Report Makes Case for FDA To Regulate Tobacco Products
FDA should have "broad regulatory authority" over the marketing, packaging and sale of tobacco products, according to an Institute of Medicine report released on Thursday that details tobacco use and related health trends in the U.S., CQ HealthBeat reports (Phillips, CQ HealthBeat, 5/24).
The report found that tobacco use is responsible for 440,000 U.S. deaths and $89 billion in health care costs each year. The report also found that 21% of adults smoke, compared with 42% in 1965, the year Congress began mandating a warning label for cigarettes. Twelve percent of high school seniors smoke, according to the report, a decline from 17% in 1992 and 23% in 1999 (Lee, Washington Post, 5/25).
The report said that almost half of the 44.5 million U.S. smokers will die prematurely of a tobacco-related illness if they do not quit the habit. The report also noted that cigarettes are unique in that they contain carcinogens and other toxins that would be banned by federal law if tobacco products were not explicitly exempt (Szabo, USA Today, 5/25).
Richard Bonnie, a University of Virginia law professor who led the panel responsible for the report, said, "Most [smokers] regret having taken up the habit and struggle to quit" (Washington Post, 5/25). Bonnie added that only federal intervention can lower the percentage of smokers in the country.
In addition to saying that FDA should regulate tobacco products, the IOM report recommended:
- Requiring that all health insurance plans -- including Medicare and Medicaid -- cover smoking cessation programs;
- Enacting nationwide bans on smoking indoors in all nonresidential areas (USA Today, 5/25);
- Limiting tobacco advertising to black-and-white print-only formats;
- Prohibiting the use of "mild," "light" and "low-tar" in cigarette packaging, unless the claims are backed by scientific research, and also banning other "misleading" information;
- Requiring large graphic warnings of the dangers of smoking on all cigarette packs and cartons;
- Restricting the type of establishments that can sell cigarettes, requiring that they are licensed and mandating that they display warnings and cessation ads;
- Creating a strategy to gradually reduce the allowable nicotine content of cigarettes (CQ HealthBeat, 5/25);
- Increasing the excise tax on cigarettes as much as $2 per pack (Washington Post, 5/25);
- Dedicating $15 to $20 per capita of proceeds from higher taxes or other financial sources each year to finance state tobacco control efforts; and
- Undertaking additional efforts to discourage youth interest in smoking and access to tobacco (Schmid, AP/Seattle Post-Intelligencer, 5/25).
The panel said such measures could help reduce the nation's smoking population to 10% by 2025 (Washington Post, 5/25).
Bonnie said, "We are not talking about eliminating tobacco use. We want to reduce it to the point that (it) is no longer a substantial public health problem" (Richmond Times-Dispatch, 5/25).
Bills proposed in the Senate (S 625) and House (HR 1108) would put FDA in charge of tobacco regulation.
Sen. Tom Harkin (D-Iowa), a co-sponsor of the legislation, in a release said, "This report should serve as a wake-up call to Congress to pass legislation immediately so that the FDA has the authority to protect the public and give the people the right tools to make informed decisions" (CQ HealthBeat, 5/24).
However, FDA commissioner Andrew von Eschenbach said that reducing nicotine levels would cause people to adapt their habit to maintain the intake of nicotine. He added, "We could find ourselves in a conundrum of having made a decision about nicotine only to have made the public health radically worse" (AP/Seattle Post-Intelligencer, 5/25). "What we absolutely want to avoid is a scenario in which FDA is approving something that it not safe and is not protecting and promoting public health," von Eschenbach said.
The Senate bill to regulate tobacco has the support of Philip Morris, which in a statement said, FDA regulations would speed up tobacco companies' efforts to "refocus their effort to pursue reduced-harm products." The company added that it "believes regulation should also bring predictability and clear standards" to the U.S. tobacco industry (Henderson, Boston Globe, 5/25).
Rival R.J. Reynolds said Philip Morris only supports the bill because the proposed limitations on advertising would entrench the company's dominant market position (Washington Post, 5/25). The IOM report is available online.
In related news, almost three out of every four U.S. households prohibit smoking, a significant increase from 43% a decade ago, according to a study published Thursday in CDC's Morbidity and Mortality Weekly Report, the AP/Arizona Daily Star reports.
The study -- which CDC claims is the first to take a state-by-state approach to analyzing smoking in U.S. homes -- was based on a 2003 national survey conducted mostly by phone. For a household to qualify for the survey, all residents had to be older than age 15 and all members had to agree on the smoking rules.
CDC officials said expanding limits on smoking in public buildings contributed to the shift displayed by the report.
Corinne Husten, co-author of the study and chief of the epidemiology branch of CDC's Office on Smoking and Health, said the report "really says that people are starting to understand the hazards of secondhand smoke."
Utah led the country with nine out of every 10 homes prohibiting smoking, while Kentucky was in last place, with one in every four homes prohibiting smoking (AP/Arizona Daily Star, 5/25).