Health Groups Unite on Tobacco Deal

The public health community broke an internal impasse and sent its clearest signal yet that the tobacco industry should make much deeper concessions than it has accepted so far and that there is deep skepticism about granting tobacco companies any legal protection from future lawsuits.

Physicians C. Everett Koop and David A. Kessler, two leaders of the anti-tobacco forces, released a letter signed by 20 public health groups calling on Congress to adoptan array of specific measures designed to discourage children from starting to smoke, to raise the price of cigarettes by $1.50 and to regulate strictly the industry’s manufacture and marketing of tobacco products.

The letter clearly opposes any legal protections for the industry, which has demanded them as the price for any deal in which they agree to curtail their advertising and marketing campaigns aimed at teenagers.

Legal protections for the industry were key to the settlement reached June 20 between the tobacco companies and the 40 state attorneys general who had sued them for the cost of treating tobacco-related illnesses.

In exchange for a prohibition on future class-action lawsuits and punitive damages for past actions, the industry agreed to pay billions of dollars in punitive damages, stop advertising and marketing its products to children and pay for a massive anti-smoking campaign. Many of the settlement’s provisions, such as protection from future lawsuits, require legislation by Congress.

Koop and Kessler also released two studies, slated for publication in today’s Journal of the American Medical Assn., that show strong correlations between the tobacco industry’s magazine advertising and children’s decisions to start smoking. One of the studies, conducted at UC San Diego, tracked 1,752 California teens from 1993 to 1996 and found that 34% of those who experimented with tobacco did so in response to promotional campaigns.

“There is a united front and the public health community has come together,” said Kessler, a former commissioner of the Food and Drug Administration and now dean of Yale Medical School. “I know of no public health group, I know of no organization that is in favor of granting this industry any concessions.”

However, five groups that signed the Koop and Kessler letter--including the National Center for Tobacco Free Kids, the American Heart Assn. and the American Cancer Society--also wrote a letter to Koop and Kessler saying that they would not automatically reject legislation with limited legal protections but wanted to review any legislation in its entirety. Their letter made it clear that, while they had left the door open to limited legal protections, they had adopted a significantly less accommodating position than in the past.

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“We will only support strong, comprehensive legislation . . . and the June 20, 1997, agreement as negotiated does not meet those criteria,” the letter said. It added, however, that the five groups might support legislation with some limits on the industry’s future liability if it also includes strong public health provisions.

“It’s impossible to say that we will ignore a bill that could save millions of lives,” said Matt Myers, general counsel of the National Center for Tobacco Free Kids. “We will look at any bill at the end of the process and evaluate it in its entirety.”

Koop, a former U.S. surgeon general, said he and Kessler would do much the same.

“When people talk about immunity, some people are talking about total immunity for sins past, present and future; some are talking about very limited liability about either the past or the present or the future,” he said. “Until we see what words actually come out in legislative language, we can’t support or decry any of them.”

Tuesday’s announcement, which largely ends a painful internal split within the public health community about whether to support giving the tobacco industry legal protection from some future lawsuits, was welcomed by members of Congress, such as Sen. John McCain (R-Ariz.), who had specifically called on the public health community to coalesce.

McCain chairs the Senate Commerce Committee, which has jurisdiction over a significant part of any tobacco legislation that would move through Congress. He has not yet taken a position on whether the companies should get limited liability in future lawsuits.

The studies released Tuesday suggest that exposure to tobacco advertisements and promotions such as caps and T-shirts is more effective than previously had been documented in influencing teenagers to smoke.

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