How is it possible that tobacco products are still responsible for more than 7 million deaths each year despite decades of regulatory efforts and public health messaging against their use?

“In many ways, the tobacco industry wrote the playbook for skirting responsibility for their products, including misinformation campaigns and, in some cases, outright fraud,” said Michael Darden, associate professor at the Carey School of Business. “While cigarette smoking has declined in the U.S., the prevalence is much higher in other countries, and the emergence of e-cigarettes has made a challenging policy and regulatory dilemma between encouraging smoking cessation and discouraging youth initiation.”

As such, the tobacco industry provides an illuminating case study for how policymakers and regulators can hold corporations responsible for the health impacts of their products and the many reasons why they fail to do so.

In its ongoing series of expert panel discussions on the most important topics of the moment, the Hopkins Business of Health Initiative brought together a group of topic experts to discuss why progress in this arena has been so slow and what lessons can be learned and applied to other corporate products and entities.

Panelists included Henry Waxman, Former U.S. Congressman and Chairman at Waxman Strategies; Mitch Zeller, J.D., Former Director of the Center for Tobacco Products, FDA; Barbara Schillo, Ph.D., Chief Research Officer, Truth Initiative; and David Levy, Ph.D., Professor of Oncology, Georgetown University

Here are some key takeaways from our experts:

  1.  The lack of political will has prevented meaningful progress. Despite broad scientific consensus on tobacco’s harms, policymakers on both sides of the aisle in Congress and presidential administrations fear the electoral consequences of unpopular decisions. Menthol in cigarettes and the use of flavors in tobacco products are well-known drivers of youth addiction. Still, multiple Democratic and Republic administrations have come and gone without taking promised action. “It's a lack of courage on the part of a lot of elected officials that we have come to the point now where we have these products that are quite dangerous, delivering a drug that's addicting, and it is causing an enormous amount of health [consequences,]” said Waxman.
  2. Corporate lobbying is politically potent. “These companies have a long history of actively opposing public health policies that we know reduce the harms of tobacco and nicotine, and we see that opposition to public health policies only increasing, not decreasing,” said Schillo. “Last year, they had registered lobbyists in all 50 states, and that intensity and that level of lobbying only increased, not decreased from the prior year.”
  3. The tobacco industry has become increasingly atomized. In the past, the industry was an oligopoly with just a few major players. Today, said Zeller, “There isn't one tobacco industry.” Instead, there is now a market full of independent companies competing with one another, and some are more committed to the pivot away from the most harmful products than others.
  4. Tobacco companies themselves are dangerously conflicted. Policies in favor of public health are also inherently at odds with the profit motive of the global corporations that produce tobacco products. “These companies see enormous profit from continuing to sell a product that is purposely designed to create and sustain addiction,” said Zeller. “So, the question for all of them is: what will it take for you to be no longer in the business of selling a product that you know will kill one out of two of your customers, long-term, prematurely?”
  5. The internet has made it harder to regulate the marketing and sale of tobacco products. Where there used to be a focus on retail stores and mainstream media outlets, the advent of the Internet has changed everything. Not only is the web an important source for purchasing products, but it's also a very important source of information and influence, particularly with a younger audience.
  6. The market is flooded with bigger, cheaper, and more potent products. “From a public health point of view, disposables are potentially the most harmful, the most addictive, the most child-oriented of all the tobacco products,” said Levy. “Right now, we have products out there that are not legally sanctioned, and we need to make sure that policies are enforceable so that we can gain more control over the more chaotic aspects of the market.”
  7. The FDA is trying to hit a moving target. When it comes to developing standards, the agency lacks the needed political support and is notoriously slow to adapt to the changing marketplace. “The FDA is put in a position to approve or not approve products subject to a highly uncertain environment,” said Levy.
  8. Policy needs to be clearer, more focused, and enforceable. Evidence from Canada projected down to the U.S.’s much larger population, shows that nicotine reduction and banning menthol will save hundreds of thousands of lives. But to achieve these goals, the FDA must have the strong support of its own commissioner and elected officials at every level to pursue and enforce these regulatory changes.