Oh, what a smoothie that David Kessler is. The commissioner of the Food and Drug Administration recently set a fire beneath one of America's most pernicious public health issues. But he said Congress must decide how to put the fire out, knowing full well that many elected officials will want only to ignore the smoke and go about their business-as-usual.
The subject was tobacco, and in a letter to an anti-smoking activist Dr. Kessler raised the possibility that cigarettes may be considered drug-delivery devices, subject to FDA regulation. The added twist: Given what we know about the health hazards, if the FDA regulated cigarettes it would have no choice but to ban them.
In a single piece of correspondence, the commissioner took the debate over sale, use and regulation to a different and more honest level than it has been taken by government before.
Kessler's letter came at the end of a week that will surely live in infamy within the tobacco industry. The Journal of the American Medical Association published a study linking cigarettes designed for and marketed to women with a sharp increase two decades ago in smoking by teenage girls. And in the annual surgeon general's report, Joycelyn Elders was withering in her criticism of advertising that plays upon teenagers' need to be cool and targets kids to replenish the ranks of smokers killed off by cancer.
There was something a little same-old-same-old about all this fuss over advertising. Although the industry has been insisting for years that it doesn't target women or kids, anyone who's seen a Virginia Slims or Joe Camel billboard understands that that's preposterous. Besides, Elders knows as well as I do how to get rid of cigarette advertising. It is to run counteradvertising.
Most Americans probably believe that there are no longer tobacco ads on radio and TV because the brave Congress banned them, which is nominally true. What really happened is that after three years of vivid counteradvertising in the late '60s _ remember "the next time your wife wants a cigarette, give her a kiss instead"? _ the tobacco industry embraced a ban and willingly retired from an arena in which the truth was far more powerful than Madison Avenue palaver.
Kessler's letter and his decision to publicly raise the question of FDA regulation of tobacco products makes all others subsidiary issues.
And his contention that tobacco manufacturers may be adding nicotine to make cigarettes more addictive brings us back to a central question. Whether talking about addiction, taxation or education, there is always at the center of the conversation an essential conundrum: How come we're selling this deadly stuff anyway?
(Industry representatives say that there is no nicotine added to cigarettes. They are the same people who say there is no real evidence that cigarettes cause cancer.)
Perhaps the greatest bar to an outright ban on cigarettes is the American aversion to prohibition, to everything from the black market it creates to the governmental control over individual choice it presumes. But the tobacco industry also constitutes one of the nation's most powerful political lobbies. It accounts directly for nearly 700,000 American jobs.
Canny Dr. Kessler, in saying he seeks advice from Congress on how to proceed, has sent its members a puzzle that defies simple solutions. Like a philosophy problem it unfolds: The FDA could most likely claim jurisdiction over cigarettes because nicotine is an addictive drug. But the FDA has so far not done so.
bb And it has not done so because, if it did, the FDA would have to ban cigarettes as unacceptably hazardous. Which they so clearly are. A pretty problem. It will be interesting to see what, if anything, Congress makes of it, or if its members will merely let the fire Dr. Kessler lighted die down again.