March 14, 2002 -- The U.S. government is bowing to the demands
March 14, 2002 -- The U.S. government is bowing to the demands of tobacco companies, a U.S. congressman says.
"Without improvements in the U.S. position, a unique opportunity to control the enormous worldwide toll of tobacco consumption may be lost," writes Rep. Henry Waxman, JD, D-Calif., in the March 21 issue of TheNew England Journal of Medicine.
The charge -- together with alarming new studies -- suggests that big tobacco hasn't reformed. It's using its muscle to quash public-health efforts to reduce smoking. Boston University researcher Michael Siegel, MD, MPH, is co-author of a recent NEJM article showing that cigarette ads in magazines reach just as many young people as ever.
"I think that there has been a common misperception that the battle is over. In fact, the absolute opposite is true," Siegel tells WebMD. "Tobacco companies continue to market to kids, and they continue to produce a product as deadly as it has always been. There have not been changes in their behavior."
Every year, tobacco-related illness kills more than 3.5 million people. That's more people than die of AIDS. And the smoking epidemic is even more explosive than the AIDS epidemic. By the year 2020, cigarettes will kill an estimated 8.4 million people a year.
"The leading cause of preventable death globally is tobacco," Michael Cummings, PhD, MPH, tells WebMD. Cummings leads the department of cancer prevention, epidemiology, and biostatistics at Roswell Park Cancer Institute in Buffalo, N.Y.
These numbers have the attention of the World Health Organization. Delegates from around the world first met in October 2000 to negotiate an antismoking treaty. It's called the Framework Convention on Tobacco Control, or FCTC.
The FCTC met for the second time in May 2001 -- and this time the U.S. delegates were appointed by the Bush administration. These delegates supported 10 of 11 changes recommended by Philip Morris, the largest U.S. tobacco company. Criticism of these changes -- some of it by Waxman -- led the U.S. delegation to drop support for some of the changes at the November 2001 FCTC meeting.
"The U.S. appears to be retrenching on positions it had in the prior administration," Cummings says. "There are very small countries around the world that have a bigger economic stake than we do in promoting tobacco, yet they have stronger antismoking positions than the U.S. It shouldn't be a point of debate to restrict smoking in public places, or help people quit, or to limit the spread of the product through deceptive marketing."
Waxman lists several major changes in the U.S. position since October 2000:
- U.S. support for taxes to reduce tobacco consumption was changed to make such taxes optional.
- Support for a ban on advertising that "appeals" to children was changed to opposition to ads "targeted" at people age 17 or younger.
- Support for measures that would ban smoking in enclosed public places was changed to opposition to mandatory restrictions.
- Several countries have proposed that public health concerns should be more important than trade rules. The U.S. delegation opposes this proposal.
- The European Union has proposed that exported tobacco products should be held to the same standards as those that apply in the country where the products are made. The U.S. delegation opposes this proposal.
Waxman, a Democrat, notes that in the 2000 election U.S. tobacco companies made $8.4 million in campaign contributions -- $7 million of which went to Republicans.
"Smoking is an epidemic like smallpox," Cummings says. "You need to control the spread of the disease. In this case, tobacco companies spread the disease. Unfortunately they profit, and profits always trump health. It is an epidemic of profits. For politicians, those profits come in the form of campaign contributions."
Mark Berlind, an attorney who works on government affairs issues for Philip Morris Management Corp., says Waxman gives the tobacco industry short shrift.
"I think Mr. Waxman understates the degree to which Philip Morris is actively supporting the adoption of a reasonable treaty," Berlind tells WebMD. "We'd love to see a treaty with regulations for things like access, marketing, ingredients, cigarette smuggling, and other issues."
The efforts of big tobacco don't stop with campaign contributions. A July 2000 report by a committee of experts commissioned by the World Health Organization (WHO) details extensive efforts by tobacco companies to undermine the FCTC and other tobacco-control actions. These efforts by the companies include:
- Promising jobs to WHO officials in return for support;
- Having tobacco consultants placed in WHO positions;
- Using influence with other United Nations agencies to pressure the WHO;
- Secretly hiring individuals and institutions that "independently" attack the credibility of WHO positions;
- Getting outside organizations to lobby against WHO activities;
- Holding media events to distract from WHO activities;
- Surveillance of WHO activities including secret monitoring of WHO meetings and conferences.
"The WHO 2000 report made a lot of allegations with regard to past conduct," Berlind says. "That was a very adversarial time for the industry. Today we are working very hard to be constructive and to work with government and with the WHO. We are being very upfront about what we do."
The FCTC meets again on March 18. The meeting comes on the heels of new studies showing that cigarettes are even more dangerous than previously thought. One study shows that "light" or "low tar" cigarettes are just as deadly as their regular cousins. But perhaps the most striking report says that nearly all cigarettes are defective.
Cummings is co-author of the report, published in the journal Tobacco Control, offering evidence that cigarette filters leak dangerous fibers into the lungs of smokers.
"You are concentrating tar on the fiber, delivering a concentrated dose," Cummings says. "Your lungs are now receiving an inorganic material that does not biodegrade. Your body doesn't appreciate having inorganic material in your lungs, and you get inflammation. Of course tar causes that, too. We thought reducing tar was the benefit of filters, but they only introduce a new risk."
Cummings says tobacco companies have known about the problem since 1957 when Eastman Kodak -- which then made the chemical used in the filters -- expressed concern to Philip Morris Co.
"We take seriously any scientific report that an aspect of our product could affect the health aspects of smoking," Brendan McCormick, manager of media relations for Philip Morris USA, tells WebMD. "Based on our assessment we do not believe the filters we use pose an additional health risk to smokers. In looking at some of that data, the evidence does not suggest the fibers actually penetrate the lung. The risk of inhalation is very low."
Cummings is skeptical of this opinion. "The industry says it doesn't cause harm, but what did they tell you about cigarettes 50 years ago?" he says.
