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Principles for effective tobacco warning systems: the USA gets a failing grade
  1. Garfield Mahood
  1. President, Campaign for Justice on Tobacco Fraud, 196 MacPherson Avenue, Toronto, ON M5R 1W8, Canada
  1. Correspondence to Mr Garfield Mahood, President, Campaign for Justice on Tobacco Fraud, 196 MacPherson Avenue, Toronto, ON M5R 1W8, Canada; gmahood{at}

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The US Food and Drug Administration (FDA) has introduced its new tobacco warning system after 35 years of weak, stale warnings. And now, ostensibly due to the COVID-19 pandemic, the FDA has delayed the ‘effective date’ of the new warnings1 until October 16, 2021. Superior warnings have been required on American products sold internationally for more than two decades. Despite the criticism below, the improved text, size and positioning of the new warnings will save thousands of lives. However, they offer little worth replicating elsewhere.

The critique that follows draws from my interest in tobacco warnings developed while heading Canada’s Non-Smokers’ Rights Association (NSRA) from 1976-2012. The NSRA led campaigns for Canada’s landmark tobacco advertising ban (1988) and for global precedent-setting package warnings (1994 and 2001). These reforms triggered tobacco-related law reform around the world and undoubtedly led to the NSRA being cited in 2000 as the inaugural recipient of the American Cancer Society’s international Luther L Terry Award in the 'Outstanding Organization' category.

Given this history with warnings, I believe that a strong tobacco product warning system incorporates at least five essential elements:

Uphold the tort law standard in the common law

Tort law requires manufacturers in the USA, Canada and other countries to warn both of the nature of the risks of their products and the magnitude of the danger caused.2 When designing tobacco warning systems, governments should not adopt a standard for warnings below what is considered acceptable in law for other products. Unfortunately, the USA has done precisely that.

Almost every warning system on the globe has a warning of lung cancer, but this key warning did not make the final list of American warnings. In contrast, Canada had two effective lung cancer warnings in the 2001 phase of its warnings. One read ‘WARNING CIGARETTES CAUSE LUNG CANCER’. The subtext spelled out the …

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