Spending $5 billion a year on tobacco cessation for 25 years would profoundly improve the health of Americans

Sep 10 2005

An article published in the Sept. 8, 2005 New England Journal of Medicine sheds new light on the $130 billion smoking cessation plan proposed in the Department of Justice suit against the tobacco companies.

The tobacco cessation plan was embroiled in controversy when Department of Justice attorneys reduced the amount proposed for the smoking cessation remedy from $130 billion over 25 years to $10 billion over five years.

"Spending $5 billion a year on tobacco cessation for 25 years would profoundly improve the health of Americans," says Dr. Michael Fiore, author of the article and the government's expert tobacco-cessation witness in the Department of Justice trial. "This is why it is such a tragedy that the Justice Department backed away from their original cessation remedy. Can you imagine what would happen if, as we projected with this plan, one million smokers quit each year - 33 million over time?"

Smoking remains the single greatest preventable cause of disease and death. A recent study in the British Medical Journal found that the life of a cigarette smoker is, on average, 10 years shorter than a non-smoker. Half of current smokers are projected to be killed prematurely by smoking - 23 million Americans in all.

In economic terms, smoking costs billions. According to the Centers for Disease Control & Prevention (CDC), annual health care and lost productivity costs for smoking exceed $167 billion. In contrast, the CDC estimates that the total state investment in tobacco control is under $862 million a year.

The cessation plan presented at the trial included offering free medications and counseling to the 33 million smokers who want to quit (70 percent of current smokers), with the goal of helping one million additional smokers quit each year, at a cost of $5.2 billion per year, to be paid by the tobacco companies. The program, to continue for an estimated 25 years, was based on The National Action Plan for Tobacco Cessation prepared for and approved by the Department of Health and Human Services' Interagency Committee on Smoking and Health in February 2003.

The plan was generated by a 15-member committee which worked for six months gathering information and conducting hearings in Chicago, Denver and Washington D.C. Dr. Fiore, who is professor of medicine and director of the University of Wisconsin Center for Tobacco Research and Intervention, chaired the committee.

According to Dr. C. Everett Koop, former U.S. Surgeon General: "The Action Plan provides a blueprint for getting proven cessation treatment to literally every smoker in America who wants to quit. This can have enormous benefit for everyone, adding years of life for former smokers and reducing health care costs for all Americans. Making the tobacco companies pay for this is only proper." The cessation plan, based on scientific evidence, included:

• A comprehensive national quit line that would provide counseling and medication treatment to the 10 percent of smokers projected to use it each year.
• A paid media campaign promoting the quit line and evidence-based treatments for quitting smoking.
• Smoking cessation research to help more smokers successfully quit.
• Training for health care providers so that they can intervene more effectively with patients who smoke.

"Some people can quit smoking on their own, but treatment increases the odds of lasting success, which increases the odds of lasting health," says Jack E. Henningfield, professor of behavioral biology and director of The Robert Wood Johnson Foundation's Innovators Combating Substance Abuse Awards Program at the Johns Hopkins University School of Medicine. "If the nation were to fully fund the program Dr. Fiore outlined, both the human and financial tolls of tobacco would be dramatically reduced."

Like Dr. Fiore, Dr. Henningfield served as an expert witness for the government in the DOJ trial. Both are recipients of the Innovators Award.

Innovators Combating Substance Abuse is a national program of The Robert Wood Johnson Foundation that recognizes and rewards those who have made substantial, innovative contributions of national significance in the field of substance abuse. Each award includes a grant of $300,000, which is used to conduct a project over a period of up to three years that advances the field.