Her name is long forgotten and how she thought up her macabre suicide remains a mystery. But the lonely death of a middle-aged woman in November 1998 who sealed the doors and windows of her Hong Kong bedroom and then set light to a pan of barbecue charcoal was a solitary tragedy that mutated into an international epidemic.

Fourteen years after what was the first recorded case globally by charcoal burning, the trend has gone global. It has claimed thousands of lives, it is the leading method of suicide in parts of Taiwan, and it has spread to the US and most recently to the UK.

Fuelled by lurid and descriptive newspaper reports of the original case, charcoal burning quickly became the second most common form of suicide in Hong Kong, accounting for 320 deaths in 2003. Although it declined in subsequent years, it is on the rise again and accounts for between 150 and 160 deaths a year, or around a sixth of all Hong Kong suicides.

As well as the city that spawned the ghoulish practice, Hong Kong is also the place that pioneered moves to tackle it — hosting a trial one-year project in which sales of barbecue charcoal were restricted at supermarkets and stores in one district, leading to an impressive  53 percent fall in deaths by charcoal burning.

By taking charcoal off the shelves and keeping it in a store room, making packets available only upon request to customers, the suicide rate using the method in the district, where the project was carried out in 2006-2007, was reduced by the equivalent of 11 people.

The project, summarized in a detailed 2010 academic study, was deemed so successful it has since been adopted and promoted by officials in Taiwan as a long-term method to tackle the trend, which has become so widespread it now accounts for almost one in three suicides in Taipei.

But in Hong Kong, the two main supermarket chains Wellcome and Park n Shop — which took part in the 2006-2007 experiment — have steadfastly refused to continue or extend the trial scheme and have reverted to stocking charcoal on shop shelves, stonewalling repeated appeals from the University of Hong Kong’s Centre for Suicide Research and Prevention.

Now the center’s Director Paul Yip Siu-fai hopes the supermarkets and the Hong Kong government will have a change of heart as a new study published in prestigious medical journal The Lancet on Friday analyses the Hong Kong experiment for a worldwide audience and argues that such initiatives can save lives.

Written by Yip together with psychiatric, social work and medical experts from the US and Taiwan, the paper demonstrates forensically how restricting access to a popular means of suicide leads to an overall reduction in the death rate.

In a powerful, authoritative argument for community intervention, the paper says: “The probability of individuals attempting suicide decreases when they are precluded from implementing a preferred method.

“Moreover, if a highly lethal method is not available and some individuals do not defer their attempt, they frequently use less lethal, more common ones ... The sudden, unplanned (or briefly planned) nature of many suicides implies that individuals tend to use the method most readily accessible to them.

“When a lethal method is unavailable at the moment of potential action, suicide attempts might be delayed so that (in some cases at least) suicidal impulses will pass without fatal effects.”

Contrary to popular prejudice, the paper argues, people who are put off using a readily available means of suicide do not always go on to kill themselves using another method.

“Many community members express common misunderstandings that, despite data showing powerful population-level effects, a seriously suicidal person will inevitably find a way to die and that all methods have roughly equal case fatalities,” it says.

In reality, the experts concluded, people who put off a chosen course of suicide may either give up their attempt altogether, or choose an alternative, less lethal method with a higher chance of survival and more opportunity for intervention.

For Yip, the failure of officials and supermarkets chains in Hong Kong to seize the initiative offered by the results of the experiment in restricting charcoal sales is baffling and disappointing, particularly as suicides using the method now appear to be rising.

While Hong Kong’s overall suicide rate has stabilised at around 960 cases a year, charcoal burning cases have climbed back up from a low of around 130 to between 150 and 160 a year.

“I do hope the supermarket chains or stakeholders can rethink the matter to see whether they would like to help,” he said. “Our figures suggest that once the measure (the restriction on charcoal sales) was removed, we have seen an increase in charcoal burning suicides.

“When you look at traffic accidents in Hong Kong, less than 150 people a year die this way but we do more to prevent traffic accident deaths. We begin efforts in schools, we change traffic lights where necessary, we educate the public about how to cross the road. And yet less people die in traffic accidents than commit suicide by charcoal burning.”

Although the success of the Hong Kong experiment is apparently ignored in its home city, it is enthusiastically embraced in Taiwan. Yip and his colleagues will visit Taiwan in August to help implement the restrictions on charcoal sales in shops.

“They have introduced restrictions there that are greater than those we tried in Hong Kong,” he said. “You cannot buy charcoal over the counter. You have to fill in a form with your address. If you look distressed, they provide you with pamphlets so you can seek help.”

The appeal to Taiwanese officials of the measures to restrict charcoal sales were that it offered a rare opportunity to influence suicide trends which is not available with other methods such as hanging or jumping from high buildings, he said.

Yip and his colleagues have also been invited to the UK, where charcoal burning suicide is a relatively new phenomenon, to share the experiences of how Hong Kong has attempted to tackle the issue.

However, unless there is either legislation forcing restrictions of charcoal sales or a dramatic change of heart by the city’s leading supermarket chains, Yip will be forced to admit to his overseas audiences that Hong Kong has failed to act on the findings of the experiment it hosted.

Both Park n Shop and Welcome declined to answer questions from the China Daily on why they had rejected requests from Yip’s team for city-wide restrictions on charcoal sales. They also declined to give their views on the findings of the 2006-2007 experiment or to say whether they would be prepared to reconsider its position in the light of the paper published in The Lancet.

Park n Shop Public Relations Manager Teresa Pang — who has previously cited convenience and lack of storage space in urban stores for not keeping charcoal off the shelves — sent an emailed statement saying: “At Park n Shop, we always believe that spreading messages of positive living is important.

“Back in 2002 we have put a label on each pack of charcoal selling in our stores to spread the message of positive living and also added help hotlines if assistance is required from professionals. We will continue our efforts in this respect as our commitment to serving the community.”

Wellcome issued a statement through an external public relations company insisting the company “takes suicide prevention very seriously”. “Charcoal sold at Wellcome is clearly printed with Suicide Prevention Service Hotlines’ information,” the statement said.

It added: “Also, charcoal purchasing trends at our stores indicate that the vast majority of sales were made together with food, drinks, condiments and utensils needed for the preparation of barbeque meals. As a responsible corporate citizen, we will continue to monitor this issue, paying particular attention to the opinions and feedback of experts as well as the community.”

Asked why he believed there was such apparently unshakeable resistance from the supermarkets, Yip said: “I think in their minds, they believe if you take away this means, they will find another means to kill themselves anyway so it is not really useful.

“What we are saying is that we have shown it is effective, we have shown the results, so please take away this bias.

“The second aspect is the stigma attached to suicidal people and to mental illness. They (the supermarkets) do not have a heart to help these people in the same way that they would help cancer patients or people dying from other diseases.

“The third thing — and this really is very unfortunate — is that Hong Kong is so profit-oriented. They will try to remove anything that stops them reaching their targets and they don’t know how to put value on a human life.

“It makes me very sad when we claim ourselves to be Asia’s World City. Our ability to help vulnerable people is a way to judge how humanistic and civilized we are. These so-called corporate social responsibility companies talk of becomes a slogan rather than a genuine response to a well-researched, evidence-based appeal.”

Yip said he hoped the incoming administration would act on the issue and even consider legislation forcing shops, supermarkets and wet markets across Hong Kong to restrict charcoal sales, although he admitted he and his colleagues felt like “voices in the wilderness”.

“I have spoken to government officials in the past and they told me ‘We are not ready to do this and it is not on our agenda’,” he said. “They are passing the ball from one court to another, and all the time people continue to die from charcoal burning. That is very disappointing.

“With a new government, we have a lot of expectations. Mr (CY) Leung is a man appealing for change from a profit-oriented to a people-oriented society.

“Convenience is one of the top considerations of the Hong Kong people but we are talking about helping the vulnerable and disadvantaged. I do think if we can go down the route to legislation it would be helpful. If not we should at least revisit the situation.”

A spokeswoman for the Labour and Welfare Bureau indicated that the government was unlikely to consider legislation, although she stressed that it actively supported research and initiatives to reduce the number of suicide cases. “We aim to raise awareness of suicide prevention at the community level through public education and publicity,” the spokeswoman said in a written response.

“The administration attaches much importance to tackling suicide problem at source. We provide the relevant welfare, medical and health services for those in need. Public education is also provided while publicity is conducted to promote positive messages of treasuring life and positive attitude towards adversities.”

The paper published in The Lancet on Friday emphasises a key point in restricting the means to commit suicide: “To be successful, this type of strategy depends on committed societal leadership and sustained political will.” To the dismay of Yip and his colleagues, both those elements appear, from their standpoint, to be in pitifully short supply.