Institute Urges Extensive Smoking Deterrents

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By Christopher Lee
Washington Post Staff Writer
Friday, May 25, 2007; Page A03

In the 43 years since the U.S. surgeon general warned of the dangers of cigarette smoking, the percentage of Americans who light up has been cut in half, tobacco companies have paid billions of dollars in legal settlements and smoking has come to be widely reviled as a nasty habit.

But that is not enough -- not when there are 440,000 deaths a year from tobacco use and $89 billion annually in smoking-related health costs, the influential Institute of Medicine said yesterday in a report that called for several new measures to further drive down tobacco use. The institute is a branch of the National Academies, a scientific organization chartered by Congress to advise the government on scientific and technical issues.

\"There are still 45 million cigarette smokers and another 9.7 million users of other tobacco products,\" said Richard J. Bonnie, a University of Virginia law professor who led the panel of 14 experts that produced the report. \"Most of them regret having taken up the habit and struggle to quit. The nation's goal should be to reduce tobacco use so substantially that it is no longer a significant public health problem.\"

To that end, the report calls for state and local governments to ban smoking in malls, restaurants and virtually all other public indoor settings, and for the Food and Drug Administration to regulate the marketing, packaging and sale of tobacco products. The panel also recommended raising excise taxes on cigarettes by as much as $2 a pack and developing a federal plan to gradually reduce the amount of nicotine in cigarettes so that they are no longer addictive.

About 21 percent of all adults smoke today, compared with nearly 42 percent in 1965, the year Congress required cigarette packages to carry a health warning. Youth smoking also has declined substantially in recent years. About 12 percent of high school seniors were daily smokers in 2006, compared with 17 percent in 1992 and 23 percent in 1999, the report said. Experts noted that youth smoking rates fluctuate more than adult rates.

The IOM report heartened members of Congress who have again introduced legislation that would grant the FDA authority over the manufacturing, marketing and sale of tobacco products, including the power to restrict advertising, require stronger warning labels, and regulate the amount of nicotine and other ingredients.

The legislation, which has bipartisan support, would also give the FDA power to end vending-machine and self-service sales of tobacco, prohibit tobacco advertising near schools, ban fruit- or candy-flavored cigarettes and stop cigarette makers from using claims such as \"light\" or \"low-tar\" unless they are scientifically proved.

\"It's disgraceful that year after year, Congress has bowed to the tobacco lobby,\" Sen. Edward M. Kennedy (D-Mass.), a lead sponsor of the bill, said in a statement. \"Hopefully the IOM's powerful call to action will be the irresistible force that finally compels the Senate and House to act.\"

The legislation has the backing of market leader Philip Morris USA, maker of Marlboro cigarettes, but R.J. Reynolds Tobacco Co. plans to fight it, saying it would help entrench Philip Morris's dominant position by limiting advertising opportunities.

In a statement yesterday, Philip Morris said that it would oppose substantial increase in excise taxes and that states should devote more money from the 1998 tobacco settlement to smoking cessation and youth smoking prevention. In February, the Government Accountability Office reported that states had devoted only 3.5 percent of the $52.6 billion they received in tobacco payments between 2000 and 2005 to tobacco control efforts.

\"The IOM's recommended actions to combat youth smoking could more quickly be addressed by tapping into this existing funding source -- rather than attempting to create a new one,\" said Howard Willard, an executive vice president of Philip Morris USA.

Other recommendations from the IOM experts included banning online sales of tobacco products; limiting tobacco advertising and displays to black-and-white, text-only formats; requiring picture warnings on cigarettes; and restricting the number of retail outlets that can sell tobacco and requiring that they obtain a license to do so. The experts said that such measures could help cut the share of adults who smoke to 10 percent by 2025, meaning 11 million fewer people would be smokers.

\"What the report makes clear is that unless the states dramatically increase their level of activity, we can't expect significant further progress in reducing the death from tobacco,\" said Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, who was not on the panel. \"And even if the states do so, we won't achieve our major public health goal unless the federal government enters the fray.\"