Tuesday, November 11, 2008

IN MY VIEW: After Election, Anti-Smoking Groups Should Go Back to the Drawing Board and Craft Effective Federal Legislation

Today I outline my proposal for what I believe would be effective federal legislation to address the problem of tobacco use.

Unlike the current FDA tobacco legislation, for which there is no evidence base (merely wild and unsupported conjecture), my proposal is based on solid scientific evidence about what interventions are most effective in actually reducing tobacco use.

While the anti-smoking groups promoting the FDA legislation claim that it will reduce smoking rates and save "countless" lives, they provide absolutely no evidence to support their claim, nor do they even explain the mechanism by which these countless lives will be saved. As I have argued, they are correct that "countless" lives will be saved because we won't be able to count them. The legislation will actually result in the loss of lives because it will undoubtedly increase smoking rates by undermining years of education about the hazards of cigarettes (it gives an FDA seal of approval to cigarettes and creates the public perception that cigarettes are safer).

The legislation also provides virtual immunity to the tobacco companies. Once the FDA asserts jurisdiction over tobacco products, there will be no chance for punitive damages in tobacco cases, thus ending any serious litigation threat for the industry.

Even worse, the legislation transfers over to the federal government the fraud that anti-smoking groups have accused the tobacco companies of committing. The government will now be in the business of defrauding the American public by implying, without scientific support, that cigarettes are safer.

In contrast to the FDA legislation's interventions, which have not been shown to have any impact on smoking (and which would actually increase it), two interventions which have been conclusively shown to reduce smoking are:

1. Increasing the price of cigarettes through substantial cigarette tax increases; and

2. Anti-smoking advertising campaigns using the mass media (such as the "truth" campaign).

My proposal would combine these two interventions.

In addition, it would create - for the first time - an incentive for cigarette companies to stop marketing their products to youths and to make serious efforts to decrease youth smoking.

Finally, it would directly benefit existing smokers by providing services and resources for medical treatment and research.

The Rest of the Story

This proposal, which is modeled after the proposal which Senator Enzi introduced into Congress this session, is based on the following three interventions:

1. An increase in the federal excise tax on cigarettes.

2. A graduated series of financial penalties for cigarette companies, which is based on the number of underage youths who are smoking each company's brands of cigarettes, and with targets for youth smoking prevalence that decrease gradually over time.

3. The specific allocation of the funds generated by #1 and #2 to the following programs:

a. A national anti-smoking media campaign, building on the "truth" campaign.

b. The creation, development, implementation, and maintenance of anti-smoking media campaigns in each of the 50 states.

c. Direct services to benefit existing smokers, including treatment of smoking-related diseases and research into better treatments and cures for these diseases.

The strength of the proposal is that even though the revenues generated would decrease over time if smoking prevalence declines, less funds will be necessary as fewer people smoke. In other words, the purpose of the program would be to put itself out of business. As smoking rates fall to very low levels, much less funding will be necessary. So in a sense, the program is self-regulating.

Furthermore, the program does not make the federal or state governments dependent upon cigarette consumption. There remains a strong incentive to reduce smoking because falling cigarette revenues will not threaten the funding of essential government services. It will reduce funding for the anti-smoking programs, but less funding will be necessary because fewer people will be smoking.

The national anti-smoking campaign would be directed by an independent foundation, most likely the American Legacy Foundation, which would work in concert with the states to plan and coordinate the federal and state-specific media campaigns.

The state-specific media campaigns would be run either by state health departments or by independent foundations established in the states. These would be closely coordinated with the national campaign. The American Legacy Foundation would play a critical role in these coordination efforts and would share the results of its formative research to assist the states in planning effective media campaigns. It would also create and share a repository of effective anti-smoking advertisements and allow for the tailoring of these ads towards specific states.

The penalties levied on tobacco companies would be based on the number of underage youths who are smoking their cigarette brands. Money would be allocated towards the conduct of a national survey to assess market share of each cigarette brand among underage youths and to monitor the prevalence of youth smoking. The penalties would be graduated over time -- meaning that targets for youth smoking prevalence would be set and penalties would increase over time for failure to meet these targets.

The research funding would help to address the lack of effort and success in treatment of certain smoking-related diseases, such as lung cancer, pancreatic cancer, and emphysema, for which little progress has been made. It would allow research and treatment of these diseases to accelerate at a time when federal funding for research into treatment for these diseases is declining.

Funding would also be included for smoking cessation services for those smokers who want to take advantage of such programs. This would include a national smoking cessation hotline with referral to subsidized or free treatment programs or services.

The Office on Smoking and Health at CDC would be the national coordinator of all of these programs. For the first time in history, the CDC would develop a true national tobacco control plan and would have the resources to develop and implement this plan, coordinating its efforts and providing technical assistance and needed resources to health departments of independent foundations in each of the 50 states.

Funding would not be decreased for states which have already funded their own anti-smoking media campaigns, so as not to serve as a deterrent for states to put funding into tobacco prevention and education programs. The federal funding would supplement, not replace these programs.

Unfortunately, I am afraid that the national anti-smoking groups are so committed to and obsessed with their ill-fated and ill-conceived FDA legislation that there is little chance my proposal will receive any serious consideration.

So while this post is probably a waste of time and I'm probably banging my head against the wall or speaking to a brick wall, it is sure nice - it least for a fleeting moment - to consider what a truly effective national tobacco control strategy might look like.

I offer this proposal in grateful appreciation and honor to the following individuals: my parents, and the heroes of tobacco control - Stanley and Susan Rosenblatt, Dr. Alan Blum, Dr. Stan Glantz, John Polito, Patty Young, Regina Carlson, and Frank and Margaret Amodeo; and in memory of my mom, my grandmother, Dr. Ronald Davis, and Dr. John Slade. I also extend appreciation to Senator Mike Enzi (R-WY) for having the courage to put on the table, for the first time, a Congressional tobacco control proposal that has real teeth. In doing so, he has achieved something that the major, national anti-smoking groups have failed to ever do.

No comments: