'Desperate Housewife' Makes Desperate Plea for Lung Cancer Awareness

Lung cancer is the leading cause of cancer death both for men and for women as well as every major racial/ethnic group in the United States. Among women, about 30,000 more die from lung cancer than breast cancer each year. More women are diagnosed with breast cancer but because of advances in early detection and treatment, the vast majority of these women survive. The inverse is true for lung cancer. The overwhelming majority of those diagnosed die, many soon after diagnosis. One form of cancer creates a legion of survivors to advocate for research and access to care while the other form of cancer leaves only fifteen percent to fight on. Many of these survivors blame themselves for their illness or soon tire of everyone else blaming them with the provocative question, “Were you a smoker?”

I was recently reminded of this fact when I had the honor of filming a TV segment with actor, Kathryn Joosten, the former star of “West Wing” (the President’s executive assistant) and now of “Desperate Housewives” (the crotchety neighbor). Martin Sheen’s character was a smoking President, and now President Obama has been vocal about his own very real struggle to quit. The nation needs the real-life occupants of 1600 Pennsylvania Avenue to do as much as possible to stem the tide of the leading cause of cancer death, either through equity in research funding, advances in early detection or prevention and cessation services. Indeed, of the ten recommendations proposed in 2003 by the government’s own Inter-Agency Committee on Smoking and Health, only one -- the establishment of telephone quit lines in every state -- has been implemented.



5:35 PM | | 0 Comments

Does Obama’s Smoking Habit Change Your View of the President?

A CNN poll conducted earlier this summer reported that Obama’s smoking habit does not change most Americans’ view of the President and I agree that it should not. Smoking is a powerful addiction whether you are a waitress, a truck driver, a college student or the President of the US. We should be proud of him for telling the truth and trying to quit. If he is like most who have smoked he may need to try to quit more than once before it sticks.

10:10 AM | | 0 Comments

New iPhone App a Gateway for Smoking?


We recently came upon this story about a new Apple iPhone application that allows young people (the game is rated 17 and up) to blow virtual smoke rings. The game: better the smoke rings, the better the points.

Having young people model smoking is just one step away from actually smoking. It would be interesting to know whether a corporate entity is underwriting this application and, if so, which one. Smoking in the movies has for decades and still does glamorize smoking in a big way so I am not surprised young people are attracted to such a “game.” It is irresponsible to have an application where young teens “play” smoking for rewards.



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FDA, Health Reform and a New American Way

Recently after years of hard work by advocates for public health and congress a bill giving the Food and Drug Administration (FDA) regulatory control over the tobacco industry has passed. It gives the FDA broad authority to require the disclosure of the ingredients in cigarettes and to regulate their marketing to both adults and children. Of great importance, it will eliminate one of the greatest consumer frauds in the modern history of the United States and indeed the world; that smoking “light” or “low tar’ cigarettes confers lower risk.

Millions of U.S. smokers gravitated to these new light products instead of trying to quit smoking lured by the false belief that they were at least doing something positive to reduce their risk. The law is a great public health victory, but the work now begins to make it all that it can be. Important issues will include consumer disclosure and marketing restrictions. Further research will be needed to define the impact of lowering nicotine levels because the evidence is sparse and contradictory. Users of lights did compensate by smoking their cigarettes further (e.g. to the filter) and smoking more. Smaller studies have found little increase in smoking to compensate for lower nicotine levels but these have been small in scale and cannot be extrapolated to the broad population of smokers. This research will be crucial. If it turns out that lower nicotine levels can be managed to eliminate the phenomenon of compensation, we could gradually reduce the number of smokers as we reach points in nicotine levels at which smokers can’t be bothered to continue. Already we know that non-nicotine cigarettes cannot maintain a market based on tobacco industry reports. 

Lately we have had some other real victories too. The federal excise tax has been increased and this has led to more smokers trying to quit. Combined with the soon-to-be seen FDA-induced graphic warning labels, the disappearance of light cigarettes and the potential in the U.S. Justice Department case for the tobacco companies to have to publicly correct the fraudulent misrepresentations they have made to the public for several decades, we have good cause to believe that we’re on the road to real progress. These activities will all markedly increase quit attempts but sadly most Americans lack insurance coverage to support the medical and counseling interventions which give them the greatest chance of quitting successfully. Smoking is a chronic, relapsing behavior and the typical smoker tries many times before they are ultimately able to quit. With all these measures aimed at stimulating quit attempts it would be a sad day indeed were health reform to pass without substantive provisions to enable the 70% of smokers who want to quit to do so. No single action has a greater potential for curbing health care costs. The medical care cost alone associated with smoking cost is nearly 100 billion dollars a year. This EXCLUDES lost productivity which nearly doubles the tab. 

While flavored cigarettes will soon disappear from the shelves, the controversial issue of menthol flavored cigarettes remains. The new FDA law contains a provision that addresses menthol as a flavoring. Once appointed, a new Tobacco Products Scientific Advisory Committee is charged with examining "the impact of the use of menthol in cigarettes on the public health, including such use by children, African Americans, Hispanics and other racial and ethnic minorities." The committee's recommendations on these critical topics to the Secretary of Health and Human Services are to be made within one year of the committee being established. 

Legacy is very concerned about menthol and sees this as one of the FDA's early priorities. As this process unfolds, we will join other major organizations, including federal agencies, in hosting a conference in Washington, DC, on October 19 and 20 to discuss new research on the menthol issues to inform and provide context for the FDA as it tackles this subject. 

We are now at a historic cross road. Will we keep taxing cigarettes, under-funding state tobacco control from the Master Settlement Agreement funds made available by 46 states AG’s and make what little goes to help curb our leading cause of preventable first on the chopping block for state cuts. Or will we acknowledge that millions of Americans, smokers and non-smokers alike have lost their lives, lost their quality of life and lost their loved ones to a man-made epidemic, one we lack only the political will to end. Fully incorporating tobacco prevention and cessation public education and comprehensive treatment services into to health reform with the goal of driving smoking below 5% by 2020 will save a great deal of money, countless lives and spur the United States’ productivity. Can we as a nation really afford to take a pass on this? Some cynics point out that fully funding tobacco control will drive up social security costs because people will live longer. Are other health services subjected to this odd test? If they were, might we just as well stop providing health services altogether?

5:19 PM | Labels: , , , | 0 Comments

Higher Taxes on Cigarettes: A Social Injustice?

In 2001, I spoke at the National Conference on Tobacco or Health on the topic of social justice and the tobacco epidemic. Then I said, “We must also say to the states that raising taxes on tobacco products is right because it reduces consumption. But higher taxes take a much bigger bite out of the budget of the poor smoker than the well-off smoker. Higher taxes on cigarettes should not be a form of social injustice. States that raise taxes have a moral obligation to use these funds to expand prevention and cessation programs.” I went on to calculate the cost to a family of four, living at the poverty line, where both parents have a two-pack-a-day habit. The cost of their cigarettes amounted to roughly 40% of their monthly income.



On April 1, a significant increase in the federal excise tax occurred bringing the total federal tax on a pack of cigarettes to $1.01 -- an increase of 62 cents per pack. In a significant breakthrough, the tax also covers little cigars with a tax increase of 97 cents per pack to $1.01. The sales of little cigars have risen 240% from 1997 to 2007, and there is evidence of their growing popularity in the African-American community. The revenues from these new taxes will go to expand the Children’s Health Insurance Plan which will cover 3 million more uninsured children. What the tax will not support is an expansion of services for low-income smokers among whom the rates of smoking are highest. In fact, the level of coverage for cessation services among Medicaid plans and private insurance -- as well as support to public education about quitting -- remains quite dismal. Indeed, as states are facing record deficits some are sharply curtailing their services. In a rather extraordinary move, the Washington State legislature reduced its tobacco control program by about 39% and explicitly stated that the public education advertising program should cease. Such campaigns are a principal means of alerting smokers to services that exist and help them to be motivated to use them. The nation’s network of telephonic quit lines, which is designed to coach individual callers through a quit attempt, is so starved for funds that it has been thoroughly overwhelmed by the onslaught of callers resulting from the increase in the federal excise tax. In fact, the only national paid advertising campaign to encourage smoking cessation supported by the public health community is BecomeAnEX, a campaign created by the American Legacy Foundation® and backed by the National Alliance for Tobacco Cessation. It cannot nationally advertise the quit lines because their capacity is too low to absorb the millions of potential callers.

The Master Settlement Agreement resulting from the negotiations between the states’ Attorneys General and the tobacco industry led to a large increase of funds going to states. While a few states have spent the minimum amount the CDC recommends to support a tobacco control program, the vast majority have not done so, leaving countless addicted smokers nowhere to turn. Many who read this may believe that anyone can quit on their own, if they just try hard enough. Unfortunately, science has taught us that this simply isn’t so. The result then is each time we raise the tax and fail to set aside funding for services, we sentence people to a lifetime of addiction and for half of them, tobacco-related death. There is always another call on public money more urgent than supporting tobacco control -- this despite the fact the tobacco use is the leading behavioral cause of preventable death. There are likely many causes of this phenomenon, among them disdain for smokers and a love of Big Tobacco’s campaign contributions.

Hopefully America’s brand of health reform will address the fact that public education on quitting smoking and access to services to succeed in quitting are crucial if we are to continue to reduce smoking, which currently claims the lives of 440,000 Americans each year.

12:25 PM | Labels: , , | 4 Comments

E-Cigarettes


When I first heard about e-cigarettes, I wondered how I myself would have responded to their appearance on the scene back when I was a chain smoker trying periodically to quit. Ironically, I think I would have definitely tried them at least once, more if I found them to be satisfying. I did not know then what I know now, and on top of that, the whole landscape has changed a great deal. Back then, when I was a chain-smoking 20-year-old, there were no medical treatments available for quitting smoking, the early medical trials on the efficacy of nicotine replacement therapy were just beginning. Today, we now have a variety of cessation treatments which can be tailored to a wide variety of individual circumstances. These treatments have been rigorously studied so we know their success rates, and they have come down in price so that they are now more affordable than smoking. This is even more important as the cost of a pack of cigarettes has risen most recently by the increase in the federal excise tax. This price increase alone is likely to lead to millions of smokers attempting to quit and a million actually succeeding.

So where do e-cigarettes fit in? The blogosphere is now filled with testimonials from people who perceive e-cigarettes to be meeting their needs. What could be the downside to this? Unfortunately e-cigarettes are unlikely to be a panacea and in fact, already their importation is being stopped at the border. Why? As of this writing, these products -- which have proliferated under a variety of brand names and forms -- have not been subjected to rigorous testing with regard to their safety or efficacy.


These products ought to come under FDA authority for two key reasons. First, the FDA is in the position to determine whether the product is safe for its users, for those who breathe the second hand fumes created by its use and for children who might be attracted to and ingest the nicotine delivery vials flavored with apple, banana and vanilla (www.puresmoker.com) or cherry, mint-chocolate and strawberry (www.johnsoncreeksmokejuice.com). Second, only clinical trials can determine whether these products lead to cessation success. Many of the products claim to not have cessation as a goal in what I believe is a thinly veiled effort to try to escape regulation as a nicotine delivery device.

What are the problems with these products beyond the fact that we do not know whether they are safe or work? In the real world, they could produce some pretty ugly consequences. There is every reason to believe they could rapidly become a gateway smoking product for kids and teens and in fact many companies already offer non-nicotine versions (which presumably would not come under FDA authority). The online marketing offers more youth-enticing flavors like bubble gum. Yes, bubble gum.

Then there are two other big downsides. People who intended to really quit instead substitute e-cigarettes in all the places they now cannot smoke and therefore never get around to really quitting and then there are the people who have quit for years but just cannot resist trying the new “safe” product out and before you know it they are hooked again on the real thing.

Stay tuned for what the FDA does.

3:30 PM | Labels: , | 0 Comments

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