Source: San Mateo County Times (CA) 
Author:  C. Everett Koop
Contact:  
Pubdate: Friday, 13 Mar 1998

DON'T FORGET THE ALREADY ADDICTED SMOKERS

To date, most of the tobacco control efforts of this administration have
focused on preventing young people from taking up smoking. Everyone can
agree that teen-agers and younger children should not smoke. Even the
tobacco in dustry can safely join in that refrain, and frequently does,
with characteristic and clamorous hypocrisy as it turns its marketing
machines loose on the young. But at exactly what age does the plight of
American smokers lose its poignancy?

One-third of teen-agers who experiment casually with cigarettes will become
regular smokers, with one-half of these trying to quit, but failing by age
18. The vast majority of current smokers were hooked in their teens or
earlier. During the '80s, the tobacco industry mounted a public relations
campaign maintaining that smoking was an adult decision." It was a model of
reverse psychology, tempting teens at the same time it offered false
assurance to their elders. The vast majority of smokers are captive to
their addiction, so that most who "decide" to quit cannot - not without
help or years of repeated tries.

If we pretend that adult smoking is a consumer choice like any other, we
fall prey to the trap laid by Big Tobacco. Addiction makes the very notion
of choice moot. Who would freely choose sickness and suffering, lost
productivity or 50 percent chance of premature death? Yet cigarette smokers
of all ages continue to die prematurely at the rate of more than 400,000
per year. if not one single young person started smoking from this day
forward, these losses would still continue unabated for 30 years. Imagine
1,000 jumbo jets emblazoned with Marlboro and Winston and Camel insignia
crashing each year for the next three decades, Should we accept such
dramatic losses as par for the course?

We must not focus our efforts so narrowly on preventing tobacco use by
youth that we send smokers the message that we have abandoned them - that
their addiction is their own fault and that we don't care about them. This
is exactly what the tobacco industry wants them to hear. Forget quitting,
hedge the health bets instead.

Responding to founded fear tobacco companies unleashed so-called "low-tar"
brands in effort to hold on to their smokers and reduce the concerns of the
uninitiated. But in their attempt to avoid becoming yet another statistic,
smokers have only changed the form of their resultant lung cancers from the
squamous cell cancer of the upper lung to the adenocarcinomas of the lower
lung a they inhaled more deeply to extract the nicotine their bodies craved
from such cigarettes. There is an alternative. We can combine tobacco
prevention in tiatives with efforts to ensure that those who are hooked can
obtain effective treatments.

The facts are that quitting smoking at any age reduces the risk of
premature death; current treatments can substantially increase the odds of
quitting. It therefore seems logical that each decision to smoke should
present an equal opportunity not to smoke and an equal opportunity to get
help. The Food and Drug Administra tion's actions in 1996 to restrict
tobacco marketing to minors and to approve over-the-counte marketing of
nicotine gum and patches for adults were pioneering steps in the right
direction. So are several pieces of congressional legislation currently
under discussion that include provisions for tobacco addiction treatments.

NEVERTHELESS, much remains to be done if our nation is to make tobacco
dependence treatment as acceptable and as readily available as tobacco
itself. We must evaluate and approve potentially life-saving treatments for
tobacco dependence at the level of priority we assign to treatments for
diseases such as AIDS and cancer. Signaling such a course could help
empower the private sector to meet these challenges in a way that will
contribute to the health of our nation in the short and long run. Currently
the dustry is lobbying Congress for its own solution to the needs of
smokers. Under the guise of a newfound concern for the health of their
consumers, these companies want incentives to market products that they
claim will reduce the dangers of smoking. We do not want to stifle
development of such products. Indeed, we should require reduced toxicity of
tobacco products, as we now understand that they are unnecessarily
dangerous and addictive. But such a course should not enable tobacco
companies to undermine our efforts to reduce overall tobacco use by
allowing them to advertise their products with claims such as "low-tar." or
"reduced delivery."

LEGITIMATE concern for the health of tobacco users should balance efforts
to reduce the toxicity of tobacco products with the means to expedite the
development of new treatments for those who are addicted. Under its
existing authorities, including its designation of cigarettes and smokeless
tobacco products as combination drug and device products, the FDA has many
regulatory tools at its disposal to accomplish its goal of reducing the
risk of death and disease in tobacco-addicted Americans. Congressional
legislation that weakens the FDA's authority over tobacco reduces its
ability to serve the public health.

1 strongly encourage any forthcoming congressional legislation or executive
actions to strengthen, if not leave alone, the FDA's authority over
tobacco, and to support the FDA's ability to evaluate new treatments and
treatment approaches in a manner that is consistent with the devastation
wrought by unremitting tobacco use. Moreover, in our battle with Big
Tobacco, we should not hide behind our children. Instead, as we take every
action to save our children from the ravages of tobacco, we should
demonstrate that our commitment to those who are already addicted and to
those who will yet become addicted. will never expire.

C. Everett Koop was surgeon General from 1981 to 1989