Health Reform and IQOS

Recently I was on a panel of experts at an American Cancer Society’s Cancer Action Network (ACSCAN) program that focused on tobacco. As a former member and chairperson of Iowa’s Tobacco Use and Prevention Commission, I sat with a long time friend, Cathy Calloway, who is one of the national associate directors of the State and Local Campaign Team for ACSCAN. As panelists, we discussed the current status and remedies regarding tobacco use and abuse in Iowa

I’ll share some background on the initial efforts to end smoking in the United States.

In 1964 the United States Surgeon General’s Report on Smoking and Health began suggesting the relationship between smoking and cancer.

In the mid-1990s, more than 40 states commenced litigation against the tobacco industry, seeking monetary, equitable, and injunctive relief under various consumer-protection and antitrust laws. The general theory of these lawsuits was that the cigarettes produced by the tobacco industry contributed to health problems in the population, which in turn resulted in significant costs to the states’ public health systems. The lawsuit was premised on a simple notion: you (the tobacco industry) caused the health crisis; therefore, you pay for it. The states alleged a wide range of deceptive and fraudulent practices by the tobacco companies over decades of cigarette and other tobacco product sales. Other states soon followed. The state lawsuits sought recovery for Medicaid and other public health expenses incurred in the treatment of smoking-induced illnesses.

In November 1998, the Attorneys General of 46 states, as well as of the District of Columbia, Puerto Rico, and the Virgin Islands, entered into the Master Financial Settlement Agreement (the Tobacco Settlement) with the four largest manufacturers of cigarettes in the United States.

My friend Cathy had recently returned from a work trip to Columbia in South America. She told me of learning about IQOS (purported IQOS stands for I Quit Ordinary Smoking). IQOS is a new tobacco delivery system by Phillip Morris, one of the world’s leading producers of cigarettes, which heats tobacco via an electronic system without burning the tobacco. Some people know a device such as this as a “vape.” The IQOS, according to Phillip Morris, allows the tobacco taste with nicotine without harmful chemicals being released.

Historically, as cigarette use in the United States has declined, tobacco companies have begun to look for new nicotine delivery devices and worldwide for growth.

Drawing on their experiences in the United States, Big Tobacco is having great success abroad. The United States is now home to two of the world’s three largest multinational cigarette companies and is the world’s largest exporter of cigarettes. These companies use advertising and marketing techniques that have long been banned or restricted in the United States. They also apply political and economic pressure to circumvent other countries’ public health laws, often under the guise of “free trade.” And, in countries where market access is difficult due to government regulations, the multinational tobacco companies are allegedly complicit in cigarette smuggling in an attempt to gain market share.

The Federal Drug Administration (FDA) is now reviewing the IQOS device for use in the US. The device is being used in many other countries around the world, just as it is now used in Columbia.

Given the ravages of tobacco on our citizens and our health care system, I have considerable skepticism about this new tobacco use product. I have seen Big Tobacco consistently fight efforts to reduce tobacco use while we use the three pillars of tobacco prevention efforts: 1) consistent, major increases in tobacco excise taxes, 2) strong tobacco prevention and cessation programs, and 3) major restrictions on the use of tobacco in public and worksite locations.

Tobacco use has diminished in Iowa with these efforts from adult use of 26 percent to 17 percent but major efforts are still needed in the area of smoking cessation for people with mental health illnesses, as well as maintenance of prevention and cessation programs. Big Tobacco has been successful in decreasing the state funds for these efforts from $12 million when I was on the Commission in the mid-2000s to $4 million now.

We must be vigilant and wary of new tobacco products and tobacco use devices. At a time when health care coverage is declining in Iowa as well across the country, we cannot afford to see tobacco use increase. On this Halloween, I warn: Beware of IQOS.




Health Reform and Why Words should matter

Ah, words! Especially to writers, they are more precious than jewels, as essential as air, and powerful enough to create entire worlds. We chase them, massage or mince them, we roll them around in our mouths, savoring every delicious subtlety. Mostly, we love them.

~Tammy Letherer

Ms. Letherer wrote these words on a blog entry entitled “Why Words Matter (In and Out of the Locker Room), on October 16, 2016.  In that post, she discussed her unhappiness with Donald Trump’s language regarding women.

In Iowa, former US Representative Bruce Braley lost his Senate race with Joni Ernst in large part to an audio tape of his words to political contributors in Texas disparaging our senior Senator, Chuck Grassley, describing him as “a farmer from Iowa who never went to law school.”

This year’s health care debate centered on the Republicans’ efforts to repeal the Affordable Care Act (ACA) has led to many statements by Republican leaders in Iowa which should come back to haunt them this Halloween season and for seasons to come, as Bruce Braley’s words haunted him.

US Representative David Young gave verbal support of a previous bill that passed the House but was rejected earlier this summer by the Senate. This was a bill that President Trump described as “mean”. Those words of support by Representative Young for a ‘mean’ health care bill should be remembered.

On September 26, the Senate bill that was pulled from consideration by Majority Leader Mitch McConnell because of a lack of support. However, Senator Chuck Grassley gave strong verbal support for the bill saying, “You know, I could maybe give you 10 reasons why this bill shouldn’t be considered, but Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. That’s pretty much as much of a reason as the substance of the bill.”

Senator Grassley’s verbal support for a bill that he believed had multiple reasons not to be considered should also be remembered by Iowans.

Iowa Governor Kim Reynolds also gave verbal support for this most recent bill even though it would take money from Iowa for health coverage when our for-profit Medicaid program is losing money and our individual insurance market is on life support.

She said, “People were sold a bill of goods with Obamacare.” Is taking money away from Iowa going to make Iowa healthcare better? Senator Grassley is saying, in so many words, that the Senate bill was also a ‘bill of goods.’ Iowans should also remember Kim Reynolds’ words.

Bruce Braley learned the hard way that words matter; will Representative Young, Senator Grassley, and Governor Reynolds also discover that their words matter? My underlying message, especially for Senator Grassley, is that campaign promises are not nearly as important as improving health care coverage for Iowans.

Finally, on the final day of September, my wife and I walked the Ledges State Park in Boone County. Due to a washed out road, access to the beautiful sandstone canyon was limited to pedestrian traffic. After walking past the washed out site, the road through the canyon was passable and we saw several empty parking spots. The symbolism of the empty parking spaces struck me as an analogy for health care in Iowa: if Medicaid is cut back and if the individual market implodes, I fear empty hospital beds, empty clinic exam rooms, and empty hospitals. The ‘road closed’ sign will be up for Iowa patients without health care coverage.

Iowans deserve health care and words should matter.