Commentary: An Unhealthy Deal With Big Tobacco

After years of taking aim at the tobacco Goliath, public-health researchers have a pretty good idea how to curb smoking. Unfortunately, lawyers don't.

That's the conclusion many public-health experts are coming to after examining the fine print in the tobacco deal announced on June 20. Most of them were not included in the negotiations, and they are now taking a hard look at the bottom line: What does the deal mean for public health? The answer seems to be: not much.

"It's a pretty clear victory for the tobacco companies," says Stanton A. Glantz, a cardiology researcher and antismoking advocate at the University of California at San Francisco. He cites two worrisome provisions in the deal as proposed: The industry put potentially insurmountable roadblocks in the way of FDA regulation of nicotine and won the right to keep secret millions of pages of documents.

"FRAUD." In a court decision in North Carolina earlier this year, the FDA won blanket authority to regulate nicotine. But the settlement puts such severe limits on that authority that the FDA might never be able to act. "Whoever controls nicotine wins," says Douglas Blanke, an assistant attorney general in Minnesota.

The deal also aims to block release of 30 million pages of internal documents in Minnesota alone--documents that could turn public opinion even further against tobacco companies. "When the full extent of the fraud and conspiracy is generally known, the public and the Congress will be less interested in givebacks to the industry," Blanke says.

These loopholes could disappear as Congress turns the proposed settlement into law. In the meantime, however, legislators should focus on how they can really improve public health. We now know which measures work and which don't. For example, in the early 1990s, California and Massachusetts each raised cigarette taxes 25 cents per pack and put the money toward tobacco control and health education. From 1992 to 1996, per capita consumption of cigarettes dropped by an average of 19.7% in Massachusetts and 15.8% in California, vs. 6.1% in the other 48 states.

The success was due to a combination of antismoking measures, says Michael P. Eriksen, director of the Surgeon General's Office on Smoking & Health (OSH). They included workplace and community education programs, public antismoking campaigns, and restrictions on access to tobacco. Another key was public approval, as expressed by passage of referendums to boost the taxes.

EDUCATION. Some solid antismoking measures are included in the proposed settlement. "It certainly is good to get tobacco out of sporting events and off billboards," says John R. Garrison, CEO of the American Lung Assn., although he rejects the settlement overall. Dudley Hafner, executive vice-president of the American Heart Assn., likes the curbs on marketing to teens, the anti-tobacco education campaign, and limits on secondhand smoke--but objects to tying the FDA's hands.

It's important, while evaluating the deal, to remember tobacco's toll. Smoking claimed an average of 430,700 American lives per year from 1990 to 1994. Smoking causes heart disease and cancer of the lung, larynx, mouth, esophagus, and bladder, and contributes to other ailments in smokers and nonsmokers alike.

Still, the deal falls short of what's needed to counter those threats. For proof, look at how the stock market has embraced the deal. Investors have bid up tobacco shares, assuming the industry will continue to thrive. That is a sign that the deal is bad for public health.

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