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Bolder Action Is Needed to Keep Young People From Smoking

While we are waiting for the FDA to act, states should immediately raise the legal age for buying tobacco to 21. Cities and towns should ban the sale of tobacco altogether.
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As a former smoker, I know how easy it was to pick up the habit at age 18. I know how quickly nicotine addicts, 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.

The Food and Drug Administration'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. CVS Caremark's recent decision to stop selling tobacco this fall was a wonderful, progressive and important step by the company. However, neither will be a critical turning point in the battle against cancer unless our federal, state and local governments seize the moment and take bold action to keep young people from starting an addiction that could plague them for life.

The FDA should classify tobacco for what it is, a mixture of addictive, psychoactive, and carcinogenic drugs. While we are waiting for the FDA to act, states should immediately raise the legal age for buying tobacco to 21. Cities and towns should ban the sale of tobacco altogether.

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. 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.

Eighty-five percent of adults who smoke today began before they were 21, and 68 percent, like me, began at 18 or younger. And research has shown that adolescents are more likely to become addicted to tobacco than those who start at an older age.

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 are, 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.

Fortunately, frustrated by the slow pace of federal action, state and local governments are stepping forward. In recent weeks, 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 from Hawaii to 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. 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, 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 started at the grassroots, seemed unlikely at first, and quickly spread. It's time to take the next big steps.

Momentum from CVS's action is an opportunity that we should not waste. We should immediately raise the age for tobacco purchases to 21 across the country and begin the process of banning tobacco sales altogether.

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