come standing of tumour biology, but the bystander effect. TK phosphoryaway pessimistic from the sixteenth because of more sophistication and lates the antivirals acyclovir and ganUICC (International Union against coordination in chemotherapy, radiociclovir; the triphosphate is cytotoxic. The introduction of HSV-TK sensiin New and conference he said. Cancer) therapy, surgery", By tises cells to these drugs. In the Oct 30 to Nov 5. A theme was cancer 2000, he thought, two-thirds of cancers would be preventable, two of bystander effect, neighbouring cells in the developing world, where hightech diagnosis and management of three cases would be curable, and are sensitised, possibly by gap junccancer is of practically no relevance palliation in the remainder would be tions allowing the transfer of small : molecules between cells. Delivery to the poor. : effective. In gene therapy, DNA synthesis is ’. limits the application of gene theapy. Prafulla Desai (Tata Memorial! Centre and Secretary-General for the required for integration of the altered Could the bystander effect be harconference) attributed failure in can- gene, so dividing tumour cells are a nessed in isolated lesions such as cer to large tumour burdens, inadebrain tumours? Blaese described antitarget for restoration of tumour suptumour responses in 8 of 15 such quate facilities for diagnosis and pressor genes, antagonism of oncotreatment, and incomplete undergene or growth-factor patients after stereotactic injection of of and introductumour and host of induction standing biology apoptosis, the HSV-TK system followed by tion of changes in tumour metaboresponses. By contrast, "The increasganciclovir. ing cure rates in childhood cancer lism. The herpes-simpex-virus (HSV) That an epidemiological relation occurred regardless of our under- thymidine-kinase (TK) system, disdoes not equal cause and effect underlines the debate about diet and cancer. A low-fat diet has been linked Tobacco control in Canada and Australia to a decreased frequency of breast cancer in post-menopausal women, No slngte factor will reduce the incidence of cancer more than the control of tobacco but cohort and case-control designs (with beneficial spin-offs. in other smoking-related diseases). Education and cessation : have inadequacies. In intervention programmes remain important, but control of the tobacco industry, of the product and its availability, and protection of the non-smoker are additional aims of the studies, sample size needs to be large the In several this is to countries, antismoking lobby. lobby powerful enough put : and duration of study long, which "In on said Ken the defensive. we are the Canada, establishment’, industry now Kyle means that cost is important. Russ of the UICC’s North America Tobacco and Cancer Programme. "’Education is not : Prentice (Fred Hutchinson Cancer : Research enough to change attitudes to starting or stopping use of tobacco. What is Center) described the : a to tobacco." is to control comprehensive necessary package According Kyle, Women’s Health Initiative, a large collaboration between health and advocacy groups was the key to their results to US study on the effect of dietary fat o’6te, which is a reason that the antismoking lobby has been fragmented and not so : successful in other countries, including the UK. The achievements include a ban on : replacement on breast and colon cancer. It has two non-cancer arms, with tobacco advertising, large and stringent health warnings on cigarette packs (figure; : a 9-year mean follow-up. The low-fat the French translates as "Cigarettes are addictive"), minimum pack sizes of 20 (to arm includes other dietary changes, 1 can kill you discourage "kiddie"-pack buyers), and noso a positive association will not be smoking in many public areas (Air Canada easy to interpret. Prentice concluded crée une flights included). The next plan in Canada is : that La full-scale intervention trials generic and plain packaging: one dull colour, should be restricted to those with the a prominent health warning, and one font for all brand names. The Canadian programme ; greatest public-health implications. on when tax raised a as a setback earlier this Anthony McMichael (London School received year cigarettes, previously : of Hygiene and Tropical Medicine) control measure, had to be lowered (see lancet 1994; 343: 470). The tobacco warned about the pitfalls of dietary industry in Canada had been legally exporting cigarettes to the US, which is strange, said Kyle, because the Canadian brands were not liked there. Then the packs entered trials. Exposures are complex, diffi: cult to measure, and the black market and were smuggled back across the border to undercut the highperhaps lifetaxed price. mechanisms are long, probably Tobacco smuggling is on the international agenda for governments, whose tobacco factor have a indirect, may any one tax policies are undermined by it, and for the tobacco industry who say, roundabout, : are and effects effect, likely that the solution is to reduce taxes. Luk Joossens from the European Bureau for : marginal to between differ Action on Smoking Prevention, Brussels, pointed out that smuggling in Europe populations. : involved the importation of international brands to northern ports (Antwerp was a : Those leaving New Delhi with a : bleak view about progress in cancer favourite) rather than the movement of, say, Spanish national brands, which are "The for this cheap. industry is morally responsible smuggling", says Joossens. "They research probably arrived there with should control their stock more securely." : expectations that were too high. Nigel Gray, just elected as president of the UICC and a long-term campaigner in : UICC convenes again in this large Victoria, Australia, described how tobacco-control measures in Australia had reduced format in Rio de Janeiro in 1998. If the prevalence of smoking to 25% from 72% in men in 1945. Some groups showed : with less spectacular results (eg, the under-employed). Projected falls in lung-cancer optimism. : you attend, go CONFERENCE

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mortality had started. "The tobacco industry is struggling to keep the milligram of nicotine per cigarette, whichI infer is the minimum addictive dose", said Gray.

: David McNamee

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