FDA should use its power to lower nicotine in cigarettes, former chief says

By Lyndsey Layton
Thursday, June 17, 2010

A year after Congress gave the federal government the authority to regulate tobacco, anti-smoking activists are applauding the initial steps taken by the Food and Drug Administration to control cigarette marketing and advertising. But a prominent public health figure says that the efforts are not enough and that the FDA could achieve dramatic change by using its new power to lower the amount of nicotine in cigarettes.

David A. Kessler, a former FDA commissioner, said Wednesday that the agency's efforts to date are laudable but "marginal" compared with what the agency has the legal authority to do -- reduce nicotine levels to the point where a smoker no longer craves cigarettes.

"If you do this, you can save 200,000 to 300,000 lives a year," Kessler said. "Everything else pales in comparison."

He made the remarks during a forum marking the anniversary of legislation that put tobacco under federal regulation for the first time.

The FDA declined to comment on Kessler's proposal, but a spokeswoman said that "one of the goals of the agency is to promote cessation in order to reduce the public health burden of tobacco use."

In the legislation, Congress gave the FDA significant new powers to restrict the way tobacco can be marketed and advertised, especially toward children. A number of those provisions take effect next week, including a ban on the use of the terms "light," "mild" and "low tar" in cigarette marketing. In addition, tobacco companies will no longer be able to sponsor sporting or cultural events and cannot sell cigarettes in vending machines, except in adult-only establishments.

The law also directs the FDA to study the role of menthol in cigarettes and whether it should be banned, and it calls for tobacco companies to paste large and graphic health warnings on cigarette packages by 2012, among other changes.

"It's remarkable what the FDA has been able to accomplish in this first year," said Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, citing several of the new rules.

Kessler tried unsuccessfully to regulate tobacco in the 1990s when he was leading the FDA. But in 2000, the Supreme Court ruled 5 to 4 that the FDA had exceeded its statutory authority.

While the new law prevents the FDA from banning cigarettes or reducing nicotine levels to zero, it does permit the agency to lower levels of the drug. The amount of nicotine in a cigarette should drop from about 10 milligrams to less than 1 milligram, Kessler said.

The idea of reducing nicotine has been debated for some time in public-health circles, with some arguing that it would create a black market for full-strength cigarettes, while others believe it might actually increase smoking as smokers puff away to absorb enough nicotine to feed their addiction.

William Phelps, a spokesman for the nation's largest tobacco company, Altria, formerly known as Philip Morris, said, "If the agency decides to regulate nicotine levels, we will work with the FDA to share our knowledge and views."

Nicotine addictions are among the most difficult to end and are on a par with dependence on heroin and cocaine, according to a 1988 report by the surgeon general. According to the Centers for Disease Control and Prevention, 400,000 deaths each year are related to tobacco use. About 20 percent of the population smokes.

Reducing the nicotine level would make it unlikely that anyone trying cigarettes for the first time would become addicted, Kessler said. "The real issue is, are we just going to regulate this product, or are we really going to save lives?" he said.

Some anti-smoking groups applauded Kessler's idea.

"In the long term, you have to solve the addiction problem in order to solve the tobacco problem," Myers said.

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