Experts increasingly contemplate end of smoking

In this April 29, 1964 file photo, etiquette expert Cathy Bauby shows how puffing a cigarette like a steam engine shows that one is behind the "Jet Age" and doesn't care how one looks, during a demonstration in New York. Fifty years on, health officials have begun to predict the end of cigarette smoking in America. A confluence of changes has recently prompted public health leaders to start throwing around phrases like "endgame" and "tobacco-free generation." Now, they talk about the slowly-declining adult smoking rate dropping to 10 percent in the next decade and to 5 percent or lower by 2050. (AP Photo/Dan Grossi)

10 feb 2014--U.S. health officials have begun to predict the end of cigarette smoking in America.

They have long wished for a cigarette-free America, but shied away from calling for smoking rates to fall to zero or near zero by any particular year. The power of tobacco companies and popularity of their products made such a goal seem like a pipe dream.

But a confluence of changes has recently prompted public health leaders to start throwing around phrases like "endgame" and "tobacco-free generation." Now, they talk about the slowly-declining adult smoking rate dropping to 10 percent in the next decade and to 5 percent or lower by 2050.

Acting U.S. Surgeon General Boris Lushniak last month released a 980-page report on smoking that pushed for stepped-up tobacco-control measures. His news conference was an unusually animated showing of anti-smoking bravado, with Lushniak nearly yelling, repeatedly, "Enough is enough!"

"I can't accept that we're just allowing these numbers to trickle down," he said, in a recent interview with the AP. "We believe we have the public health tools to get us to the zero level."

This is not the first time a U.S. health official has spoken so boldly. In 1984, Surgeon General C. Everett Koop called for a "smoke-free society" by the year 2000. However, Koop—a bold talker on many issues—didn't offer specifics on how to achieve such a goal.

"What's different today is that we have policies and programs that have been proven to drive down tobacco use," said Matthew Myers, president of the Campaign for Tobacco-Free Kids. "We couldn't say that in 1984."

Among the things that have changed:

—Cigarette taxes have increased, making smokes more expensive. Though prices vary from state to state, on average a pack of cigarettes that would have sold for about $1.75 20 years ago would cost more than triple that now.

—Laws banning smoking in restaurants, bars and workplaces have popped up all over America. Airline flights have long been off-limits for smoking.

—Polls show that cigarette smoking is no longer considered normal behavior, and is now less popular among teens than marijuana.

—Federal officials are increasingly aggressive about anti-smoking advertising. The Food and Drug Administration launched a new youth tobacco prevention campaign last week. At about the same time, the Centers for Disease Control and Prevention debuted a third, $60-million round of its successful anti-tobacco ad campaign—this one featuring poignant, deathbed images of a woman featured in earlier ads.

—Tobacco companies, once considered impervious to legal attack, have suffered some huge defeats in court. Perhaps the biggest was the 1998 settlement of a case brought by more than 40 states demanding compensation for the costs of treating smoking-related illnesses. Big Tobacco agreed to pay about $200 billion and curtail marketing of cigarettes to youths.

—Retailing of cigarettes is changing, too. CVS Caremark, the second-largest U.S. pharmacy chain, announced last week it will stop selling tobacco products at its more than 7,600 drugstores. The company said it made the decision in a bid to focus more on providing health care, but medical and public health leaders predicted pressure will increase on companies like Walgreen Co. and Wal-Mart Stores Inc. to follow suit.

In this April 8, 2003 file photo, David Ozanich of Brooklyn smokes outside the Live Bait bar in New York after a city-wide ban on smoking in bars and restaurants went into effect. Laws banning smoking in restaurants, bars and workplaces have been implemented in places across the country. (AP Photo/Diane Bondareff, File)

"I do think, in another few years, that pharmacies selling cigarettes will look as anachronistic" as old cigarette ads featuring physician endorsements look today, said CDC Director Dr. Tom Frieden.

These developments have made many in public health dream bigger. It's caused Myers' organization and others to recently tout the goal of bringing the adult smoking rate down to 10 percent by 2024, from the current 18 percent. That would mean dropping it at twice the speed it declined over the last 10 years.

In this Oct. 16, 1937 file photo, Alfred Gwynne Vanderbilt lights the cigarette of Eleanor Young at the opening of the Sert Room of the Waldorf Astoria in New York. (AP Photo)

The bigger goal is to reduce U.S. smoking-related deaths to fewer than 10,000, from the current level of 480,000. But even if smoking rates dropped to zero immediately, it would take decades to see that benefit, since smoking-triggered cancers can take decades to develop.

But while some experts and advocates are swinging for the fences, others are more pessimistic. They say the key to reaching such goals is not simply more taxes and more local smoking bans, but action by the U.S. Food and Drug Administration to regulate smoking.

In this Jan. 11, 1937 file photo, Eugene O'Neil, playwright and winner of the Nobel Prize, holds a book and a cigarette in his hospital bed in Oakland, Calif. during his first interview since being stricken with appendicitis. (AP Photo/RJF)

A 2009 U.S. law gave the FDA the authority to regulate tobacco products. The law barred the FDA from outright blocking the sale of cigarettes, but the agency was free to take such pivotal steps as prohibiting the use of appealing menthol flavoring in cigarettes and requiring cigarette makers to ratchet down the amount of addictive nicotine in each smoke.

But nearly five years after gaining power over cigarettes, FDA has yet to even propose such regulations. Agency officials say they're working on it.

This undated photo provided by RKO shows dancer-actor Fred Astaire for the 1935 film musical "Top Hat" with a cigarette in his mouth. (AP Photo/RKO)

A spokesman for Altria Group Inc., the maker of Marlboro, said the company supports FDA exercising its regulatory authority over tobacco products. But as a whole, the industry has tended to fight regulation. Some of America's largest tobacco companies—though not Altria—sued to stop FDA-proposed graphic warning labels on cigarette packs. A federal court blocked the ads.

"The industry makes money as long as they can delay regulation," said Kenneth Warner, a University of Michigan public health professor who is a leading authority on smoking and health.

In this undated image from video provided by Resound Marketing in August 2013, Jenny McCarthy uses a blu eCig in a television advertisement. Electronic cigarettes have often been described as a less dangerous alternative to regular cigarettes. But there are few studies exploring exactly what chemicals are in them, and whether they are harmful. Some experts believe that at a time when cigarette smoking has finally become passe in popular culture, e-cigarettes may re-glamorize puffing away in public places. (AP Photo/Resound Marketing)

Warner and Michigan colleague David Mendez estimate that, barring any major new tobacco control victories, the adult smoking rate will drop from its current 18 percent only to about 12 percent by 2050. If health officials do make huge strides, the rate could drop as low as 6 percent, they think.

But Lushniak said zero. Will that ever happen?

Some experts doubt it. As long as cigarettes and other combustible tobacco products are legal, it's likely some people will smoke them.

In this Thursday, April 21, 2011 file photo, Queens District Attorney Richard Brown, left, joins state and federal officials in the Queens borough of New York to announce a crackdown on cigarette smugglers and tax evaders behind a display of cartons of confiscated cigarettes. Cigarette taxes have increased around the country. Though prices vary from state to state, on average a pack of cigarettes that would have sold for under $1.75 20 years ago would cost about $6 now. (AP Photo/Frank Franklin II)

"It's hard to do a ban on cigarettes because you're taking something away from people they have and are using. Once you have something, you hold tight," said Richard Daynard, a Northeastern University law professor who focuses on tobacco issues.

Better, he said, to bar people from having a product in the first place. He is intrigued by legal efforts in Singapore and a handful of other countries to ban sales of tobacco to anyone born after a certain year—2000, say. That would be constitutional, he said. The question is: Would American culture accept it?

In this Saturday, March 2, 2013 file photo, John Connelly, left, inhales marijuana vapor just after midnight, with the help of bar worker Jenae DeCampo, right, in the upstairs lounge area of Stonegate, a pizza-and-rum bar in Tacoma, Wash. Owner Jeff Call charges patrons a small fee to become a member of the private second-floor club, which prohibits smoking marijuana, but does permit "vaporizing," a method that involves heating the marijuana without burning it. Washington and Colorado became the first states to pass legislation legalizing marijuana use for adults over 21. Polls show that cigarette smoking is no longer considered normal behavior, and is now less popular among teens than marijuana. (AP Photo/Ted S. Warren)

Probably not, said Ruth Malone, editor-in-chief of the scientific journal Tobacco Control.

"In our culture, we tend to think we have a right to things even if they're terrible for us," she said.

A growing number of experts believe the most promising option is to get people to switch voluntarily to something else, like electronic cigarettes.

In this Wednesday, May 20, 1998 file photo, Olympic gold medalist Tara Lipinski, right, stands with school children in an anti-tobacco rally on Capitol Hill in Washington. The rally was sponsored by the Campaign for Tobacco-Free Kids. (AP Photo/Dennis Cook)

Electronic cigarettes are battery-powered devices that provide users with aerosol puffs that typically contain nicotine, and sometimes flavorings like fruit, mint or chocolate. They've often been described as a less dangerous alternative to regular cigarettes. But there are few studies exploring exactly what chemicals are in them, and in what concentrations, and whether those levels are harmful.

In this Thursday, April 14, 1994 file photo, the heads of the nation's largest cigarette companies are sworn in before a hearing of a House Energy subcommittee which was holding hearings on the contents of cigarettes on Capitol Hill in Washington. More than 40 states brought lawsuits demanding compensation for the costs of treating smoking-related illnesses. Big Tobacco settled in 1998 by agreeing to pay about $200 billion and curtail marketing of cigarettes to youths. From left are Robert Sprinkle III, executive vice president for Research American Tobacco Co.; Donald Johnston, American Tobacco; Thomas Sandefur Jr., Brown and Williamson Tobacco Corp.; Edward Horrigan Jr., Liggett Group Inc.; Andrews Tisch, Lorillard Tobacco Co.; Joseph Taddeo, U.S. Tobacco Co.; James Johnston, RJ Reynolds; and William Campbell, Phillip Morris USA. (AP Photo/John Duricka)

They're controversial: Some experts believe that at a time when cigarette smoking has finally become passe in popular culture, e-cigarettes may re-glamorize puffing away in public places. Cigarette sales could surge.

"It could go in either direction," said John Seffrin, the American Cancer Society's chief executive officer.

In this Monday, Nov. 30, 1987 file photo, U.S. Surgeon General C. Everett Koop sits with elementary school students at P.S. III in the Manhattan borough of New York to warn them of the dangers of smoking. In 1984, Koop called for a "smoke-free society" by the year 2000. (AP Photo/Richard Drew)

But if the FDA can ratchet down nicotine in conventional cigarettes to levels below what's in e-cigarettes, perhaps everyone who clings to smoking will switch to the higher-nicotine new products. That could achieve the end of smoking, at least of combustible, carcinogen-filled cigarettes—or so the thinking goes.

In this Thursday, May 14, 1998 file photo, Minnesota Attorney General Hubert Humphrey III holds an internal RJR document stating that tobacco causes lung cancer, while testifying on Capitol Hill in Washington before the Democratic Tobacco Task Force. (AP Photo/Khue Bui)

In the past, "the country really wasn't ready" to walk away from cigarettes," Daynard said. "I think the country's ready now."

This image provided by the New York Public Library shows one of the cigarette advertisements from 1920s through the 1950s included in an 2008 exhibit at the library. The ad featuring a baby reads, "Gee, Dad, you always get the best of everything... even Marlboro!" (AP Photo/New York Public Library)

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This image provided by the New York Public Library shows one of the cigarette advertisements from 1920s through the 1950s included in an 2008 exhibit at the library. The ad which features a man dressed as a doctor holding a pack of Lucky Strike cigarettes reads, "20,679 physicians say 'LUCKIES are less irritating'" (AP Photo/New York Public Library)