APPENDIX 21
Letter from Dr John Slade to the Clerk
of the Committee (TB 26)
PROGRAM IN ADDITIONS
I write to offer comments for the Parliamentary
Select Committee on Health in its investigation of the tobacco
industry.
I am a physician, a specialist in addiction
medicine. For more than a decade I have studied the tobacco industry
and worked for the regulation of its products here in the United
States. My work has included critiques of tobacco industry behaviour
and new products as well as efforts to help the Food and Drug
Administration investigate this industry. With others, I have
also published papers that outline future directions for tobacco
product regulation.
There is no more important public health opportunity
in the world today than tobacco product regulation.
The tobacco industry produces highly toxic,
dangerous consumer products without offering the usual consumer
protections of product regulation and fair and complete labelling.
As a result, products are offered which promise one thing and
deliver another. Low tar cigarettes, for instance, imply reduced
risk of illness, but the data on compensation and the epidemiologic
data have repeatedly shown that low tar smokes are deceitfully
deceptive. Consumers have been harmed by the low tar scam. Industry
documents show that low tar smokes were intended to keep health-concerned
customers in the franchise, to dissuade them from quitting.
While the tobacco industry has secretly understood
the addictive and toxic nature of its products, it has thrown
a cover over the engineering and design of its products preventing
health officials from knowing whether tobacco products are being
manufactured with the least possible toxicity and addictiveness.
The available evidence indicates, in fact, that cigarettes are
deliberately designed to maximize addiction. As far as reducing
the toxicity of cigarettes in important ways, there are a number
of promising avenues that should be openly discussed and assessed
in a regulatory process. Many of these are described in the paper
I wrote with Jack Henningfield on tobacco product regulation for
a supplement to the Food and Drug Law Journal, a paper
that is already before your committee.
Cigarette makers have, over the years, invested
heavily in designing products that hold out the substantial promise
of major toxicity reductions. BAT was a leader in this field in
the 1960s as detailed in Cigarette Papers University of
California Press, 1996). Presently, RJ Reynolds, Philip Morris,
and now, through its purchase of RJ Reynolds' international business,
Japan Tobacco have products based on technologies which look very
promising (Eclipse, Inside, Hi-Q and Accord). Unfortunately, the
companies are stymied in their marketing of these products because
they do not have the normal set of regulatory relationships with
national drug and device agencies that ordinary pharmaceutical
companies have. This has meant that they have not brought their
products forward for an ordinary discussion of safety and potential
marketing claims or for ordinary consideration of how to market
these products in ways that reduce the use of conventional products
while not expanding the market as filter and low tar cigarettes
did in the past.
The companies seem reluctant to engage in this
discussion possibly because of the admissions it might entail,
but if products such as these are to be brought forward in a meaningful
way, these discussions must occur. Part of the needed process
is a regulatory review of the data about these products. This
will involve critical thinking on the part of regulatory agencies
about what is needed to support various claims and what sort of
monitoring is necessary to be certain that the products do not
harm the public health but rather become part of the solution.
Company officials I have talked with about these
matters have indicated an interest in governmental regulation,
but we diverge from each other in considering such issues as how
much discretion the regulator is to have, what standards are to
be applied, and with what speed rules can be implemented.
There also, frankly, is a large knowledge gap.
Industry personnel have most of the active, working knowledge
of how their products are designed and how they work. Government
and non-government public health workers are at a tremendous disadvantage
in this area. Some of the disparity is being made up by the formerly
secret documents now available as a result of litigation in the
US, but governments will need to make investments in the scientific
and engineering expertise needed to develop at least as good an
understanding of these products as the industry already has.
Since the 1950s, first with filters and then
with low tar, cigarette makers have repeatedly brought out products
which have had the appearance, but not the substance, of reducing
health problems. Instead, the products that might represent genuine
advances have largely remained laboratory curiosities. This behaviour
has largely seemed motivated by the simple business principle
that the most money is made by selling the most product to the
largest number of customers. It is the responsibility of government
to intervene in this grotesque situation and impose requirements
that tobacco products be honestly presented to consumers for what
they are and that tobacco products be no more deadly and addictive
than necessary.
If the US Supreme Court upholds FDA authority
over cigarettes and smokeless tobacco products, this country will
be poised to move in this direction. The Canadian government already
is. Health Canada has broad regulatory authority over all tobacco
products, and it is moving deliberately towards establishing a
regulatory scheme for these products analogous to that for other
consumer products.
A jury in Florida recently found that the major
companies had fraudulently misrepresented their products, and
juries in California and Washington have levied punitive damages
against Philip Morris for its deceit. These judicial findings
are part of a more general environment in which cigarette makers
are shifting their public stances on addiction and disease causation.
Two small tobacco companies, Liggett Group and
Star Scientific, have made forthright, unqualified assertions
that cigarettes cause illness and addiction. Liggett has voluntarily
put an addiction warning on its cigarette packets. Star Scientific
has made its views available on its web site, www.starscientific.com.
In contrast, Brown & Williamson (a wholly
owned subsidiary of BAT), RJ Reynolds and Philip Morris continue
to equivocate. They are more frank in saying things like the scientific
consensus is thatsmoking causes disease, but they still do not
own these statements as reflecting their own corporate beliefs.Illustrative
of the current hedges is the web site that Philip Morris has just
launched at www.philipmorris.com/tobacco.bus/index.html. The company
indicates that there is a medical and scientific consensus about
smoking and disease and that consumers should rely on it, but
the company falls short of accepting these conclusions for itself
and relying on them itself in making its own decisions. Were Philip
Morris itself to actually rely on these conclusions, the ones
it says consumers should rely on, one would hope that its approach
to designing and marketing its products would be very different
from what it actually is. Instead of race cars and cowboys, instead
of cynical games about the tar league tables, the marketing of
Marlboro would feature clear communication about doses, detailed
information on health harms, discussions of addiction, and practical
information on how to stop. Marlboro itself would be designed
to be no more addictive and no more toxic than necessary. In the
absence of Philip Morris doing these things on its own, government
is left to require these things of the company and of other cigarette
makers as well.
13 October 1999
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