FDA Releases Selection of Graphic Warnings

The FDA released Tuesday their final selection of 9 graphic warnings to be placed on all cigarette packaging and advertising by September 2012. These warnings will replace the ubiquitous black and white labels that have been in use for the past 25 years. The Federal Trade Commission found in 1981 that they had little deterrent effect. The new warnings will cover 50% of packaging and 20% of advertising.

CDC research conducted in 14 foreign nations has shown that graphic warnings spur smokers to think about quitting. However, there remains question as to the efficacy in a society as literate as the U.S. Are there really individuals that do not know tobacco will kill you? One of the critiques of youth focused prevention is that young persons do not grasp the same concept of long term health risk. Will these graphic warnings actually penetrate this worldview and prevent initiation?

One of the most unique criticisms of graphic warning labels comes from Martin Lindstrom author of the book Buyology. Lindstrom’s book is an analysis of the effectiveness of marketing tactics involving MRI and EEG brain scanning technologies called nueromarketing. His findings were that graphic warnings on cigarette packaging did little to inhibit craving and promote cessation. In an interview on NBC’s Today show in 2008 he remarked,

“We couldn’t help but conclude that those same cigarette warning labels intended to reduce smoking, curb cancer, and save lives had instead become a killer marketing tool for the tobacco industry.” The crux of his argument is that visual stimuli, like the graphic warnings, over time becomes associated with cigarettes as effectively as any overt branding.

None of the marketing reforms called for in the Family Smoking Prevention and Tobacco Control Act go to the lengths of eliminating branding and advertising called for in the WHO’s Framework Convention on Tobacco Control. Limiting advertising to black on white as well as a preclusion from claiming that a tobacco product was FDA approved were almost immediately held up by litigation. The judicial history of commercial speech in the U.S. may place significant obstacles to ratification in this country.

Perhaps the most positive aspect of these new warnings is the inclusion of the 1-800 QUIT NOW national quit line number. Getting a minimum of social support and counseling to smokers can only act as a prompt for cessation that did not exist previously.

World No Tobacco Day Celebrates Global Treaty

The World Health Organization (WHO) will celebrate the annual World No Tobacco Day on May 31. The 2011 theme calls attention to the Framework Convention on Tobacco Control(FCTC). The first global treaty initiated under the auspices of the WHO, the FCTC has been in force since 2005 with over 170 signatory parties to date reaffirming “the right of all people to the highest standard of health and new legal dimensions for cooperation in tobacco control.”

The United States signed on as a non-party in 2004. The Senate has yet to ratify the treaty. There had been concern that the U.S. would try to weaken provisions and doubts about the possibility for implementation. In fact, the Family Smoking and Tobacco Prevention Act of 2009, giving limited authority over tobacco to the FDA, contains provisions allowing non-voting participation by the industry on a scientific advisory panel. This compromises Article 5.3 of the FCTC conflicting with the first guiding principal of the treaty that, “There is a fundamental and irreconcilable conflict between the tobacco industry’s interests and public health policy interests.” This seems to have been ignored when major public health groups in the U.S. collaborated with Philip Morris to pass this law.

Additionally, the treaty recommends that all tobacco advertising be banned. While other nations are proposing plain packaging and have products hidden behind counters this promises difficulty in the U.S. Unlike many countries, U.S. courts have upheld a doctrine of commercial speech for tobacco companies. Given the recent Citizens United decision, it is not clear how sympathetic the sitting Supreme Court will be to compelling public health concerns about tobacco.

The strength of the FCTC, despite the influence of the tobacco industry in this country, is a recognition of the extent and potential for harm caused by multi-national tobacco corporations. Writing in the August, 2006 Human Rights Quarterly, on The Emerging Human Right to Tobacco Control, Dr. Carolyn Dresler notes,

“In the developed world, the health effects of tobacco on the individual are well established, as are its effects on society. However, only predictions based on experience of the established tobacco consuming markets are available to warn of the impending epidemic of tobacco related death and disease that will disastrously affect individuals and society in the developing world.”

It is only with global initiatives like the FCTC can we begin to meet this challenge.