Surgeon General's Report Strategizes for Tobacco 'End Game'

"We need to eliminate the use of cigarettes and create a tobacco-free generation," he says

Published in CSP Daily News

Boris Lushniak

WASHINGTON -- The U.S. Surgeon General has released "The Health Consequences of Smoking--50 Years of Progress: A Report of the Surgeon General," coming 50 years after the 1964 Surgeon General's report that concluded that cigarette smoking causes lung cancer. In the new, 978-page report, Acting Surgeon General Boris Lushniak looks at "'end-game' strategies that support the goal of eliminating tobacco smoking, including greater restrictions on sales."

That 1964 report identified smoking as a cause of serious diseases. The new report adds diabetes, colorectal and liver cancer, rheumatoid arthritis, erectile dysfunction, age-related macular degeneration and other conditions to the list of diseases that cigarette smoking causes. In addition, the new report concludes that secondhand smoke exposure is now known to cause strokes in nonsmokers.

"Smokers today have a greater risk of developing lung cancer than they did when the first Surgeon General's report was released in 1964, even though they smoke fewer cigarettes. How cigarettes are made and the chemicals they contain have changed over the years, and some of those changes may be a factor in higher lung cancer risks. Of all forms of tobacco, cigarettes are the most deadly--and cause medical and financial burdens for millions of Americans," said Lushniak.

"Evidence-based interventions that encourage quitting and prevent youth smoking continue to be underutilized. This report strengthens our resolve to work together to accelerate and sustain what works--such as hard-hitting media campaigns, smokefree air policies, optimal tobacco excise taxes, barrier-free cessation treatment and comprehensive statewide tobacco control programs funded at CDC-recommended levels," he said.

"Enough is enough," Lushniak said in an interview with Reuters. "We need to eliminate the use of cigarettes and create a tobacco-free generation."

Chapters 14, 15 and 16 are of particular interest to the tobacco and the tobacco retailing industries.

Chapter 14, "Current Status of Tobacco Control," covers the changing public image of tobacco; changes in the tobacco industry, products and product regulations; tobacco control policies (including taxes); regulations on youth access; bans and restrictions on advertising and promotion; and tobacco product litigation.

Chapter 15, "The Changing Landscape of Tobacco Control--Current Status & Future Directions," covers "potential end-game strategies."

"New 'end-game' strategies have been proposed with the goal of eliminating tobacco smoking. Some of these strategies may prove useful for the United States, particularly reduction of the nicotine content of tobacco products and greater restrictions on sales (including bans on entire categories of tobacco prod­ucts)," the report said.

End game strategies discussed in the scientific literature:

  • Reducing nicotine yields: Gradual reduction of cigarette nicotine content to nonaddicting levels through government action.
  • Reducing product toxicity: Implementation of product regulatory standards to require manufacture of tobacco products with very low toxicity.
  • Gradual supply reduction: Phasing out tobacco use on a timetable by gradual reduction of supply to zero or some minimal level.
  • Prohibiting sales to future generations: Implementing a ban on sales for people born after a particular date, so that smokefree cohorts are created that progressively increase in coverage and size.
  • Banning cigarettes: Ban on the production and sale of cigarettes and/or cigarettes and additional tobacco products
  • Selling tobacco through a not-for-profit agency: To avoid the profit motive, transfer control of supply and sales to a not-for-profit agency that has the goal of reducing consumption.

Chapter 16 is "A Vision for Ending the Tobacco Epidemic: Toward a Society Free of Tobacco-Caused Death & Disease."

Click here to view the full Surgeon General's report and other information.

Although he does not directly address the "end-game" strategies, Brian May, spokesperson for Richmond, Va.-based Altria Group Inc., provided the following statement to CSP Daily News:

"The report covers a number of issues, and we are encouraged to see it highlights the opportunities FDA regulation can provide--particularly the potential for harm reduction through product innovation.

"We're now in a new era of federal regulation of tobacco products. Moving forward, we believe FDA regulation, particularly as it applies to product innovation, has the potential to substantially reduce the harm caused by smoking. We support (and communicated again to FDA last fall) extending its regulatory authority over all tobacco products, including those containing tobacco-derived nicotine such as e-cigarettes.

"Philip Morris USA agrees with the overwhelming medical and scientific consensus that cigarette smoking causes lung cancer, heart disease, emphysema and other serious diseases in smokers. Smokers are far more likely to develop serious diseases, like lung cancer, than nonsmokers. There is no safe cigarette.

"We also hope federal tobacco regulation will help all stakeholders move beyond conflict to an environment that offers real and practical solutions. By working with the FDA, we hope to help resolve many of the issues that concern the public, our consumers, the public health community and our tobacco companies.

"These are many of the reasons we supported legislation that gave the FDA the authority to regulate tobacco products. We believe that regulation is best achieved through a science-and evidence-based approach that results in reasonable regulation.

"For those who continue to use tobacco products, a growing body of evidence suggests some tobacco products are lower risk than others. Our tobacco companies believe the development of and appropriate communications about lower-risk tobacco products within the FDA regulatory context should be part of a comprehensive harm reduction strategy that complements proven prevention and cessation strategies.

"This complementary strategy focused on creating and recognizing innovative tobacco products that could reduce harm for smokers is also important. The FDA has the tools and scientific expertise to assess potentially reduced risk tobacco products, and the law creates pathways for appropriate communications about lower-risk products. Our tobacco companies continue to focus on developing lower-risk products that appeal to adult tobacco consumers and see this as an important business opportunity under FDA regulation."

Winston-Salem, N.C.-based Reynolds American Inc. and Greensboro, N.C.-based Lorillard Inc. declined a CSP Daily News request to comment on the new report.

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