1. Agust n Montesa,
2. Joan R Villalb b

1. aFacultade de Medicina e Odontolox a, Universidade de Santiago de Compostela, bInstitut Municipal de Salut P blica, Ajuntament de Barcelona, Barcelona, Spain

1. Joan R Villalb , Institut Municipal de Salut P blica, Pl Lesseps 1, 08023 Barcelona, Spainjrvillal at

• Received 18 October 2000
• Revised 9 January 2001
• Accepted 18 January 2001

Next Section Abstract

BACKGROUND A major factor influencing tobacco use is its price. Fiscal policies on tobacco are a key ingredient of any comprehensive control strategy, as they can be used to raise prices. The European Union (EU) developed directives to ensure some harmonisation of the fiscal pressure on tobacco across its member states.

OBJECTIVES To provide a simple comparison of tobacco prices in the EU, adjusting for the purchasing power of each currency.

DESIGN For price comparisons, a 20 units pack of Marlboro was the reference product, and data refer to April 2000. Purchasing power parities (PPP) for each member state currency have been compiled. These are currency conversion rates, which convert to a common currency and equalise the purchasing power of different currencies.

MAIN OUTCOME MEASURES Nominal prices of a Marlboro pack for each member state, and a price index, estimated taking as reference the EU mean. Adjusted prices and an adjusted price index have been estimated using PPP.

RESULTS Nominal prices show wide variation, with the cheapest pack in Portugal (59) and the most expensive in the UK (196) the range of variation is three fold. However, PPP adjusted prices reveal a different distribution. In three countries adjusted prices are outliers, but all other countries make two clusters, one around the average EU index of 100, the other around a lower value of 85.

CONCLUSIONS These results suggest that fiscal harmonisation policies in the EU do not have an even effect at reducing availability by its impact in price.

• cigarette price
• fiscal policy
• health policy
• European Union.

A major factor influencing tobacco use is its price fiscal policies on tobacco are a key ingredient of any comprehensive control strategy, as they can be used to raise prices besides providing governments with revenue.1 3 The European Union (EU) developed common directives to ensure certain levels of harmonisation of the fiscal pressure on tobacco across its member states, the most relevant being the council directive 92/79/EEC of 19 October 1992 on the approximation of taxes on cigarettes (with minor amendments since its approval).4 While essentially a fiscal policy directive, it is very relevant to smoking prevention, and its effect in decreasing smoking has been documented.5

Tobacco price has several components. The tobacco control movement has attempted to influence governments into raising prices though taxation. However, given that countries differ in economic conditions as well as in other major factors related to tobacco trade, direct comparisons may be misleading. This paper attempts to provide a simple comparison of tobacco prices in the EU, adjusting for the purchasing power of each currency. The interest for such an adjustment originates from the fact that a basic consumption basket differs in price across countries. For example, one unit of Spanish currency affords less consumption in the UK than in Spain in these circumstances, it is necessary to adjust for differences to compare the cost of a pack of cigarettes in terms of foregone consumption of the rest of goods.

Previous SectionNext Section Methods

For price comparisons, a 20 units pack of Marlboro was the reference product. Data on prices in EU member states were provided by the Spanish Tax Agency for April 2000. A price index has been estimated, taking as reference the EU mean (100). Purchasing power parities (PPP) for each member state currency have been compiled from the Organization for Economic Cooperation and Development (OECD) report on comparative price levels in February 2000, available from the web.6 These PPP are in fact currency conversion rates which both convert to a common currency and equalise the purchasing power of different currencies. In other words, PPP adjust the differences in price levels between countries in the process of conversion. Using PPP, adjusted prices of a Marlboro pack for each member state as well as an EU mean have been estimated. An adjusted price index has also been estimated for each.

Previous SectionNext Section Results

Results are presented in table 1. Nominal prices show wide variation, with the cheapest pack in Portugal (59) and the most expensive in the UK (196) the range of variation is three fold. However, the PPP adjusted prices reveal two features which deserve comment in a global distribution with a bimodal pattern.

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Table 1

Price and price adjusted to purchasing power parities (PPP) (in Euros) of a 20 unit pack of Marlboro cigarettes by member state. European Union, April 2000

There are three countries whose adjusted prices are outliers when related to the rest Luxembourg, with a very low adjusted price index (68) and Ireland and the UK with a high adjusted price index (155 and 168).

All other countries make two clusters, one around the average EU index of 100, the other around a lower value of 85. The Netherlands, Greece, Portugal, Germany, Spain, and Austria, ranging from 81 92, are a cluster of countries with lower adjusted price index. On the other side, France, Belgium, Finland, Italy, Denmark, and Sweden cluster around the EU average.

Previous SectionNext Section Discussion

The crude and adjusted results of this comparison are useful to have a clearer vision of actual prices in the EU. A few years ago, the Big Mac index of cigarette affordability was suggested for comparisons in this journal.7 Although intuitive, it is not easy to build, and is subject to other variations. On the other side, the OECD and the EU fiscal authorities collect routinely the data to provide crude and adjusted comparisons of cigarette affordability.

These results suggest that fiscal harmonisation policies in the EU do not have an even effect at reducing affordability by having an impact on price. Besides, many countries have local and popular cigarette brands, which may be much cheaper than Marlboro. The EU fiscal policy has been built around the concept of the most popular brand (which for instance in Spain has evolved from Ducadosto the more expensive Fortuna). While comparisons based on the most popular brand are useful to check tobacco availability in each country, the actual policy component is obscured by other factors. Marlboro is the most widely sold brand in the EU, takes a major portion of the market in each country, and thus comparisons based on this brand are more readily understandable.

The policy relevance of this issue is clear. From a preventive position it is desirable that the cost of tobacco products is high and even across the EU. The fact that prices are much lower in some countries implies that availability is higher. Another relevant issue is smuggling, which acts by weakening the fiscal component of tobacco control policies and offering a cheaper brand. The crucial role of smuggling has been discussed recently.8 The tobacco industry has often used the argument that higher taxes lead to smuggling, in order to weaken taxation policies. However, ev
idence points to smuggling being linked to a weak state rather than to price.9 What this paper adds

The tobacco control movement has advocated fiscal policies to decrease smoking. International comparisons of tobacco affordability are difficult, because of the variety of cigarette brands, diverse economic conditions, and other major factors related to tobacco trade. The comparison of tobacco prices in the EU shows that nominal prices of a single and popular cigarette brand (Marlboro) display a wide range of variation. Prices adjusted by purchasing power parities reveal a different distribution, with three countries behaving as outliers while all others converge in two clusters, one around the average EU index of 100, the other around a lower value of 85.

It is noteworthy that adjusted prices actually converge in two clusters, with three outliers. It would be desirable to have them converge around the EU average. This could be obtained by ensuring higher prices in Luxembourg, and in those countries with prices around 85% of the EU average. However, the higher price in Ireland and the UK shows a lower level of availability which may be maintained.

Previous SectionNext Section Acknowledgments

The authors gratefully acknowledge the invaluable comments of Professor Angel L pez Nicol s (Universitat Pompeu Fabra, Barcelona) to an earlier version of this manuscript, which helped them to improve it.

Previous Section References

1. 1. Jha P

   (1999) Curbing the epidemic. Governments and the economics of tobacco control. (The World Bank, Washington). Search Google Scholar

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   (1998) Reactions of adult and teenaged smokers to the Massachusetts tobacco tax. Am J Public Health 88 1389 1391. Medline Web of Science

3. 1. Townsend J

   (1996) Price and consumption of tobacco. Br Med Bull 52 132 142. Abstract/FREE Full text

4. European Union. Council directive 92/79/EEC.
5. 1. Bosanquet N,
   2. Magee J

   (1999) Adolescents and smoking evidence from France and Spain. J Adolesc 22 601 605. CrossRef Medline Web of Science

6. Organisation for Economic Cooperation and Development.
7. 1. Scollo M

   (1996) The Big Mac index of cigarette affordability. Tobacco Control 5 69. Search Google Scholar

8. 1. Joosens L,
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   (1998) Cigarette smuggling in Europe who really benefits? Tobacco Control 88 1389 1391. Search Google Scholar

9. 1. Joosens L,
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   (2000) How can cigarette smuggling be reduced? BMJ 321 947 950. FREE Full text

European parliament workshop on electronic cigarettes 7 may 2013

Camel natural flavor 8 cigarettes
Posted on May 3, 2013 by admin

Another very interesting week in Politicoville

While the ENVI Committee has arranged its workshop for 7th May with a distinctly biased panel of experts , neatly lined up to make a case for the reclassification of electronic cigarettes as medicinal products, effectively banning them and removing them from the millions of EU citizens who are already vaping instead of smoking (not to mention the many more millions who would not have the option to even try them), the JURI Committee the Legal Affairs team has published its Draft Opinion. And guess what?

There is no legal basis for reclassifying electronic cigarettes as medicinal products, and no legal or moral justification for restricting access to products demonstrably far less harmful than smoking tobacco.

The workshop agenda reads like a who s who (WHO?) of zealous ANTZ whose single minded aim is the utter destruction of the tobacco industry, to be achieved by denormalising (and dehumanising) smokers. Heaven forbid that smokers should be offered products that are a demonstrably attractive, appealing and far, far less dangerous alternative. No, say the ANTZ. They will still look like they re smoking, and they ll be enjoying themselves, and that doesn t fit with our plans at all!

Following an intro by the ENVI Rapporteur, Linda McAvan MEP, and a position statement from the European Commission, the line up includes

Roberto Bertollini, Chief Scientist and WHO Representative to the European Union allocated 15 minutes to speak.

Biography

Dr Roberto Bertollini holds a degree in medicine and a postgraduate degree in paediatrics, as well as a master s degree in public health from the Johns Hopkins University, United States of America. In addition to his position as WHO Representative to the European Union, Dr Bertollini is Chief Scientist with the specific task of supporting the Regional Director s Office with the scientific evidence that underpins WHO health policies and strategies.

From 2007 to 2010, he was coordinator of evidence and policy for the environment and health at WHO headquarters, from 2000 to 2007 he was a technical director at WHO/Europe, and from 1993 to 2000, he was the founding director of the WHO European Centre for Environment and Health in Rome, Italy.

His main professional interests concern the environmental influences on health, with special reference to the effects of emerging threats such as climate change as well as the use of epidemiology for public health policy development and the evaluation of public health programmes and practices.

I am sure that Dr Bertollini is a dedicated professional, with the very best of intentions, but since his job is to deliver the WHO s position, his contribution to this workshop is unlikely to be helpful concerning electronic cigarettes. (The WHO s position was set out in no uncertain terms here.)

This will be followed by 40 minutes from various medicines regulators. Yes, that s right medicines regulators for 40 minutes. I wonder if anyone can guess what their perspective on this issue is likely to be?

Well, the first of these is Jeremy Mean from the MHRA. (I don t think he likes me very much.) In February 2010, the MHRA s position was that electronic cigarettes are dangerous (wrong) unregulated (untrue) products which ought to be removed from the market immediately (within 21 days), or be given one year to get a marketing authorisation (impossible), or left alone (but this last option was worded in such a way as to be a non option ).

(The MHRA Public Consultation MLX364 can be found here.)

The Regulatory Policy Committee gave MLX364 a resounding thumbs down in June 2010.

The MHRA s report of the outcome of this public consultation included the following detail on work it would be carrying out

The programme of research will include a work stream on investigation of the levels of nicotine which have a significant pharmacological effect, the actual use of existing nicotine products in the marketplace, their effect on smoking cessation and modelling of the potential impact of bringing these products into medicines regulation on public health outcomes. We envisage the programme of research will take about 18 months to complete and that a final decision on the regulation of nicotine containing products will be made in Spring 2013.

Well Spring has sprung, the grass is riz, I wonder where the evidence is? Perhaps we shall find out on Tuesday .

The other medicines regulators are from Germany where two court cases have been fought and lost by Health Ministries in two of the Bundesl nder, and Finland, whose National Institute for Health and Welfare had this to say in February last year

According to the reliable research available, electronic cigarettes contain the same components that endanger health as conventional cigarettes, some that even cause cancer, says the Director General of THL, Pekka Puska. The long term effects on the functioning of the respiratory organs are not well known. Research has also shown that the quality of the liquids used in electronic cigarettes varies greatly, and that the product descriptions do not always match the real contents.

FIOH urges workplaces to treat the smoking of electronic cigarettes in the same way as that of real cigarettes. A non smoking workplace is the most advisable solution, says Harri Vainio, Director General of FIOH.

(How they have the audacity to describe what fed into this position as reliable research is beyond me!)

So it is unlikely at best that any of these presenters will have anything useful to contribute to this workshop, which is supposed to be providing information for MEPs so that they can make informed decisions in the legislative process.

Part 3 of the bill of fare for this workshop is entitled Scientific information clinical and research findings , and who is topping the list? Oh dear, oh dear the European Respiratory Society. Many of you will remember the outrageous behaviour of Professor Christina Gratziou in dramatically misrepresenting her research findings to the press, leading to dangerously misleading headlines in the papers such as Electronic cigarettes could damage your lungs as they cause less oxygen to be absorbed by the blood not even remotely borne out by the (as yet unpublished) study referred to. (For more on this, see our blog post here.)

This has severely damaged the European Respiratory Society s credibility, particularly with regard to electronic cigarettes! Mercifully, it is not Professor Gratziou who will be presenting, but Professor Francesco Blasi.

Does Professor Blasi take a more enlightened, public health focussed approach? Judge for yourselves

at present, we have no certain figures to say if e cigs are good or bad for your health , although they can have an incidence on young people , giving rise to a new lifestyle and vicious circle of emulation and addiction.

So that s a no then.

Next up is Dr Charlotta Pisinger, Senior research fellow at Research Centre for Prevention and Health, Copenhagen. Surely she will want to promote harm reduction strategies for smokers?

There is no control of the e cigarette and some of them have been found contamination with very harmful / toxic substances. In addition, you have no idea what effect inhaling fumes all day, for perhaps years, has on the lungs. With e cigarette consumed in everyday life, will be smoking again normalized, which affects the social norm. One can assume that it will thus inspire children to start smoking or smoke vapor cigarettes. And it’s really a bad thing, she says.

So that s another no , then.

The final speaker in this section of the workshop is Jean Fran ois Etter, whose presentation is entitled Understanding nicotine addiction .

Many of you will have read Dr Etter s book (as have I), The Electronic Cigarette an Alternative to Tobacco? (If you haven t done so yet, I
can highly recommend it.) On the whole, Dr Etter has spoken a great deal of good sense on the subject of electronic cigarettes. Furthermore, he has made a significant and very useful contribution to the scientific evidence base with two published papers (here and here).

However, there is a possibly unavoidable bias in favour of some kind of light touch medicinal regulation for electronic cigarettes. It often feels as if these eminent professionals are incapable of recognising any value to any kind of regulation unless it is medicines regulation despite the well publicised and frequent failings. (See Chantix, Seroxat, MHRA dereliction of duty, Avandia, Device regulation scandal, etc.)

As it stands, Dr Etter is the only one in the current line up from whom there is even the slightest chance of hearing anything positive about electronic cigarettes, but the context is still likely to be with reclassification as a medicinal product. Where is Professor Gerry Stimson, the father of Harm Reduction? Where is Clive Bates, former Director of ASH UK? Where is Dr Konstaninos Farsalinos, who is tirelessly providing the very studies policy makers keep asking for? Where is Professor Peter Hajek? Dr Jacques Le Houezec? Dr Carl Phillips? Paul Bergen? Anyone with something useful to contribute???

None of these renowned experts has been invited to provide the benefit of their considerable knowledge and expertise in this field. Not one.

Finally, a grand total of five minutes yes, five minutes will be given to the German ecig consumer group, IG ED. Five minutes to rebut these professors, scientists, doctors, and experienced political players. Five minutes to describe the vital importance of keeping electronic cigarettes in the hands of the millions of former smokers who have already made the switch. Five minutes to make the case for ensuring that current and future smokers who have not yet made the switch are given that opportunity. Five minutes to beg for their lives and yours, and mine.

Nice to see that there will be a balanced position, isn t it?

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