Facing Down the Enemy: Be Tough on Tobacco!

Volume 18, Number 3, European Edition - March 2013

Facing Down the Enemy: Be Tough on Tobacco!

Thierry Le Chevalier,a Mark Lawlerb

aInstitut Gustave-Roussy, Villejuif, France; bSchool of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Northern Ireland

Disclosures of potential conflicts of interest may be found at the end of this article.

On 29th March 2004, Ireland became the first country in the world to introduce a comprehensive nationwide smoking ban in the workplace. At the time, it was regarded as a high-risk political strategy, as the Irish Minister of Health faced down vested interest in the tobacco and vintner industries. In the days and months leading up to the introduction of the legislation, many commentators opined that it would not be adhered to, but the intervening 9 years have proven them wrong, as this action became the catalyst for a major global public health initiative, with many countries following Ireland's lead, culminating in the recent introduction of a smoking ban in Guangzhou in China.

Mirroring the adoption of these smoking bans, the World Health Organization (WHO) negotiated the treaty on the Framework Convention for Tobacco Control (FCTC), which was ratified and brought into force in 2005. The key objective of this Convention is “to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke by providing a framework for tobacco control measures to be implemented at the national, regional and international levels in order to reduce continually and substantially the prevalence of tobacco use and exposure to tobacco smoke” [1]. The current membership of the FCTC encompasses 176 nations, representing nearly 90% of the world's population.

But what has been the health benefit of this smoking ban and other tobacco control policies? A recent study has evaluated the relative contribution of policies implemented in Ireland during the period 1998–2010 on smoking cessation and reducing smoking attributable deaths (SAD) [2]. The results are significant, indicating a relative reduction in smoking prevalence of 22%, allied to 1,716 fewer SADs. The dynamic simulation model predicts that this will lead to a 29% relative reduction and 50,215 fewer SADs by 2040. Ireland has continued to introduce public health policies that challenge smoking practices, including stronger tobacco advertising rules (2011) and a partial ban on smoking in public playgrounds (2012). If these stricter FCTC-consistent policies are actively pursued, an even greater effect on smoking cessation and the reduction in SADs will be seen over the next 30 years.

In the UK, smoking prevalence approached 30% by the late 1990s. This prompted the development of smoking cessation treatment programs and the introduction of a smoking ban in the workplace. A recent evaluation of control policies in the UK showed results comparable to Ireland's, with a relative reduction of 23% in smoking rates in the period 1998–2009 and a projected 240,000 lives saved by 2040 [3]. Implementing FCTC policies in the UK, as outlined above, will further encourage smoking cessation and lead to a concomitant decrease in the number of SADs by 2040. Data from other European countries [4,5,6,7] indicate similar trends, with a reduction in smoking prevalence and associated premature mortality. In 2010, The Tobacco Act came into law in Finland, limiting the marketing and supply of tobacco products and enshrining in law the aspiration to make Finland tobacco free by 2040 [8].

These studies demonstrate that strict public health policies in relation to tobacco pricing, a smoke-free workplace, advertising restrictions, and smoking cessation treatment programs can significantly reduce smoking prevalence and prolong people's lives. However, at last October's European Society for Medical Oncology (ESMO) congress in Vienna, it was extremely disappointing to find that in bars and restaurants over 50% of the seating area is devoted to smokers, ensuring that nonsmokers have to endure smoke-filled air, no matter where they are seated. Given that one of the key highlights of the ESMO congress was the impressive results of drugs like crizotinib in ALK-positive lung cancer [9], as highlighted recently by European Perspectives [10] and discussed in detail in the recent seminal article in The Oncologist [11], it was painfully ironic that the announcement of a new potential standard of care in lung cancer was made in a European country that has decided not to pursue a strict tobacco control policy. Emphasising the challenge that the oncology community in Europe faces, a recent referendum in Switzerland defeated the proposal to introduce a complete smoking ban in the workplace by almost 2:1, aided in part by a Swiss Business Federation-orchestrated public campaign.

Given the challenges that Europe and its citizens face in this area, European Perspectives last month launched “Lung Cancer, from Prevention to Cure” as one of its key themes. This series will feature a number of critical commentaries and opinion pieces, supplemented by authoritative video/audio interviews by acknowledged leaders in the field. In the current issue, Luke Clancy emphasises the importance of adopting strong measures to curtail tobacco use in Europe, while Rolf Stahel outlines a pan-European approach for identifying biomarkers that can help underpin a stratified medicine approach for the treatment of this deadly disease.


The authors indicated no financial relationships.


1. Framework Convention Alliance. Available at Accessed March 1, 2013.

2. Currie LM, Blackman K, Clancy L, et al. The effect of tobacco control policies on smoking prevalence and smoking-attributable deaths in Ireland using the Ireland SS simulation model. Tob Control 2012 [Epub ahead of print].

3. Levy DT, Currie L, Clancy L. Tobacco control policy in the UK: Blueprint for the rest of Europe? Eur J Public Health 2012 [Epub ahead of print].

4. Levy DT, Blackman K, Currie LM et al. Germany SimSmoke: The effect of tobacco control policies on future smoking prevalence and smoking-attributable deaths in Germany. Nicotine Tob Res 2013;15:465–473.

5. Levy D, Gallus S, Blackman K et al. Italy SimSmoke: The effect of tobacco control policies on smoking prevalence and smoking attributable deaths in Italy. BMC Public Health 2012;12:709.

6. Nagelhout GE, Levy DT, Blackman K et al. The effect of tobacco control policies on smoking prevalence and smoking-attributable deaths. Findings from the Netherlands SimSmoke Tobacco Control Policy Simulation Model. Addiction 2012;107:407–416.

7. Levy DT, Blackman K, Currie LM et al. SimSmokeFinn: How far can tobacco control policies move Finland toward tobacco-free 2040 goals? Scand J Public Health 2012;40:544–552.

8. Savuton Suomi 2040. Available at Accessed March 1, 2013.

9. Shaw A. Phase III randomized study of crizotinib versus pemetrexed or docetaxel chemotherapy in advanced, ALK-positive non-small cell lung cancer (NSCLC). Abstract LBA1 presented at: European Society of Medical Oncology Congress; October 2012;Vienna, Austria.

10. Soria J-C, Lawler M. Targeted therapy in lung cancer: Are we approaching a new standard of care? The Oncologist European edition 2013;18:xxix–xxxii.

11. Ou SH, Bartlett CH, Mino-Kenudson M et al. Crizotinib for the treatment of ALK-rearranged non-small cell lung cancer: A success story to usher in the second decade of molecular targeted therapy in oncology.

Correspondence: Thierry Le Chevalier, MD, 39 Rue Camille Desmouline, Villejuif Cedex, France, 94805. Telephone: 33-1-445-943-22; Fax: 33-1-445-943-22; e-mail:   Received February 25, 2013; accepted for publication March 7, 2013. ©AlphaMed Press 1083-7159/2013/$20.00/0