By: Dr. Carolyn Dresler, retired thoracic surgical oncologist, former Associate Director for Medical and Health Sciences for the Office of Science at the Center for Tobacco Products within the FDA, and Chair of the Board of Trustees for Action on Smoking and Health
One of the biggest successes for the tobacco industry was convincing the world that the tobacco epidemic is caused by people who smoke.
Wrong. The tobacco industry has created the demand by addicting youth, partially through marketing but mostly by changing the chemistry of the tobacco product to be as addictive as possible.
As a retired thoracic surgeon who has seen the human death toll of the tobacco epidemic firsthand, I can tell you unequivocally that addiction removes choice. The data also shows that the majority of people who smoke want to quit, wish they had never started, and hope their children never start.
The tobacco industry’s business model is based on a product they’ve engineered to addict their customers before they become adults. If a new product came on the market tomorrow that was unnecessary, highly addictive and killed when used as intended, it would be immediately removed from shelves, and the directors of the company behind it would likely be prosecuted. But we’ve given the tobacco industry a pass and came to accept this massive unnecessary death toll as part of the fabric of society.
The United Kingdom is ready to change that, joining the tobacco endgame pioneers in the Maldives, 23 towns in Massachusetts, 4 cities in California, 4 cities in Minnesota, and 1 city in New York.
The United Kingdom’s Tobacco and Vapes Act will end the sale of tobacco products to anyone born after 2008. For this bill, tobacco products are defined as any product containing tobacco leaf, including cigarettes, cigars, loose tobacco, chew, and heated tobacco (i.e. IQOS).
Globally, this is called a Tobacco-Free Generation (TFG) policy which falls under the Tobacco Endgame umbrella category of new, greatly needed policies to phase out the sale of commercial tobacco products. These are not radical measures but rather a necessary and rational next step to protect future generations from addiction and their subsequent deaths.
Other Tobacco Endgame policies being implemented include a complete ban on the sale of tobacco products (as we see in California cities), a similar age-based phase out of the sale of all nicotine products (as we see in Massachusetts cities), and a phase out of tobacco retailer licenses (as we see in Minnesota, New York, and Massachusetts cities).
Current tobacco control regulations have saved millions of lives and their implementation and enforcement must be accelerated, but the majority are almost entirely demand-based; very few address the supply of tobacco products, and this is a problem as there is a limit on what demand-reduction policies can accomplish for the tobacco epidemic.
Today, 490,000 Americans still die annually from a completely preventable tobacco-related disease. Tobacco products remain a leading cause of preventable death both in the US and worldwide. This is an addiction problem that we must address more proactively, and tobacco endgame policies are that accelerating solution.
In the US, a 2023 CDC Survey revealed that 57% of adults supported a policy prohibiting the sale of all tobacco products. The Research Brief clarifies, “More than 61% of respondents who did not currently use tobacco products and about one-fourth of respondents who currently used tobacco products supported this policy.”
In Great Britain, raising the age of sale to create a smokefree generation is supported by 69% of people, with just 12% opposed.
In both Great Britain and the United States, youth and adults are required to drive with seatbelts and without being intoxicated. Neither of these public health measures are indicative of a nanny-state regulation, nor is a Tobacco-Free Generation policy.
The public is with us. It’s policymakers who need to catch up, stop taking tobacco industry donations, and begin strengthening the policies to protect citizens from the aggressive tobacco industry.
There is no freedom in addiction which means it is not a choice to make. We must treat nicotine addiction with the same sensitivity and support as we treat alcohol and drug addiction – nicotine is more addictive than heroin and cocaine. Tobacco products cannot be sold as though they are an ordinary consumer good; tobacco products kill when used exactly as intended, requiring no overuse or misuse to cause death.
Tobacco and nicotine regulation policies must reflect the reality of their addictiveness and harm. It’s time to phase out the sale of commercial tobacco products.