American College of Physicians: Internal Medicine — Doctors for Adults ®

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Anti-smoking forces shoring up support for FDA's role

From the January 1997ACP Observer, copyright 1997 by the American College of Physicians.

By Elizabeth Prewitt

As the 105th Congress gets under way, the College and other anti-smoking activists are asking the legislature not to modify the FDA rule governing the sale, distribution and marketing of tobacco products to children.

Public health advocates are busy shoring up congressional and administration support for the FDA rule amid reports that a "comprehensive deal" is in the works to address complaints by the tobacco industry. Some opponents of the rule would like Congress to completely eliminate FDA jurisdiction over tobacco regulation.

The tobacco industry and advertisers, for example, have filed a suit in U.S. District Court in North Carolina challenging FDA jurisdiction to regulate tobacco products. Thirty-three states have filed a friend-of-the-court brief in support of FDA jurisdiction, arguing that cigarettes are drug-delivery devices, and that the rule is not a violation of the First Amendment. Kentucky, Virginia and North Carolina oppose FDA authority over tobacco regulation.

ACP opposes efforts to eliminate FDA authority over tobacco and believes that the FDA must be allowed to respond to new tobacco products and marketing techniques.

Both industry and public health camps are watching with interest as Congress makes committee assignments and the White House fills staff and administration posts. Some anti-smoking activists are already concerned that two Republican senators from tobacco-growing states, John Warner (R-Va.) and Mitch McConnell (R-Ky.), have been added to the Labor and Human Resources Committee, which has legislative jurisdiction over the FDA.

Moreover, filling one of the most important posts in the administration's anti-smoking position, that of FDA administrator, could significantly affect the administration's role in the tobacco debate. (David A. Kessler, MD, will stay on until his successor is named.) In addition, the appointment of the next Surgeon General, as well as the decision to replace White House Chief of Staff Leon E. Panetta with Erskine Bowles from North Carolina, could have an impact on the strength of the administration's anti-smoking bent.

In addition, 20 states are involved in lawsuits to recover Medicaid expenditures that can be linked to smoking-related illnesses of beneficiaries. A multi-billion dollar settlement of $6 to $10 billion could entice the states to negotiate a deal. Such a settlement would recognize the harmful effects of smoking and settle some anti-smoking lawsuits; on the other hand, the terms of the settlement might prohibit the states from further legal action to recover monetary damages.

The College is an active participant in coalition activities to mobilize anti-tobacco activists at the national, state and local levels. The College has provided assistance to chapters in their anti-smoking efforts (see ACP to chapters: help end smoking where you live in the November 1996 ACP Observer), and has written to Congress in opposition to any legislative proposal which strips the FDA of jurisdiction and support of "meaningful and comprehensive authority over tobacco" by the FDA.

Elizabeth Prewitt is Senior Associate for Government Relations in ACP's Washington, D.C., office.

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