A report from the Institute of Medicine (IOM) asks Congress to give the FDA control over the ingredients, labeling, and marketing of cigarettes and other tobacco products. The aim of the panel of experts who prepared the report is to "reduce smoking so substantially that it is no longer a significant public health problem."
The IOM is associated with the National Academy of Sciences, which was created by a Congressional charter to advise Congress on scientific and technological matters.
Despite a 50 percent decline in smoking in the United States since 1964, there is no doubt that smoking remains a major public health problem. About 21 percent of American adults smoke, and roughly half are likely to die of tobacco-related diseases if they continue to smoke. Tobacco use is responsible for an estimated 440,000 deaths annually in the U.S., along with another 50,000 deaths from secondhand smoke.
And the problem is even more acute elsewhere: By 2050, for instance, 3 million people in China will be dying of tobacco-related causes each year.
Some of the actions recommended by the IOM:
- Requiring all insurers to cover smoking-cessation programs
- Licensing all retail outlets that sell tobacco, similar to the current practice of having the states license the sale of alcohol
- Limiting tobacco advertising and promotions to black-and-white displays that contain only text
- Reducing youth interest in smoking and access to tobacco, in part by banning online sales of tobacco products and their shipments directly to consumers
- Banning smoking in all nonresidential indoor areas
- Requiring cigarette packs and cartons to carry pictured warnings of the dangers of smoking
- Increasing cigarette taxes greatly
- Reducing nicotine levels in cigarettes
While I certainly agree with the dire need to reduce cigarette smoking and the use of other tobacco-containing products, I have little hope that the measures proposed by the IOM would cure our addiction to tobacco.
For example, as mentioned by the current head of the FDA, cutting the nicotine content of cigarettes in half would probably lead smokers to double the number of cigarettes they smoke so as to attain the same levels of nicotine required by their addiction. And insurance coverage for smoking cessation is a sensible idea, but, in truth, we lack effective methods that will get most smokers to stop permanently.
Moreover, the FDA is already struggling mightily in its efforts to meet its other responsibilities, namely approving and regulating medications and devices. The agency needs considerably more federal funding to meet these obligations before undertaking the major task of regulating tobacco use.
Despite my doubts and inability to come up with better ideas, however, the IOM's recommendations are worth pursuing, especially if Congress were to approve enough funds to make such efforts feasible. An immediate, huge increase in cigarette taxes might not only curtail cigarette purchases directly but could also provide the money needed to fund other steps to curb smoking.
