Philippe Boucher's Rendez Vous: Elif Dagli, MD

Rendez-vous with Elif Dagli, MD

Head of the department of pediatric chest disease in Istanbul, Turkey
By Philippe Boucher

Monday, August 7 2000

Nota: I met with Elif Dagli during the 11th world conference on Tobacco or Health in Chicago. A slightly different version of this interview was published in the daily journal of the conference (in the August 7th issue).

PB : Thank you Elif for accepting our rendez-vous. May I ask you to introduce yourself?

Elif Dagli : I am a simple pediatric chest physician. I am professor of pediatrics and run the department of pediatric chest disease in Istanbul. In 1985 I was appointed in a sanatorium in Ankara as a pediatrician and noticed that nearly all the physicians smoked. The chest surgeon who was operating lung cancers every day , did his ward round with his cigarette in hand while advising patients to stop. Amazed at the situation, I carried out a survey of smoking among different groups of health professionals in Turkey . Then I got a scholarship from the British Council to work at Brompton Hospital in London. During my London time, the Society of European Respiration ( SEP in those days) had a meeting in Freiburg and I had the chance of presenting my data.

My ultimate dream was to meet Sir John Crofton. A very modest looking gentleman came and asked questions about my poster. I about fainted when I read his name badge. He was Sir John. Since then his motivation and never ending support, along with continuous long distance education from David Simpson have kept me involved in tobacco control. Once hooked with tobacco control I have found it seriously addictive!

Q1. First question : Can you tell us about the situation in Turkey?

ED : Turkey is a big tobacco producer : 500.000 people work in tobacco production and distribution, if you include their families, about 3 million people are involved : a big number of voters in this country of 65 million. All tobacco activities in Turkey used to be controlled by the national monopoly. It was not a benevolent institution but it was not aggressively trying to expand consumption : there was no advertising and the Turks only smoked turkish cigarettes made in Turkey from turkish tobacco. When Philip Morris started to be interested into the Turkish market, this had to change.

So in 1986, during a night session of the Parliament with hardly anybody present the monopoly law was quietly transformed so that Philip Morris was allowed to export its products and advertise for them. Internal Philip Morris documents, now available, show how the corporation decided to approach Ozal who was the prime Minister then became President of Turkey to push for this first decisive end to the monopoly.

The Health community tried to fight back and prepared a bill with the support of the Health Minister.
But he suddenly resigned in 1990 . . . under pressure from the industry (as he acknowledged publicly five years later). The bill was nonetheless approved by the Parliament. It still had to be signed by the President Ozal, who refused to do it. " We made Ozal veto the bill" bluntly states a Philip Morris document. The argument used was a classic one : respect of the freedom of choice.

If Ozal died in 1993, this strategy was used as well by the industry in Egypt and in Argentina where then President Menem used as well his presidential veto against tobacco control legislation.

Q2. What happened when Philip Morris was able to enter the market and after the failure of this first attempt to regulate tobacco?

ED : Once accepted in Turkey Philip Morris lobbied to get a bigger share of the market through a new bill that took away from the state monopoly the rights to fix prices and collect taxes.

Meanwhile a second health oriented tobacco control bill was nevertheless introduced that took 3 years to be adopted by the Parliament (I'll spare you all the delaying tactics) and submitted to the new President, Suleiman Demirel.

"If you smoke, you get more intelligent."

This statement was at the time presented by all the turkish media as the result of a new yet unpublished scientific study. After I had tracked the original work (via Keith Ball in London and Stanton Glantz in San Francisco) it appeared that the same study showed that the impact of smoking on the brain was very short : not one newspaper in Istanbul agreed to carry this precision. Not one radio, not one TV channel. Since the tobacco lobby was so strong, my friends and I were very concerned that President Suleiman Demirel would not sign the tobacco control act, like his predecessor. The Presidend finally agreed to meet us. I recall I pleaded to him that he -as the son of a poor family- should side with the people, not a rich and powerful corporation. When he said : " I am going to sign this bill" , everybody in the room started crying. It was november 26 1996.

Q3. How are things now?

ED : The war never stops. Recently Philip Morris has been lobbying heavily to get Formula One races into Turkey, a move that would require an exemption from the advertising and sponsoring ban.
First they tried to influence the sports Minister, then the Tourism Minister. It was amaring, the American lobbyists were everywhere.

Q4. Can you explain what you call the Philip Morris algorithm?

ED: from my experience, I have devised this algorithm about how Philip Morris invades a developing country:

1. They install a factory in a neigboring country to promote smuggling (in Turkey's case the factory was in Bulgaria)

2. Once they have significantly promoted smuggling they lobby to obtain the right to legally export cigarettes (that would take care of the smuggling problem!)

3. They lobby to abolish any existing tobacco control law, especially concerning advertising and promotion

4. They Increase the consumption by targeting youth and women with heavy advertising and promotion

5. They push for the privatization of the former monopoly

6. They buy out the former monopoly.

Turkey is now in phase 4.

Q5. What keeps you going and what would you like to achieve?

ED: Turkey is a natural laboratory to investigate thec behavior of transnational tobacco corporations, the behavior of local politicians, and the unawareness of the public.

Every day something really exciting happens. It boosts up my adrenalin level. Like all TC advocates I have the genetic defect for expecting to achieve the impossible.

I think my biggest achievement is probably the Tobacco law in 1996, that bans all advertising
sales to minors and introduces smoking restrictions in public places. This was the success of a coalition but we finally got the law with the help of an international campaign. However, there is still much more to be done. I will be a happy if we can :

a) stop the privatization of theTurkish Monopoly

b) stop the lobby of PM and Reynolds to reverse the Tobacco law

c) make all the politicians and media understand that they are being watched and any friendship with industry will give them a bad reputation. I hope other developing countries now under siege by Philip Morris and the like can resist their invasion. Now they are trying to invade Iran. Who's next ?

PB: Thank you Elif for taking the time to be with us today.
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