DAVID KESSLER, the United States Food and Drug Administration commissioner, is attempting to bring the tobacco industry under his agency's control. The president and Congress should firmly and publicly back Dr. Kessler as he seeks to regulate tobacco companies.
The tobacco industry occupies a special place among Washington's special interests. One need not look further than the recent Senate gutting of a proposed tobacco tax that would have helped finance health-care reform. Two Senate committees - Labor and Human Resources and Finance - approved health-care language that included $1.50- and $1-per-pack tobacco taxes, respectively. The members of those committees knew that the majority of Americans were willing to accept a significant tobacco-tax increase, even up to $2 per pack. What happened? When Sen. George Mitchell (D) of Maine announced his bill, the tobacco tax had wilted to 45 cents per pack, phased in over five years. It seems that the new Senate math is being taught by the tobacco lobby.
The tobacco industry has always had its way with Congress. Just ask the Tobacco Institute, the Washington-based lobbying arm for the tobacco industry. On numerous occasions, it has taken to publicly proclaiming satisfaction with the legislative process on Capitol Hill. Kessler knows this lesson all too well. By publicly turning up the heat on tobacco regulation, he's thrown a sabot into the tobacco industry's wheel of fortune. It's one thing for the tobacco industry to lobby Congress, where the money spigot is always open and running. Muscling aside a determined FDA commissioner may be another story.
Slanted tobacco survey
Clearly Kessler believes tobacco is an enormous public health problem, as does the world's health community. The potential for preventing a generation of young people from becoming hooked on tobacco and becoming statistics in the next round of smoking-related deaths appears to be his motivation to bring tobacco under FDA regulation. The tobacco industry has responded with attempts to color Kessler a prohibitionist. It even includes that language in its national survey questions to ensure that it can falsely portray a public dissatisfaction with regulating tobacco.
For example, a recent Roper Starch telephone survey commissioned by R. J. Reynolds asks the question: ``Do you think the federal government should regulate the purchase, use, and production of tobacco products if such regulations would likely result in the prohibition of cigarettes or smoking ...?'' A Gallup survey commissioned by our coalition last year asked a different question and found that 68 percent of Americans - both smokers and nonsmokers - believe that tobacco products should be regulated by the FDA in a manner similar to how drugs are regulated.
What approach is Kessler likely to take to regulate tobacco? In a letter sent to our coalition in February, Kessler said he was asking Congress for ``guidance'' on the issue. So far, nothing concrete has emerged from Capitol Hill. The most logical step for Congress to take would be to move on a bill introduced by Rep. Mike Synar (D) of Oklahoma that would give the FDA the same clear-cut authority to regulate tobacco it currently has for foods, drugs, and cosmetics. The bill specifically does not ban tobacco products. But the bill must move through the House Subcommittee on Health and the Environment. That committee has been, historically, a graveyard for tobacco-control legislation.
But Kessler can propose regulations for tobacco without congressional action. He appears to be interested in ratcheting down nicotine levels in cigarettes to below an addictive threshold, which is yet to be agreed upon by the scientific community. That action could keep cigarettes from a drug classification, but they would still be a dangerous product.
For the past decade, the Coalition on Smoking OR Health has advocated FDA regulation of tobacco products as one of the most effective and reasonable approaches to tobacco control. At a minimum, FDA regulation of tobacco should encompass the following:
Manufacturing: Require the tobacco industry to disclose to the public the levels of nicotine, tar, chemical additives, and all other potentially harmful substances in tobacco products.
Sales: Require the enforcement of laws so that tobacco products are not sold to anyone under the age of 21.
Labeling: Require all tobacco products to carry warnings on addiction, chemical additives, and other information critical to public health. The FDA should prohibit use of misleading claims in both the labeling and advertising of tobacco products.
Advertising: Ban all tobacco advertising targeted at children. The FDA should ban or restrict deceptive or misleading images for all tobacco advertising as is done for other products.
Promotion: Ban free or discounted giveaways of tobacco products. The FDA should eliminate the sponsorship of any event, such as a sports or arts event, that uses the brand name of a tobacco product.
Don't ban, but regulate
The public-health community must continue to help smokers who want to quit, and do everything it can to prevent children and teenagers from starting to smoke. Our health organizations have worked with millions of smokers who want to quit. We know how difficult it can be. A ban will not work. But we are in the midst of a tobacco epidemic. Smoking is expected to kill 419,000 Americans each year. It adds $30 billion annually in direct medical costs to our national health-care bill. The suffering it causes individuals and families is immeasurable.
Tobacco regulation is a straightforward and admirable public-health goal. It is perfectly in line with the FDA's responsibility and the government's role in public-health and safety issues. Congress has a choice: Give in once more to tobacco special interests or work with Kessler. For his part, President Clinton can show that he means it when he inveighs against special-interest politics. He should stand behind his FDA commissioner while he stands up to the tobacco industry.
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