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Excerpts from: Tobacco fund only a fraction of health costs
The toll in deaths and monetary damage from smoking continues to rise, according to a recent CDC study.

By Susan J. Landers AMNews [05/06/02]

Source:
JAMA: http://jama.ama-assn.org/issues/v287n18/ffull/jwr0508-1.html
CDC: http://www.cdc.gov/tobacco/statehi/statehi_2002.htm

Washington -- The latest $5 billion tobacco settlement payment to the states on April 15 closely followed the release of new findings by the Centers for Disease Control and Prevention showing that costs associated with smoking are actually much higher.

Each pack of cigarettes sold in the United States costs the nation an estimated $7.18 in medical care costs and lost productivity due to smoking related deaths, said the CDC on April 12. From 1995 to 1999 those losses totaled more than $150 billion each year, according to the agency.

"When people look at the settlement and think it is for complete repayment for harm done by tobacco to our society they need to look at these new numbers from the CDC and think again," said Tom Houston, MD, AMA's director of Science and Community Health Advocacy Programs. "It is very clear that the settlement is only a fraction of the economic damage that is being repaid," he said.

Smoking also continues to be the leading cause of preventable deaths in the United States, said the CDC, resulting in an estimated 440,000 premature deaths annually from 1995 through 1999. On average, adult men and women smokers lost 13.2 and 14.5 years of life respectively, said the CDC.

Economic damage from smoking totals more than $150 billion each year.

"The fact that nearly half a million Americans lose their lives each year because of smoking-related illnesses is a significant public health tragedy," said David Fleming, MD, CDC's acting director.

"It's important now more than ever that states and local communities put in place comprehensive tobacco control programs to stem this tidal wave of preventable deaths," he added.

Among the CDC's other findings:

* Among adults, 124,813 deaths were from lung cancer, 81,976 were from heart disease and 64,735 were from lung disease.
* Smoking-related cancers and lung disease deaths in women increased from 1995 to 1999.
* Smoking during pregnancy resulted in more than 1,000 infant deaths annually.

Federal action

Meanwhile, the AMA applauded the federal government's renewed interest in a lawsuit against the tobacco industry. The Association expressed support for a set of proposals made by the Justice Dept., which are intended to reduce tobacco use.

The litigation, begun in 1999, is separate from the 1998 master settlement agreement between the tobacco industry and the state attorneys general.

Among the Justice Dept.'s proposals is a ban on such terms as "light" or "low-tar" cigarettes. The terms are inaccurate, said AMA Executive Vice President Michael D. Maves, MD, in an April 8 letter to Attorney General John Ashcroft.

Adult smokers lose an average of 13-14.5 years of life.

Those descriptors also may cause harm as they serve as deterrents to smokers who are seeking to quit, Dr. Maves said. Instead of quitting, many switch to the "light" products.

Research, most notably a recent National Cancer Institute monograph, shows that the reduced tar products carry no health benefits. Instead, smokers tend to inhale more deeply when using the lighter product, Dr. Houston explained.

"They end up self-titrating for nicotine and having essentially the same health risks they had when they were smoking their higher nicotine cigarettes," he said.

The NCI monograph concluded that the adoption of lower-yield cigarettes in the United States had not prevented the continued increase in lung cancer among older smokers.

In addition, cigarettes labeled "low-tar" do not typically deliver lower tar to smokers, and people who smoke low-tar cigarettes cannot expect to have fewer smoking-related health problems, the monograph said.

The AMA also supported the Justice Dept.'s effort to force tobacco companies to disclose all ingredients and additives included in cigarettes. "Neither the public nor the public health community is fully aware of the health implications of tobacco additives," Dr. Maves said in his letter to Ashcroft.

Currently, cigarette companies are required only to send the information on additives to the CDC, which "locks it up in a safe," Dr. Houston said. "So the issue here is the public really doesn't know what they are smoking."

The AMA also believes that the tobacco industry should be required to test the tobacco product ingredients as they are used -- or in this case smoked -- by the consumer to determine their toxicity.