“Ending the Tobacco Epidemic: A Federal Plan” is the startling title of a speech scheduled for March 14 by Dr. Howard Koh, Assistant Secretary for Health in the U.S. Department of Health and Human Services (HHS). He will be keynoting the annual meeting of the Society for Research on Nicotine and Tobacco in Houston. Will the Obama Administration actually pursue tobacco prohibition?
The “tobacco epidemic” theme is not new. In November 2009, Health Secretary Kathleen Sebelius named Koh chair of an HHS working group tasked to develop a strategic action plan. Their report (here), published a year later, was titled “Ending the Tobacco Epidemic.”
The working group’s vision, “a society free of tobacco-related death and disease,” morphs into an argument for prohibition. For example, the group quoted a 2007 study by the Institute of Medicine (here) which discussed “the ultimate goal of ending the tobacco problem in the United States.” They also cited a chapter in the 2007-2008 President’s Cancer Panel report (here) titled “The Scourge of Tobacco in America Must End.” The chapter’s topline message is clearly abolitionist: “Ridding the nation of tobacco is the single most important action needed to dramatically reduce cancer mortality and morbidity. There is no substitute for this action if we are to eliminate the sickness and death caused by tobacco use.”
Tobacco prohibition is a shared theme throughout HHS. The National Cancer Institute’s Tobacco Control Research Branch envisions “a world free of tobacco use and related cancer and suffering” (here), while CDC’s Office on Smoking and Health yearns for “a world free from tobacco-related death and disease.” (here)
In a relentless and unscientific bid to “end” the “tobacco epidemic,” federal government officials are deliberately misapplying causation from smoking, a legitimate risk factor for many diseases, to tobacco in general. This prohibition crusade ignores the enormous life-saving potential of tobacco harm reduction, the substitution of smoke-free tobacco products for cigarettes.
Tobacco prohibitionists treat all tobacco products as equally dangerous; this is factually incorrect and dangerously unethical. Smoke-free products, including smokeless tobacco and e-cigarettes, are vastly safer than cigarettes. Britain’s prestigious Royal College of Physicians reported that “consumption of non-combustible tobacco is on the order of 10-1,000 times less hazardous than smoking.” The College concluded that “smokers smoke predominantly for nicotine, that nicotine itself is not especially hazardous, and that if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved.” (here)
A study funded by the National Cancer Institute addressed the ethical considerations: “[smokeless] products pose a substantially lower risk to the user than do conventional cigarettes. This finding raises ethical questions concerning whether it is inappropriate and misleading for government officials or public health experts to characterize smokeless tobacco products as comparably dangerous with cigarette smoking.” (abstract here)
Congress has already endorsed the legality of tobacco and has given the FDA regulatory authority over the manufacture, marketing and distribution of tobacco products. It is unacceptable, at this stage, for HHS, “the principal agency for protecting the health of all Americans,” to spend taxpayer funds in pursuit of tobacco prohibition. Rather, the agency should embrace the compelling scientific foundation for tobacco harm reduction and educate the nation’s 45 million smokers about its significant health advantages.