The Same Pill That Costs $1,000 in America Sells for $4 in India

Compliments of Bloomberg 

Outsiders don’t want their daughters to marry any local boys, according to the village elders swapping stories in a tailor’s shop behind the Sikh temple, because most residents are infected with black jaundice.

That’s what they call hepatitis C, which is so common in parts of India’s Punjab state that the tailor-shop gossips might not be off base in their estimate. But prevalence could be something of an advantage these days. Drugmakers have made the village of Lande Rode one of the theaters in a battle to grab market share for sofosbuvir, a miracle cure that Gilead Sciences Inc. sells in the U.S. as Sovaldi at a retail price of $1,000 a pill. Gilead licensed 11 Indian companies to make generic versions, and they sealed marketing deals with others. Competition has been so fierce it’s driven down the cost and spurred thousands to be tested.

Manufacturers “want more and more patients” and are willing to wheel and deal on price, said Nirmaljeet Malhi, a gastroenterologist at Apollo Hospitals in Ludhiana, about 200 kilometers (124 miles) from Lande Rode. “If one agrees to it, the others will also have to. It’s a race where one cannot say no — because then they’re going to lose the business.”

The companies sponsor screening drives, hand out free test kits to hospitals and offer bulk discounts to entire villages. Sofosbuvir was cheap by most any standard when it hit the market in Punjab at $10 in March. Then the cost kept dropping, to as low as $4.29, and doctors predict it will continue to fall.

Game Changer

That’s in contrast to the situation in the U.S., where Gilead set off a firestorm in December 2013 by listing Sovaldi at $84,000 for a 12-week course regimen. It’s a game-changing drug, often wiping out an infection in three months, and without the debilitating side effects of earlier treatments that took longer. Still, the cost started the latest backlash over high medicine prices. Dozens of state Medicaid plans limited access to the drug, and a U.S. Senate report chastised the company. Gilead, which has said it priced Sovaldi responsibly and thoughtfully, is giving insurers and bulk purchasers discounts.

Like others in the industry, the company arranges to make life-saving cures available in some parts of the world for far less; laws and pressure introduced so-called tiered pricing after expensive anti-HIV treatments became available in the ’90s and reduced deaths in rich countries and not poor ones. In exchange for a 7 percent cut of sales, Gilead gave companies including Mylan NV, Cipla Ltd. and Natco Pharma Ltd. rights to make generics for distribution in 101 developing nations where hepatitis C is often untreated and $1,000 is more than people might earn in a year. The company wants to “foster competition in the marketplace” in low-income areas, according to spokesman Nathan Kaiser.

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Final tally: Police Shot and Killed 986 People in 2015

Compliments of Washington Post 

On the afternoon of New Year’s Eve, Las Vegas police cornered Keith Childress Jr., who was wanted for a number of violent felonies. They opened fire on the black 23-year-old after he refused to drop the object in his hands, which turned out not to be a gun but a cellphone.

And with that, the nation logged what is probably its final police shooting death of 2015, a year in which 986 such killings occurred, well more than double the average number reported annually by the FBI over the past decade.

The shooting is the final one to be counted as part of The Washington Post’s year-long project tracking on-duty police killings by firearm, an issue that has taken on new urgency after a number of high-profile killings of unarmed African American men. The Post sought to document every shooting death at the hands of police in 2015, revealing troubling patterns in the circumstances that lead to such shootings and the characteristics of the victims.

The project will continue this year. Embarrassed federal officials have announced plans to improve their data collection, but the new initiative will not be in place until 2017. Already, The Post has tallied 11 fatal police shootings in 2016.

Over the past year, The Post found that the vast majority of those shot and killed by police were armed and half of them were white. Still, police killed blacks at three times the rate of whites when adjusted for the population where these shootings occurred. And although black men represent 6 percent of the U.S. population, they made up nearly 40 percent of those who were killed while unarmed.

Regardless of race, about a quarter of those killed displayed signs of mental illness. December was the fourth-deadliest month in 2015 for police shootings, with 89 shootings. There was only one state without a fatal police shooting last year: Rhode Island.

The number of shooting deaths may yet rise for 2015. The Post is tracking a few cases where it’s unclear whether police gunfire killed someone or whether the person committed suicide. And new cases that have gone unreported could always emerge.

Childress’s death in many ways encapsulates the complex nature of these incidents. On one hand, the young man was unarmed, carrying nothing but a cellphone. At the same time, he had a history that suggested a capacity for violence, and he behaved suspiciously, ignoring officers’ commands for a full two minutes and advancing even as the officers threatened to shoot.

And like an increasing number of police interactions with citizens, the incident was partially captured on a camera worn by one of the police officers.

Two weeks before his death, Las Vegas police said, Childress failed to show up for a sentencing hearing in Phoenix. In December, a jury had convicted him of a litany of charges, including kidnapping and robbery in connection with a 2013 home invasion in which he and several others posed as bounty hunters and robbed a house at gunpoint.

“Based on the fact that Childress was facing a lengthy stay in prison, it appears he skipped the sentencing and fled to Las Vegas to avoid prison time,” Undersheriff Kevin McMahill of the Las Vegas Metropolitan Police Department told reporters during a briefing this week.

Childress was staying with close friends in Las Vegas when the U.S. Marshals Service became aware of his location, McMahill said. But when the marshals attempted to approach him, he fled, prompting the federal agents to seek help from local police.

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Money Troubles? You Are Not Alone

Compliments of Marketwatch 

Americans are starting 2016 with more job security, but most are still theoretically only one paycheck away from the street.

Approximately 63% of Americans have no emergency savings for things such as a $1,000 emergency room visit or a $500 car repair, according to a survey released Wednesday of 1,000 adults by personal finance website Bankrate.com, up slightly from 62% last year. Faced with an emergency, they say they would raise the money by reducing spending elsewhere (23%), borrowing from family and/or friends (15%) or using credit cards to bridge the gap (15%).

This lack of emergency savings could be a problem for millions of Americans. More than four in 10 Americans either experienced a major unexpected expense over the past 12 months or had an immediate family member who had an unexpected expense, Bankrate found. (The survey didn’t specify the impact of that expense.) “Without emergency savings, you may not have money to cover needed home repairs,” says Signe-Mary McKernan, senior fellow and economist at the Urban Institute, a nonprofit organization that focuses on social and economic policy. “Similarly, without emergency savings, people could raid their retirement account.”

The findings are strikingly similar to two other reports, one by the U.S. Federal Reserve survey of more than 4,000 adults released in 2014. “Savings are depleted for many households after the recession,” it found. Among those who had savings prior to 2008, 57% said they’d used up some or all of their savings in the Great Recession and its aftermath. And another survey of 1,000 adults released last year by personal finance website GOBankingRates.com found that most Americans (62%) have less than $1,000 in their savings account (although that doesn’t include retirement or other investment accounts).

Why aren’t people saving? Millions of Americans are struggling with student loans, medical bills and other debts, says Andrew Meadows, a San Francisco-based producer of “Broken Eggs,” a documentary about retirement. Central bankers hiked their short-term interest rate target last month to a range of 0.25% to 0.50% from near-zero, but that’s still a small return for savings left in bank accounts. Indeed, personal savings rates as a percentage of disposable income dropped from 11% in December 2012 to 4.6% in August 2015, according to the Bureau of Economic Analysis, and now hover at 5.5%.

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Mexico First to Approve Prostate Cancer Drug Invented at Weizmann Institute

Compliments of Haaretz

Mexico has become the first nation to approve a drug based on bacterial chlorophyll to treat early-stage prostate cancer. The breakthrough technique invented by Israeli scientists, which seems to involve no side effects to speak of and can preclude prostate removal, is also undergoing approval processes in Europe.

The combined therapy of the novel drug, Tookad Soluble, and laser illumination was invented at the Weizmann Institute of Science, Rehovot. Clinical development was done together with Steba Biotech, a Luxembourg company specializing in prostate cancer therapies.

The therapy, provided as an outpatient procedure lasting just a few hours, has been approved by the Mexican health authority Cofepris for the focal treatment of early-stage prostate cancer, Weizmann announced Monday.

Focal treatment is a cousin of targeted treatment. The idea is to treat diseased tissue while not touching noncancerous tissue, since many of the cancer therapies are generally poisonous or otherwise obnoxious to the body. It is the latest wrinkle in prostate cancer therapy, as an alternative to whole-gland therapy, culminating in radical excision of the offending gland.

The therapy paradigm developed by Prof. Yoram Salomon of the Biological Regulation Department and Prof. Avigdor Scherz of the Plant and Environmental Sciences Department at Weizmann consists of an intravenous Tookad infusion, immediately followed by shining near-infrared laser light “inserted” into the sick tissue using thin optic fibers, guided by ultrasound.

Plants famously use chlorophyll to turn sunlight energy into food. Certain bacteria can do the same. Scherz is the one who first cooked up Tookad in his lab from bacteriochlorophyll.

Chlorophyll-containing bacteria are microscopic, but here we see they can proliferate to the point of being noticed by NASA: A bloom of cyanobacteria forming around Fiji. Norman Kuring, NASA Earth Observatory, Wikimedia Commons.

Once the drug is administered, the laser light “turns on” the circulating drug locally. The result is the extensive generation of unstable toxic molecules, oxygen and nitric oxide radicals, which damage the blood vessels feeding the tumor. Starved for blood and oxygen, the tumor tissue dies but nearby tissues remain unaffected.
Where the light is not shined on the drug, it circulates around the patient’s blood system doing nothing much until being totally cleared after some three to four hours.

“The use of near-infrared illumination, together with the rapid clearance of the drug from the body and the unique non-thermal mechanism of action, makes it possible to safely treat large, deeply embedded cancerous tissue using a minimally invasive procedure,” Weizmann stated.

The marketing approval follows success in the Phase III clinical trial in Mexico, Peru and Panama, involving 80 patients. The test confirmed efficacy and the “minimal side effects” previously found in Phase II clinical trials, Weizmann stated.

Pressed by Haaretz, the Weizmann team explained that the side effects found were “transient and were related to the procedure itself” – meaning, not the drug. They included, for instance, the side effects that may be caused by insertion of a catheter, such as burning when urinating shortly afterwards. Others may feel nausea after anesthesia, but the Tookad itself was not seen to have side effects.
Meanwhile in Europe, a second Phase III clinical trial was recently wrapped up. The study compared disease progression, the rate of freedom from cancer and urinary and erectile functions in patients treated with Tookad and those undergoing active surveillance with a follow-up of two years, among more than 400 patients in 11 European countries. The findings are being evaluated by the European Medicines Agency.

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Kuwait Becomes Latest Saudi Ally to Downgrade Ties With Iran

Compliments of Washington Post 

Kuwait became the latest in a growing list of Saudi Arabian allies to cut or downgrade ties with Iran, saying Tuesday that it has recalled its ambassador to Tehran in solidarity with the kingdom as tensions deepen.

The widening rifts — opened by the execution of a prominent Shiite cleric in Saudi Arabia on Saturday — have pitted Saudi Arabia and its Sunni allies against Tehran’s Shiite leadership. The confrontations could push the region dangerously closer to conflict and imperil critical objectives including peace efforts in Syria and the fight against the Islamic State.

Calls for restraint have come from around the world as each side digs in.

Bahrain and Sudan earlier joined Saudi Arabia in severing diplomatic relations with Iran on Monday. The United Arab Emirates, a key Iranian trading partner, recalled its ambassador, and then Kuwait followed suit.

Shiite-led protests, meanwhile, have flared across the Middle East. In Tehran, the Saudi Embassy was ransacked and burned just hours after the cleric, Nimr Baqr al-Nimr, was put to death.

Nimr was a leading voice among Saudi Arabia’s Shiite minority, which has complained of discrimination and other pressures at the hands of the kingdom’s Sunni rulers. Saudi authorities convicted Nimr of terrorism-related acts.

Among the worries is whether the impasse could set back attempts at finding a political formula to end the civil war in Syria, where Iran backs the government of President Bashar al-Assad and Saudi Arabia is on the opposite side as a major supporter of anti-Assad factions.

After emergency talks in Riyadh, the United Nations’ special envoyfor Syria, Staffan de Mistura, said Tuesday that Saudi leaders had expressed “clear determination” not to let the disputes derail Syrian peace bids. De Mistura next travels to Tehran to assess whether the talks between rival Syrian factions can go ahead as scheduled Jan. 25.

The diplomatic feud also could become an unwelcome distraction for Washington and its Western allies in the fight against the Islamic State in Syria and Iraq.

The Obama administration, caught in the middle by its quest for a closer relationship with Iran and its long-standing alliance with Saudi Arabia, said it hoped Tehran and Riyadh would dial back the hostile rhetoric that has fueled the worst crisis between the regional rivals in decades.

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Dutch Government Backs Strong Encryption, Condemns Backdoors

Compliments of The Daily Dot 

The Netherlands government issued a strong statement on Monday against weakening encryption for the purposes of law enforcement and intelligence agencies.

The move comes as governments in the United Kingdom andChina act to legally require companies to give them access to wide swaths of encrypted Internet traffic. U.S. lawmakers are alsoconsidering introducing similar legislation.

The Dutch executive cabinet endorsed “the importance of strong encryption for Internet security to support the protection of privacy for citizens, companies, the government, and the entire Dutch economy,” Ard van der Steur, the Dutch minister of security and justice, wrote in the statement. “Therefore, the government believes that it is currently not desirable to take legal measures against the development, availability and use of encryption within the Netherlands.”

Encryption scrambles data so that only those with the keys to unscramble it can access it. For example, Internet users utilize encryption whenever they access a website that has an HTTPS connection, which protects their Web traffic from interception, and Apple iOS devices and Google Android devices are encrypted by default when the user turns on the lock screen.

Last month, the Netherlands parliament committed €500,000 in funding to OpenSSL, a free set of encryption tools used widely and sponsored in part by the United States government.

“Confidence in secure communication and storage data is essential for the future growth potential of the Dutch economy, which is mainly in the digital economy,” Van der Steur wrote.

“Encryption supports respect for privacy and the secret communication of citizens by providing them a means to communicate protected data confidentially and with integrity. This is also important for the exercise of the freedom of expression. For example, it enables citizens, but also allows empowers important democratic functions like journalism by allowing confidential communication.”

Encryption is protected under privacy laws in Articles 10 and 13 in the Dutch constitution, Van der Steur argued, as well as Article 8 of the European Convention on Human Rights and Articles 7 and 8 in the European Union Charter.

Weakening encryption will also expose Internet traffic to eavesdropping by criminals, terrorists, and foreign intelligence services, Van der Steur said. That’s an argument supported by awide variety of technologists warning against the weakening of encryption.

“The protection of these fundamental rights is applicable to the digital world,” he wrote.

The minister of security and justice described at length the virtues of encryption, from protecting laptops against theft to allowing the Dutch government itself to communicate online safely with its citizens about taxes and digital IDs.

“Cryptography is key to security in the digital domain,” Van der Steur argued.

The rights are not absolute, however, and “infringement is permissible” given “a legitimate purpose” as well as regulation and restriction by law, he said.

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Canada Going Ahead With Saudi Arms Deal Despite Condemning Executions

Compliments of The Globe Unlimited 

The Canadian government is proceeding with a controversial $15-billion arms sale to Saudi Arabia even as it publicly condemns Riyadh for a mass execution of 47 people, including a dissident Shia Muslim cleric.

Foreign Affairs Minster Stéphane Dion released a statement this week decrying the capital punishment meted out Jan. 2 and calling on the Saudis to respect peaceful dissent and respect human rights. Sheik Nimr al-Nimr, the Shia cleric, was executed along with 46 others convicted on terrorism charges.

But the biggest Saudi mass execution in decades – delivered by beheading and in a few cases firing squad – is not moving Ottawa to reconsider a massive deal to supply the Mideast country with armoured fighting vehicles. The transaction will support about 3,000 jobs in Canada for 14 years.

“A private company is delivering the goods according to a signed contract with the government of Saudi Arabia. The government of Canada has no intention of cancelling that contract,” Adam Barratt, director of communications for Mr. Dion, said on Monday.

Federal rules oblige Ottawa to examine whether arms shipments to countries with poor human-rights records, such as Saudi Arabia, would endanger the local population.

This is no ordinary transaction between a Canadian company and a foreign customer.

The former Conservative government used its diplomatic resources to lobby the Saudis hard for this contract. A federal Crown corporation brokered the agreement on behalf of General Dynamics Land Systems Canada, a subsidiary of a major U.S. defence contractor.

The Canadian Commercial Corporation, the Crown agency that helps Canadian exporters access markets abroad, is the prime contractor, ultimately responsible for delivery of the light armoured vehicles to Riyadh.

Cesar Jaramillo, executive director of Project Ploughshares, an anti-war group that tracks arms sales, said on Monday that Mr. Dion’s criticism of the mass executions carried out by Riyadh sounds unconvincing given Ottawa’s unwillingness to cancel the arms sale.

“Canada’s condemnation of the most recent gross human-rights violations by the Saudi regime rings somewhat hollow against the backdrop of the $15-billion worth of Canadian military exports that this very regime is set to receive with Ottawa’s blessing,” Mr. Jaramillo said.

The light armoured vehicles made by General Dynamics Land Systems in London, Ont., are marketed as equipped with automatic weapons. The LAV 6.0 model is described as having “effective firepower to defeat soft and armoured targets.”

A spokesman for General Dynamics Land Systems on Monday said the company has entered the “material procurement phase” of the LAV contract, which means it is acquiring components and materials from suppliers to build the product.

Critics including Project Ploughshares and Amnesty International have cited Riyadh’s abysmal human-rights record and said this transaction would appear to violate Canada’s export-control regime.

The Department of Foreign Affairs is required to screen requests to export military goods to countries “whose governments have a persistent record of serious violations of the human rights of their citizens.” Among other things, it must obtain assurances that “there is no reasonable risk that the goods might be used against the civilian population.”

Human-rights groups say it is hard to imagine how the Saudi transaction could pass this test. Activists allege Saudi Arabia sent Canadian-made fighting vehicles into Bahrain in 2011 to help quell a democratic uprising. The Canadian government does not deny this happened. It says only that it does not believe the vehicles were used to beat back protests.

Most of the 47 executed on Jan. 2 were Sunnis convicted of al-Qaeda attacks in Saudi Arabia a decade ago.

Sheik al-Nimr, the most vocal critic of the ruling Al Saud family among the Shia minority, had come to be seen as a leader of the sect’s younger activists, who rejected the quiet approach of older community leaders.

The prominent cleric’s death has triggered a diplomatic war between Sunni-ruled Saudi Arabia and Iran, where Shia Muslims form the majority. Saudi Arabia cut ties with Iran on Sunday after an angry mob stormed its embassy in Tehran.

Canada is making plans to expand diplomatic relations with Iran. Prime Minister Justin Trudeau said before the October election he wanted to reopen Canada’s embassy in Tehran.

Conservative foreign affairs critic Tony Clement is urging the Liberals to shelve the idea.

“Iran continues to be a dangerous state sponsor of terrorist groups around the world. When Iran moves away from its terrorist activities, Canada should then act to restore relations,” Mr. Clement said.

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Why Working Fewer Hours Would Make Us More Productive

Compliments of The Guardian 

I worked 100-hour plus weeks as a hospital doctor in the early 1990s. Those dangerous rotas left me low and unable to string a sentence together, let alone give sick people what they needed. Doctors’ crazy hours were reduced, but it seems they may be returning with the new junior doctors’ contract.

Meanwhile, David Cameron will head to Brussels for EU negotiations, planning to insist that UK workers should continue to be able to opt out of the 48-hour maximum working week. Long working hours are on the agenda.

But what about tackling the issue at its roots? What if everyone had a shorter working week? We would be healthier and happier, and society would be less unequal and more sustainable.

A top public health doctor recently said that long working hours was a big cause of mental ill health, and a big 2015 study linked long working hours with an increased risk of stroke and heart disease.

Less time at work would mean more time to care for children and family, be a school governor, look in on elderly neighbours, or organise a game of football. It would mean more time to create the community spiderweb of connections and favours and reciprocation that keeps the world going round.

More than 6 million of us in Britain work more than 45 hours a week, while 1.85 million of us are unemployed. While it would need to happen gradually, alongside some reskilling and training, a shorter working week for all would mean fairer distribution of available work. It would reduce the number of people working far too many hours, and also the number with no work at all.

For people on lower incomes, it would have to go hand-in-hand with a living wage – something that Britain now agrees on, across the political spectrum. For higher earners, it would fulfil pent-up demand – in London, for example, only 3% of jobs with average or higher salary levels are advertised as part-time, according to Timewise Foundation.

It would help with gender equality too, as men would have more time to look after the kids and the house. About 85% of in-work British men work more than 30 hours a week, but only 57% of in-work women.

Shorter hours could also help mitigate climate change. According to a report from the US Center for Economic and Policy Research, reduced greenhouse gas emissions go hand-in-hand with shorter working hours for a variety of factors including lower levels of consumption.

With all these benefits, cutting the working week should be at the top of every politician’s agenda. But it bumps up against some big prejudices. Would the economy fall apart? How would our open-all-hours society function? And wouldn’t we turn into a nation of couch potatoes?

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Truths of Diversity Policies

Compliment of Harvard 

U.S. companies spend millions annually on diversity programs and policies. Mission statements and recruitment materials touting companies’ commitment to diversity are ubiquitous. And many managers are tasked with the complex goal of “managing diversity” – which can mean anything from ensuring equal employment opportunity compliance, to instituting cultural sensitivity training programs, to focusing on the recruitment and retention of minorities and women.

Are all of these efforts working? In terms of increasing demographic diversity, the answer appears to be not really. The most commonly used diversity programs do little to increase representation of minorities and women. A longitudinal study of over 700 U.S. companies found that implementing diversity training programs has little positive effect and may even decreaserepresentation of black women.

Most people assume that diversity policies make companies fairer for womenand minorities, though the data suggest otherwise. Even when there is clear evidence of discrimination at a company, the presence of a diversity policy leads people to discount claims of unfair treatment. In previous research, we’ve found that this is especially true for members of dominant groups and those who tend to believe that the system is generally fair.

All this has a real effect in court. In a 2011 Supreme Court class action case, Walmart successfully used the mere presence of its anti-discrimination policy to defend itself against allegations of gender discrimination. And Walmart isn’t alone: the “diversity defense” often succeeds, making organizations less accountable for discriminatory practices.

There’s another way the rhetoric of diversity can result in inaccurate and counterproductive beliefs. In a recent experiment, we found evidence that it not only makes white men believe that women and minorities are being treated fairly — whether that’s true or not — it also makes them more likely to believe that they themselves are being treated unfairly.

We put young white men through a hiring simulation for an entry-level job at a fictional technology firm. For half of the “applicants,” the firm’s recruitment materials briefly mentioned its pro-diversity values. For the other half, the materials did not mention diversity. In all other ways, the firm was described identically. All of the applicants then underwent a standardized job interview while we videotaped their performance and measured their cardiovascular stress responses.

Compared to white men interviewing at the company that did not mention diversity, white men interviewing for the pro-diversity company expected more unfair treatment and discrimination against whites. They also performed more poorly in the job interview, as judged by independent raters. And their cardiovascular responses during the interview revealed that they were more stressed.

Thus, pro-diversity messages signaled to these white men that they might be undervalued and discriminated against. These concerns interfered with their interview performance and caused their bodies to respond as if they were under threat. Importantly, diversity messages led to these effects regardless of these men’s political ideology, attitudes toward minority groups, beliefs about the prevalence of discrimination against whites, or beliefs about the fairness of the world. This suggests just how widespread negative responses to diversity may be among white men: the responses exist even among those who endorse the tenets of diversity and inclusion.

In another set of experiments, we found that diversity initiatives also seem to do little to convince minorities that companies will treat them more fairly. Participants from ethnic minorities viewed a pro-diversity company as no more inclusive, no better to work for, and no less likely to discriminate against minorities than a company without a pro-diversity stance. (Other researchers have seen more promising results of pro-diversity rhetoric and images, but it’s clear they’re no panacea.)

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Hawaii Raises Smoking Age to 21; Military Supports New Law

Compliments of Denver and The West 

Hawaii is raising the legal smoking to age 21 for traditional and electronic cigarettes on Jan. 1, becoming the first state in the nation to do so.

Public health officials are hoping that by making it more difficult for young people to get their hands on cigarettes, they will keep them from developing an unhealthy addiction.

“In Hawaii, about one in four students in high school try their first cigarette each year, and one in three who get hooked will die prematurely,” said Lola Irvin, administrator with the chronic disease prevention and health promotion division of the Hawaii Department of Health.

Officials included electronic smoking devices in the law after noticing a spike in the number of students trying electronic cigarettes. The percentage of Hawaii public high school students smoking electronic cigarettes quadrupled over four years to 22 percent in 2015, and among middle-schoolers, 12 percent reported using them in 2015, a sixfold increase over four years.

While Hawaii is the first state to raise the smoking age to 21, more than 100 cities and counties have already done so, including New York City. The town of Needham, Massachusetts, raised the smoking age to 21 in 2005, and a decade later the percentage of adults smoking was 50 percent lower than the rest of the state.

Several military bases in Hawaii expressed their support for the move, saying their bases would comply with the state law.

“We see it as a fitness and readiness issue,” said Bill Doughty, spokesman for the Navy Region Hawaii. “When we can prevent sailors from smoking or using tobacco, if we can get them to quit, then that improves their fitness and readiness, and it saves them a ton of money too.”

But critics say that if a man or woman is old enough to potentially die defending their country, they’re old enough to make a decision about smoking. “If you can serve the country, you should be able to have a drink and a cigarette,” said Justin Warren, 22, an X-ray technician in the Army.

Taylor Dwyer, 21, also an Army X-ray technician, said smoking is a “way for us to come down after the work day. It’s not like a regular work day. It’s a lot more stressful, especially for people who are in combat jobs.”

Rear Adm. John Fuller, commander of Navy Region Hawaii, countered those arguments in a blog post, saying “If someone is young enough to fight for their country, they should be free from addiction to a deadly drug.”

As the state begins enforcing the law, the first three months of the year will be dedicated to educating the public, so warnings will be handed out instead of fines, officials said.

After that, young people caught smoking will be fined $10 for the first offense and $50 or community service for any further offenses. Retailers caught selling cigarettes to people under 21 can be fined $500 for the first offense and up to $2,000 for later offenses.

The Health Department has distributed about 4,000 signs to 650 vendors, said Lila Johnson, public health educator at the agency. To reach tourists, officials have been meeting with representatives from the tourism industry, business and hotels, and officials plan to produce signs in different languages, she said.

“People are going to be coming in and out of our state that aren’t aware of it,” Johnson said. “It’s a matter of education. We hope to see a lot more states picking it up so we’re not the only one.”

Sabrina Olaes, 18, said she started organizing events to educate her classmates about the dangers of smoking after getting frustrated finding herself surrounded by fumes from electronic cigarettes in the girl’s bathroom at her school.

She called the tobacco industry’s marketing practices deceptive, and said some of the flavors of electronic cigarettes are targeted at young people. But her smoking friends didn’t always want to hear what she had to say.

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