Today, the Institute of Medicine released its report Ending the Tobacco Problem: A Blueprint for the Nation. In a public briefing Richard J. Bonnie, Chair of the IOM Committee on Reducing Tobacco Use, explained that “ending the tobacco problem” means reducing tobacco use “so substantially that it is no longer a significant public health problem.”
In the U.S., tobacco use claims an estimated 440,000 lives and rings up an estimated $89 billion in health care costs every year. Worldwide, it’s responsible for five million deaths each year, making it the second major cause of death.
The reduction in U.S. smoking – tobacco use has declined by more than 50% since 1964 – is a major public health achievement, but Bonnie noted that there are still 45 million smokers and that smoking initiation rates in young adults appear to be rising. To preserve and enhance gains already made, the committee recommends strengthening existing tobacco control measures “such as excise tax increases, indoor smoking restrictions, comprehensive state-based programs, media-based prevention campaigns, school-based programs, and cessation therapies and services.” To truly end the tobacco problem, though, Bonnie explained that stronger tools are needed:
To put the nation on a sure course for ending the tobacco problem, we also need to change the legal structure of tobacco control. Tobacco products are not ordinary consumer products. For no other lawful consumer product can it be said that the acknowledged aim of national policy is to suppress consumption altogether rather than to promote safe or responsible use. Yet, these dangerous products are essentially unregulated. Congress should enact a federal regulatory statute that is suited to the unique history and characteristics of tobacco products.
Congress should empower the Food and Drug Administration to regulate the manufacture, marketing, and distribution of tobacco products, and should permit the states to undertake additional interventions to complement federal regulations. Our report specifies many features of the proposed regulatory program, some of which reiterate recommendations offered by previous IOM committees in 1994 and 2001. Among the key elements are graphic package warnings modeled after those required in Canada; limiting advertising to a text-only, black-and-white format; banning any activities by tobacco companies that target youth; and aggressive regulation of retail outlets, including state experiments to reduce the number of retail outlets. The committee also urges FDA to explore the feasibility of gradually reducing the nicotine content of cigarettes.
Such authority for the FDA may not be far off. The Family Smoking Prevention and Tobacco Control Act introduced in February by Senators Kennedy and Cornyn and Representatives Waxman and Davis would “give the FDA the authority to regulate tobacco products in order to keep tobacco manufacturers from enticing young people to smoke and to assist current smokers in quitting.” PARTNERS, a coalition made up of 60+ organizations including the American Lung Association, American College of Cardiology, and Society for Public Health Education, supports the legislation.
The rationale for giving the FDA authority over tobacco makes sense, but how well would this work in practice? The agency is already under fire for falling behind on drug and food safety, and Congress seems reluctant to give it the funds it needs to do a better job. (See our PDUFA posts for more on the drug safety issue.) If we really want to end the Tobacco Problem – and we should – we’re going to need to strengthen the FDA.
Liz Borkowski works for the Project on Scientific Knowledge and Public Policy (SKAPP) at George Washington University’s School of Public Health and Health Services.