BALTIMORE — Five years ago this month, the Food and Drug Administration released some striking images of the damage that smoking can do. These stark and disturbing pictures dominated the news cycle, as millions of Americans got a glimpse of the unvarnished truth.
In one, healthy lungs were juxtaposed with blackened and diseased ones that had been poisoned by tobacco. Another photo zoomed in on a human mouth, the teeth stained and rotted, and the lower lip abscessed. Yet another showed a woman wailing in pain from the deadly effects of secondhand smoking.
The F.D.A.’s message to the public was that tobacco companies would soon be required to include such images on every pack of cigarettes. Kathleen Sebelius, the secretary of health and human services at the time, welcomed the move.
“These labels are frank, honest and powerful depictions of the health risks of smoking,” she noted, “and they will help encourage smokers to quit, and prevent children from smoking.”
Big Tobacco’s response? Within months, an industry group sued the F.D.A., its then commissioner, Margaret Hamburg, and Ms. Sebelius herself on First Amendment grounds, arguing that the requirements to display these warnings on tobacco products were unconstitutional and would make them “a mouthpiece for the Government’s emotionally charged anti-smoking message.”
The industry won an injunction when the presiding judge agreed that the images were “calculated to provoke” rather than disseminate “purely factual and uncontroversial information.” The court’s ruling — inform, but do not inflame — sent the federal health authorities back to the drawing board.
The same industry that brought the world the infamous Marlboro cowboy and Joe Camel was now fighting corrective images designed to direct consumers away from cigarettes, a product that kills half of its long-term users. The success of the industry’s lawsuit means that five years after the labels were announced with such fanfare, and seven years after the law that mandated them was passed, America is still waiting.
How many deaths could have been prevented if the tobacco companies had not succeeded in staying the F.D.A.’s hand?
New research estimates that at least 3,000 deaths attributable to smoking in the United States could be averted in the first five years when the new labeling goes into effect. But the Food and Drug Administration already has a wealth of evidence to justify its implementation of the Family Smoking Prevention and Tobacco Control Act, the 2009 law that requires the agency to deliver the new labels. And no court ruling has removed the F.D.A.’s obligation to devise such warnings.
One recent study found that labels with graphic images worked better than ones with text warnings only, by giving people a more memorable and negative view of smoking. Another study of young people between the ages of 18 and 30 found that the labels made them more fearful of the health effects of smoking and more wary about taking up the habit. Research conducted around the F.D.A.’s announcement found that graphic labels improved people’s recall of the warning and health risks of smoking.
As a recent voting member of the F.D.A.’s Tobacco Products Scientific Advisory Committee, I reached out to Mitch Zeller, the director of the agency’s Center for Tobacco Products, to ask why the new labeling still hadn’t seen the light of day. Mr. Zeller told me that the center was doing research to develop new warning labels that conformed with the 2009 law. This kind of research can take time, he said, and it is important to accumulate the best evidence for the proposed warnings. Mr. Zeller could not provide specifics on a timeline for implementation.
It was less than a decade ago that American tobacco companies were found liable for covering up the health risks from smoking. The delay over labeling has once again made the United States an outlier in the global effort to address this pressing public health need. Nearly 80 countries around the world — from Bangladesh and Canada to Egypt and Pakistan — have embraced graphic labels and the resounding research behind them. Some, like Australia and Britain, have gone further still and forced companies to remove their branding, and display only stark images on their packaging.
In the United States, though, the tobacco companies are still winning, while the people who continue to smoke are losing out. As are the children who will take up smoking. And as are those among us who will lose a parent, a sibling or a child to tobacco-caused disease. More than 50 years after the surgeon general’s report on “Smoking and Health” laid bare the dangers of smoking, America is still beholden to Big Tobacco.
This industry has bullied us enough. The Food and Drug Administration has deferred action for too long, and must meet the tobacco companies with the same vigor, audacity and urgency that the industry has employed so effectively for decades. The F.D.A. must uphold its mandate and deliver the kind of public health service that the law requires and that America deserves.
By Johanna Cohen - The NY Times/June 3, 2016
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