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 teenagers and younger children should not smoke. Even the tobacco industry 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 teenagers who experiment casually with cigarettes will become regular smokers, with one-half of these trying to quit, but failing, by age 18. In fact, 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 fears, tobacco companies unleashed so-called "low-tar" brands in an 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 cancers of the upper lung to the adenocarcinomas of the lower lung as they inhaled more deeply to extract the nicotine their bodies craved from such cigarettes. There is an alternative. We can combine tobacco prevention initiatives 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 Administration's actions in 1996 to restrict tobacco marketing to minors and to approve over-the-counter 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 tobacco industry is lobbying Congress for its own solution to the needs of smokers. Under the guise of a new-found 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.
I 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 those who will yet become addicted, will never expire. The writer was surgeon general from 1981 to 1989.