Congress is about to begin deliberations of two competing approaches to tobacco regulation. The outcome of the debate will have an impact on business--and public health--for decades to come.
The first approach, known as the Kennedy-Waxman bill, will give the beleaguered Food and Drug Administration (FDA) authority to regulate tobacco. On its face, this is a good thing. After all, cigarettes are the leading preventable cause of death in the United States.
But the devil is in the details. First of all, the Kennedy-Waxman bill, named after its sponsors Sen. Ted Kennedy, D-Mass., and Rep. Henry Waxman, D-Calif., was in fact written by Altria (which was formerly Philip Morris) and an activist group, the Campaign for Tobacco Free Kids (CFTFK).
The bill has numerous provisions that, from a public health perspective, actually make matters worse, rather than better.
For instance, the bill will make it virtually impossible for companies to promote less harmful forms of tobacco. If the bill passes, we won't replicate the good news coming out of Sweden, where tobacco-related deaths plummeted when smokers switched from cigarettes to the less harmful snus, or smokeless tobacco.
Snus is a pouch of tobacco that gives smokers the nicotine they crave without the myriad harmful chemicals that come from burning and inhaling tobacco. The risk of oral cancer from smokeless tobacco is low--far lower than the oral cancer risk from smoking cigarettes.
And switching from cigarettes to snus eliminates the risk of heart disease, lung cancer and the other systemic diseases related to smoking. And of course, there's no secondhand smoke from snus.
The key fact in the harm reduction equation is that nicotine is not the harmful component of cigarettes, something that CFTFK and Altria ought to know by now.
Beyond that, the public health community, with a few exceptions, is far too complacent about today's dismally low quit rates.
Even with the gum, the patch, pharmaceuticals, counseling, public pressure, smoking bans and everything else, quit rates fail to exceed 15%. It is time we took a more compassionate approach and gave smokers more tools to help them reduce their risk and quit cigarettes.
Further, the bill would give the FDA authority to require cigarette makers to lower the level of nicotine in cigarettes. If the FDA exercised that authority, smokers would have to smoke more--and get more of the bad stuff--in order to get the relatively harmless but addictive nicotine they crave. Pretty sly of Altria.
Finally, by letting the FDA allow some tobacco products and claims and forbid others, this bill gives Altria exactly what it wants: the blessing of the Food and Drug Administration, which is known for establishing the safety of items under its purview.
The FDA's most recent commissioner, Andrew von Eschenbach, understood this. For the head of a federal regulatory agency, he did the unthinkable. He sought to decline greater regulatory authority and opposed the bill.
But there is hope. On Wednesday, Rep. Steve Buyer, R-Ind., and Rep. Mike McIntyre, D-N.C., are introducing a bipartisan bill that provides for a science-based pathway toward the approval of harm-reduction claims. It calls for the creation of a Tobacco Harm Reduction Center based out of the Department of Health and Human Services--rather than involving the FDA.
This bill, and a similar one that North Carolina's Richard Burr plans to introduce in the Senate, is more likely to improve public health--by creating a realistic regulatory framework that would lead to a reduction of tobacco-related death and disease. It is no surprise that Altria opposes this approach in favor of the Kennedy-Waxman bill.