Expanding FDA Regulation of Tobacco Products

Mr. McAllister is a health-systems consultant based in Chapel Hill, North Carolina.

President Obama recently signed into law a measure that would dramatically enhance FDA regulatory authority over tobacco products, including the marketing and content of cigarettes. Although I am usually nervous when government inserts itself in personal choices and behavior, the data reflecting the health implications of smoking and the societal health care delivery costs resulting from tobacco use are compelling.

The Centers for Disease Control and Prevention estimates that cigarette smoking causes >400,000 deaths each year. Statistics reflecting other tobacco- related morbidities are even more dramatic. Consumption among young people has remained a significant problem, despite all the negative outcomes associated with tobacco use.

A Multipronged Approach

Tobacco consumption is an addiction that usually requires multiple interventions to achieve permanent cessation. Cessation efforts have been suboptimal for decades, but more recent pharmacotherapeutic advances have helped many individuals stop—or at least reduce—cigarette consumption. Smoking cessation programs, including those

delivered by pharmacists, have also been helpful, but these programs are inconsistently available and limited in scope, factors largely related to limited resources and inadequate funding.

It seems to me that all practicing pharmacists have an opportunity, if not a responsibility, to be active participants in smoking cessation initiatives. Estimates indicate today’s smoking population still approaches 50 million individuals, so plenty of opportunity exists to implement the comprehensive approach required to be successful in reaching the patients we serve.

The Joint Commission has helped hospitals ban smoking in their facilities. We need to exhibit leadership in all hospitals and community pharmacies by eliminating the sale of all tobacco products as a professionwide statement to discourage tobacco use. All pharmacists should ask our patients about tobacco use and provide (not just offer) smoking cessation materials as well as referral to other providers who can collaborate in cessation efforts. Such efforts should take place in every encounter until the patient denies continued tobacco use.

We should lobby for increased reimbursement for smoking cessation interventions, including minimal copays for products and services. The frequency of pharmacist encounters, our excellent availability, our reputation as a trusted professional, and our proven expertise in successful interventions establish us as the optimal provider of smoking cessation.

Reaching Out to the Community

We must educate our patients about the morbidity and mortality associated with smoking and offer community outreach programs, especially those targeted toward the young. We also should reach out to other providers to collaborate on this wellness imperative. Continued research on smoking cessation strategies and novel pharmacotherapeutic agents that improve cessation outcomes should be funded as federal priorities.

Finally, pharmacists (especially our pharmacy leaders) should endeavor to keep this societal imperative as one of our most significant priorities until we accomplish our goals. What do you think? â–