Tobacco in the Modern Form of Cigarettes Has Been Around Since 1913, When R

Tobacco vs. FDA 1

Running Head: TOBACCO VS. FDA

Tobacco: Why the Government has Little Control over This Killer.

Julie E Chalker

English 315

Summer 2003 Tobacco vs. FDA 2

Abstract

Tobacco is the number one preventable cause of death in the United States. On

August 28, 2996, The US Food and Drug Administration asserted jurisdiction over cigarettes. This was done under the presumption that tobacco is a drug because of the nicotine that is contained in it and its effects on the human body. Tobacco companies add many unhealthy and deadly products to the cigarette as fillers. They also use many deadly pesticides in the growing of the tobacco plant. These additives, pesticides, and nicotine are not under regulation at this time because of the Supreme Court ruling that the FDA did not have the authority to control this cancer causing product. Therefore, tobacco remains to be highly unregulated and thousands of our children become addicted every day. Many of these children will eventually die from health problems cause by cigarettes.

Immediate action needs to be taken to regulate this drug that causes cancer and its additives; just as most other products are regulated. Tobacco vs. FDA 3

Tobacco: Why the government has little control over this killer?

Introduction

Cigarettes are an American product; an American product that killed over 4.2 million people worldwide in the year 2000 (MacKay, 2002). In the United States alone, more than 400,000 premature deaths annually are attributed to tobacco (Rabin, 2001).

“Tobacco kills more people than AIDS, alcohol, motor vehicle accidents, homicide, suicide, illegal drugs, and fires combined”. Also studies have shown that “…of adult smokers, 82% had their first cigarette before the age of 18” (Boyd, 1996). Yet, this top killer, targeted at children, remains one of the most unregulated products in the United

States. For years the tobacco industry has denied and covered up the health effects that are caused by their multi billion dollar product, “$45 billion” (Emmons, 1997) to be more fairly accurate. Since the beginning of the cigarette, tobacco companies have gone through loop holes to stay away from government regulation. The pesticides and additives in cigarettes need to be under the same regulations that other food and drugs are because of their deadly characteristics. This paper will show the health consequences of smoking to the smokers and nonsmokers. Because tobacco has been proven to affect the nonsmokers in negat5ive ways, the FDA must assert jurisdiction over the product to protect our breathing space.

Disease and Death from Tobacco

In 1964 the Surgeon General of the United States issued its first report of the danger of smoking. In this report they states, “On the basis of more than 7,000 articles relating to smoking and disease already available at that time in the biomedical literature, the Advisory Committee concluded that cigarette smoking is a cause of lung cancer and Tobacco vs. FDA 4 laryngeal cancer in men, a probable cause of lung cancer in women, and the most important cause of chronic bronchitis.” It goes on to state that due to these findings

“cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action” (Jones, 1997). This report prompted the government, and the tobacco industry, to conduct further research on tobacco and its health consequences. “Lung cancer was the first disease definitively identified as caused by smoking” (Glantz, 1999). Since that time it has also been proven that other cancers such “pharynx, larynx, oesophagus, pancreas, bladder, kidney, stomach, and myeloid leukemia” (Doll, 1995) are linked to smoking. Also, “smoking increases the risk of death from a host of non-cancerous lung disease like pneumonia and influenza” and emphysema. Also “smoking is the largest controllable risk factor for heart disease”

(Glantz, 1999).

A cigarette is more than just tobacco leaf rolled up in paper. “A burning cigarette is a small chemical factory that produces more than 4,000 chemicals, including 43 known cancer-causing substances and over 400 other toxins, including the addictive drug nicotine (Glantz, 1999). First, nicotine as an addictive drug will be discussed. Then the focus will be shifted to the additives and fillers that make up the 43 known carcinogens and their effect on the body.

Nicotine as a Drug

Nicotine is the ingredient in cigarettes that has the most attention of the US

Department of Health and the Food and Drug Administration (FDA) at this time. This is because “under the present law, tobacco is not a drug, nor a food, nor a cosmetic”

(Emmons, 1997) and is therefore out of the jurisdiction of the FDA. Yet, if the FDA can establish that tobacco companies control and “deliberately developed seeds to produce Tobacco vs. FDA 5 high-nicotine, low-tar tobacco plants” (Gavaghan, 1994), nicotine would classify as a drug under the current laws. “The 1988 Report of the Surgeon General on nicotine addiction is an authoritative reference that establishes the addictive nature of nicotine”

(Slade, 1995). Shortly after this report we saw a real life example of the power of this addiction. “Nicotine deprivation led Russians in 1990, freed from Communist but not tobacco’s dominion, to riot when the cigarette supply ran out. The government had to spend billions of scarce dollars to purchase more from the United States” (Goldsmith,

1994). The US tobacco companies were more than willing to provide this service. This started the beginning of the dominance of US tobacco in the former Soviet Union.

There is increasing proof that the tobacco companies are not only aware of the addictiveness of nicotine, they manipulate the levels in cigarettes to keep more customers. Secret research was conducted by British American Tobacco about nicotine and its addictiveness. The results were that “there is increasing evidence that nicotine is the key factor in controlling, through the central nervous system, a number of beneficial effects of tobacco smoke, including its action in the presence of stress situations. In addition, the alkaloid [nicotine] appears to be intimately connected with the phenomena of tobacco habituation (tolerance) and/or addiction” (Slade, 1995). Another American

Tobacco research report said, “The selection of types and grades of tobacco can control the amount of nicotine present in the blend…” (Hilt, 1996). And another piece of proof from a direct quote of Addison Yeaman, vice president and general counsel, Brown and

Williamson states, “moreover, nicotine is addictive. We are, then, in the business of selling nicotine, an addictive drug effective in the release of stress mechanism” (Glantz,

1995). Yet, publicly the tobacco companies still deny the addictiveness of nicotine and swore before Congress that it was not addictive. Yet, despite the scientific and source Tobacco vs. FDA 6 proof, the highly addictive drug is still unregulated in cigarettes. One of the main reasons for this is that the tobacco companies have spent billions of dollars in lobbyist and bribes to stop this regulation. The reason that it is fought so much by the tobacco companies is because, the possibility of FDA exerting jurisdiction over cigarettes raises many broader social issues for Congress and the tobacco companies to contemplate. It could lead to the possible removal of nicotine-containing cigarettes from the market, the limiting of the amount of nicotine in cigarette, or restricting access to them… (Adams, 1999). Yet, nicotine is not the main cause of health consequences. It is actually “the addictiveness of nicotine [that] keeps people smoking long enough for the tobacco smoke to cause serious illness and death” (Slade, 1995).

Table 1.1 What’s in Cigarette Smoke…? There are over 4,000 chemicals, including: Cancer causing Agents Acetone Hexamine Nitrosamines Nail Polish Remover Barbeque Lighter Crysenes Acetic Acid Hydrogen Cyanide Cadmium Vinegar Gas Chamber Poison Benzo(a)pyrene Ammonia Methane Polonium 210 Floor/Toilet Cleaner Swamp Gas Nickel Arsenic Methanol P.A.H.s Poison Rocket Fuel Dibenz Acidine Butane Napthalene B-Napthylamine Cigarette Lighter Fluid Mothballs Urethane Cadmium Nicotine N. Nitrosonornicotine Rechargeable Batteries Insecticide/Addictive Toluidine Carbon Monoxide Nitrobenzene Metals Car Exhaust Fumes Gasoline Additive Aluminum DDT/Dieldrin Nitrous Oxide Phenols Zinc Insecticides Disinfectant Magnesium Ethanol Stearic Acid Mercury Alcohol Candle Wax Gold Formaldehyde Toluene Tobacco vs. FDA 7

Silicon Preserver-Body Tissue Industrial Solvent Silver Vinyl Chloride Titanium Makes PVC Source: Glantz, 1999.

Additives

As stated earlier, tobacco smoke has been proven to contain over 4,000 chemicals, of which 400 are known toxins and 43 or more known carcinogens. Carcinogens are substances that cause cancer. Table 1.1 shows some of the more common chemicals in cigarettes and their more common uses. These ingredients are given to the FDA by the tobacco companies each year. Yet, “nowhere in the listing is any consideration given to whether these additives are safe when inhaled” (Glantz, 1996). Also, when a chemical is combined with others and then changed by burning, the new product can be very harmful.

In addition to these and other additives, deadly pesticides are used during the actual growing of the tobacco plant.

Pesticides

Tobacco has been grown in the United States for hundreds of years. It is one of the highest cash crops in the United States. Yet, after World War II the way that tobacco was grown changed dramatically. Farmers started using “chemicals developed for war… new, synthetic pesticides… which helped farmers attain higher yields with less labor…”

(Hickey, 1998). A pesticide can enter the body in three ways: by ingestion, absorption through the skin or eyes, or breathing. Smokers inhaling tobacco containing pesticide residues, therefore, are exposing themselves, and others, to pesticides. In some cases, pesticide residues in smoke inhaled by smokers accumulate in the smoker's body. Tobacco vs. FDA 8

Pesticides have been of great concern to farmers and consumers. Because of this the

Environmental Protection Agency (EPA) under the FDA monitors and regulates the pesticides used on crops. Plus, the “the U.S. Department of Agriculture (USDA) is responsible for testing tobacco for pesticide residues. However, the USDA tests only for pesticides that are no longer used in the U.S…. no screening is done by any U.S. government agency to detect residues of pesticides that are legally sprayed on tobacco crops in the U.S.--even though some of these pesticides may cause cancer or birth defects” (McDonough, 2003). Table 1.2 shows some of the pesticides used on tobacco today and their health effects to humans and animals. The General Accounting Office reported that “for every other product treated with pesticides and consumed by people or animals, the government assesses the health consequences of the pesticides used, sets safe limits on pesticide residues and routinely tests residue levels to assure compliance.

Tobacco products have largely managed to escape all three of these layers of oversight”

(McDough, 2003). Tobacco pesticides include some of the most dangerous pesticides used in the United States. They can cause acute poisoning, cancer, nervous system damage and birth defects (Hickey, 1998). The residues that are left on the tobacco plant are then transferred to the smoker and the nonsmokers. This only adds to the toxic nature of the cigarette.

Table 1.2 * Aldicarb- one of the most acutely toxic pesticides registered in the U.S.--less than one one-thousandth of an ounce is a lethal dose for a human. Aldicarb causes chronic damage to the nervous system, suppresses the immune system and adversely affects fetuses. In human cells, aldicarb causes genetic damage. Aldicarb's causes damage to hearing, vision, kidneys, and livers and is both carcinogenic and mutagenic. Although it has been banned in at least 13 countries, it is still widely used in the U.S. and has been found in groundwater in 27 states.

* Chlorpyrifos, broad spectrum organophosphate insecticide and the most widely used insecticide in the United States, is also used on tobacco. Chlorpyrifos affects the nervous Tobacco vs. FDA 9 system by inhibiting an enzyme that is important in the transmission of nerve impulses. Symptoms of acute poisoning include headache, nausea, muscle twitching and convulsions. Exposure to chlorpyrifos products has also been associated with human birth defects. Genetic damage in human blood and lymph cells and has also been found to affect the male reproductive system. Chlorpyrifos is known to contaminate air, groundwater, rivers, lakes, rainwater and fog.

* 1,3--D (1,3--Dichloropropene, also known as Telone) is a highly toxic soil fumigant that causes respiratory problems in humans, as well as skin and eye irritation and kidney damage. 1,3--D causes cancer in laboratory animals and genetic damage in insects and mammal cells. It leaches through soil easily and has been found in U.S. groundwater, drinking water and rainwater.

But more than just human health is at stake. Many insecticides used on tobacco are especially hazardous to wildlife and the environment. Pesticides used on tobacco such as carbofuran, aldicarb, fenamiphos, disulfoton and ethoprop are all extremely toxic to birds and have caused wildlife deaths.16 Frequent drenching of hundreds of thousands of acres of farmland with highly toxic chemicals destroys beneficial insects and soil microorganisms, while contaminating groundwater, surface water, rivers and lakes. Source: Hickey, 1998.

Environmental Tobacco Smoke

Another serious health concern of smoking is Environmental Tobacco Smoke

(ETS). ETS is also known as passive smoking and second hand smoking. “The inhalation of ETS is generally known as passive or involuntary smoking” (Samet, 1991). In 1986 the Surgeon General issues the first report on passive smoking. Some of the key elements that report are: Involuntary smoking causes disease, including lung cancer, in healthy nonsmokers; and parents who smoke have children that have an increased frequency of respiratory infections, and slower development of lung functions (Glantz, 1999).

“Exposure to ETS…is the third leading preventable cause of death in the United States- surpassed only by cigarette smoking and alcohol use” (Arbes, 2001). There are two different defined types of smoke that come from cigarettes, mainstream and side stream.

“Mainstream cigarette smoke is the material drawn from the mouth-end of a cigarette Tobacco vs. FDA 10 during a puff” (Guerin, 2000). The more toxic smoke from a cigarette is the side stream smoke, which is the smoke that comes directly off of the end of the cigarette. “When the cigarette is not being smoked, it is burning at a lower temperature. This leads to less complete-and therefore dirtier-combustions than when a smoker is drawing on the cigarette” (sic Glantz, 1999). This problem can be more fully understood when we realize that, “an average cigarette burns approximately 12 minutes. And average cigarette smoker inhales for only 24 seconds of these 12 minutes. [Therefore] two thirds of the smoke from a burning cigarette is released into the air that others must breathe” (Whelan,

1984). In the United States “approximately 48 million persons over the age of 18 are smokers” (Novotny, 1995) and in the year 2000 an additional “4.5 million kids age 12-17 were current smokers” (Meier, 2000). With the fact that “24 billion packages of cigarettes are purchased annually” (Novotny, 1995), the amount of pollution in the air is almost suffocating at times. Many of the same health consequences from smoking have been proven to be present in those exposed to ETS. “…Heart disease, lung cancer, respiratory effects, low birth weight babies, sudden infant death syndrome, asthma induction, middle ear infections, bronchitis, and pneumonia” have all been linked to ETS. In addition,

“53,000 deaths annually in the United States have been attributed to second hand smoke”

(Arbes, 2001). The most vulnerable group exposed to passive smoking is children.

“Because [children’s] bodies have not adapted to chronic exposures to the poisons in cigarette smoke, they are more sensitive to the ill effects of the smoke than smokers are”

(Glantz, 1999).

Clean Air Act

The United States Environmental Protection Agency (EPA) classified second hand smoke as a Group A carcinogen, known to cause cancer in humans (Glantz, 1999). Tobacco vs. FDA 11

Because of this, and continued pressure from anti-tobacco groups, the Clean Air Act was put before Congress to protect the nonsmokers. In the 1986 Surgeon General’s report on passive smoking it was stated that “the simple separation of smoker and nonsmokers within the same air space may reduce, but does not eliminate, the exposure of nonsmokers to ETS” (Samet, 1991). The basis of regulation should be the overall good of public health. Health Professionals and eventually government are constantly faced with the decision of whether private health is more important than the health of the public. Our nation is founded on rights of the individual. Yet, when those rights interfere or stop another’s right to freedom and prosperity, government steps in to make life better for all involved. “Clean indoor air laws present the traditional public health dilemma of whether the individual’s rights to smoke and take responsibility for his or her own health are outweighed by the public’s right to clean air” (Rabin, 2001).

Most people are sensitive to tobacco smoke in some way. In a survey of 1,000

Toronto residents, almost 90 percent said they were affected and annoyed by cigarette smoke (Whelan, 1984). Because of this irritation and the developing proof of more serious health consequences, the Clean Air Act was pushed through in State governments before Congress and the federal government made their laws. “Despite a $1.3 million advertising campaign [in California] by the cigarette companies (compared to the

$130,000 spent by the nonsmoker’s rights forces), the public supported the law…this was the first such political defeat for the tobacco companies” (Glantz, 1999). State and local governments have taken primary responsibility for enacting clean indoor air laws. Yet, in

1989, the federal government took a stand against ETS, when President Bush announced the Administration's clean air proposal which comprehensively addresses three areas of environmental concern: acid deposition, toxic air pollution, and urban air quality (Clean Tobacco vs. FDA 12

Air Act Amendments, 1990). This was to help restrict smoking in public places under the federal government jurisdiction, such as the Postal Service and government buildings. It also showed that our federal government cared about the health of its citizens.

FDA’s attempt to regulate

The Clean Air Act was an important step in protecting the rights of the nonsmokers. As stated before, children are the most affected by passive smoke. Children often lack the ability to leave when people are smoking around them. Figure 1.3 shows the adverse health affects on children that are caused by smoking. This is because of their smaller bodies and the lack of choice to leave the situation. Although many steps have been taken to protect them, there is little that can be done about the smoking at home.

This is because “formal structures for protecting children in the home are usually only used in certain circumstances…and legislation to ban smoking in the homes is unlikely… other strategies to reduce children’s exposure to environmental tobacco smoke”

(Ferrence, 2000) must be put in place. We have the moral right to protect the children of this country and those around the world.

Table 1.3 Tobacco vs. FDA 13

Source: MacKay, 2002.

The FDA was attempting to further the process of protecting our children in 1996 when they “asserted jurisdiction over the marketing of tobacco products and imposing restrictions designed to further restrict youth access to tobacco” (Rabin, 2001). By doing this, the FDA wanted to ensure that: all tobacco products meet the manufacturing, labeling, marketing, and performance standards that other legal drugs and devices meet; all additives I tobacco be tested for safety and be disclosed to the public; there be scientifically based testing and rating requirements for tar, nicotine and carbon monoxide; and there be an end to deceptive labeling and marketing of low-tar nicotine product

(Firshein, 1998). Each of these points is important to protecting our children and adults from the harms of smoking and second hand smoking. They would help to keep children from getting cigarettes as well as informing them and adults of the dangers of smoking due to the ingredients of the cigarette. “The regulations represent the most significant Tobacco vs. FDA 14 federal regulation of tobacco sine the enactment of the Cigarette Labeling and

Advertising Act in 1965 and the advertising broadcast ban in 1970” (Gostin, 1997). The

FDA’s assertion of jurisdiction of tobacco products fell under the Federal Food, Drug, and Cosmetic Act. Under the relevant portion of the Act, a product is a “drug” or

“device” if it is an article…intended to affect the structure or any function of the body.

David Kessler, the director of the FDA, pointed out in his address to Congress in 1997 that the basis of classifying cigarette as a drug came from a cumulative 2 ½ year investigation of tobacco products and increasing scientific consensus that nicotine in cigarettes and smokeless tobacco cause addiction (Kessler, 1997). Including the scientific evidence, there were emerging internal documents from the tobacco companies revealing their knowledge of the addictiveness of nicotine and their intent to sell it. One of the

Nation’s largest tobacco companies in 1972 said, “Think of the cigarette pack as a storage container for a day’s supply of nicotine…as a dispenser for a dose unit of nicotine… as a dispenser for a dose of unit nicotine. Think of a puff of smoke as the vehicle for nicotine. Think of a puff of smoke as the vehicle of nicotine and the cigarette the most optimized dispenser of smoke (Adams, 1999).

Immediately after these regulations were put into place by President Clinton, the tobacco companies began to contest the legal authority of the FDA in court. The tobacco companies made two main arguments while contesting the FDA’s assertion of jurisdiction. The first was that the FDA had previously taken the position that it did not have jurisdiction over tobacco products. Second, the tobacco industry argued that the intended use of a product must be determined exclusively on the basis of the promotional claims made by the manufacturer (Kessler, 1997). It is true that previously the FDA asserted that it did not have jurisdiction over tobacco products. “Congress typically Tobacco vs. FDA 15 excluded cigarettes from major food and drug legislation, often as a result of Tobacco

Company lobbying.” Another reason why this was done was because of the lack of concrete evidence that the product was a drug and that nicotine levels were controlled by the tobacco industry. Now the FDA had concluded that “…cigarettes are a combination product having a drug component, nicotine, and device component, specifically processed tobacco, the ventilation system, and filters” (Gostin, 1997). In response to the second claim of the tobacco industry, that the intent of a product must be determined by promotional claims. We must recognize that the FDA has the “…authority to consider evidence of the pharmacological effects and uses of a product, as well as evidence of the manufacture’s knowledge and actions, [this] is necessary for the protection of the public health” (Kessler, 1997). If not, any company could avoid regulation be “promoting and advertising” their product as something that it is not.

On March 21, 2000, the US Supreme Court ruled 5-4 that under existing laws the

US Food and Drug Administration did not have jurisdiction to regulate tobacco products or the cigarette companies marketing practice (Meier, 2000). Not only did this take away the privileges of the FDA to regulate the market and labeling, it also vetoed other laws that had been put into place. The main one was the campaign by the FDA, in conjunction with state authorities, to monitor the sale of tobacco to children under 18. In August 1996 implemented a “regulation [that] included a series of youth access and advertising restrictions.” These provisions were important because, “it [made] it illegal for retailers to sell cigarettes to anyone under 18 and required that retailers check photographic identification of anyone under the age of 27” (Natanblut, 2001). The decision by the

Supreme Court has left “neither the FDA of any other federal entity [to] exercise jurisdiction over tobacco products or implement measures to restrict tobacco marketing to Tobacco vs. FDA 16 kids…” (Meier, 2000). This is a serious issue that must be dealt with and corrected for the safety of our nation.

Conclusion

When all the information is present, the health consequences of tobacco and cigarettes are unnerving to the general population. Therefore, “unless Congress passes new legislation that expressively provides” (Meier, 2000) the FDA authority to regulate tobacco, “500 million children alive today will die from the effects of tobacco by the year

2050” (MacKay, 2002). Most of Adults who do smoke do not fully understand the ingredients of the product they are inhaling. The Food and Drug Administration of the

United States has the duty to enact and enforce laws pertaining to the health of our nation. It is now up to Congress to pass a law giving the FDA the authority to regulate cigarettes. Cigarettes are a deadly drug that kills not only those who use them, but people around them also. The government must protect the innocent people of its nation. Tobacco vs. FDA 17

References

Adams, W., Brick, J. (1999). The Tobacco Wars. Cincinnati, OH: South-Western

College

Publishing.

Arbes, S. J., Agustsdottir, H., & Slade, G.D. (2001). Environmental tobacco smoke and

periodontal disease in the united states. American Journal of Public Health, 91,

253-257.

Barnes, D.E., Hanauer, P., Slade, J., Bero, L.A., & Glantz, S.A. (1995).

Environmental tobacco smoke: The brown and wlliamson documents. The

Journal of the American Medical Association, 274, 248-252.

Boyd, M.A. (1996). Butt out!! Journal of Contemporary Health Law and Policy, 169,

170-197.

Doll, R. (1994). Health Effects of Tobacco. In K. Salma (Ed.), Tobacco and Health. New

NY: Plenum Press.

Emmons, K.M., Kawachi, I., & Barclay, G. (1997). Tobacco control: A brief review of its

history and prospects for the future. Hematology/Oncology Clinics of North

America, 11, 184-191.

Ferrence, R., & Ashley, M.J. (2000). Protecting children from passive smoking. British

Medical Journal, 321, 310-311.

Firshein, J. (1998). US public-health groups petition FDA to take tougher action on

tobacco. The Lancet, 351, 276.

Gavaghan, H. (1994). FDA claims nicotine levels were manipulated. Nature, 369, 696.

Glantz, S.A. (1999). Tobacco Biology and Politics. Waco, TX: WRS Group, Ltd. Tobacco vs. FDA 18

Glantz, S.A., Barnes, D.E., Bero, L., Hanauer, P., & Slade, J. (1995). Looking through a

keyhole at the tobacco industry. The Journal of the American Medical

Association, 274, 219-223.

Glantz, S.A.., Slade, J., Bero, L.A., Hanauer, P., & Barnes, D.E. (1996). The cigarette

papers. Los Angeles, CA: University of California Press.

Goldsmith, M.F. (1994). FDA trying to make a case for tobacco regulation. The Journal of the

American Medical Association, 271, 1648.

Gostin, L.O., Arno, P.S., & Brandt, A.M. (1997). FDA regulation of tobacco advertising

and youth smoking. The Journal of the American Medical Association, 277, 410-

Guerin, M.R., Jenkins, R.A., & Tomkins, B.A. (2000). The Chemistry of Environmental

Tobacco Smoke: Composition and Measurement. Boca Raton, FL: Lewis

Publishers.

Hickey, E. & and Chan, Y. (1998). Tobacco, Farmers and Pesticides: The Other Story.

Retrieved July 28, 2003, from http://www.panna.org

Hilt, P.J. (1996). Smokescreen: The truth behind the tobacco industry cover-up.

Reading, MA: Addison-Wesley Publishing Company, Inc.

Jones, R.M. (1997). Strategic management in a hostile environment: Lessons from the tobacco industry.

Westport, CN: Quorum Books.

Kessler, D.A., Barnett, P.S., Witt, A., Zeller, M.R., Mande, J.R., & Schultz, W.B. (1997).

The Tobacco vs. FDA 19

legal and scientific basis for FDA’s assertion of jurisdiction over cigarettes and

smokeless tobacco. The Journal of the American Medical Association, 277, 405-

MacKay, J, & Erickson, M. (2002). The Tobacco Atlas. Brighton, UK: World Health

Organization.

McDonough, S. (2003). Potent Pesticides Used On Tobacco. Retrieved July 28, 2003, from

http://www.cbsnews.com.

Meier, E. (2000). Supreme court ruling on FDA oversight of tobacco. Pediatric Nursing,

Natanblut, S.L., Mital, M., & Zeller, M.R. (2001). The FDA’s enforcement of age

restrictions on the sale of cigarettes and smokeless tobacco. The Journal of Public

Health Management Practice, 7(3), 1-10.

Novotny, T.E., Bartlett, J.C., Miller, T.S., Rice, D.P., Max, W.B., & Merritt, R. (1995).

Medical Care Expenditures Attributed to Cigarette Smoking: United States 1993.

In K. Slama (Ed.), Tobacco and Health. (pp 315-318). New York, NY: Plenum

Press.

Rabin, R.L., & Sugarmen, S.D. (2001). Regulating Tobacco. New York, NY: Oxford

University

Press.

Samet, J.M. M.D., M.S., Spengler, J.D. PhD, M.S. ( 1991). Indoor Air Pollution.

Baltimore,

MD: The Johns Hopkins University Press Tobacco vs. FDA 20

Slade, J., Bero, L.A., Hanauer, P., Barnes, D.E., & Glantz, S.A. (1995). Nicotine and

addiction: The brown and williamson documents. The Journal of the American

Medical Association, 274, 225-227.

Whelan, E.M. (1984). A Smoking Gun: How The Tobacco Industry Gets Away With Murder.

Philadelphia, PA: George Stickley Co.