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December 5, 2001

The Necessity of Global Tobacco Regulations

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JAMA. 2001;286(21):2737. doi:10.1001/jama.286.21.2737-JMS1205-5-1

While multinational tobacco companies market high tar and nicotine cigarettes worldwide, in developing countries they advertise these products with techniques that are banned in their home countries.1 Of the 8.4 million deaths that tobacco is expected to cause by 2020, 70% will occur in transitional countries.2 Global legislation must hold tobacco companies to the same standards of safety in developing markets that they are held to in their industrialized home markets. To create such global legislation, the World Health Organisation's (WHO's) 191 member states are currently negotiating a legally binding international agreement, the Framework Convention on Tobacco Control (FCTC), which may include legally binding rules on tobacco smuggling, international standardization, disclosure of product contents, and package design and labeling.3

The ethical basis of the FCTC is the principle that a multinational corporation has a nondelegable duty to protect citizens from harm caused by its products. This includes the duty to ensure that all activities are conducted with the highest standards of safety and to provide all necessary information and warnings regarding the activity involved.4 In addition, the "negative harm" principle of business ethics requires that, in their operations abroad, corporations have an obligation not to add to the suffering and deprivation of people.

Tobacco companies have argued that people should be allowed to consume products of their choice freely.5 However, a recent World Bank report cites 3 ways in which the choice to buy tobacco products differs from the purchase of other consumer goods. First, many smokers are not aware of the high probability of disease and premature death their choice to smoke entails, and thus, their consent to be exposed to harm is uninformed. Children and teenagers in particular may not have the capacity to assess properly information on the health effects of smoking. Second, the highly addictive nature of nicotine, particularly as it is delivered in a manufactured cigarette, limits the tobacco user's freedom to choose not to smoke.6 Third, smokers impose both direct and indirect costs on other non-consenting individuals. These failures to meet "free" market standards provide a rationale for demand-reduction interventions.7

Beyond this theoretical justification for action, there is also a practical one. Tobacco companies have shown themselves to be incapable of self-regulation.8 Despite the fact that cigarette smoke contains some 4000 different constituents, 60 of which are known carcinogens,9 there is evidence that tobacco companies have failed to perform in-house smoking and health research, and that this failure was, in part, the result of tobacco company efforts to mislead the public about the health effects of smoking.10

The tobacco companies have deliberately increased the addictive potential of cigarettes through their well-documented strategy of manipulating nicotine levels.6 Furthermore, a WHO committee concluded that tobacco companies had conspired to undermine the agency's tobacco control programs around the world. The committee made 58 recommendations to protect against the subterfuge of the tobacco industry.11

During a global public hearing in October 2000, the WHO supported measures and policies to restrict youth access to tobacco. Recently, 3 major tobacco companies proposed weak voluntary global marketing standards, but such measures are known to have only limited impact on youth and adult consumption of tobacco.12 At the same time, tobacco companies opposed comprehensive advertising bans and price increases, interventions that have had a measurable and sustained impact to decrease tobacco use.

Tobacco companies have an ethical responsibility to minimize the harm caused by their products in developing countries and to adhere to the same safety standards in developing countries that they use in their home countries. They have proven themselves unwilling or unable to meet this responsibility voluntarily, and the cost of this failure is enormous. The kind of legally binding global regulation of dangerous practices that the FCTC could provide has become necessary.

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