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.