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FDA Has The Right Idea With Graphic Smoking Warnings

Harold Mandel's picture
Lighting up a deadly cigarette

Clearly, the US Food and Drug Administration has been right to fight for graphic warnings about smoking, with success with this approach in Canada signifying the results would be likewise good in the United States. The US Food and Drug Administration was planning to move ahead with orders for such labels in 2012 prior to being blocked by a decision from a federal judge. As is so often true in dealing with legal issues of this nature in a paradoxically mixed up American society, this court order to protect the sales of what is actually poison in the form of cigarettes made little sense to health conscious people. The question many people continue to raise is would these labels have worked in helping to lower smoking rates?

When Canadian researchers used graphic cigarette warning labels in Canada, they found a statistically significant lowering of smoking rates, in comparison to the USA, reports the scientific journal Tobacco Control. It has been concluded that the adoption of graphic warning labels in cigarettes lowers smoking prevalence. It has been estimated that if the USA had adopted these warning labels in 2012, the total number of adult smokers in the USA would have decreased approximately 5.3–8.6 million in 2013.

Graphic US warning labels on cigarette packs could have dramatic effects

In a discussion of this research the University of Waterloo has written that graphic warning labels on cigarette packs could lead to 8.6 Million fewer smokers in the United States. This of course could save millions of lives. Researchers in Canada found that graphic warning labels placed on cigarette packs was associated with a decrease in smoking rates in Canada of between 12 percent and 20 percent between 2000 and 2009. These researchers have estimated that if the same model which was used in Canada was applied to the United States, the presence of graphic warnings against smoking cigarettes would potentially lead to a decrease of millions of smokers.

Therefore graphic warning labels placed on cigarette packs could potentially have a dramatic impact on helping to reduce smoking and cutting smoking related deaths in the United States. The previously proposed US Food and Drug Administration model actually under-estimated what the health impact of graphic warnings would likely have been. This flawed analysis in 2011 by the US Food and Drug Administration appears to have under-estimated the impact of graphic warning labels on U.S. smoking rates, and had an effect on the federal judges decision in this case.

This flawed analysis was in fact a primary factor in an August 2012 decision by the U.S. Court of Appeals for the D.C. Circuit, which found that the FDA's analysis "essentially concedes the agency lacks any evidence that the graphic warnings are likely to reduce smoking rates." Researchers at the University of Waterloo and the Ontario Institute for Cancer Research in Canada have said that the model which was used by the FDA significantly under-estimated the actual impact which graphic warning labels could have. EmaxHealth reporter Robin Wulffson, MD has reported on the blocking of graphic cigarette ads by a federal judge.

Graphic smoking warnings are working in Canada

The researchers made the observation that smoking rates in Canada decreased more dramatically following the introduction of graphic warnings. The new analysis has indicated that the potential reduction in smoking rates is significantly larger than that estimated in the FDA's model and has proven the effectiveness of health warnings which include graphic pictures. The lead author of the paper, Dr. Huang, has stated, "These findings are important for the ongoing initiative to introduce graphic warnings in the United States." The apparent effectiveness of prominent health warnings on smoking has been discussed in an article by EmaxHealth reporter Armen Hareyan.

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An original proposal by the US Food and Drug Administration to have extremely graphic labels placed on all cigarette packs was effectively challenged by the tobacco industry. The federal court which saw a decision against the FDA cited the extremely low estimated impact on smoking rates as a consideration in its judgment. The researchers in Canada say that their analyses corrected for errors which were in the FDA's analysis. It is now believed that the effects of graphic warnings on smoking rates would be significantly stronger than the FDA had originally found. It is hoped these new results which provide stronger support for a revised FDA proposal for graphic warnings and that these new findings will have an impact on future legal decisions regarding this issue.

The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) has issued Article 11, which requires parties to the FCTC to implement large, rotating health warnings for cigarettes. Canada has become one of 177 countries which are parties to the FCTC. This covers about 90 percent of the world's population. Canada has already introduced graphic warnings, but many other countries have not yet done so. The policy director of the Non-Smokers' Rights Association, Melodie Tilson, has said, "Canada was the first country to introduce pictorial warnings, and many other countries have since been inspired to use this powerful method of communicating the harms of cigarettes and other tobacco products."

Graphic smoking warnings could have value worldwide

The senior advisor at the World Lung Foundation, Dr. Judith Mackay, has commented, "These new research findings show clearly the value of graphic warnings for countries all over the world." It has been emphasized that large graphic warnings which are placed on both the front and the back of the cigarette pack constitutes a very low cost and very high impact affirmative policy for lowering tobacco use.

The principal investigator of the International Tobacco Control Policy Evaluation Project, Professor Fong, has said, "This study adds to the strong and growing number of studies showing the powerful and positive impact of graphic warnings on reducing smoking rates." There are now 60 countries which have already introduced graphic warnings or which have
passed legislation to do so. Clearly, the use of graphic warnings to inform smokers and non-smokers alike about the harms which are associated with tobacco use is a rational approach to working towards the eradication of smoking.

It has been my professional experience that graphic warnings of the type being used by Canada and other nations and proposed by the US Food and Drug Administration have a deep and lasting effect on the consciousness of people. Consider that some traffic courts order people who have speeding tickets and DUIs to go to driving classes which have films with vivid photos of crippled and dead bodies from traffic accidents. This type of approach to raising awareness about the hazards of traffic accidents is also used by online driving courses which can lower your insurance rates. These graphic images of mutilated bodies appears to have a lasting impact on people's minds and encourages more responsible driving.

It therefore does not appear to me that the US Food and Drug Administrations proposed extremely graphic warnings of the hazards of smoking on cigarette packs was overdone at all, but it does appear to me that the conjectured positive impact of these warnings was under-estimated. I am personally saddened that a federal judge ordered these warnings held up.

However, it is not the first time I have witnessed a judge put out an order that represents a clear and present danger for the health of people. Judges after all often order people to take orders of psychiatrists and to take their drugs which are poisons, just like cigarettes are. This all presents us with a serious problem in dealing with a profit driven health care system where anything appears to go for big profits, including pushing poisons and buying places on the judiciary for judges who will promote unhealthy, but profitable practices for powerful special interest groups.

In the area of health care, particularly during a time of the failings of the capitalist system across the USA and worldwide for the majority of people, it appears a socialist system of health care should be explored for the United States. My answer to medical students and doctors who would scream bloody murder if confronted with such an option due to fears that they would not earn the hundreds of thousands or even millions of dollars a year which they are presently earning, is they could consider quitting the medical profession if their first concern is profits instead of the provision of optimal patient care and public health care services. Would it really be that hard for more physicians to consider driving high quality $20,000 Mazdas instead of over-priced $72,000 Mercedes!



Smoking habit is very dangerous for your health.