Release delayed of report on how country can cut smoking

Exclusive: Chief health ministry statistician estimates that tobacco-related diseases cost nation NIS 1.75 billion.

By JUDY SIEGEL-ITZKOVICH
man smoking 311 (photo credit: Marc Israel Sellem/The Jerusalem Post)
man smoking 311
(photo credit: Marc Israel Sellem/The Jerusalem Post)
Deputy Health Minister MK Ya’acov Litzman has for two weeks prevented the publication of an 80-page “Public Committee Report for Reducing Smoking and the Damage It Causes” – even though the committee was composed of numerous ministry experts and its senior cost-effectiveness expert proved last year that fighting tobacco consumption will save many lives and expenditures.
The public committee was chaired by ministry director-general Dr. Ronni Gamzu and included Prof. Eliezer Robinson, chairman of the Israel Cancer Association; Tel Aviv University health promotion expert Dr. Leah Rosen; ministry occupational health director Dr. Eli Rosenberg; and Boaz Sofer, former head of the Tax Authority. Five other senior Health Ministry officials participated in the many months of sessions to prepare a long-term plan to cut smoking by 2015-2020, with both short-term and long-term goals.
Some 10,000 Israelis reportedly die of smoking-related causes, including 2,000 who are non-smokers but breathe in toxic smoke emitted by others’ cigarettes, cigars and pipes.
According to a report published by The Marker on February 2 before the ministry set the embargo on the report, the Gamzu Committee strongly advocated a comprehensive program to reduce smoking – including a significant hike in tobacco taxes and the prohibition of smoking at swimming pools, wedding halls and bus stations. Soon after, the ministry invited health reporters to a personal briefing by Litzman on the committee’s recommendations, many of which would require the passing of legislation to implement.
But the night before the briefing was to have been held in Litzman’s Jerusalem office, the ministry cancelled the briefing and said the report would be embargoed until further notice.
Asked for comment two weeks ago, Gamzu told The Jerusalem Post that since the report was sent to health reporters in advance for perusal, he saw “no reason to cancel the embargo and allow publication” even without the briefing.
But later, the ministry director-general said the reason for the postponement was that Justice Minister Yaakov Neeman met with Litzman on the eve of the scheduled briefing and asked that it be postponed because Neeman said “there are loose ends and more work must be done on the report.”
Gamzu rejected the claim that representatives of the powerful tobacco industry had demanded the embargo so it could get the recommendations – which would seriously hurt cigarette sales if carried out – toned down. The ministry spokeswoman’s office told the Post that it was Litzman who had insisted on the continuation of the embargo until further notice.
Asked to comment on Sunday, the ministry spokeswoman said that “the [Gamzu Committee] report in fact [was] leaked and even appears on the Internet, but the Health Ministry asked to [preserve the embargo] to continue the delicate interministry work so [the report would constitute] not only recommendations but lead also to implementing them and not to create opposition before the work is completed.”
The Gamzu Committee was set up by the director-general following the long failure of the Gillon Committee to recommend ways to reduce smoking. In June 1999, the Israel Medical Association filed a suit in the High Court of Justice demanding that the ministry declare nicotine – the main addictive substance in tobacco – to be recognized officially as a dangerous drug.
The court directed the ministry to set up the public committee headed by Courts Registrar Judge Alon Gillon to look into the nicotine question and propose ways of reducing the smoking rate. Although it started hearings at the end of 1999, held many sessions with dozens of witnesses and amassed large amounts of data, Gillon, a former smoker, never wrote a report with recommendations and was criticized by the High Court for not doing so. The Gamzu Committee was the belated result.
Last year, Dr. Gary Ginsberg of the ministry’s Medical Technology Assessment Office, wrote a scientific analysis of the cost-effectiveness of interventions to reduce the smoking-related burden of disease in Israel. It was written in collaboration with health policy researcher Dr. Bruce Rosen of the Meyers- JDC-Brookdale Institute and the ministry’s Healthy Israel 2020 Initiative.
This 24-page report found that 13 interventions that the government could carry out and enforce – including more than doubling taxes on tobacco products, establishing a national help line for quitting tobacco, offering free individual counselling to smokers and giving free medications shown to help kick the habit – would be “very cost effective” while eight others would be “cost effective.”
Ginsberg and his colleagues examined averted treatment costs for tobacco-related diseases and increases in the Quality Adjusted Life Years (QALYs) of those who quit smoking. They estimated that in 2008, over 456,000 days in the general hospitals were attributed to smoking, with the per-diem cost of hospitalization NIS 1,835. Thus, some NIS 874 million was spent on treating victims of tobacco, 74 percent of that attributable to active (as opposed to sidestream) smoking.
The authors estimated that the total direct cost to the country’s health services (including in the community) at about NIS 1.75 billion, equal to 0.25% of the country’s gross national product.