120 miles west of here, in a little brown house in Columbia a few blocks from the University of Missouri where he has taught economics for 30 years, my brother Walter is getting sicker. Feisty and sparkly-eyed, Walter’s still charming, still very much in-your-face, but he’s rail-thin now, and coughs a lot. He has been hospitalized several times in recent months for severe emphysema, so disabling he can’t teach. Cigarettes are destroying my brother’s lungs. He is addicted to a drug in cigarettes called nicotine, and sometime this year or the next or the next, he is going to die because of that addiction. I am not a fan of cigarettes.
This fall the Supreme Court will hear arguments in a case that might have saved my brother’s life, had it been brought 20 years earlier. The issue before the court is wether or not the Food and Drug Administration has the legal authority to regulate cigarettes. The FDA argues that it does, as cigarettes are delivery devices for a dangerous addictive drug, nicotine. The tobacco industry argues — and the notably-conservative fourth circuit of the Federal Appeals Court has agreed — that the FDA does not have the legal authority to regulate cigarettes, as Congress has not specifically given the FDA the authority to regulate nicotine as a drug. The use of tobacco in this country in the coming century will in large measure be determined by what the Supreme Court decides.
I teach biology at Washington University, and every year lecture to my students on the scientific issues underlying smoking, lung cancer, and nicotine addiction. For the two central scientific questions, the picture is clear-cut:
1. Are cigarettes harmful? The scientific evidence that cigarettes are a direct cause of lung cancer is now indisputable. Chemicals released into the lungs from cigarette smoke damage the genes that control cell division, leading directly to continual cell division and lung cancer.
2. Is cigarette smoking addictive? Anyone who has tried unsuccessfully to stop smoking knows the answer to this question. Nicotine in cigarette smoke is a powerfully addictive drug. The way in which nicotine causes addiction has been studied by neurobiologists, who find that it binds to the surface of brain nerve cells at specific sites usually reserved for another brain chemical. These sites are the thermostats of the brain, mechanisms it uses to adjust levels of many brain activities. Like twisting the dial on a central control, the binding of nicotine to these sites produces many changes. After a while, the smoker’s body makes compensating adjustments, and systems return pretty much to normal — as long as the smoker keeps smoking. Take away the nicotine, however, and all those compensating adjustments throw everything out of wack, and all at once rather than gradually. The only way to keep things “normal” is to keep smoking. The smoker is addicted. Internal tobacco company records that have come to light in the last few years make it clear that the tobacco companies have been well aware of the adictive nature of nicotine, the companies adjusting the levels of nicotine in cigarette tobacco to insure adequate levels for addiction. While this issue is still being argued in the courts, the records leave little room for doubt.
The FDA’s case seems clear: cigarettes are dangerous and addictive and, like other dangerous addictive drugs, should be regulated. But as in any issue where billions of dollars of commerce and taxes are at stake, the sheer size of the money involved clouds the issue. Were the drug at issue cocaine (whose mechanism of addiction is very similar to nicotine), no one would question the FDA’s authority to regulate its use. Such regulation of dangerous drugs is just what the FDA was designed to do. No one has ever suggested that the FDA apply to Congress for permission to regulate every dangerous drug it controls. The only reason it is happening this time, with this drug, is money. Lots of it.
Manufacturing and selling cigarettes is very profitable, and the tobacco industry does not relish the prospect of regulation by the FDA, fearing the FDA might insist on less nicotine, reducing addiction and thus sales. The Tobacco Lobby wants Congress rather than the FDA to decide what if anything should be done to regulate cigarettes. It is no accident that the Tobacco Lobby contributes a great deal of money to congressional PACs. Left to Congress, there is not going to be any significant regulation of tobacco, and everybody in Washington knows it.
The FDA has functioned very well to shield public safety issues from political and commercial pressures, and the Supreme Court should not tie its hands in this instance. Let the FDA do its job. Enough people have died.
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