Giving 10% to gain eternity

While the US tobacco industry settled the mammoth tobacco suits lodged by the 50 US states, elsewhere in the world the tobacco giants continue their denials and questionable marketing practices seemingly oblivious. From this perspective, the events described in Michael Orey's book seem more like a minor skirmish on the edge of the tobacco control movement than a victory for the combined forces of governments and the public health community. Keeping in mind this minor quibble, Assuming the Risk is a tremendously readable and interesting book. Like the fictional novels of John Grisham, it is the characters who drive much of the book's plot. As with most events that change the course of a movement, the US Master Settlement Agreement truly began years earlier in a small and poor county of the poorest state in the United States. Thus, starting with the Willie Horton case, which would serve as the linchpin and common reference point for the proceedings that followed, readers are led through the many cases and events that would culminate, years later, with Mississippi's decision to file suit against the US tobacco industry, a move subsequently followed, probably most notably by Minnesota, by the remaining 49 states. As Orey proceeds with his discussion, readers are introduced to a growing cast of characters, their every personality quirk and foible apparently disclosed by the author. Thus we are told of Merrill Williams' quasi-neurotic tantrums, Jeffery Wigand's difficult temperament, and Mike Moore's career-long determination to do good, as well as many other thumbnail portraits. Where Orey leaves readers wanting is in not discussing the merits of the US states' litigation-driven strategy. Is the $246 billion Master Settlement Agreement really a victory for public health? People are now questioning whether any deal made with the tobacco industry can ever be consistent with the interests of public health. While discussing the role of Congress in legislating the first multi-state agreement, Orey never addresses the apparent lack of coherence exhibited by US politicians on the issue of tobacco control. After reading this book, you get the feeling that the US public and politicians feel that no further legislative or regulatory action is necessary now that the tobacco industry has been forced to pay. Perhaps one cannot fault Orey for sticking to what he does best, which is describing the situations, the people, and the maneuvering that lead to US tobacco's first major setback. Written in a journalistic style that eschews legal jargon in favor of plain language, this book will be of most interest to those outside the legal profession. If not a must read, at least a good read.

This paper builds on a growing body of literature analyzing the economic effects of the so-called Master Settlement Agreement (MSA) between the “big four” tobacco companies and the State Attorneys General. Because the marginal cost imposed by the settlement is a function of the market sales of the original four participants, subsequent participating firms will most likely be at a disadvantage. Consistent with increased market power for the original signers, the data since the settlement show increased price overshifting of taxes. Additionally, price undershifting is shown to have occurred prior to the MSA, which would be a rational response of a firm facing a settlement that imposes marginal costs inversely related to sales volume at the time of the agreement. These results suggest that efficiency evaluations may overstate the social benefits of the agreement and the persistent profitability of the industry may be due to the MSA.

The houses of medicine and public health need to heal their own deep rifts in order to present a united front to interests that threaten to derail a proposed settlement with the tobacco industry, warned the American Medical Association (AMA) and US Food and Drug Administration (FDA) recently. During the National Conference on Cardiovascular Health: Coming Together for the 21st Century, Lonnie Bristow, MD, secretary-treasurer of the AMA, and Mitchell Zeller, associate commissioner for policy at the FDA, agreed most strongly on the point that good legislation is possible only if doctors, public health officials, and policy makers work together to get the most they can from the tobacco industry while it appears vulnerable. The FDA has already begun to regulate the sale of cigarettes, said Zeller. A pilot project to “sting” retailers who sell cigarettes to minors has proven so successful that the agency is poised to extend it to all 50 states, he said. On the negative side, the power of the tobacco lobby continues to make itself felt. Earlier this year, Congress refused to appropriate the $34 million the agency asked for to enforce tobacco regulations. In fact, the Senate, with powerful pro-tobacco members, approved only $5 million. But grassroots lobbying by public health officials changed minds, and the money was passed, Zeller said. But in a recent conference committee to resolve differences between House and Senate bills, only $18 million in new funds was found to fund the enforcement. The agency was forced to take $16 million from other programs to meet its commitment, said Zeller. The proposed tobacco settlement announced by industry and government officials last June has been …

his section of the journal explores variousapproaches and the failure of the Master Settle-ment Agreement (MSA) to meet tobacco controlneeds of priority populations. Many factors make thesepopulations particularly vulnerable. Some groups haveexperienced an extraordinary growth in the past 10years, namely, Hispanic/Latino and Asian and PacificIslanders (U.S. Bureau of the Census, 2000), increasingtheirpurchasing powerandbecomingmoreattractivetothe tobacco industry. Others experience high preva-lence rates sometimes double that of the generalpopulation, such as American Indians, Vietnamese,gay/lesbian/bisexual/transgender (Joint Ethnic TobaccoEducation Networks [JETEN], 2003; Ryan, Wortley,Easton, Pederson, & Greenwood, 2001) and low socio-economic status (SES) communities (U.S. Departmentof Health and Human Services [USDHHS], 1998). Oth-ers suffer a disproportionate burden of tobacco-relateddiseases, such as African Americans, lesbian/gay/bisexual and transgender (LGBT) community, andAmerican Indians, experiencing premature death, lostproductivity (Max, Rice, Zhang, Sung, & Miller, 2002;USDHHS, 1998), higher rates of lung cancer mortality,cardiovascular disease, and asthma (JETEN, 2003).However, they benefit less because of lack of fundingfrom the MSA and other health care dollars going spe-cifically to these groups.The current financial crisis of many states has fueleda controversial debate on how to best spend MSA andother tobacco funds (Givel & Glantz, 2002; Schultz,2002). The public believes a significant proportion ofdollars should go toward tobacco control (Batra, Patkar,Weibel, Pincock, & Leone, 2002). However, at its best in2000, tobacco prevention allocations were limited toonly 9.2% of the revenues obtained from the settlement(Bergman, 2003). In most states, tobacco control needsof priority populations have been chronicallyneglected. Tightening of state budgets with the elimina-tion of tobacco control and other health programs sig-nals a potentially severe health crisis. The NCSLreported that only 3% of MSA moneys would be allo-cated in 2004 for tobacco prevention (Bergman, 2003).Thisisnotenoughtomeetoveralltobaccocontrolneedsin the future. Priority populations maywell be the hard-est hit. The cost of treating smoking-related diseasesand the lost productivity from smoking-related deathsis calculated at approximately U.S.$15.8 billion annu-ally, in California alone (Max et al., 2002), a state withhigh protection against smoking. The costs to the nationare anticipated at well over $100 billion dollars a year.At a time when foundations have also eliminated orlargely reduced their tobacco control funding and thestatesutilize themoneystodealwiththeirbudgetcrisis,who will protect the health of citizens in each state?In this section the article titled, “More Money MoreMotivation? Master Settlement Agreement and TobaccoControl Funding in Communities of Color” the authorsdocument historical factors, institutional barriers, andthe state of MSA funding for priority populations. Theypresent three model approaches to achieving fundingparity in tobacco control for priority populations. “AnAnalysis of Tobacco Industry Marketing to Lesbian,Gay, Bisexual, and Transgender (LGBT) Populations:Strategies for Mainstream Tobacco Control and Preven-tion” describes the “short but turbulent” targeting bythe tobacco industry of the LGBT populations, resulting

In 1998, 46 states were involved in a Master Settlement Agreement (MSA) with the tobacco industry. The other four states settled on their own. Our goal is to answer a counter factual question: how would these four states have fared had they been included in the MSA? We use data from Viscusi (2002) to explain settlement shares for states participating in the 1998 tobacco MSA, and to predict settlement shares for the four nonparticipating states. We find that two nonparticipating states (Minnesota and Mississippi) may have fared substantially worse had they been included in the MSA.

In 1998, the attorneys general of 46 states signed a Master Settlement Agreement with the four largest tobacco companies in the United States. The agreement prohibits tobacco advertising that targets people younger than 18 years of age. We analyzed the trends in expenditures for advertising for 15 specific brands of cigarettes and the exposure of young people to cigarette advertising in 38 magazines between 1995 and 2000. We defined cigarette brands as "youth" brands if they were smoked by more than 5 percent of the smokers in the 8th, 10th, and 12th grades in 1998; all others were considered to be "adult" brands. We classified magazines as youth-oriented magazines if at least 15 percent of their readers or at least 2 million of their readers were 12 to 17 years old. "Reach," a standard measure of exposure to advertising, was defined as the number of young persons who read at least one issue of a magazine containing an advertisement for a particular brand of cigarette during a given year. In 2000 dollars, the overall advertising expenditures for the 15 brands of cigarettes in the 38 magazines were $238.2 million in 1995, $219.3 million in 1998, $291.1 million in 1999, and $216.9 million in 2000. Expenditures for youth brands in youth-oriented magazines were $56.4 million in 1995, $58.5 million in 1998, $67.4 million in 1999, and $59.6 million in 2000. Expenditures for adult brands in youth-oriented magazines were $72.2 million, $82.3 million, $108.6 million, and $67.6 million, respectively. In 2000, magazine advertisements for youth brands of cigarettes reached more than 80 percent of young people in the United States an average of 17 times each. The Master Settlement Agreement with the tobacco industry appears to have had little effect on cigarette advertising in magazines and on the exposure of young people to these advertisements.

Objective: To examine the tobacco industry’s efforts to influence public policy and block the legislative process on tobacco control in Hong Kong, 1973 to 1997. Method: Systematic review of relevant...

Health communication: a call for papers

BackgroundTobacco addiction is a complex, multicomponent phenomenon stemming from nicotine’s pharmacology and the user’s biology, psychology, sociology, and environment. After decades of public denial, the tobacco industry now agrees with public health authorities that nicotine is addictive. In 2000, Philip Morris became the first major tobacco company to admit nicotine’s addictiveness. Evolving definitions of addiction have historically affected subsequent policymaking. This article examines how Philip Morris internally conceptualized addiction immediately before and after this announcement.Methods and findingsWe analyzed previously secret, internal Philip Morris documents made available as a result of litigation against the tobacco industry. We compared these documents to public company statements and found that Philip Morris’s move from public denial to public affirmation of nicotine’s addictiveness coincided with pressure on the industry from poor public approval ratings, the Master Settlement Agreement (MSA), the United States government’s filing of the Racketeer Influenced and Corrupt Organizations (RICO) suit, and the Institute of Medicine’s (IoM’s) endorsement of potentially reduced risk products. Philip Morris continued to research the causes of addiction through the 2000s in order to create successful potentially reduced exposure products (PREPs). While Philip Morris’s public statements reinforce the idea that nicotine’s pharmacology principally drives smoking addiction, company scientists framed addiction as the result of interconnected biological, social, psychological, and environmental determinants, with nicotine as but one component. Due to the fragmentary nature of the industry document database, we may have missed relevant information that could have affected our analysis.ConclusionsPhilip Morris’s research suggests that tobacco industry activity influences addiction treatment outcomes. Beyond nicotine’s pharmacology, the industry’s continued aggressive advertising, lobbying, and litigation against effective tobacco control policies promotes various nonpharmacological determinants of addiction. To help tobacco users quit, policy makers should increase attention on the social and environmental dimensions of addiction alongside traditional cessation efforts.

Objective: To explore tobacco industry accounts of its use of indirect tobacco advertising and trademark diversification (TMD) in Malaysia, a nation with a reputation for having an abundance of such...

A historian's indictment of the US tobacco industry

The 1998 Tobacco Master Settlement Agreement (MSA) was developed between states and tobacco manufacturers to settle the states' lawsuits against tobacco manufacturers and recover tobacco health-related costs. States won billions of dollars and concessions regarding how tobacco products could be advertised. The purpose of the MSA was to prevent cigarette smoking and compensate for health expenses incurred in the treatment of tobacco smoking-related illnesses. Twelve years after the settlement, it is clear that MSA monies have been gravely diverted from tobacco prevention and cessation programs to balance budgets. The authors' review indicates that increases in funding for state tobacco prevention and cessation programs reduce tobacco use across all populations. Implications for social policy and social work practice are offered.

Smoking and Externalities Regulation: Why Legislative Action has Gone Too Far

During the Trump Administration, state attorneys general (AGs) have become entrenched as integral policymaking actors in the United States. Their expanding policymaking role fits broader patterns of polarized politics, as partisan coalitions of AGs are increasingly willing to sue the federal government, a trend that gathered steam in the Obama Administration and has reached a crescendo in Trump's first year. However, state AGs do cooperate, particularly in corporate litigation to address allegedly widespread, illegal behavior. Utilizing a comprehensive dataset of multi-state lawsuits and Supreme Court amicus briefs, we identify continuity and change in how AGs have employed their powers, by examining their activities during the first year of the Trump presidency and placing these activities in the context of previous administrations. This analysis is accompanied by a pair of case studies, one on conflictual AG environmental litigation and another on bipartisan efforts to address the opioid epidemic. Both demonstrate AG's prominent policymaking power, a power unlikely to abate anytime soon.

Shortly after 1998, leading members of Georgia's government, medical community, and public-spirited citizenry began considering ways in which some of Georgia's almost $5 billion, 25-year settlement from the tobacco industry's Master Settlement Agreement with the 50 states could be used to benefit Georgia residents. Given tobacco's role in causing cancer, they decided to create an entity and program with the mission of making Georgia a national leader in cancer prevention, treatment, and research. This new entity--called the Georgia Cancer Coalition, Inc. (GCC)-- and the state of Georgia subsequently began implementing a far-reaching state cancer initiative that includes five strategic goals: (1) preventing cancer and detecting existing cancers earlier; (2) improving access to quality care for all state residents with cancer; (3) saving more lives in the future; (4) training future cancer researchers and caregivers; and (5) turning the eradication of cancer into economic growth for Georgia. Assessing the Quality of Cancer Care identifies a set of measures that could be used to gauge Georgia's progress in improving the quality of its cancer services and in reducing cancer-related morbidity and mortality.