Tobacco Documents Online

I ! B33b LM435 P322 GOLD JAMA-J AM MED ASSOC broadcast antismoking commercials, smoking restrictions in show -7hy new brands pose a serious and special danger to pub- restaurants and private workplaces, the radio and tPh °' th over and above currently existing brands. ad ban, and the tar/nicotine listing requirei true that the empirical data to support a ban on radio and television ad ban resulted in about .e advertising are equivocal. However, given the vast in real ad spending for cigarette companies wit _ reduction in demand.3 To be prudent, a total au uan s-fiould be accompanied by controls on the introduction of new cigarette brands/varieties and by antismoking policies known to reduce consumption. Such effective measures include excise tax increases, res- taurant smoking restrictions, and broadcasting antismoking commercials. For each 10% increase in real cigarette price, a demand decrease of approximately 3.7% results 3 For each 10% increase in the smoking-age population covered by gov- ernment smoking restrictions, a drop in demand of around 6.5% is seen.3 An optimal antismoking agenda would give highest priority to these efficacious policies. William L. Simonich, PhD Cancer Treatment Centers of America Zion, Ill 1. Gostin LO, Brandt AM. Criteria for evaluating a ban on the advertisement of ctig- arettes: balancing public health benefits with constitutional burdens. JAMA 1993; 269:904-909. 2. Bergler R. Advertising and Cigarette &rnoking: A Psychological Study. Bern, Switzerland: Hans Huber Publishers; 1981. 3. Simonich WL. Government Antismoking Policies. New York, NY: Peter Lang Publishing Inc; 1991. In Reply.-Smoking is a highly complex and insufficiently understood behavior. Consequently, effective reductions in smoking behavior are likely to be achieved through a com- prehensive public health strategy based on the best available ^ data. At the same time, antismoking policiPQ spectful of human rights and ^••-' ' socially Dr Sirr could sha manufact elasticity, maintain i We supl cigarette s smoking pi caution reg Simonich-, ban on the i GovernmE broad specti public health in public are enacted, mon strictions coul Most data on s ing long-term t complexity of designing studies that show a causal relation- ship between advertising and smoking, any evaluation of a ban must rest on a careful assessment of many factors. The profound harms of smoking, the history of unsuccessful reg- ulation of the industry, the unique characteristics of ciga- rettes in American life, and the minimum burdens on First Amendment values lead us to reiterate our conclusion that a ban on cigarette advertising would be an important part of a comprehensive public health strategy. Lawrence 0. Gostin, JD American Society of Law, Medicine, and Ethics Boston, Mass Allan M. Brandt, PhD Harvard Medical School Boston, Mass 1. Respiratory Health Effects of Paesive Smoking: Lung Cancer and Other Disor- ders. US Environmental Protection Agency, Office for Research and Development, Office of Health and Environmental Assessment; 1992. Nicotine Inhaler for Smoking Cessation To the Editor.-In a recent article, Tannesen et al' suggest that a nicotine inhaler in smoking cessation could be imple- mented in general practitioner offices with high success rates and that it would be "acceptable" to patients. In addition, the program is described as "low intervention." Results from their study do not. --- tatements. vho were recruited through io were motivated to quit me to the clinic for a total ach visit lasting "from 30 ~tapes on smoking cessa- the use of the nicotine I and biological parame- ing. Such broad and ex- , but in my practice as ,iysicians, I don't think -vention efforts. More- :h efforts, the placebo mg cessation rate at 1 a,2 23%'0 of participants •andomized to placebo be acceptable to pa- riences with the use is been unacceptable ine inhaler, when it ..., . ost as much or more ..~,~ used at a per-unit dose? Furthermore, ~^t rs"o K, I &essa.4a--L- to smoke.' For _-- .,w, on smoking would require -_...,.a,nent of both its public health benefits as well as its potential intrusiveness. Policies, such as an ad ban, that focus attention and responsibility squarely on the tobacco industry for the risks of their product may have certain benefits over policies directed at individual smokers. The proposal to ban the introduction of new cigarette brands is also problematic. While government could constitutionally ban the manufacture of cigarettes, it has chosen not to do so. If government continued to allow the manufacture of cigarettes but prohibited the introduction of new brands, it probably would be regarded as arbitrary and capricious. In order for such a law to pass constitutional muster, advocates would have to 322 JAMA, July 21, 1993-Vol 270, No. 3 .,,u tne patients in the study receive their inhalers free of charge? If both answers are yes, then I expect that the inhaler will be less acceptable than envisioned, thus making success rates less than reported. Effectiveness trials with other nicotine replacement strategies have shown them to be less successful than that reported in controlled research reports s Finally, did patients truly use an average of 3.8 inhalers per day, with each inhaler on average good for 300 puffs, as reported? If true, then the average patient puffed 1.2 per minute every hour for 16 hours a day. Again, I am not sure my patients would find this acceptable. Adam Goldstein, MD University of North Carolina Chapel Hill A COrGHT MERRMFDICAL ASSDC3 IL 2031367501 Letters