Tobacco control: More can be done
Tobacco control: More can be done
Mon, 12 Jan 2004 19:30:00
Boston, MA - In 1998, the attorneys general of 46 US states reached an agreement with the four major tobacco companies there to recover their Medicaid expenses and to penalize the firms for their deceptive practices. The resulting Master Settlement Agreement (MSA) has its strengths and drawbacks, but overall there is still much room for improvement in tobacco control, says Dr Steven A Schroeder (University of California, San Francisco) in a special report in the January 15, 2004 issue of the New England Journal of Medicine, available online January 11, 2004.
As part of the MSA, tobacco companies were required to pay the states an estimated US $206 billion over 25 years, and they agreed to changes to marketing policies and made previously secret documents available on the internet.
Schroeder is the unpaid chair of the American Legacy Foundation, an antitobacco organization established as a result of, and funded by, the MSA. However, he explains that the MSA is a watered-down version of what would likely have happened had the 46 states settled separately with industry and represents the compromise reached when the previous "general-settlement" legislation never came to a vote in the Senate. (Because the MSA did not address federal regulations, it did not require congressional approval.)
Limitations
Consequently, there are a number of limitations of the MSA, Schroeder says in his report. For example, many tobacco-control elements that had been part of the original settlement were dropped from the MSA, including the assigning of jurisdiction over tobacco to the FDA and tighter enforcement of rules banning sale of tobacco to minors.
In addition, the money pledged to the states by tobacco companies as part of the MSA "has created perverse incentives for the states to keep the tobacco industry financially healthy," Schroeder notes. Also, many of the states are spending the money on budget deficits rather than directly on tobacco education and treatment of smoking-related illnesses, he points out.
Some plus points
But on a more positive note, the MSA has resulted in the most significant increases in spending on tobacco-use prevention and cessation in history, Schroeder says, citing his own organization's "Truth" campaign, which helped reduce the smoking rate among young people in the US to a 27-year low. Also, increases in tobacco taxes as a result of the agreement have deterred smokers and may well turn out to be the most important antitobacco benefit of the MSA, he says.
Progress...would be faster if federal policymaking matched both the rigor of the scientific evidence against tobacco use and the resolve of antitobacco advocates.
Legislation to promote clean indoor air has also been "a major success of the antitobacco movement in the US," Schroeder notes, which, along with raising tobacco taxes, are "simply more robust ways to reduce tobacco use than implementing programs to prevent people from starting to smoke or to promote smoking cessation."
Nevertheless, there have been limited successes in these fields too, he notes. For example, the Veterans Health Administration is "a model healthcare system for smoking cessation." But there is still much room for improvementa federally funded national quit line with a toll-free number linked to a media campaign to encourage smokers to call the number "would be a major help," as would support for web-based smoking cessation services, Schroeder opines.
Risks known 50 years ago, but government initiatives still weak
The scientific evidence of the harm caused by tobacco was unearthed almost 50 years ago, but there was little counteradvertising about tobacco until the mid-1990s, and government initiatives have been relatively weak, Schroeder says, adding, "440,000 Americans die every year from smoking, and 8.6 million more suffer from serious tobacco-induced illness." And although US smoking rates are slowly declining, "progress...would be faster if federal policymaking matched both the rigor of the scientific evidence against tobacco use and the resolve of antitobacco advocates...[who] have engaged in a four-decade battle against the US tobacco industry," he concludes.
Boston, MA - In 1998, the attorneys general of 46 US states reached an agreement with the four major tobacco companies there to recover their Medicaid expenses and to penalize the firms for their deceptive practices. The resulting Master Settlement Agreement (MSA) has its strengths and drawbacks, but overall there is still much room for improvement in tobacco control, says Dr Steven A Schroeder (University of California, San Francisco) in a special report in the January 15, 2004 issue of the New England Journal of Medicine, available online January 11, 2004.
As part of the MSA, tobacco companies were required to pay the states an estimated US $206 billion over 25 years, and they agreed to changes to marketing policies and made previously secret documents available on the internet.
Schroeder is the unpaid chair of the American Legacy Foundation, an antitobacco organization established as a result of, and funded by, the MSA. However, he explains that the MSA is a watered-down version of what would likely have happened had the 46 states settled separately with industry and represents the compromise reached when the previous "general-settlement" legislation never came to a vote in the Senate. (Because the MSA did not address federal regulations, it did not require congressional approval.)
Limitations
Consequently, there are a number of limitations of the MSA, Schroeder says in his report. For example, many tobacco-control elements that had been part of the original settlement were dropped from the MSA, including the assigning of jurisdiction over tobacco to the FDA and tighter enforcement of rules banning sale of tobacco to minors.
In addition, the money pledged to the states by tobacco companies as part of the MSA "has created perverse incentives for the states to keep the tobacco industry financially healthy," Schroeder notes. Also, many of the states are spending the money on budget deficits rather than directly on tobacco education and treatment of smoking-related illnesses, he points out.
Some plus points
But on a more positive note, the MSA has resulted in the most significant increases in spending on tobacco-use prevention and cessation in history, Schroeder says, citing his own organization's "Truth" campaign, which helped reduce the smoking rate among young people in the US to a 27-year low. Also, increases in tobacco taxes as a result of the agreement have deterred smokers and may well turn out to be the most important antitobacco benefit of the MSA, he says.
Progress...would be faster if federal policymaking matched both the rigor of the scientific evidence against tobacco use and the resolve of antitobacco advocates.
Legislation to promote clean indoor air has also been "a major success of the antitobacco movement in the US," Schroeder notes, which, along with raising tobacco taxes, are "simply more robust ways to reduce tobacco use than implementing programs to prevent people from starting to smoke or to promote smoking cessation."
Nevertheless, there have been limited successes in these fields too, he notes. For example, the Veterans Health Administration is "a model healthcare system for smoking cessation." But there is still much room for improvementa federally funded national quit line with a toll-free number linked to a media campaign to encourage smokers to call the number "would be a major help," as would support for web-based smoking cessation services, Schroeder opines.
Risks known 50 years ago, but government initiatives still weak
The scientific evidence of the harm caused by tobacco was unearthed almost 50 years ago, but there was little counteradvertising about tobacco until the mid-1990s, and government initiatives have been relatively weak, Schroeder says, adding, "440,000 Americans die every year from smoking, and 8.6 million more suffer from serious tobacco-induced illness." And although US smoking rates are slowly declining, "progress...would be faster if federal policymaking matched both the rigor of the scientific evidence against tobacco use and the resolve of antitobacco advocates...[who] have engaged in a four-decade battle against the US tobacco industry," he concludes.
|
Source...