Paul Belcher

Cross border health care in Europe

European Commission proposals provide legal clarity and more information for patients

Reducing harm from alcohol

The UK must tackle the problem of cheap alcohol

The European Commission and pharmaceutical policy

A victory for profits over public health?

The EU Tobacco Products Directive must not be derailed

This week, tobacco control activists across Europe were expecting to celebrate a win in a protracted war with the tobacco industry. After an extensive preparatory phase, the European Commissioner for Health and Consumer Policy was due to present his proposals for a revised Tobacco Products Directive to the other Commission services on Oct 22, 2012, with a view to adopting the text by Dec 19, 2012. This process has been derailed after the resignation of EU Commissioner John Dalli, amidst allegations that he was aware of, but took no action to stop, impropriety. The proposed contents of the revised Tobacco Products Directive had been trailed in advance, most notably when an advanced draft was leaked to the German media. The revised Directive built on a wealth of research, much of it derived from the tobacco industry’s internal documents released under US court orders. This information had provided important new insights into how the industry had manipulated the composition of cigarettes—for exam ple, by adding fl avourings that would make their products more attractive to children and by changing the pH to increase the initiation of nicotine addiction. The research also revealed the sophistication of industry research on cognition to enhance the appeal of images of its products. The revised Directive was expected to tackle the industry’s once secret tactics to ensnare future generations of smokers. Specifi cally, it was expected to maintain the existing ban on all forms of smokeless tobacco (except Sweden, which had secured an opt out during its accession to the European Union to protect its domestic snus market), and extend the ban to e-cigarettes. These measures recognised concerns that the industry may seek to circumvent the danger that smokers, faced with indoor smoking bans, might quit. These products would help to ensure that consumers remained nicotine dependent. The Directive was also expected to: ban a range of fl avourings; standardise the width, length, and colour of cigarettes; limit displays at point of sale; require larger graphic warnings on packs; and possibly propose future reviews, including the option of plain cigarette packaging. Although many aspects of the tobacco industry’s response to the proposed revised Directive are not known, it might have adopted a similar approach to that revealed in a report of how it sought to “block, amend, delay” the existing Directive through direct and indirect lobbying to challenge the legality and the technical aspects of the Directive. The EU’s health Commissioner at that time, David Byrne, was however wise to such tactics, as were a number of key Members of the European Parliament, and the Directive passed. This time, it is diff erent. The progress of the Directive has come to a halt and this delay seems likely to prevent its promulgation within the period of the current European Parliament. Activists now fear that the version of the revised Directive that is eventually presented—if at all—will be much weaker than the text as it stands today. Even if it is eventually enacted, the tobacco industry will have benefi ted from the delay, not only through probable increased sales in the EU but also in other parts of the world that might have followed the EU lead. So what happened? Although many facts are unclear, some key developments are known. On Oct 16, 2012, Maltese Commissioner Dalli was summoned to meet the President of the European Commission, José Manuel Barroso. He was told that the European Anti-Fraud Offi ce (OLAF), had evidence that a Maltese businessman had approached a Swedish smokeless tobacco manufacturer, trading on Dalli’s name and claiming to be able to infl uence the Directive, and seeking considerable fi nancial advantage for doing so. It also seems that this approach might have been made after the draft Directive had been fi nalised. The OLAF report remains secret and the matter is now under

The Cattle-Plague and Vaccination

were slaughtered immediately after they ceased to feed, and before any decided symptoms had appeared. I found the food in the maniplies of a natural consistency, which goes to prove that its dry and hardened state is the result of the fever. As thirty-one* of Mr. Blakes stock have died under every mode of treatment, may not this great mortality be fairly attributed to the previous affection of the mouth and feet-the fever-pdison producing death by sudden shock to the nervous system, before the development of the more marked symptoms of true cattle-plague?