Mr. Speaker, it is pronounced ``Buyer.'' My family is Alsatian; so if you go back in my ancestry, I know the gentleman is new here to the Congress, it was de Buyer. So my sense is that the gentleman…
Mr. Speaker, it is pronounced ``Buyer.'' My family is Alsatian; so if you go back in my ancestry, I know the gentleman is new here to the Congress, it was de Buyer. So my sense is that the gentleman will remember it for a while.
I come to the floor here to talk about a very pivotal issue that will be facing the public health of our country, and this is the issue of tobacco. Members of the House will be presented with a choice here relatively soon about which Federal regulatory structure over tobacco products we should use.
Now, it is interesting, for a long time the issue was whether we should regulate tobacco or not regulate tobacco. There is now this growing concensus that the Federal Government in some way should regulate tobacco, and now we are trying to figure out with regard to who should do that regulation. Should it be the FDA under Health and Human Services; or, as Mr. McIntyre and I are proposing, that it be a separate agency under Health and Human Services, we call it a harm reduction agency, that will focus on reduction of the risk associated with many different types of tobacco products.
So I believe that the critical issue to be considered is, how do we measurably and effectively reduce the disease and death associated with tobacco use while products remain legal and over 45 million Americans have not, cannot, or will not quit?
Keeping the American tobacco consumer and the public uninformed about the differences in risk between smoking cigarettes and using nonburning forms of tobacco or other nicotine products will not help our Nation to overcome the death and disease attributed to tobacco use.
Telling current tobacco smokers to ``Just Say No,'' to quit now, is not the most effective way to save lives. Creating a regulatory scheme that discourages and in fact chills the development of new, lower risk products is directly opposite of what many in the scientific and public health communities even advocate today. But those are the underlying tenets of what is referred to as the Waxman tobacco legislation called the Family Smoking Prevention and Tobacco Control Act.
What do experts say about Mr. Waxman's approach on tobacco?
Well, the prestigious health organization, the Royal College of Physicians, says, ``The current situation is perverse, unjust, and acts against the rights and best interests of smokers and the public health. Harm reduction has the potential to play a major part in preventing death and disability in millions of people who currently smoke and who either cannot or will not otherwise quit smoking. These smokers have a right to be able to obtain and choose from a range of safer nicotine products, and they have a right to accurate and unbiased information to guide that choice.''
From the American Association of Public Health Physicians, ``In the judgment of AAPHA, the current bill in its form will do more harm than good in terms of future tobacco-related illness and death. The current bill,'' referring to the Waxman bill, ``with all its seemingly promising elements, has so many restrictions on Federal regulatory authority that it will be unable to effect favorable change. This bill is based on the false premise that cigarettes can be made safer and that all tobacco products are equally harmful. This bill places barriers to truthful communications about the relative risk of less hazardous smokeless tobacco products and near insurmountable barriers to the development of new lower risk products.''
Now, these are two examples of organizations that have some growing concerns about the Waxman legislation. Now, in the face of that there is a growing consensus that significant harm reduction policies and programs, when combined with prevention and cessation, are, in my belief and that of Mike McIntyre, the chief cosponsor of North Carolina, that it is the key to a significant reduction in disease and death from tobacco use.
So the Waxman legislation, despite the years of characterizations and representations by its proponents, does not incorporate in any meaningful way a comprehensive prevention, cessation, and harm reduction strategy. Actually, on the contrary; for a very long time, those of whom believe that a harm reduction strategy in fact threatens cessation and prevention programs. I look at this and say that they should all work together, that four fingers and a thumb makes a hand. And so, without the phalanges, do you really have a hand? So I believe that they all should have to work together, and that is what we are seeking to do here is having a harm reduction strategy that incorporates prevention, education, and cessation.
I am also greatly concerned that the Waxman legislation continues to ignore the evolution of opinion in the scientific and public health communities, and relies on tactics taught and thought that were effective in the early 1990s, such as it includes provisions that the Supreme Court had thrown out with regard to restrictions on First Amendment on advertising these issues. I was really concerned about it, and Mr. Waxman believes it is okay. I have great, great concern here.
Congressman Mike McIntyre and I have introduced H.R. 1216, the Youth Prevention and Tobacco Harm Reduction Act. This legislation imposes significant regulatory oversight within the Department of Health and Human Services over tobacco products, and incorporates many of the provisions included in Henry Waxman's legislation.
It includes serious policy and programs of prevention, cessation, and harm reduction, which we believe will lead to saving thousands of lives over the next decades. It will squarely address the issue of tobacco use by minors through additional resources and enforcement at the State levels.
In fact, Mr. McIntyre's and my legislation is even stronger in the protections for minors on two points. Number one, we say unto the States that with regard to the Master Settlement Agreement and monies that were supposed to be spent by the States on tobacco cessation and education and prevention programs, at the end of the Master Settlement before it was signed there was this last-moment agreement. Rather than dictating unto States on what percentage of the monies are to be spent on tobacco prevention and cessation programs they said, well, we will just leave it to the discretion of the States. The CDC then every year publishes a report with regard to what the percentage that States should be spending, States are not spending on those programs. So Mr. McIntyre and I come in, and we are dictating unto the States that they are to spend their Master Settlement Tobacco Agreement on programs to help children.
The other point that Mr. McIntyre of North Carolina and I have is on protecting children. We are also saying to the States that we want you to treat tobacco like alcohol. So where it is illegal for a minor to possess alcohol, we also say: States, you should make it illegal for minors to possess tobacco.
With that, let me yield to a major cosponsor of this legislation. This is bipartisan legislation. It is an alternative to Mr. Waxman. And, actually, what Mr. McIntyre and I were really hopeful is that our bill here would have been adopted in the Energy and Commerce Committee as a substitute. If we could have combined our effort with that of Mr. Waxman's, we would have 435 votes here on the floor, and we could make this a reality and make our society a healthier and safer place.
I want to thank the gentleman for his efforts. He is a strong advocate of our agricultural policies and is very concerned with regard to ensuring that the Federal regulatory oversight from Health and Human Services does not interrupt with growing practices by our farmers.
I thank the gentleman for his help and his support on the bill. This is an issue about the public health of our country and the fact that we have a bipartisan approach here, a bill that we seek to decrease the mortality and morbidity rates is extremely important. There are over 100 nations around the world that are struggling with this issue. Tobacco is a legal product. It is the smoking that really hurts and harms and kills people. It is not the nicotine. And so what we are trying to do is to migrate people from smoking products to smokeless products. The very large risk differential, it is the difference between combustion and noncombustion products.
The gentleman understands that. And he is embracing the harm reduction strategy from a public health perspective. And he also wants to make sure that we work in concert with our growers, that we have very sound export policies with regard to our trading partners around the world so we don't have any World Trade Organization violations, while at the same time we are cognizant of illicit trade issues. The gentleman is an expert in these areas. And I welcome his support. And I thank him for being here tonight.
What I would like to do is I'm going to share a chart that the world has never seen. And I am hopeful that here in the United States we can continue to lead the world and to make the world a healthier place. And so what I'm going to do here is I want to talk about our harm reduction strategy and to talk about the risk differential among a continuum of risks. So the best way for me to do this is to put a chart up so all the Members can have a look at this. And I will talk about it here for a second.
I have continuum of risk here at the top, along then with the relative risk of chronic disease here on the side. And what I have done is what is not on the chart, I don't put cigars or pipe tobacco in here. That is outside of the regulation of not only our bill but also of Mr. Waxman's bill. But pipe and cigar is the most toxic. If I were to go on this chart, what I put on this chart listing 100 percent as the most toxic, under that which of tobacco products are to be regulated by our bill would be your nonfiltered cigarettes, so that would be your roll-your-own cigarettes or a Lucky Strike or other forms of generic cigarettes that are nonfiltered.
So I think common sense is going to tell you if there is not a filter on it, you're going to smoke it, you're going to inhale a lot of toxic substances and carcinogens deep into your lungs.
The next, as we look at continuum of risk, among available products that are on the marketplace here in the United States in North America, so you have your nonfiltered cigarettes. Next are your filtered cigarettes. That kind of makes sense. If I'm going to put a filter on it, I'm going to reduce the risk between those two types of instruments that deliver nicotine. So that is what the key here is. People want access to their nicotine. And it is the smoking that harms them. And so how do you reduce the harm? And so what drives some people a little crazy here is that can you really say that there is a safer type of cigarette? Well, if you want to take a science-based approach, you really have to be very honest about this and say, well, among the types of cigarettes, there are different types of cigarettes as a delivery device of nicotine that are safer than others. But they are all not entirely safe. But there is a risk differential. And it should be discussed. So we have from nonfiltered to filtered cigarettes.
What I don't have here, which sort of comes up next, is you actually have vented filtered cigarettes. But what we are finding out from the science-based approach is that if you put vents into the filters, even though you're trying to reduce the smoke and a lot of the bad, toxic substances, people will draw on that cigarette a little harder, and so they are sucking it deeper in their lungs. And that is not a good thing.
Next we have our tobacco-heated cigarettes and electronic cigarettes. The reason I put question marks with regard to both of these types of nicotine delivery devices is that with regard to tobacco-heated cigarettes there are a couple of products that are out on the market. Philip Morris has the Accord and Reynolds American has the Eclipse. So these are out on the marketplace. We do know that these types of nicotine delivery systems are a much less riskier product than say your strictly just filtered cigarette or your nonfiltered cigarette. But where do they fall on the chart? There isn't enough science to tell us exactly where. We know it is better. It is not completely safe, but it is better. And we don't know exactly where, but we know it is falling downward on the continuum of risk chart. So we really do need some science here to tell us where the electronic cigarette and tobacco- heated cigarettes fall on that.
So that is part of the reason we want to create, under Health and Human Services, a separate agency that will focus our Nation's expertise on tobacco. And I want to be able to do that without people believing that, well, if FDA is regulating tobacco, that somehow that it is an okay product. No. This is a high-risk product. And what is important is that somehow we get to the American people they get informed, they can make an informed choice among an array of products along the continuum of risk.
So after electronic cigarettes, if we can truly move an individual out of smoking, if they are looking on how I can gain my access to nicotine, I think people know that, hey, the surgeon general is right. There is some risk that will accord anything that has to do with smoke. If you can transition, or migrate, a population from smoking to a smokeless product, I assure you, we can take out up to around 80 percent, based on the science, almost 80 to 90 percent of the health risk can be taken away.
Now the American public needs to know that. So you say, okay, what's
the difference between a U.S. smokeless product and Swedish Snus? Well, the difference is the U.S. smokeless product is fermented, and the Swedish Snus is pasteurized. So if you can actually move to the Swedish Snus, you can eliminate about 98 percent. Think about this. Ninety- eight percent of the health risks can be taken away, yet people can still gain access to nicotine.
Now, if you wanted to go on a little bit further, there are dissolvables of tobacco that have no nitrosamines. That is the really bad stuff, and you can remove that and you can still gain access to your nicotine. And these dissolvable products that are just being introduced and tested in the marketplace are these Orbs or a tobacco stick or a strip that you can lay on your tongue and you can gain access to the nicotine.
Now, I assure you, you don't gain as quickly the access to the nicotine and get the sensation upon the brain as you would smoking the cigarette. But you can gain access to the nicotine, and people then can make an informed choice, gosh, I can gain access to my nicotine, I don't get it as quickly, I can get it, but, gee, maybe it is worth it for me to live a few more years and enjoy my family. I can enjoy my nicotine and, gee, I'm not going to die from smoking. You see, that is extremely important. And as we move people and then migrate them down from this continuum, you can move then to therapeutic, there are therapeutic methods to gain access to nicotine, through the gum, the patch, the lozenges, and then for the individuals who seek to quit.
And that is part of the process of what we are doing here is we want to incorporate a harm-reduction strategy to inform a population that if you want to gain access to your nicotine, it is the smoke that is really going to kill you. So if you can get them off of smoking and move them to smokeless products and then move them from there to therapeutic and then pharmaceutical to eventually cessation and quitting.
Now, that is part of the harm reduction strategy. And what I believe is extremely important is when we have this as a strategy, you have about 40 million smokers over here on this end of the chart, and you only have about 2 million down here that are actually trying to quit. In the meantime, of the filtered cigarettes, about 80 to 85 percent of the individuals who are smoking the cigarettes are smoking lights or ultralights. Now why are they buying lights or ultralights? Because somehow they believe that if they smoke a light or ultralight that it will be less harmful for them. You see, people are trying to make an informed decision, and they think it will be less harmful for them. The reality is these are products that are going to be harmful to you. I think people need to know and understand that.
So what we are hopeful here is that in our legislation, we create this Harm Reduction Center under Health and Human Services where we take our great minds and we do science. We do science on the entire array of products along a continuum of risk, and we inform the public so that the public, when they buy these products, that we can actually migrate our population from combustion to noncombustion products and hopefully quitting, while at the same time, we want to make our investments in education and prevention programs, not just for children and minors, but also for adults.
What is important here, what we are finding, is that when people migrate from smoking to smokeless, some fear that, wow, if somebody starts here, the smokeless product, will they actually migrate this direction on the chart, headed up the chart? The reality is it is not what is happening in the marketplace. So that is why we have created an alternative public health position for tobacco.
My good friend, Mr. Waxman, I applaud his perseverance over the years and his persistence. His legislation has sort of an abstinence-only approach on tobacco. I respect Mr. Waxman. We have had a good working relationship over the years. And I really was hopeful that he would incorporate this harm reduction in his bill. Now, he said, ``Steve, I have got harm reduction in my bill.'' I said, ``well, Henry, you may have it in the bill.'' But what he has are unrealistic standards that products that may gain access to the marketplace. He has a two-tiered, a two-pronged tiered test, one that will test at the individual and one at the public with regard to the impact of a particular product. It will almost be impossible for new products to gain access to the market.
If we truly wanted to make our society healthier, what we should be doing is encouraging people to move from combustion to noncombustion products. And we can do that, if I can take out 80 percent of the health risk, we are making our country healthier and hopefully then move to cessation.
That is why I call this the continuum of risk chart. And it is open and free to the world to use this chart, to scrutinize the chart. And I'm hopeful that other legislative bodies around the world will incorporate harm reduction as a strategy for a nation for them to be healthier.
The harm reduction policies advocated in H.R. 1261 are an important method to figure out how we can satisfy the nicotine cravings among all of these legal type products.
What I would like to share are what some of the scientists actually say about tobacco harm reduction as a public health strategy. From the American Association of Public Health Physicians, dated 2008, ``tobacco harm reduction is taken to mean encouraging and enabling smokers to reduce their risk of tobacco-related illness and death by switching to less hazardous smokeless tobacco products.''
You see, the reason I don't have advertising restrictions in my bill is I think it is extremely important. Mr. McIntyre and I created this bipartisan piece of legislation for a purpose. We want to make sure that people are informed with regard to their entire array of products, tobacco products. And you need to be able to inform them as to what products have the higher risk, which ones have less risk.
And what really concerns me is, if you make, let the FDA do this, of which the FDA it is counter to their culture, even, to somehow say that one cigarette, this is a safer cigarette among an array of cigarettes that are harmful. That is a very, very challenging endeavor for them. And so it is why some in the public health community are a little concerned.
The International Journal for Drug Policy, their quote, ``Numerous alternative systems for nicotine delivery exist, many of them far safer than smoking. A pragmatic public health approach to tobacco control would recognize a continuum of risk and encourage nicotine users to move themselves down the risk spectrum by choosing safer alternatives to smoking without demanding abstinence.'' That is the International Journal of Drug Policy, and that is exactly what we are trying to do here.
There is another quote from the American Association of Public Health Physicians, ``In practical terms, enhancement of current policies, based on the premise that all tobacco products are equally risky, will yield only small or barely measurable reductions in tobacco-related illnesses and death. Addition of a harm reduction component, however, could yield a 50 to 80 percent reduction in tobacco-related illness and death over the first 10 years, and likely a reduction of up to 90 percent within 20 years.''
Now you see why Mr. McIntyre and I are so excited about this alternative approach, because abstinence only does not achieve the goals to make a society healthier with regard to tobacco. And this is exactly what we are trying to achieve, that is also being endorsed here by the American Association of Public Health Physicians.
The Royal College of Physicians in 2007 stated, ``Harm reduction is a fundamental component of many aspects of the medicine and, indeed, everyday, life, yet for some reason, effective harm reduction principles have not been applied to tobacco smoking. It is very clear that for most of the major health effects of tobacco, smoking is many times more dangerous than smokeless tobacco use.''
The American Council on Science and Health stated, ``The American Council on Science and Health believes that strong support of tobacco harm reduction is fully consistent with its mission to promote sound science in regulation and in public policy, and to assist consumers in distinguishing real
health threats from spurious health claims. As this report documents, there is a strong scientific and medical foundation for tobacco harm reduction, which shows a great potential as a public health strategy to help millions of smokers.''
With regard to--here is another one from SmokeFree Pennsylvania. ``Although smokeless tobacco is just as addictive as cigarettes and should not be used by those who are not addicted to nicotine, cigarettes are about 100 times deadlier than smokeless tobacco products.''
Here is a quote from Britton and Edwards, The Lancet, in 2007. ``The risk of adverse effects associated with snus,'' now snus is pasteurized product, Swedish snus, ``is lower than that associated with smoking, overall by an estimated 90 percent. Whatever the true overall hazard, use of low nitrosamine smokeless products is clearly substantially less harmful than tobacco smoking.''
Why am I pulling out these quotes? I am pulling out these quotes because what has been talked about as those who support the Waxman legislation is that somehow all of these products are equally harmful. That is false. That is what I want to convey to everyone. They are not equally harmful. And it is extremely important that the public be informed about all that these types of products, along a continuum of risk, so people can make informed choices. We do that every day. We make decisions on what kind of automobile we want to drive. We do the continuum of risk. How about what we eat, what we drink? We make choices and decisions every day. Should I put on my seatbelt, should I wear a helmet. All kind of things. We make judgments.
When I look at the farmers, my gosh, there are all types of risk out on the farm, and a lot of judgments are made along a continuum of risk along with the farm machinery.
We make these judgments. Why don't we do that as a public health strategy for tobacco? It only makes sense. And what I am really hopeful here--I had a really good discussion last week with Mr. Waxman about some tweaks on amendments, some of which he didn't agree to of which I was hopeful.
I really appeal to my good friend from California because we could combine, and I shared this with him. We could combine our efforts here. If he would endorse this harm reduction strategy with his bill, we could get this to the President's desk. I really believe that this could pass in a very large number.
I remember years ago when Joe Kennedy and I combined our efforts together, and when we would come to the floor it would pass 435 to nothing. And I was really hopeful, I had an earnest effort here, good discussions with Mr. Waxman, and I told him I would take a good hard look at his bill and I would recommend some changes, and I was really hopeful that he would combine a harm reduction strategy with his abstinence only approach, and we would truly have the four fingers, a thumb that will make a hand. But without this, he is only going to have, I don't know what you call it, a thumb and a palm. I guess he is only going to have a palm. And that is really not going to be good. So I want to build a hand and not just a palm to help our country.
The other point I have is, Madam Speaker, I would submit for the Record a letter from the American Council on Science and Health from Dr. Elizabeth Whelan dated March 12, 2009, and, dated October 18, 2008, the AAPHP Tobacco Harm Reduction Resolution, titled Resolution on Tobacco Harm Reduction.
American Council
on Science and Health,
New York, NY, March 12, 2009.
Hon. Steve Buyer,
Rayburn House Office Building,
Washington, DC.
Hon. Mike McIntyre,
Rayburn House Office Building,
Washington, DC.
Dear Representative Buyer and Representative McIntyre: On
behalf of the more than 400 scientists who advise our
organization, and the hundreds of thousands of consumers we
represent, thank you for your work on H.R. 1261. Our
scientists understand the urgent need to reduce the dreadful
toll of cigarettes on the American people--with over 400,000
smoking-related deaths each and every year in our country.
Your bill is a tougher, science-based alternative to Rep.
Waxman's HR 1256.
H.R. 1256 will not only fail to reduce the ravages of
cigarette-induced disease and death--it will likely worsen
it. The new regulation of tobacco ``additives'' will not
lower the toxic and carcinogenic mixture induced by the
combustion and inhalation of cigarette smoke. The enhanced
restrictions on lower-risk tobacco products, such as
smokeless tobacco and ``clean'' nicotine--which have been
shown to assist addicted smokers in quitting--will condemn
the over 40 million addicted smokers to the same old ``quit
or die'' pair of options.
Successful quit rates are under 20% utilizing the
currently-approved remedies. The Waxman legislation would
codify this failed policy into law.
Perhaps the worst aspect of this Waxman approach is that it
gives FDA responsibility for overseeing tobacco issues. This
will allow the cigarette makers to cloak themselves in the
mantle of being ``FDA Approved,'' shielding them from
liability for their irresponsible marketing schemes and
manipulation of cigarettes' addiction capabilities.
Your bill--H.R. 1261--will obviate most of the detrimental
and counterproductive effects of the Waxman bill. Truthfully
telling the American consumer about lower-risk tobacco
products--harm reduction rather than ``quit or die''--along
with stringent marketing restrictions and attention-getting
warning labels, and the establishment of a tobacco-regulation
section in the Department of Health and Human Services--not
the FDA--will all be of major benefit in reducing the toll of
cigarettes in America.
Sincerely,
Dr. Elizabeth M. Whelan,
President.