Interagency Committee on Smoking and Health
Meeting Summary: November 6, 2003
Public and Private Sector Roles in Tobacco Use Reduction
Discussion—Committee and/or Public Comments
Christine Williams, M.Ed., Agency for Healthcare Research and Quality, referring to the
situation in Massachusetts where tobacco control funding is being cut due to the state
budget crisis, talked about the importance of building a strong business case in support of
tobacco use prevention and cessation programs. Not only do these programs pay off in the
long run, but there are also short–term savings from investment in tobacco cessation
programs.
Dennis Richling, M.D., Union Pacific Railroad, mentioned the need to get the private payer
community to view tobacco cessation as treatment for an addictive disorder rather than a
preventive service. Dr. Carmona agreed with Dr. Richling's point, and talked about the
"perverse incentives" in the healthcare system which favors treatment over prevention.
Aron Primack, M.D., M.A., Fogerty International Center, talked about the need to approach
tobacco use not only from a medical perspective, but also from an educational perspective.
(He recognized the Department of Education representative present at the meeting.) Liza
Veto, Department of Education, introduced herself and talked about her role as one that was
doing exactly as Dr. Primack suggested—translating what we think of as traditional public
health messages into education messages.
Scott Leischow, Ph.D., National Cancer Institute, mentioned a collaborative project between
NCI, the National Institute for Drug Abuse, and the National Institute on Alcoholism and
Alcohol Abuse to develop more effective medications to treat tobacco dependence.
Dr. Carmona asked the committee to consider an issue that he has been involved with as
Surgeon General which focuses on how to create incentives for prevention efforts and
eliminate what he considers "perverse incentives" in our current health care system.
Furthermore, he asked the committee to consider whether the responsibility for this shift
should come from the private or public sector.
Timothy Condon, Ph.D., National Institute on Drug Abuse, acknowledged that he did not have
an answer for Dr. Carmona, but talked about the stigma of addiction and how important it is
to educate people about the differences in how addictive and other medical disorders should
be treated.
Robert Mecklenberg, consultant with the National Cancer Institute, offered a comment about
the need to consider the tobacco industry's influence, and how this had not been directly
addressed by the committee.
Dennis Richling, M.D., Union Pacific Railroad, went back to Dr. Carmona's question regarding
the need to reorient the healthcare system to provide incentives for preventive efforts. Dr.
Richling believes that the business community accepts the importance of prevention, but is
also faced with growing healthcare costs and the need to make difficult choices. He
believes that national leadership through a public-private partnership could begin this
process of change. Dr. Carmona responded by saying he is considering a future Surgeon
General report focused on prevention.
Jonathan Samet, M.D., commented that there are models available for estimating health costs,
but perhaps there is a need for tools that are easier to use to make these estimates.
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