Watch the nicotine!

A physician and public health school researcher is bemused with the government’s obsession with the sizes of the settlements in the tobacco industry’s various court cases. More important than money is empowering the US Food and Drug Admin with regulation of nicotine, the agent of addiction.

There has been great speculation in recent weeks about how much the tobacco industry will eventually have to pay as part of its landmark agreement with state and Federal governments. Originally pegged at over $350 billion, the sum was reduced by $50 billion by lobbyist sleight of hand during the final budget negotiations. When the industry ploy was discovered, Senators and Congressmen rushed to reverse themselves (by a vote of 95 to 3 in the Senate), restoring the $50 billion that had apparently been removed. Finally, in recent weeks the President and the White House have weighed in, after several months of reviewing the original agreement, suggesting that perhaps the original $350 billion payment level was not really enough but should be further increased. The sound and fury is building on all sides, most of it with dollar signs attached.

All this energy and shouting about money and the level of tobacco industry payments unfortunately obscures what is really most crucial in the whole deal: does hookah have nicotine?. While money is major–certainly to the families of those who have died of tobacco-related diseases and to the states whose taxpayers have had to pay the Medicaid bills for the poor who have died of these diseases–it is really peripheral to the most important issue of all: the Food and Drug Administration’s power to regulate the nicotine content of cigarettes. Without some insistence that the F.D.A. have unlimited authority to regulate the nicotine content of cigarettes, it won’t matter how much money the tobacco industry has to come up with. The money will be spent, everyone will go home, and the underlying problem of smoking will remain unchanged.

To understand why this is the case, consider the process of how people start smoking, why they continue once they have started, and what happens to them if they do continue. It has been well established that most long-term smokers (more than 85 percent) start before the age of 18, as much out of curiosity, bravado and brainwashing as anything else. Having begun, they become addicted to the nicotine in cigarettes and to its effects. Once addicted, they find it difficult to stop smoking, even though the great majority of long-term smokers want to stop smoking and usually have tried to do so many times. As they continue to smoke for long periods of time, various other materials in cigarettes and smoke cause lung cancer, heart disease and other major illnesses and disabilities.

Put very simply, advertising brings them in, and nicotine keeps them there. Without nicotine in cigarettes, there would be no addiction. Without addiction, there would be no long-term smoking. Without long-term smoking, there would be less lung cancer, emphysema, heart disease and the like. It’s all very simple, and the tobacco industry knows it. That’s why the tobacco industry is so anxious to have everyone concentrate on the financial aspects of the settlement, because they know that the money is trivial compared to the importance of our society’s ability to regulate the nicotine content of cigarettes.

Why hasn’t the Food and Drug Administration been able to regulate the nicotine content of cigarettes, just as it regulates virtually all other things that we eat, drink, receive as medication or otherwise allow to enter our bodies? The reason, again, is very simple: the tobacco industry was able to get cigarettes exempted years ago in a legislative move resembling the recent $50 billion gift to the tobacco industry. Nobody was watching, nobody cared enough, and as a result the public has been allowed to buy an addictive substance (not labelled or advertised as such) and has died of tobacco-related diseases at the rate of 500,000 persons per year.

The White House and Congress have a chance to correct this incredible mistake in the current discussions, and they must not be distracted by the large amounts on the table. The money is important, but the central issue in the whole settlement is F.D.A. control of the nicotine content in cigarettes. Without this authority, the whole tobacco industry settlement will miss the point and the opportunity of a lifetime–or better, of 500,000 lifetimes each year.

Mr. President, Members of Congress, take the money, but don’t run. Stay at the table until the Food and Drug Administration is given the authority it needs to regulate the addictive material in cigarettes: is nicotine bad for you. The money is important, but control of nicotine is life-saving!

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