Correspondence
Framework Convention on Tobacco Control
N Engl J Med 2002; 347:537-538August 15, 2002
- Article
To the Editor:
Congressman Henry A. Waxman (March 21 issue)1 is to be applauded for his tireless efforts in tobacco control. The actions of the U.S. delegation at the Framework Convention on Tobacco Control (FCTC) in May 2001 were disappointing, and it was no surprise that this group (appointed by the current administration) supported almost all of the positions promoted by Philip Morris. It is also quite likely that Congress will fail to pass Representative Waxman's bills, H.R. 1043 (To amend the Federal Food, Drug, and Cosmetic Act to provide the Food and Drug Administration jurisdiction over tobacco) and H.R. 1044 (To prevent children from using tobacco products, to reduce the health costs attributable to tobacco products, and for other purposes). It is to be noted that the subtitle of Richard Kluger's Ashes to Ashes (quoted by Rep. Waxman regarding “the purchase and manipulation of the political process” by the tobacco industry) is America's Hundred-Year Cigarette War, the Public Health, and the Unabashed Triumph of Philip Morris.
1 ReferencesJames H. Lutschg, M.D.
4022 N. Bluebonnet Rd., Baton Rouge, LA 70809
glutschg@earthlink.net 1
Waxman HA . The future of the global tobacco treaty negotiations. N Engl J Med 2002;346:936-939
Full Text | Web of Science | Medline
To the Editor:
I attended the four rounds of the FCTC, including the most recent round on March 18 to 23, and observed the events that Representative Waxman reports. The United States continues to try to weaken the treaty, even though a large majority of nations, especially those from the developing world, support strong tobacco-control measures.
If the FCTC does not explicitly state that its public health provisions are to take priority when they conflict with trade rules, it will permit continued industry attempts to thwart domestic tobacco-control efforts. The tobacco industry has a long history of using trade law as a tool to frustrate tobacco-control policies. The United States recently joined other nations in recognizing the primacy of health over trade by agreeing to a health exception to international patent rules so that developing nations could have access to affordable AIDS drugs. Surely the same approach should be taken in the case of tobacco, which already kills more than 4 million people worldwide annually, with the number projected to increase to 10 million by 2030.
We need a strong and enforceable treaty that obligates nations to take specific actions to reduce the rates of death and disease caused by tobacco use around the world. The leadership of the United States is vital to achieving this goal and ensuring that the treaty protects public health, not the interests of the tobacco industry.
Judith Wilkenfeld, J.D.
Campaign for Tobacco-Free Kids, Washington, DC 20005
jwilkenfeld@tobaccofreekids.org To the Editor:
The United States has taken a strong position at the international FCTC. The Department of Health and Human Services leads the U.S. delegation at the convention and wishes to clarify some of the issues raised by Representative Waxman. The Bush administration is fully engaged in efforts to reduce the use of tobacco, both domestically and internationally, with a strong focus on prevention, especially among young persons.
The United States has had a leadership role in recommending initiatives to reduce exposure to secondhand smoke, particularly in indoor public places and the workplace — an area in which we have had success domestically. We support the prohibition of false, misleading, or deceptive labeling of tobacco products. Domestically, the Department of Justice is suing the tobacco industry, seeking equitable remedies against the industry for having engaged in a racketeering enterprise in violation of the federal Racketeer Influenced and Corrupt Organizations Act.
Raising the cost of tobacco products discourages tobacco use, which makes tax measures an effective means of reducing tobacco consumption. However, we cannot agree to an international treaty that would interfere with the constitutional power of Congress and the states to set tax policy and rates.
The United States cannot agree to a total ban on tobacco advertising. The First Amendment of the Constitution guarantees a certain freedom of speech, including that for commercial activities. We do support restrictions on tobacco advertising and marketing that are in conformity with the Constitution. At the same time, we have publicly encouraged countries that can and wish to go further in restricting advertising to create a more stringent protocol.
We have taken the lead in promoting efforts to reduce tobacco smuggling, a practice that provides cheap tobacco to young persons. We will host a conference at the United Nations this summer to address the global problem of illicit trade in tobacco.
The Bush administration is committed to seeking a tobacco treaty that is strong, that works to reduce tobacco use around the world, and that the President and Congress can sign and ratify. The tobacco convention can help to create a safer and healthier world.
Eve E. Slater, M.D.
Department of Health and Human Services, Washington, DC 20201Author/Editor Response
Mr. Waxman replies:
To the Editor: I am pleased that Dr. Slater shares my conviction that an effective FCTC “can help to create a safer and healthier world.” However, her claim that the current negotiating positions of the United States are strong is consistent neither with the observations of tobacco-control experts such as Ms. Wilkenfeld nor with the facts.
Here are the facts. Regarding secondhand smoke, although the U.S. delegation has supported a provision to encourage the protection of nonsmokers in indoor public places and workplaces, it has opposed language to make these efforts mandatory for nations that sign the treaty.1 Regarding advertising, the U.S. delegation has failed to support a definitive ban on the terms “light” and “low-tar,”1 despite the National Cancer Institute's conclusion that such descriptors mislead smokers.2 Negotiators from the United States could also go much further, without running afoul of the First Amendment, than the current U.S. position of opposing only tobacco promotions “targeted” at children. This standard is so weak that it would not stop even Joe Camel, the cartoon character that R.J. Reynolds said was designed for adult audiences.3 Regarding taxes, there is no constitutional or other legal barrier blocking the U.S. negotiators from supporting mandatory tobacco taxes; indeed, support for language in the treaty requiring taxes on cigarettes and other tobacco products was the official negotiating position of the previous administration.4 Even with regard to smuggling, the area in which the United States has shown the most leadership, the U.S. delegation has yet to support a key requirement that cigarette packs carry unique markings to help law enforcement agencies trace smuggled goods back to the origin of the crime.1
These details matter. For the upcoming rounds of treaty talks, Dr. Slater and the administration should adopt negotiating positions consistent with the evidence-based guidance of health experts.
4 ReferencesHenry A. Waxman, J.D.
House of Representatives, Washington, DC 205151
U.S. positions on selected issues at the third negotiating session of the Framework Convention on Tobacco Control. Washington, D.C.: Committee on Government Reform, 2002. (Accessed July 25, 2002, at http://www.house.gov/reform/min/inves_tobacco/index_accord.htm.)
2
Risks associated with smoking cigarettes with low machine-measured yields of tar and nicotine. Washington, D.C.: National Cancer Institute, 2001.
3
Brody JE. Smoking among children is linked to cartoon camel in advertisements. New York Times. December 11, 1991:D22.
4
Intergovernmental Negotiating Body on the WHO Framework Convention on Tobacco Control, First Session, Geneva, 16-21 October 2000. Geneva: World Health Organization, 2001. (Unpublished document A/FCTC/INB2/3.)
