Bonnie Testifies Before Congress on FDA Regulation of Tobacco
Professor Richard Bonnie, who recently served as chair of the Institute of Medicine's (IOM) Committee on Reducing Tobacco Use, testified before the House Subcommittee on Health on the bill HR1108, which would among other things give the FDA the authority to regulate tobacco products. His testimony, delivered on Oct.3, was based on the IOM report, Ending the Tobacco Problem: A Blueprint for the Nation. The report outlined a plan for the federal and state governments to reduce tobacco use to the point that it is no longer a significant health problem in the United States.
"Our report was not only about federal legislation and the FDA. It had a much broader scope, and a lot of the recommendations were directed to the states and private insurers. A key component of the blueprint for the nation, as we described it, is for the federal government to get off the sidelines. We need to change the regulatory landscape of tobacco control, and an important part of doing that is giving the FDA jurisdiction to regulate tobacco products," Bonnie said.
Various versions of HR1108 have been circulating in both the House and Senate for the past 5 or 6 years, he explained. Congressional staffers and tobacco control proponents are optimistic that this bill can be enacted this year.
The Bush administration has not taken a position on the bill and the current FDA commissioner Andrew von Eschenbach declined to testify, Bonnie said. Instead von Eschenbach submitted a written statement, which didn't take a firm position on the bill, but raised concerns about the FDA having jurisdiction over tobacco. One of the reasons he cited was that it could undermine the mission of the FDA to regulate a product that would be banned if it were subject to the usual FDA requirements.
"The [IOM] committee concluded that the necessary authority should be conferred on the FDA because it is the nation's preeminent public health regulatory agency and because it is the only agency with the necessary combination of experience in product regulation and scientific expertise on tobacco-related disease and nicotine addiction," Bonnie said in his testimony.
Although smoking has been declining gradually in recent years there is still a lot of work to be done. "The rate of adult smoking is still 21%," he said. "Even if progress continues at the present rate, 16% of adults will still be smoking in 2025. We also worry that there will be backsliding because a lot of the success that we've had recently has been in reducing initiation, trying to reduce the level of youth smoking, but that could bounce back up in a minute like it did in the 1990s, for example."
Things could get worse if current efforts aren't maintained, Bonnie said. He presented recommendations that call for more aggressive control of tobacco. "The report contains almost 100 pages documenting the effectiveness of the traditional tools of tobacco control, such as excise tax increases, indoor smoking restrictions, comprehensive state-based programs, media-based prevention campaigns, school-based programs, and cessation therapies and services."
If the IOM committee's recommendations are adopted, Bonnie believes that the prevalence of smoking could be cut in half by 2025. "That would mean that about 11 million fewer people would be smoking in 2025 than would be the case if current trends continue," he testified. But, regulatory measures need to be taken to ensure the end of tobacco use as a major public health concern. Adding warning labels that cover a large portion of the packaging, limiting advertising to black and white text, banning tobacco companies from targeting youth, and aggressive regulation of retail outlets are some of the suggestions the committee recommended.
Smoking is the worst public health problem in the nation today, Bonnie said. "No one else can regulate tobacco products and their packaging except the federal government. What we want to see happen is a comprehensive and coordinated effort with the federal government playing a bigger role than it is now and, if that happens, it will strengthen and reinforce all the efforts that need to be going on at the state level," he said.
Bonnie hopes that his testimony "adds another important voice, the voice of the National Academy of Sciences, to this effort. My impression from the reactions from all of the advocacy groups and lobbyists is that our report has already had an impact and they're relying on it."
Bonnie also gave the keynote address to the Conference on Tobacco sponsored by the National Association of Attorneys General, held in Seattle on October 15. This Conference is held every three years under the Master Settlement Agreement between the states and the tobacco companies. After summarizing the IOM report, Bonnie focused particularly on the report's proposed restrictions on tobacco advertising. He argued that "restricting advertising of tobacco products to a text-only, black-and-white format would survive constitutional attack because it does not curtail opportunities for communicating and receiving information about tobacco products."