trol regulation will be cited aggressively by tobacco lobbyists in other countries and international bodies as grounds for resisting stronger regulation."
The United States has a significant self-interest in developing a strong international tobacco control policy. The 1997 IOM report, America's Vital Interest in Global Health suggests that by becoming a leader in international health issues, "the United States will fulfill its national responsibility to protect Americans' health, enhance U.S. economic interests, and project U.S. influence internationally."83
U.S. government action will often require concerted action with other countries as well. Unilateral actions would merely encourage U.S. firms to shift operations abroad or open the door for foreign firms to take over markets now dominated by U.S. firms, with no change in underlying behavior. The tobacco industry has long operated from an international perspective, and public health measures must be similarly global. Adoption of a comprehensive domestic tobacco control program is of unquestioned importance in the United States, but it will be incomplete without commitment to an international collaborative effort.
The National Cancer Policy Board chose to issue its first policy statement on tobacco control because tobacco use is the single largest cause of cancer deaths,84 and because tobacco joins AIDS as one of two major growing health threats worldwide.85 The board believes that:
The single most direct and reliable method for reducing consumption is to increase the price of tobacco products, thus encouraging the cessation and reducing the level of initiation of tobacco use.
Some of the revenues generated should go to support tobacco control measures.
Lack of a research foundation and incomplete disclosure of proprietary data about nicotine addiction, health effects of additives, and behavioral responses to levels of nicotine and other constituents in tobacco make it difficult to foresee the optimal regulatory strategy. Yet as scientific data accumulate, future regulation of nicotine levels, additives, tar and other tobacco constituents might well be needed. Limiting FDA's authority now is unwise.
Regardless of whether the U.S. Congress passes legislation similar to that proposed in the settlement, the United States needs a much more robust system for monitoring tobacco use and a stronger infrastructure at the state and local levels. Nongovernment organizations must also be supported, as they hold government and private parties to account.
Federal research agencies should augment their efforts to gain knowledge about which tobacco control measures are most effective, studied at sufficient dose and duration.
Research is a federal responsibility and must encompass research on tobacco related diseases and behaviors, but research to understand underlying factors is also needed. Finally,