Filtering tobacco's harmful pitch

Philip Morris' support for federal oversight is causing suspicion within the public health community. It should.

Editorial. Aug. 25, 2003.

"I'm here to emphasize our strong support for passage by the 108th Congress of meaningful and effective regulation of tobacco products by the Food and Drug Administration." -- Mike Szymanczyk, chair and CEO of Philip Morris USA, June 3, before the House Committee on Government Reform

At first glance, these words are a shock to almost anyone who has paid attention to the ongoing tobacco wars -- the public health community's effort to minimize Big Tobacco's death grip on the American public.

See related content

Skirmishes have resulted when health advocates have sought Food and Drug Administration authority to regulate the manufacture, sale, distribution and marketing of tobacco products. This position includes stiff marketing restrictions regarding how, when and where advertising messages can be communicated and the display of clear label warnings about the harm that tobacco use inevitably causes.

Tobacco companies traditionally have responded by tirelessly campaigning in opposition.

So why the turn around?

Simple. Philip Morris now wants a certain brand of FDA regulation that will buttress its interest in pursuing the "reduced-harm" market -- designing and selling what they say are less risky cigarettes.

These products include cigarettes engineered to have lower amounts of cancer-causing compounds and electronic gadgets that heat instead of burn tobacco. But unclear regulatory circumstances likely would minimize the industry's ability to promote them as a less harmful option for smokers.

If it feels like déjà vu, it should.

In the 1960s and 1970s, light and low-tar tobacco products came onto the market. People chose this lower-yield route in large numbers, thinking they were reducing their risks or taking a step toward quitting. Some smokers even considered the "lower-risk" option as a reason not to quit. It is now known, though, that those who made this change ultimately faced the same dangers.

A recent AMA Board of Trustees report cited a 2001 National Cancer Institute monograph that summed up the fatal fallacy those smokers believed. "This monograph provided definitive scientific basis for concluding that light and low-tar cigarettes did not decrease tobacco-related illnesses and deaths, and showed that these terms deceived millions of smokers, providing the false assurance that these products were a safe alternative to quitting smoking," the AMA noted.

The trustees' report, which the AMA adopted as policy in June, recommended that "cigarette manufacturers should be prohibited from using deceptive terms such as 'light,' 'ultra light,' 'mild,' and 'low tar.' "

Some public health experts acknowledge that the idea of harm reduction warrants exploration. The Institute of Medicine recently wrote a detailed report, "Clearing the Smoke," which lays out the key issues in play -- including the challenges involved in ethically determining a product to pose less health risks. These questions will have to be explored over the long term and be given strict scientific scrutiny.

But policy-makers may tackle the subject sooner.

The truth about the so-far sordid history of "lower risk" cigarettes offers an important and compelling cautionary tale. Two competing regulatory approaches are currently emerging on Capital Hill. One is viewed as more industry friendly and is supported by Philip Morris. The burden of proof it would place on tobacco companies would require them to demonstrate that products reduce smokers' exposure to toxins, carcinogens and other harmful cigarette ingredients before they could make reduced-harm claims. The other approach, based on public health principles, would require cigarette makers to prove a product actually is less harmful to individual smokers before making any such claims. Moreover, companies would have to demonstrate that such claims would not deter potential quitters from quitting or encourage new smokers to start.

It is critical that lawmakers, in considering any such legislation, remember recent history -- the tragedies borne by those who thought they were making a healthier switch the last time around -- when they consider the difference between these two approaches.

The lessons from these experiences are painful ones. But they make clear that the industry should be regulated not on its terms but on those that advance the best interest of public health.