How Should Tobacco Be Regulated?

A new survey published in the American Journal of Public Health finds the following:

Knowledge of current public opinion is important as the Food and Drug Administration (FDA) applies the best scientific evidence available to tobacco product regulation. Based on a nationally representative survey of the US adult population, we report 43% support for banning of cigarettes, 65% for reducing nicotine, and 77% for reducing nicotine if such an action could cause fewer children to become addicted to cigarettes. The FDA should consider protecting children by removing all but nonaddictive cigarettes from the marketplace.

Only recently has the Food and Drug Administration had the power to regulate tobaccoproducts. How it will use that power remains to be seen. The Family Smoking Prevention and Tobacco Control Act of 2009 does not allow the agency to outlaw cigarettes but confers upon it the power to set standards that can reduce nicotine content and regulate chemicals in cigarette smoke.

Short of a ban, what tobacco control measures are justified based on public health benefits while also being defensible regarding concerns about limiting corporate speech? That appears to be where the rubber is hitting the road at this juncture.

What these Harvard School of Public Health researchers have done in their study is to artfully frame the issue in terms of a few specific choices. With 77% support in this survey for “removing all but nonaddictive cigarettes from the marketplace,” there now appears to be strong majority support for a major new form of regulation, though I hasten to add that the tobacco industry and its allies have not yet waged a major anti-regulation ad campaign. If and when they do, the percentages currently favoring stronger regulation may decline. That said, 77% is a strong starting point.

Crafting effective policy to regulate harmful and addictive substances requires evidence, courage and subtlety. There are no easy answers and the politics are complicated. This was underscored by a recent temporary injunction issued by Judge Richard J. Leon of United States District Court in Washington (a George W. Bush appointee), which blocked new FDA rules requiring that all cigarette packs include graphic warnings about cigarettes, similar to those required in Canada and Australia. While Judge Leon’s ruling (which he based largely on the free speech rights of tobacco companies) runs contrary to other judicial rulings on FDA tobacco policy, and may not survive appeal, it raises significant questions as how much maneuvering room is available to the FDA.

Because cigarettes are legal, the severity and wide ranging effects of cigarette addiction are under-appreciated. Lung cancer and heart disease are only two of the diseases tobacco can cause. Several years ago, when I compiled lists of risk factors for all major chronic degenerative diseases to use in the clinical nutrition course I teach, smoking was a risk factor for every single disease.

Years ago, I heard a talk by Dr. Andrew Weil of the University of Arizona Medical School, in which he asserted that a cigarette habit is harder to kick than an addiction to heroin. The massive damage that cigarettes cause to individuals and society as a whole has been amply documented and widely publicized for over 50 years (the landmark Surgeon General’s report was released in 1964), and the case against cigarettes continues grows ever stronger.

It’s time for the FDA to significantly strengthen its tobacco regulations and for the courts to recognize that public health should outweigh tobacco company profits.