Pick up a pack of cigarettes in Brazil, and you'll see a photograph of a tiny fetus, a gangrene-infected foot, a cadaver with a hole in the throat, or one of several other images warning of smoking-related risks.
Only a handful of countries require such stark photographic warnings. But thanks to sweeping legislation recently passed by Congress and signed by President Obama today, the United States is about to join the club. The Food and Drug Administration will have two years to develop "color graphic labels" for all cigarettes sold in the country. And that's just one of dozens of changes the tobacco industry faces.
Widely hailed as a landmark public-health event, the bill empowers the FDA to reduce nicotine levels in cigarettes, bans many flavored cigarettes, and imposes strict limits on where tobacco companies can advertise. Politicians have long pursued such reforms, dating back to Sen. Robert Kennedy's effort in the 1960s to ban cigarette advertising from television and radio. His brother, Sen. Ted Kennedy, who championed the bill in the Senate, hailed the legislative victory as proof "that miracles still happen."
The bill is far from the final word on tobacco regulation, however. If anything, it has sparked contentious debate about how far the FDA should go to force Big Tobacco to make cigarettes less addictive, about whether the bill is too generous to the industry (it doesn't ban menthol, for instance), and about whether certain provisions will actually stand up in court. "If you look at this bill, it's a Dr. Jekyll and Mr. Hyde," says Gregory Connolly, a public-health professor at Harvard and a leading tobacco regulation expert. "There is a piece there for Philip Morris, and there is a piece there for the kids."
One example is its approach to tobacco's addictiveness. The bill prohibits the FDA from totally removing nicotine from cigarettes, but it does allow the agency to consider reducing nicotine to nonaddictive levels. Determining that threshold, however, will require more research. Even then, officials may struggle to keep up with the industry's knack for reinventing its product. "Every time we blink, there is a new product on the street," says Connolly. "What we first have to do is stop innovation."
Another main provision, a ban on advertisements within 1,000 feet of schools and playgrounds, is already being challenged by the industry and First Amendment groups. "My concern is that a keyelement of the bill will be made illegal by a decision of the Supreme Court, and that will cascade through the states as well,"says Cheryl Healton, president of the American Legacy Foundation, a national antitobacco group. In 2001, the Supreme Court struck down a similar law in Massachusetts.
The bill reserves some of its most explicit language for labels, which will have to cover 50 percent of the front and back of a pack. The word WARNING will have to be printed in capital letters in 17-point font. And rather than gingerly alerting smokers to potential health consequences, new labels will cut to the point. Among the approved phrases: "cigarettes cause cancer" and "smoking can kill you."
Tobacco companies shouldn't have much trouble meeting that last requirement. They've been making bigger labels in the United States for years and shipping them out of the country to nations that have long done more to inform smokers of their risks.