Tobacco control: Vigilance remains imperative

It was easy to miss recent action on tobacco. News of a late January federal court ruling about a federal tobacco lawsuit was virtually drowned out by other headlines -- presidential primaries, Super Bowl hoopla and arctic temperatures. But this decision -- a step back for the tobacco industry -- is part of a broader, ongoing effort that is too important to let slide off the radar screen.

This year, in fact, marks the 40th anniversary of the 1964 landmark report of Surgeon General Luther Terry, MD, linking smoking with lung cancer and a spate of other illnesses.

The report's impact over these four decades certainly made inroads against the hold tobacco use has on the nation. Even so, its ongoing costs in terms of health and lives lost should serve as a constant reminder that there is no room for complacency.

Consider the statistics: Forty-seven million Americans still smoke, and more than 440,000 of them die from tobacco-related illnesses each year. An estimated 4.5 million kids younger than 18 are current smokers. Almost four out of 10 smoking-related deaths occur among women -- a figure that has more than doubled since 1965. And smoking in the United States generates approximately $75 billion in direct medical costs annually.

It is these numbers that compel organized medicine, public health organizations and others in the anti-tobacco fight to stay on the offensive. Fortunately, the number of tools and opportunities for action have grown enormously from the time of the surgeon general's report.

Take the federal court action. It is the most recent chapter in an ongoing case that began as a 1999 lawsuit filed by the Clinton administration and inherited by the Bush team. The recent decision was heralded as a positive development because U.S. District Judge Gladys Kessler rejected a motion filed by four tobacco companies to dismiss the Justice Dept. lawsuit. The federal government is seeking $289 billion from the tobacco industry for its alleged conspiracy to mislead the public about the health risks of smoking.

Still, this action is only one motion -- a skirmish -- in what will prove to be a long fight. The case is currently scheduled for a September 2004 trial date in the U.S. District Court for the District of Columbia. The AMA has made clear its viewpoint by adopting policy calling for federal support sufficient to lead to a favorable trial verdict or settlement clearly favoring public health.

But success here would represent only one part of a multilayered effort. There are other fronts in this battle. Ensuring adequate investment at the state level for tobacco cessation, education and prevention is another important fight, but a difficult one.

In 1998, a master settlement agreement was reached in which the tobacco industry agreed to pay 46 states approximately $206 billion over 25 years to recover the Medicaid costs of treating tobacco-related illness. Four other states settled separate lawsuits for a total of $40 billion over 25 years. The hope was that these funds would be used to support anti-tobacco activities.

But a recent American Lung Assn. report concluded that the majority of states are providing insufficient funding for such initiatives and that less than 5% of settlement funds have been used as intended. With times tight, many state governments are dipping into these funds to pay for other projects. But AMA policy encourages state medical societies, especially in states not committing substantial funding, to work with public health partners, governors and legislatures to protect that money and ensure support for comprehensive tobacco prevention programs.

Individual physicians also can make a big difference. They can work one on one with patients to help them stop smoking. They also can join with local medical organizations to push for the adoption of city and town clean air and indoor smoking restrictions, as well as measures that limit youth access to tobacco products.

The 40 years since the surgeon general's report have witnessed considerable progress in loosening tobacco's deadly grip. There is plenty more that can be done starting now -- one ruling at a time, one state budget at a time, one patient at a time -- that will save lives in 40 years to come.