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Health & Medicine 6/23/03

By Bernadine Healy, M.D.

Big Tobacco's triumph

by Bernadine Healy.

Growing enthusiasm for government promotion of safer cigarettes has united a strange trinity of Big Tobacco, no-smokeniks, and politicians of all stripes. This amity, however, could derail any hopes we have of eradicating tobacco use among our children.

The Food and Drug Administration has long wanted to regulate tobacco as a medical product. That obviously would mean banning tobacco as the addictive, carcinogenic, heart-attack- and stroke-promoting, skin-wrinkling, teeth-rotting, breath- and life-destroying scourge that it is. But the Supreme Court said no, ruling that only new law could grant the agency such tobacco over-sight. In response, the House has crafted compromise legislation. It would give the FDA a victory that from Philip Morris's perspective, pardon the expression, is to die for.

In a veritable Kabuki dance, the FDA would be meekly and tightly choreographed on anything having to do with tobacco. It could not ban existing products, or new ones if deemed no more harmful than what was on the shelves. While the agency could set "performance standards," the standards could not force lead, arsenic, or other toxins to be removed if in doing so the product became less "acceptable" to adults. Additionally, FDA would be given the huge task of figuring out which products merit the claim of "safer": for example, cigarettes with fewer cancer-producing nitrosamines or devices that heat instead of burn cigarettes to lower tars. For its work, the FDA would get fees from Big T, addicting the agency, as many of our politicians are already, to the heady taste of tobacco money.

The idea of "safer" tobacco is not new. After the 1964 surgeon general's report first condemned tobacco use, the Federal Trade Commission stepped up regulation of advertising claims. The industry responded with filters, lower tar and nicotine, and menthol-"medicated" cigarettes, all of which promoted an image of health that had particular appeal to women, who then were not big smokers. Big T also gained a certain credibility by being able to say that its products were government approved.

Rubber stamp? Oversight by the FDA could be even more of a bonus. Indeed, even the whiff that smokeless tobacco might be stamped by this health agency as safer is likely to clean up its image. "Smokeless" is the marketers' nice name for chewing tobacco or the candy-flavored lozenges in which tobacco is soaked up by the lining of the mouth and throat. Ominously, dipping and using spit bottles rather than ashtrays is gaining popularity. Adolescent boys are especially enthusiastic about the smokeless stuff; they seem to think it's macho. It certainly is a lot cheaper (negligible excise taxes) and suits smoke-free places like school or the baseball field. But it comes with nicotine addiction, putrid breath, and inflamed, receding gums along with the risk of mouth, tongue, and throat cancer. Public-health predictions suggest that smokeless tobacco would cause fewer deaths--if chewers and dippers don't also smoke cigarettes. But most of them do.

But isn't the goal less tobacco use, not more? Shrinking tobacco markets rather than expanding them? Could FDA oversight as it's now crafted actually undo the hard-won success of cutting the U.S. smoking rate to one of the lowest in the world? Four decades of surgeons general driving home tobacco's dangers have shifted the image of smoking from glamorous to grungy, from cool to suicidal. Lawsuits have also exposed the treachery of using nicotine, as addicting as cocaine, to enslave and grow a captive market. As I see it, "safer" tobacco is more likely to encourage starters and discourage quitters than to improve public health.

There are steps that will shrink the smokers' ranks. First, impose tough taxes on all tobacco products. The United States has virtually the lowest excise taxes in the world, yet we know that cost is a huge disincentive to tobacco use. Every 10 percent increase in price brings a 5 percent decrease in use for adults and a whopping 7 percent reduction for teens. Second, regulate with teeth. Why not let the FDA pull products off the market as "safer" replacements hit the shelves? Don't deny addicts their fix, but stop the trickery of candy-coated additives.

U.S. Surgeon General Richard Carmona startled a recent congressional hearing by saying that no cigarette is a safe cigarette and that they all deserve to be banned. Tobacco executives were shocked, just shocked, and the administration promptly disavowed his comments. As for luring kids to the chewing game, the surgeon general was equally clear: "No way! Bad health! Tough to quit! Very disgusting!" Bravo, Dr. Carmona. A breath of fresh air.

Copyright © 2003 U.S. News & World Report, L.P. All rights reserved.