Key Challenge for Antitobacco Activists

I read with interest the commentary by Drs. Michael S. Giveland Stanton A. Glantz, regarding state-level disbursement of monies generated bythe Master Settlement Agreement with Big Tobacco, which appeared in the February2002 issue of ONCOLOGY.[1] Unfortunately, the authors omitted the key challengefacing antitobacco activists. Although they accurately depicted underfunding oftobacco control programs (~5% of total annual allocated payments)—far lowerthan levels recommended by the Centers for Disease Control and Prevention(~25%)[2]—they failed to analyze the deceptive nature of how the remainingfunds are being categorized.

Immediately following announcement of the Master SettlementAgreement, I cowrote a commentary for the Philadelphia Inquirer,[3] addressingthese deficiencies and predicting precisely what would transpire. Big Tobaccobought immunity from a major category of liability lawsuits. And Big Tobaccobought off the state governments, purposefully failing to mandate that their"blood money" be directed at fighting the cause of the litigation,smoking.

Unclear Results

Certain states, including Pennsylvania, heralded plans toensure that these monies were escrowed and spent solely on health-relatedpursuits. Yet, it was unclear whether such appropriations were supplementingfunds that would otherwise not have been made, or whether they were supplantingdollars that would then be redirected to other budgetary items.

Unfortunately, no state is mandated to support tobaccocontrol, cancer control, public health, or even overall health care. My suit[4]failed to accomplish this—despite an appeal to the US Supreme Court—becausethe courts refused to grant me standing, despite the fact that I had also filedan action that proved I met the legal standard ("a case or controversy ripefor adjudication at this time"). As a result, there was never anopportunity to modify the contents of the Master Settlement Agreement.

Medical Legacy

The implications are profound. No private citizen can attemptto enforce the provisions of the Master Settlement Agreement when Big Tobaccoviolates it, as it already has (repeatedly). And no taxpayer can sue when thismoney is diverted to other pursuits (including road construction) that thelegislature favors. Our inability to obtain any stipulation from the parties(considering how the Attorney General "ran interference" for BigTobacco) remains the medical legacy of this ongoing payoff.

Therefore, the key annual problem will be to lobby foradditional expenditures, invoking memory of the rationale for the MasterSettlement Agreement, even as those controlling these funds will attempt as soonas possible to forget it.

ROBERT B. SKLAROFF,MD, FACP
Elkins Park, Pennsylvania

Drs. Givel and Glantz Respond

We wish to thank Dr. Sklaroff for reiterating with his ownexamples the major point of our commentary: The Master Settlement Agreement hasno funding restrictions, and health advocates must become actively involved inthe political process to ensure that all funds are spent on the most vigoroustobacco control programs.

MICHAEL S. GIVEL, PHD
STANTON A. GLANTZ, PHD
University of California San Francisco
Institute for Health Policy Studies
Cardiovascular Research Institute
Department of Medicine
San Francisco, California

References:

1. Givel MS, Glantz SA: State tobacco settlement funds notbeing spent on vigorous tobacco control efforts. Oncology 16:152-157, 2002.

2. Centers for Disease Control and Prevention: Best Practicesfor Comprehensive Tobacco Control Programs—August 1999. Atlanta, US Departmentof Health and Human Services, August 1999.

3. Godshall WT, Sklaroff R, Barg J: Tobacco settlement leavesfar too much unsettled. Philadelphia Inquirer. December 1, 1998.

4. Sklaroff R: Petition to Intervene by Robert B. Sklaroff,MD, William T. Godshall, Jeffrey Barg and Smoke-Free Pennsylvania. FiledNovember 18, 1998. In re: Commonwealth of Pennsylvania by D. Michael Fisher, inHis Official Capacity as Attorney General of the Commonwealth of Pennsylvania,Plaintiff, v Philip Morris, Inc; R. J. Reynolds Tobacco Company; Brown &Williamson Tobacco Corporation; B.A.T. Industries, plc; the American TobaccoCompany, Inc c/o Brown & Williamson Tobacco Corporation; Lorillard TobaccoCompany; Liggett Group, Inc; United States Tobacco Company; the TobaccoInstitute, Inc; the Council for Tobacco Research-USA, Inc; Smokeless TobaccoCouncil, Inc; and Hill and Knowlton, Inc, Defendants. Court of Common Pleas,Philadelphia County, Pennsylvania. Case No 97-2443, April Term, 1997.