Users Online: 401 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
 

 

Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
     

 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 61  |  Issue : 5  |  Page : 35-39  

Tobacco industry interference: A review of three South East Asian countries


1 Senior Policy Advisor, Southeast Asia Tobacco Control Alliance, Sydney, Australia
2 Executive Director, Southeast Asia Tobacco Control Alliance, Bangkok, Thailand
3 Chair of Tobacco Control Unit, Indonesian Public Health Association, Jakarta, Indonesia
4 Program Manager, Sustainable Funding for Health Promotion, Southeast Asia Tobacco Control Alliance, Bangkok, Thailand
5 Program Manager, Tobacco Industry Denormalization, Southeast Asia Tobacco Control Alliance, Bangkok, Thailand

Date of Web Publication15-Sep-2017

Correspondence Address:
Mary Assunta
Southeast Asia Tobacco Control Alliance, Thakolsuk Place, Room 2B, 115 Thoddamri Road, Dusit, Bangkok 10300, Thailand

Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_232_17

Rights and Permissions
   Abstract 

Background: The WHO Framework Convention on Tobacco Control (FCTC) Article 5.3 requires governments to protect tobacco control policies from the commercial interest of the tobacco industry (TI). TI interference is the biggest barrier to implementing comprehensive tobacco control measures. Objective: This paper reviews the extent of the TI's interference in tobacco control policy development in three countries, Thailand, Myanmar, and Indonesia, and the governments' efforts to protect these policies. Methods: The paper draws on incidents of TI interference reported in the 2016 Tobacco Industry Interference Index: ASEAN Report on Implementation of the WHO FCTC Article 5.3. Base data were obtained through a questionnaire on twenty most commonly reported incidents of interference from the FCTC Article 5.3 Guidelines recommendations. A scoring system was developed. Results: All three countries faced varying levels of TI interference. Thailand, though known for its stringent tobacco control measures, still faced interference while Myanmar remains vulnerable. Indonesia faced the highest industry interference which may explain why it is lagging behind in tobacco control and remains a nonparty to the WHO FCTC. The TI gains access to government officials through offers of technical assistance and its corporate social responsibility activities. Transparency in dealing with the TI is needed in all three countries. Most governments have not set up disclosure procedures when dealing with the TI. Conclusion: Outside the Department/Ministry of Health, other departments remain unaware of Article 5.3, not utilizing its strength to regulate the TI. More concerted effort is needed to implement Article 5.3 to achieve greater success in tobacco control.

Keywords: Article 5.3, Framework Convention on Tobacco Control, interference, tobacco industry


How to cite this article:
Assunta M, Ritthiphakdee B, Soerojo W, Cho MM, Jirathanapiwat W. Tobacco industry interference: A review of three South East Asian countries. Indian J Public Health 2017;61, Suppl S1:35-9

How to cite this URL:
Assunta M, Ritthiphakdee B, Soerojo W, Cho MM, Jirathanapiwat W. Tobacco industry interference: A review of three South East Asian countries. Indian J Public Health [serial online] 2017 [cited 2019 Jan 16];61, Suppl S1:35-9. Available from: http://www.ijph.in/text.asp?2017/61/5/35/214901


   Introduction Top


The tobacco industry (TI) interferes with governments' efforts in protecting public health through various tactics to deter and thwart their efforts. There are a wide range of interference activities which the TI uses. However, they all seek to lobby and dissuade governments from developing and implementing stringent tobacco control policies that are effective in reducing tobacco use. The WHO Framework Convention on Tobacco Control (FCTC) Article 5.3 Guidelines[1] provides a set of recommendations that governments can undertake to shield their policies from industry influence.

The Southeast Asia Tobacco Control Alliance (SEATCA) has documented how governments have fared in implementing the FCTC Article 5.3 in the Tobacco Industry Interference Index (the Index).[2],[3] The index provides examples of the TI's interference activities in nine countries in the ASEAN region and a ranking for the countries [Figure 1]. The nine countries are Brunei Darussalam, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Thailand, and Vietnam [inset [Figure 1].
Figure 1: Tobacco industry interference in ASEAN Countries.

Click here to view


This report will focus on three countries in South East Asia, namely, Thailand, Myanmar, and Indonesia[4] which are at different phases of tobacco control. Thailand is world renowned for its strong tobacco control measures,[5] Myanmar is making progress in FCTC implementation[6] and Indonesia is lagging behind.[7] According to the index, these three countries demonstrate different levels of interference from the TI and how the governments have responded to these activities. The industry in Thailand tries to undermine the progress made in tobacco control, whereas in Indonesia, it has a free hand to influence the government. Myanmar is encouraging foreign investments which include the TI; hence, it is open to the TI despite tobacco control efforts from the Ministry of Health and Sport. These three country situations provide a good basis for comparison. Since the recommendations in Article 5.3 Guidelines are consistent with the principles of anti-corruption, they are applicable to Indonesia although it is not a party to the FCTC.


   Materials and Methods Top


This review draws on the incidents of TI interference reported in the 2016 Tobacco Industry Interference Index: ASEAN Report on Implementation of the WHO FCTC Article 5.3. A questionnaire was administered by respondents in the countries who consulted with advocates, partners, and government and nongovernment organizations. Questions were based on the top twenty most commonly reported incidents of TI interference in the South-east Asian countries and referenced to specific FCTC Article 5.3 Guidelines recommendations. Respondents were required to provide publicly available evidence to support each answer. The lower the score, the better, as it indicates a lower level of interference. The scores for Indonesia, Myanmar, and Thailand were extracted and used in this review. In addition, this review also refers to the SEATCA FCTC Scorecard which provides a measurement of the WHO FCTC implementation in the ASEAN region.[8]


   Results Top


Thailand

Thailand, which has been demonstrating good progress in halting TI interference over the years,[9],[10] was subject to strong interference in 2016. Thailand's Excise Department received technical assistance from the International Tax and Investment Center (ITIC) on excise tax reform.[11] The Convention Secretariat of the FCTC has issued two notes verbale on nonengagement with ITIC to parties to the WHO FCTC.[12] The ITIC is a known TI lobby group[13] which makes industry-friendly recommendations to governments. For example, the ITIC opposes substantial excise tax increases on tobacco claiming it encourages smuggling.

In 2015, the Thai government had accepted and acted on a proposal from the Thai Tobacco Monopoly (TTM) to investigate and reorganize Thai Health Foundation. The investigation resulted in negative press for Thai Health.[14],[15] Thai Health is recognized as an international success case study of health promotion funded by dedicated tobacco and alcohol tax revenues. Thailand's experience demonstrates that even when a government is vigilant to halting TI interference, the industry will find ways to undermine the gains achieved in tobacco control polices and measures.

The Thai government faces a conflict of interest problem since the TTM is a state enterprise. Retired senior government officials are routinely appointed as TTM board members. Retired military personnel and political appointees occupy senior management position.[16] A retired army Lieutenant General is the current Chairman of TTM. Government officials such as a senior officer from the Excise Department and the Ministry of Finance are board members of the TTM. These appointments are seen as normal. The objectives of the government to reduce tobacco use and the requirement of Article 5.3 are lost in the aim of TTM. In TTM's 2015 Annual Report, the Chairman expressed “sincere appreciation to tobacco farmers, entrepreneurs, relevant government agencies, tobacco consumers as well as TTM executives and employees of their coordination and support of TTM's success which will lead to TTM sustainable growth in the future.”[17]

Early 2016, the government increased tobacco excise tax as a measure to reduce smoking. Following the tax increase, the Managing Director (MD) of TTM in February 2016 stated cigarette sales fell 3% after the tax rise and will lead to a drop in revenue of around 1 billion baht ($27.5 million) per month for the company. The MD announced cheap cigarettes to counter the sales drop. “The price will be about 40 baht per pack to target the market of low-income consumers, and help them afford cigarettes.”[18] While this promotion would frustrate the government's aim to reduce tobacco use among the poor, there is little they can do to address TTM's business tactics.

The Thai Ministry of Health has a Department of Regulation that outlines specific circumstances under which Health officials can meet with the TI.[19] Although the government has avoided attending social functions of the industry, it has created opportunities for interaction by providing technical assistance to the government such as in the enforcement of curbing the illicit trade in tobacco products. Previously, the TI was not involved nor contributed to any enforcement activities in Thailand. However, now the TTM provides an incentive to the government to seize illicitly traded tobacco.[20]

One way to curb TI influence as recommended in the Article 5.3 Guidelines is through a code of conduct or guidelines for officials when dealing with the TI. Thailand prohibits the acceptance of all forms of contributions from the TTM, including offers of assistance, policy drafts, or study visit invitations to the government and its officials; however, this applies only to the TTM. The government has set up an Article 5.3 Committee and is now developing a procedure to raise awareness within its departments on policies relating to FCTC Article 5.3 Guidelines.

Indonesia

Indonesia, still a nonparty of the FCTC, regards the TI like any other industry and welcomes it as a stakeholder. In this regard, Indonesia continues to face strong TI participation and interference in tobaccocontrol policy development. The TI intervention is not always initiated by the TI. In many circumstances, the government requests for input from the TI before formulating regulations or during the legal drafting process.

The TI uses corporate social responsibility (CSR) activities to gain access to high-level government officials. The Indonesian government accepts, endorses, and participates in CSR activities of the TI. In April 2015, the Minister of Youth and Sports officially opened the National Djarum Circuit (Djarum SIRNAS) for badminton in Li Ning Sulawesi Open 2015. In his speech, he said: “Hopefully, Djarum SIRNAS is able to bring back young athletes who will restore the glory of the Indonesian badminton in the future as they were before, which is very important in Indonesian badminton being followed by the world.”[21] In December, the Head of Ecosystem Restoration Directorate General of Conservation, Natural Resources and Environment Ministry, participated and spoke at Djarum's “Trees for Life” project. Philip Morris International spends a significant amount of its CSR dollars (US $6 million) in Indonesia.

The Indonesian government is “open” about their interactions with TI as they see such interactions as “normal.” However greater transparency is needed because details about the interaction are not publically available. The public is eventually informed of pro-industry legislations. For example, the pro-TI bill introduced for debate in parliament in 2014 was rejected by the end of the previous administration. However, to the public's surprise, the bill re-emerged in the 2014–2019 period, listed among the priority bills in 2015, and has been revised by adding protection of farmers as its main objective.

Indonesia has general guidelines to address conflict of interest (Administrative and Bureaucratic Reforms Minister No. 37/2012) which prohibits government officials from working with any types of industries/establishments outside the government services. However, this prohibition is not extended to the period immediately following their retirement when they still command respect. The former Director General of Customs and Excise, Ministry of Finance, Eddy Abdurrahman, has held many senior positions in various government agencies, including Advisor to the Finance Minister for International Economic Relations and Secretary of the Coordinating Minister for Economic Affairs. In 2015, Abdurrahman was appointed as an Independent Commissioner to the Board of British American Tobacco (BAT)/Bentoel.[22] Raden Bagus Permana Agung Dradjattun before his appointment as independent Commission of Sampoerna was Indonesia's Ministry of Finance Expert Staff for International Relations and Economic Cooperation.[23]

Despite the huge tobacco-related death toll, Indonesia treats the TI like any other industry and still does not see the need to accede to the FCTC. The concept of “TI interference” remains foreign and not seen as a problem. This opens the door for government officials to engage in unnecessary interaction with the TI. The Article 5.3 Guidelines makes several recommendations discouraging government officials from attending TI's social functions and to reject partnerships and offers of assistance from it. In Indonesia, there were incidents of senior government officials attending industry functions, handing out awards, and conducting factory visits. For example in June 2016, officials of several departments and the former governor of East Java officiated at the opening ceremony of a cigarette factory in Sidoarjo Regency, a regency of East Java.[24]

In 2016, Indonesia took a step forward in addressing TI interference and approved the Health Minister Regulation No. 50/2016 Guidelines for managing conflict of interest with the TI in the Ministry of Health. This regulation will assist the Health Ministry when it strengthens tobacco control measures.

Myanmar

Currently, Myanmar does not have an overall policy to implement Article 5.3. While the Myanmar government is open to the investment from TI, however, it has not accepted any offers of assistance from the industry in implementing tobacco control policies. Myanmar is moving forward in developing policies compliant with the FCTC.

Myanmar has banned TI related CSR activities since 2006. However, in September 2015, Japan Tobacco International (JTI) Myanmar met with the Secretary of Myanmar Investment Commission and made a small donation toward helping flood victims.[25] In February 2016, Myanmar approved legislation for pictorial health warnings (PHW) on cigarette packs to come into effect September 1, 2016. In March, JTI Myanmar, along with BAT, met with the Myanmar Investment Commission about delaying the PHW;[26] although, this department has nothing to do with the public health measure.

The Myanmar government's recent experience with JTI illustrates the need for transparency and record keeping when interacting with the TI. Although Myanmar has a comprehensive ban on tobacco advertising promotion and sponsorship, in October 2016, JTI ran a half page colored advertisement of its prominent brands in a local newspaper supposedly meant to be a “public notice” to inform its customers about new graphic PHW on cigarette packets. JTI claimed it had approached the Department of Health and obtained permission to publish the “public notice” that the announcement as it appeared in the newspaper “was formally approved by the Deputy Director General of the Public Health Department.”[27] However, a Senior Public Official from the Department of Health refutes the department giving permission, calling JTI “liars” and referring to the “public notice” as opportunistic advertising. When a journalist attempted to get a copy of the written permission from JTI, it did not respond to the journalist's request.[28] Clearly JTI had used this opportunity to do some advertising and had taken advantage of the department's lack of experience. If the government had a procedure in place to disclose meetings with the TI, records of minutes and outcomes of the meetings, it would be in a stronger position to counter any misunderstanding or lies from the industry.


   Discussion Top


Article 5.3 is a general obligation in the FCTC, and its implementation is vital to strengthen overall tobacco control efforts. While there may be some efforts toward raising awareness on the relevance of Article 5.3 Guidelines, these are not carried out in a systematic nor consistent manner. Hence, most government departments outside the Ministries of Health have little or no knowledge of FCTC Article 5.3 Guidelines and treat the TI like any other business or investor. Hence, they can even be manipulated to undermine the Health Ministry's tobacco control as seen in the case of Myanmar.

Lack of transparency remains an issue across all the three countries. The governments do not publicly disclose meetings nor have a procedure for disclosing records of interactions with the TI and its representatives. If efforts toward record keeping of interactions is stepped-up and done systematically, it will assist governments toward better implementation of Article 5.3 Guidelines.

Most governments have not set up rules nor procedures for the disclosure or registration of TI entities, affiliates organizations and individuals acting on their behalf. Such a register would be helpful to governments to identify the industry as increasingly the tobacco companies' lawyers, hired consultants, and third party entities are approaching governments to lobby on its behalf.

Tobacco companies have increased their spending on CSR in the ASEAN region as governments adopt comprehensive bans on tobacco advertising, promotion and sponsorship, or severely restrict them. Thailand has just banned TI-related CSR activities and joins Lao PDR and Myanmar who have already banned them. However, top Indonesian leadership continues to remain vulnerable to such activities.

This review provides information on the extent of the TI's influence in Indonesia which can help explain Indonesia's obstacle in acceding to the FCTC.

Limitations

As stated in the methodology, this review is based on the publically available information. It is possible that interactions may have occurred or incentives given to the TI which has not been included in this review because there are no publically available evidence to reference. Transparency is flagged as an issue in all three countries. Some information are sensitive in nature and cannot be used in this review.


   Conclusion and Recommendations Top


The recommendations in Article 5.3 Guidelines provide clear measures governments can implement to curb industry meddling and disruption. The guidelines were adopted in 2008 and this review shows Governments have to step-up their efforts in implementation dramatically. Outside the Ministries of Health, other government departments remain largely unaware of Article 5.3 and have not utilized its strength to regulate the TI. More concerted effort is needed to publicize the importance of implementing Article 5.3 to achieve greater success in tobacco control. The following are some recommendations:

  • A whole-of-government approach is vital for Article 5.3 implementation. Governments need to record and document all meetings with the TI and their outcomes. Ministries of Health need to work more closely with ministries of trade to address this. A way forward is to adopt a code of conduct for government officials
  • Procedures should be put in place to reduce TI participation in policy development
  • Transparency is needed in dealing with the TI
  • Ban all TI related CSR activities
  • Require tobacco companies to disclose and report on all expenditure on marketing, retailer incentives, lobbying, and political contributions
  • Indonesia must accede to the WHO FCTC as soon as possible to implement stringent tobacco control measures and halt interference from the TI.


Financial support and sponsorship

Initial research in Tobacco Industry Interference was supported by grant from the Bloomberg Initiative Thailand-RIRE-06B 2015.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
WHO. Framework Convention on Tobacco Control. Available from: http://www.who.int/fctc/guidelines/article_5_3.pdf?ua=1. [Last accessed on 2017 Aug 19].  Back to cited text no. 1
    
2.
Assunta M, Dorotheo EU. SEATCA tobacco industry interference index: A tool for measuring implementation of WHO framework convention on tobacco control article 5.3. Tob Control 2016;25:313-8.  Back to cited text no. 2
    
3.
Tobacco Industry Interference Index: ASEAN Report on Implementation of WHO Framework Convention on Tobacco Control Article 5.3, Southeast Asia Tobacco Control Alliance (SEATCA), Bangkok, Thailand; September 2016. Available from: http://www.seatca.org/dmdocuments/TII%20Index%202016.pdf. [Last accessed on 2017 May 15].  Back to cited text no. 3
    
4.
Indonesia, Though a Non-Party to the WHO FCTC, has Committed to the Post-2015 Sustainable Development Agenda. Goal #3 Good Health and Well-Being which Recognises the Essential Role of the WHO FCTC in Reducing non-Communicable Diseases. Available from: http://www.id.undp.org/content/indonesia/en/home/post-2015.html. [Last accessed on 2017 Aug 19].  Back to cited text no. 4
    
5.
Sangthong R, Wichaidit W, Ketchoo C. Current situation and future challenges of tobacco control policy in Thailand. Tob Control 2012;21:49-54.  Back to cited text no. 5
    
6.
Assunta M. Myanmar needs to stub out stub out growing tobacco usage. East Asia Forum 2017. Available from: http://www.eastasiaforum.org/2017/01/07/myanmar-needs-to-stub-out-gromwing-tobacco-usage/. [Last accessed on 2017 May 15].  Back to cited text no. 6
    
7.
World Health Organization. Global Adult Tobacco Survey: Indonesia. Fact Sheet; 2011. Available from: http://www.who.int/tobacco/surveillance/survey/gats/indonesia_factsheet_8_february_2012.pdf?ua=1. [Last accessed on 2017 Aug 19].  Back to cited text no. 7
    
8.
Southeast Asia Tobacco Control Alliance. SEATCA FCTC Scorecard: Measuring Implementation of the WHO Framework Convention on Tobacco Control. Bangkok, Thailand; 2016. Available from: http://www.seatca.org/dmdocuments/SEATCA%20FCTC%20Scorecard.pdf. [Last accessed on 2017 Aug 19].  Back to cited text no. 8
    
9.
Tobacco Industry Interference Index; 2014. Available from: http://www.seatca.org/dmdocuments/SEATCA-TII%20Index%20Report.pdf. [Last accessed on 2017 Aug 19].  Back to cited text no. 9
    
10.
Tobacco Industry Interference Index; 2015. Available from: http://www.seatca.org/dmdocuments/TII%20Index%202015_F_11Aug.pdf. [Last accessed on 2017 Aug 19].  Back to cited text no. 10
    
11.
Thai Edition of ASEAN Excise Tax Reform Manual Launched at Royal Thai Excise Department; 29 October, 2015. Available from: http://www.iticnet.org/news-item/thai-edition-of-asean-excise-tax-reform-manual-launched. [Last accessed on 2017 Aug 19].  Back to cited text no. 11
    
12.
Convention Secretariat of the FCTC. Industry Interference in Tracking and Tracing of Tobacco Products. CSF/NV/16/04. Geneva; 4 March, 2014.  Back to cited text no. 12
    
13.
International Tax and Investment Center. Available from: http://www.tobaccotactics.org/index.php/International_Tax_and_Investment_Center. [Last accessed on 2017 Aug 19].  Back to cited text no. 13
    
14.
Net Widens in Probe of Thai Health, Bangkok Post; 20 October, 2015. Available from: http://www.bangkokpost.com/print/735444/. [Last accessed on 2017 Aug 19].  Back to cited text no. 14
    
15.
Thai Health CEO Ready to Face Investigation. The Nation; 15 October, 2015. Available from: http://www.nationmultimedia.com/detail/national/30270925. [Last accessed on 2017 Aug 19].  Back to cited text no. 15
    
16.
MacKenzie R, Ross H, Lee K. 'Preparing ourselves to become an international organization': Thailand tobacco monopoly's regional and global strategies. Glob Public Health 2017;12:351-66.  Back to cited text no. 16
    
17.
TTM Annual Report 2015. Message from the Chairman. Available from: http://www.thaitobacco.or.th/en/message-from-the-chairman/. [Last accessed on 2017 May 15].  Back to cited text no. 17
    
18.
Thailand to Provide Lost-Cost Cigarettes to the Poor. Investvine; 27 Febraury, 2016. Available from: http://www.investvine.com/thailand-to-provide-low-cost-cigarettes-to-the-poor/. [Last accessed on 2017 May 15].  Back to cited text no. 18
    
19.
Regulation of Department of Disease Control: Regulation of Department of Disease Control. How to Contact Tobacco Entrepreneurs and Related Persons. Thailand; 2012. Available from: http://www.seatca.org/dmdocuments/Regulation%20of%20Department%20of%20Disease%20Control_2012.pdf. [Last accessed on 2017 Aug 19].  Back to cited text no. 19
    
20.
Thai Tobacco Monopoly to Award Authorities for Cracking Down on Illicit Cigarettes. NNT; 26 February, 2016. Available from: https://www.thaivisa.com/forum/topic/898119-thailand-tobacco-monopoly-to-award-authorities-for-cracking-down-on-illegal-cigarettes/. [Last accessed on 2017 May 15].  Back to cited text no. 20
    
21.
Menporabuka Djarum Sirnas Li Ning Sulawesi Open; 2015. Available from: https://www.djarumbadminton.com/sirkuit-nasional/berita/read/menpora-buka-djarum-sirnas-li-ning-sulawesi-open-2015/. [Last accessed on 2017 Aug 19].  Back to cited text no. 21
    
22.
Bentoel Group: Profile of the Board; 24 February, 2015. Available from: https://www.translate.google.com.au/translate?hl=en&sl=id &u=http://www.bentoelgroup.com/group/sites/BAT_A5EEYP.nsf/vwPagesWebLive/DO9T5KHH&prev=search. [Last accessed on 2017 May 15].  Back to cited text no. 22
    
23.
PT HM Sampoerna Tbk Annual Report; 2015. Available from: http://www.sampoerna.com/id_id/investor_information/disclosures_and_reports/documents/ar_hm%20sampoerna%202015_eng_8april.pdf. [Last accessed on 2017 May 15].  Back to cited text no. 23
    
24.
Investasi Rp 600 M Rokok Moden Diproduksi di Sidoarjo, Hasilnya Diekspor; 29 June, 2016. Available from: http://www.medianusantarasatu.com/investasi-rp-600-m-rokok-moden-diproduksi-di-sidoarjo-hasilnya-diekspor/. [Last accessed on 2017 May 15].  Back to cited text no. 24
    
25.
Donation to Myanmar Investment Commission. Available from: http://www.dica.gov.mm/en/news/donation-5400000-kyat-flood-victims-myanmar. [Last accessed on 2017 May 15].  Back to cited text no. 25
    
26.
Discussion with Myanmar JTI and BAT. Available from: http://www.dica.gov.mm/en/news/discussion-myanmar-japan-tobacco-co-ltd-and-british-american-tobacco-co-ltd. [Last accessed on 2017 May 15].  Back to cited text no. 26
    
27.
Tobacco Giant Behind Camel and Winston ae 'Liars' – Myanmar Health Official. Myanmar Business Today; 12 December, 2016. Available from: http://www.mmbiztoday.com/articles/tobacco-giant-behind-camel-and-winston-are-liars-myanmar-health-official. [Last accessed on 2017 May 15].  Back to cited text no. 27
    
28.
Carrol J. A Foreign Correspondent Based in Rangoon, Myanmar. Email Communication; 21 December, 2016.  Back to cited text no. 28
    


    Figures

  [Figure 1]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
    Conclusion and R...
    References
    Article Figures

 Article Access Statistics
    Viewed724    
    Printed10    
    Emailed0    
    PDF Downloaded102    
    Comments [Add]    

Recommend this journal