Mr. Chairman, Mr. Dingell, members of the Committee, thank you for
inviting me to appear today to discuss one of the most vital public health
issues affecting our nation: the need to protect our children from the death
and disease caused by tobacco use. On September 17, when President
Clinton called for a sweeping plan to provide American families with the
support they need to prevent youth smoking, he made clear his strong desire
to work with Congress in a bipartisan fashion to enact national tobacco
legislation. I commend you, Mr. Chairman, for your Committee's
willingness to respond to the President's challenge.
When the President announced his plan, he was joined by a broad coalition
of groups and individuals including former Surgeon General C. Everett
Koop, former FDA Commissioner David Kessler, the American Medical
Association, the American Heart Association, the American Cancer Society,
the Campaign for Tobacco-Free Kids, and a bipartisan group of state
Attorneys General. The President's plan builds on the Administration's own
FDA rule and the efforts of many of the state Attorneys General, and offers
a historic opportunity. Today, nearly 3,000 young people across our
country will begin smoking regularly. Of these 3,000 young people, 1,000
will lose that gamble to the diseases caused by smoking. The net effect of
this is that among children living in America today, 5 million will die an
early preventable death because of a decision made as a child. We can
change that if we are willing to take bold action necessary to protect our
children and our grandchildren.
More than two years ago, President Clinton and Vice President Gore began
to lead the way on youth smoking with strong support from members of this
Committee and others in the Congress. On August 10, 1995, they
announced the proposed rule by the Food and Drug Administration to
prevent young people from using tobacco products. One year later, they
announced the final FDA rule. More recently, the President moved to
protect hundreds of thousands of federal workers and public visitors by
issuing an Executive Order to make federal buildings smoke-free.
As in all successful public health campaigns, many people helped bring us
to this point - from the young child who speaks up at her town council
meeting about how easy it is for her to buy cigarettes to the state Attorneys
General who first challenged the tobacco industry in court and then took on
the industry's lawyers at the negotiating table this past spring.
Building on that hard work, the President has challenged us all to go
beyond the agreement reached this summer among many of the state
Attorneys General, and the tobacco industry. To do so, we conducted an
intensive analysis of their proposed settlement and other state suits using
the knowledge and wisdom of scores of experts from inside and outside the
Administration. Public health professionals, budgetary analysts, our best
legal minds - all have reviewed the settlement. We reached out broadly to
ensure that we had the benefit of the best thinking possible on how to
protect the public health. The Vice President, White House Domestic
Policy Advisor, Bruce Reed, and I listened to leaders of the public health
and tobacco control groups (including those representing minority
communities), tobacco farmers, and representatives of affected industries
such as convenience and grocery stores and advertising agencies. We heard
from the industry lawyers, state Attorneys General, plaintiffs' lawyers, as
well as from tobacco industry whistle blowers' and scientists and doctors
nationally known for their research on nicotine addiction. We met with
Senators and Members of Congress from both parties and from all regions
of the country. As a result, our analysis and our thinking on this crucial
public health question were invaluably enriched.
As the President said, we have moved from confrontation, denial and inertia
to the brink of action on behalf of our children. Mr. Chairman, we must get
national legislation right. First, we must strengthen those institutions that
are flexible, strong and capable enough to meet the future challenges of
protecting our children from tobacco. And second, we must demand
accountability from the tobacco industry in helping us achieve our public
health goal of reducing youth smoking.
Let me now briefly-describe the five key elements that the President has
laid out as the Administration's road map in working with Congress to craft
legislation to protect our nation's children.
The President believes that such legislation must include:
- A comprehensive plan to reduce teen smoking, including tough penalties if reduction targets are not met;
- Full express authority for FDA to regulate tobacco products;
- Changes in the way the tobacco industry does business;
- Progress toward other public health goals; and
- Protection for tobacco farmers and their communities.
COMPREHENSIVE PLAN TO REDUCE TEEN SMOKING
As the President pointed out, one of the surest ways to help reduce youth
smoking is to increase the price of cigarettes. Studies show that a 10-percent increase in cigarette
prices leads to a 7-percent reduction in teen
smoking. That is why the President has called for a combination of
industry payments and penalties to increase cigarette prices by up to a
dollar and fifty cents per pack over ten years, as needed, to help reach our
youth reduction targets.
Tough Penalties and Price Increases Aimed at Youth Smokers
Reducing teen smoking has always been America's bottom line. It must be
the tobacco industry's bottom line as well. To achieve this important goal,
the Administration believes tobacco legislation must include stiff penalties
that give the tobacco industry the strongest possible incentive to stop
targeting kids. Legislation should set ambitious targets to cut teen smoking
by 30 percent in 5 years, 50 percent in 7 years, and 60 percent in 1 0 years,
and impose severe financial penalties that hold tobacco companies
accountable to meet those targets. The Administration supports penalties
that are non-deductible, uncapped, and escalating - so that the penalties get
stiffer and the price goes up the more that companies miss the targets. The
penalties should be designed so that individual companies are accountable
for their own actions.
This objective can also be achieved by increasing the base payments from
the tobacco industry proposed in the settlement. Both increasing the base
payments and strengthening the monetary penalties on the industry if youth
smoking targets are not met would have the effect of raising the price of
tobacco products, discouraging youths from smoking, and providing in
creased revenues for public health initiatives. The Administration looks
forward to working with the Congress in deciding the best combination of
the two policies.
Counter-Advertising and Education Campaigns
To succeed in reducing youth smoking, legislation must provide for a
nationwide effort to deglamorize tobacco, warn young people of its
addictive nature and deadly consequences, and help parents discourage their
children from taking up the habit. Legislation should provide for a public
education and counter-advertising campaign, as well as state and local
prevention efforts. The Administration also supports stronger, more visible
warning labels on tobacco products.
Today's teenagers already have been exposed to billions of dollars worth of
image advertising for tobacco. That doesn't count other kinds of exposure
that glamorize tobacco use in more subtle yet very powerful ways, like
smoking in the movies. These influences create a "friendly familiarity" for
tobacco products that is hard to change in the minds of young people.
That's why we need a counter-advertising campaign that's every bit as
pervasive and powerful. Unfortunately, government funding for media
campaigns has been extremely limited. There are no powerful ongoing
national prevention campaigns. To end this silence, we need to work with
experts in the private marketing world. They can advise us on the best
messages, the best ways to target and time those messages, and the best
ways to tie in with local programing.
We already have data that show comprehensive, intensive media campaigns
can work. When combined with school and community activities and
advertising restrictions, media campaigns can reduce youth smoking. On a
national level, the U.S. Fairness Doctrine campaign of the late 1960s taught
us that tobacco counter-advertising can help reduce smoking - as long as we
deliver repetitive creative messages to wide audiences over several years.
Tobacco marketing has shifted away from traditional mass media
advertising toward targeted promotional activities. In the same way, our
counter-marketing campaigns need to include a strong grassroots
component. National campaigns are critical to get our messages on young
people's radar screens, but we know their behavior is most influenced in
their homes, neighborhoods, and communities. That is why every state and
the District of Columbia have dedicated funding to this effort, and we
should should build upon it with funds from any national tobacco
legislation.
Studies show that research-based school curricula can reduce or delay
tobacco use among our youth by teaching them the skills they need to resist
social pressures to smoke. The effectiveness of school programs is boosted
when they are coordinated with community programs. Unfortunately, most
schools have not adopted effective programs. Local education and health
agencies need additional funding through this legislation to work as our
partners in moving research to the classroom.
Restrict Access and Limit Appeal
The current FDA rule includes significant measures to reduce youth access
to tobacco products, such as requiring retailers to check photo identification
of anyone under 27, and limiting the advertising of tobacco products to
young people, by, for example, restricting such advertising near school
buildings. The Administration supports legislation codifying these
measures, imposing strong restrictions on youth access and advertising
consistent with Constitutional provisions, and establishing an effective
retail licensing scheme with tough penalties.
FDA JURISDICTION
Mr. Chairman, the President's second principle for comprehensive tobacco
legislation is that FDA must have full authority to regulate tobacco
products. We emphasize this point in part because the proposed settlement
weakens the regulatory flexibility that FDA now has and which is necessary
to deal effectively with future public health challenges presented by
growing tobacco use.
In 1996, the Administration took the historic step of asserting FDA
jurisdiction over tobacco products. Since that time, the Administration has
said it would support federal legislation explicitly affirming the FDA's
authority to regulate the manufacture, marketing, and sale of tobacco
products. Under such legislation, the FDA's authority over tobacco
products must be as effective as its authority over other drugs and devices,
and must be sufficiently flexible to meet changing circumstances. The
legislation should not impose any obligation on the FDA to make specific
findings about such speculative matters as the creation of contraband
markets; nor should it impose any special procedural hurdles or
requirements, such as enhanced standards of proof or unusual evidentiary
formalities.
CHANGES IN THE WAY THE TOBACCO INDUSTRY DOES
BUSINESS
Mr. Chairman, when we began to confront the tobacco industry's practice of
marketing to teenagers, we faced a corporate culture that insisted on blocking
access to information, on denying culpability and on sustaining unyielding
attacks on opponents in courtrooms and in the media.
As we have progressed through the process of regulation and litigation, that
culture may have begun to change. To foster that change and to make sure
that the industry continues to face its responsibility for the problem of youth
smoking, the President's third --principle is to insist on measures to expose
the industry's past misconduct, especially its efforts to market to children,
and to change the way the industry does business.
Ending the Marketing Aimed at Children
Sincere and comprehensive commitments by the industry, such as
agreements to limit advertising to children, can serve to recognize the need
for increased corporate responsibility. That is why the President reiterated
his call to the tobacco industry to end the marketing and promoting of
tobacco to children.
Document Disclosure
To ensure that patterns of corporate malfeasance are disclosed and
effectively checked in the future, national tobacco legislation must provide
for broad disclosure of industry documents, especially those containing
scientific and health information or relating to the industry's attempts to
market tobacco to children. This legislation should respect essential
principles of attorney-client privilege. But the legislation should establish
effective mechanisms to turn over to the public all non-privileged
documents, including documents that the industry has inappropriately
claimed to be privileged, as well as to disclose scientific and health-related
information even in privileged documents.
Corporate Compliance
Tobacco companies should set up comprehensive corporate compliance
programs that will reinforce the real economic incentives provided by the
youth smoking penalties to discourage companies from marketing to
children. The legislation should establish oversight mechanisms to
investigate and monitor corporate compliance and to make
recommendations to Congress on appropriate future legislation.
PROGRESS TOWARD OTHER PUBLIC HEALTH GOALS
Federal tobacco legislation provides an opportunity not only to reduce
youth smoking, but to meet other public health goals: the reduction of
environmental (second-hand) tobacco smoke, the expansion of smoking
cessation programs, the strengthening of international efforts to control
tobacco, and the provision of funds for health research and other health
objectives. Only a comprehensive approach will permit us to achieve our
objective of reducing teen smoking.
I have already mentioned that we need a well financed nationwide media
campaign to strip tobacco use of its glamour and appeal. We need ongoing
state and community interventions to reach young people where they live
and work; and we need well designed, research-based school programs to
equip them with knowledge and resistance skills. We need surveillance and
evaluation to help us gauge our success and retool our approaches; and we
need prevention research to help us better understand why young people
smoke and what we can do about it. And I cannot stress strongly enough
that we - must fund all I of these activities at levels commensurate with the
harm that tobacco causes our youth and our nation.
Second-Hand Smoke
Over the past few years, we have learned more and more about the adverse
effects of second-hand smoke - or environmental tobacco smoke (ETS) -
particularly on children. The U.S. Environmental Protection Agency
estimates that ETS causes about 3,000 lung cancer deaths each year in
nonsmoking adults. It has been linked with other health problems such as
heart disease. ETS threatens the health of hundreds of thousands of
children with asthma and other respiratory illnesses'. It was for these
reasons the President issued his Executive Order last month to make federal
buildings smoke-free. Congress should take the next step. Comprehensive
tobacco legislation should include provisions of the kind found in the
President's Executive Order, to restrict smoking in workplaces and other
public facilities.
Cessation Research and Services
Some 50 million Americans are current tobacco users and most of them
want help to break their addiction. Motivation for these smokers doesn't
seem to be the major obstacle. As I previously noted, about 70 percent of
adult smokers say they would like to quit completely. However, only about
2.5 percent of all smokers permanently quit each year.
The good news is that there are methods that work. Simple advice from a
health provider can boost cessation rates by as much as 30 percent, while
more intensive counseling or nicotine replacement therapy can double this
level. The more comprehensive and intensive the service, the higher the
success rates can be. Details are spelled out in clinical guidelines available
from the Agency for Health Care Policy and Research (AHCPR).
Smoking cessation is not just an adult issue. About 3 million teenagers are
regular cigarette smokers. Unfortunately, teens who smoke like adults
become addicted like adults. Young people vastly underestimate the
addictiveness of nicotine. Of those who thought they would not be
smoking in 5 years, 75 percent still are. Many teenagers also have the same
intense interest in quitting as do adult smokers. But at present we know
precious little about effective ways to help these young people quit.
Developing these approaches should be a high priority of tobacco-related
research. Last September, the nation's leading researchers in cessation of
tobacco use by teens met in Atlanta to discuss what we do know and what
are the most promising leads for research. Comprehensive tobacco
legislation should ensure that such research receives strong support.
Legislation should also help enable smoking cessation services to reach and
assist the millions of smokers who want to break their addiction to tobacco
products.
International Leadership
As President Clinton said in September, federal tobacco legislation must
aim not only to reduce youth smoking, but to meet other health goals as
well, including strengthening of international prevention and cessation
programs and strengthening of international efforts to control tobacco. We
recently heard from the world's health experts in Beijing about how tobacco
will become the leading preventable cause of death in the world by the year
2020. By 2025, tobacco will claim 10 million lives each year. Seventy
percent of these deaths will occur in developing countries, countries which
truly cannot afford the high social, economic and medical costs incurred as
a consequence of tobacco use. But the opportunities for prevention are real
- people in developing countries have not yet taken up the habit to the
degree that we have in the United States and in other developed countries.
There is much that we can do to assist other countries interested in our help,
bilaterally and multilaterally, through official channels and international
institutions as well as through non-governmental organizations. At a
minimum, we should give greater priority to preventing global tobacco use
by increasing our investments in this area and taking a leadership role in
mobilizing the international health community to discourage young people
from starting to smoke and to encourage those that have the habit to quit.
Because tobacco is global issue, our international priorities should be
consistent with our domestic priorities, and they are. Consistent with
domestic policy and international trade rules, it is the policy of the Clinton
Administration not to interfere with a foreign country's non-discriminatory
health-based efforts to control the use of tobacco. The Department of
Health and Human Services will continue to work with the U.S. Trade
Representative to ensure that U.S. tobacco trade policy incorporates the
health policy perspective. This includes having HHS at the table for trade
negotiations. HHS also will work with the Departments of State,
Commerce and Agriculture in dealing with tobacco issues overseas. While
we are committed to ensuring that American business interests recieve fair
and equal treatment abroad, our trade and commercial actions should do no
more than seek to ensure equal access to a shrinking global tobacco market.
Our U.S. embassies and missions should not be engaged in activities that
are likely to stimulate the demand for tobacco products, or increase tobacco
use, especially among young people.
Resources for Health Research and Other Health Care Requirements
The Administration believes that the primary objective of tobacco
legislation is to reduce youth smoking, not to raise money. But
comprehensive tobacco legislation also should take into account the health
costs associated with smoking and the resulting need for public health
investments. The legislation should generate sufficient resources to
increase funding for smoking-related health research and contribute
significantly to other important health objectives.
It is important to remember that tobacco use is responsible for 30 percent of
the prevalence of cancer, one-third of cardiovascular disease deaths and 90
percent of chronic obstructive pulmonary disease. Smoking is the leading
preventable cause of premature death in the United States. And research
continues to identify additional diseases and conditions - like SIDS, low-birth weight babies,
respiratory illness in children, miscarriage, and birth
defects such as cleft lip and palate - in which tobacco use is implicated.
Any national tobacco legislation must provide for a robust, comprehensive,
and well funded tobacco research program that examines tobacco's impact
on health, disease and quality of life. Research also must address issues at
the national, state, local, and individual levels, informing the development
of new federal and state policies, regulations and programs. The research
should be broad-based, focusing on the biomedical, clinical, behavioral,
health service, public health, and surveillance and epidemiological aspects
of tobacco-related research.
This research program should include studies of tobacco use among youth.
That seems obvious, but despite the fact that there are currently about 3
million young people under age 18 who are regular cigarette smokers, there
are major gaps in research, surveillance, and evaluation data on youth
smoking. We do not even have any state-level data on smoking among
youth or consistent data on which brands are smoked by young people.
Furthermore, little is known about effective strategies to help adolescents to
quit smoking. Developing such approaches should be a high priority of
tobacco-related research.
Let me make one more very important point with regard to a possible
financing structure and funding. Comprehensive tobacco legislation affords
us a unique opportunity to protect the public health; but that opportunity
easily could be undermined if new funds simply displace current
obligations. Specific protections are needed to prevent funds provided
under any legislation from supplanting Congress's current appropriations to
agencies engaged in tobacco-related research, as well as cessation and
education activities. In other words, funding provided by this legislation
must not replace any federal agencies' existing commitments to tobacco-related activities or other
health commitments.
TOBACCO FARMERS AND THEIR COMMUNITIES
The President's fifth principle is to protect the thousands of farmers whose
livelihoods depend on reliable markets, and whose communities are built on
the foundation of a tobacco-growing economy. We have a responsibility to
these people. They have not done anything wrong. As the President said:
They're good, hard-working, tax-paying citizens, and they have not caused
this problem. And we cannot let them, their families or their communities
just be crippled and broken by this.
Mr. Chairman, we are trying to change America and make everybody
whole. --Farmers and their communities deserve a chance to have their lives
and be made whole and go on with the future as well, and I can say I speak
for the President and his entire Administration when I say we are
determined to see that they are part of this.
Several possible solutions - from enhanced assurance of quota stability and
price protection, to the purchase on a voluntary basis of the quotas, to a
comprehensive plan of rural and economic development in tobacco growing
areas - all of these options and others have been discussed. Whatever the
best solutions, the President has made it abundantly clear that these
protections must be included in any tobacco legislation.
OUR WORK WITH CONGRESS
Mr. Chairman and Members of this Committee, the President's plan offers
us a unique opportunity to help prevent young people from using tobacco,
to reduce environmental tobacco smoke, and to help tobacco farmers and
their local communities build a better economic future. We are eager to
work with members of Congress in both parties, especially the members of
this committee.
Congress has a formidable task. Several committees in each House must
evaluate at least a part of this complicated policy area, and after an open,
public review, write national legislation that the President and the American
people can support. I can assure you that we in the Administration are
prepared to work with you and others in Congress to meet this
responsibility and to make major progress on one of the most significant
public health challenges facing our nation.
As an indication of how important we believe this opportunity is, the
President has asked the Vice President to take the lead in building bipartisan
support for our plan. Thank you.