By Edward J. Benz, Jr., MD, president and CEO, Dana-Farber Cancer Institute
Yesterday, the Boston Board of Health approved a policy raising the minimum age for buying tobacco from 18 to 21. This is great news. As a former smoker, I know how easy it was to pick up the habit at age 18. I know how quickly nicotine becomes addictive, and I know how hard it was to finally quit smoking at age 37. As a physician and president of Dana-Farber Cancer Institute, I see daily the heartbreak and havoc that tobacco wreaks on patients, families and health care costs.
Reducing the incidence of smoking is the single most effective public health intervention we could make as a nation. Smoking is estimated to cost our health system about $96 billion a year. About one-third of all cancers in the U.S. can be linked to tobacco use: not just lung cancer, but cancers of the pancreas, bladder, kidneys, mouth and throat and others. These are among the most difficult forms of cancer to treat. And it doesn’t stop with cancer. Smoking is a proven major risk factor for heart attacks, stroke, and emphysema, 4 of the top 10 killers in our society. Indeed, the Centers for Disease Control and Prevention estimates that smoking causes nearly 1 in 5 of all deaths in the U.S., more than 480,000 annually. Here’s how we can cut that number:
1. Strengthen Food and Drug Administration (FDA) jurisdiction. The FDA’s proposed regulation of e-cigarettes, as well as cigars and pipe tobacco, is a welcome assertion of the FDA’s duty to safeguard the public’s health. The FDA should also classify tobacco for what it is, a lethal mixture of addictive, psychoactive, and carcinogenic drugs.
“Reducing the incidence of smoking is the single most effective public health intervention we could make as a nation.”
-Edward J. Benz, Jr., MD, president and CEO of Dana-Farber Cancer Institute
2. At a minimum, follow Boston’s lead and raise the legal age for buying tobacco to 21 nationwide. Eighty-five percent of adults who smoke today began before they were 21, and 68 percent, like me, began at 18 or younger. Research has shown that adolescents are more likely to become addicted to tobacco than those who start at an older age. Our federal, state and local governments should seize the moment and take bold action to keep young people from starting an addiction that could plague them for life. It’s not enough but it is a good place to start.
While we are waiting for the FDA to act, states should step forward and immediately raise the legal age to buy tobacco to 21. Fortunately, frustrated by the slow pace of federal action, state and local governments are stepping forward. Lawmakers in Utah and Colorado have taken significant steps to raise the legal age for tobacco sales, and proponents there cite widespread public support. Local governments in Hawaii, New York and Massachusetts are enacting similar age restrictions. If enough states join in, perhaps the FDA will eventually support a national age of 21.
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3. Limit the sale of tobacco. CVS Caremark’s decision to stop selling tobacco last year was a progressive and important step by the company. Others should follow suit. While some local governments are already moving to raise the legal age, they can and should go further. Cities and towns should ban the sale of tobacco altogether.
Tobacco, not people who smoke, is the villain here. Most adult smokers wish they could quit, but nicotine is an uncompromising drug with effects on the brain that mimic cocaine and heroin. It should be regulated at least as tightly as those drugs, because it is delivered with a mix of toxic chemicals that cause cancer, ruin our blood vessels, and scar our lungs. Until that happens, the best thing we can do is to make it harder for people to start when they are young. But we shouldn’t wait. It is time for local cities and towns to lead the way and ban the sale of tobacco altogether.
There is ample precedent to support such an important step. The legal right of local governments to regulate what is sold within their borders for public health or other reasons is clearly established. Here in Massachusetts, eight towns still forbid the sale of alcohol within their boundaries. There are many “dry” counties remaining across the United States, and many others that are now banning those ubiquitous thin plastic grocery bags. Like the early bans of smoking on airplanes, restaurants and workplaces, the most aggressive moves against tobacco exposure start at the grassroots, are unpopular at first, and then when adopted, celebrated. It’s time to take the next big steps.