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What should be the elements of any settlement with the tobacco industry?
  1. David Burns1,
  2. Neal Benowitz2,
  3. Gregory N Connolly3,
  4. K Michael Cummings4,
  5. Ronald M Davis, Editor,
  6. Jack E Henningfield5,
  7. Donald R Shopland6,
  8. Kenneth E Warner7
  1. UCSD Medical Center, 200 West Arbor Drive, San Diego, California 92103, USA; email; dburns{at}
  2. University of California at San Francisco, San Francisco, California, USA; email; nbeno{at}
  3. Massachusetts Tobacco Control Program, Massachusetts Department of Public Health, Boston, Massachusetts, USA; email; gregconn{at}
  4. Roswell Park Cancer Institute, Buffalo, New York, USA; email: mcummings{at}
  5. Johns Hopkins University, Baltimore, Maryland, USA; email: fhenning{at}
  6. National Cancer Institute, Rockville, Maryland, USA; email: shopland{at}
  7. School of Public Health, University of Michigan, Ann Arbor, Michigan, USA; email: kwarner{at}


Litigation and regulatory assaults on the tobacco companies may create a willingness among tobacco manufacturers to bargain resources and acceptance of public policy changes for limitations of liability, as has been seen by the recent settlement with the Liggett Group. Two elements absolutely critical to any plan are the elimination of tobacco advertising and promotion and the removal of addiction as a reason for tobacco use. Minimal components of any settlement should include: (a) acceptance by the tobacco manufacturers of the causal relationship between tobacco use and disease, and the addictive nature of nicotine; (b) a total ban on tobacco advertising and promotion; (c) FDA jurisdiction over tobacco products and their nicotine content, with the intent of removing nicotine as soon as acceptable nicotine substitution products are available; (d) reimbursement to the states for Medicaid and other state expenditures attributable to smoking, to the maximum extent feasible; (e) funding for local, state, and federal programmes and research in tobacco control; (f) acceptance of legislation and regulations protecting the right of non-smokers to breathe air free of tobacco smoke; (g) funding for a large, national, media-led, anti-tobacco campaign; and (h) cessation assistance for addicted smokers. If negotiations toward a settlement proceed, it is essential that the public health community participate in defining the elements of any agreement to ensure that whatever agreement develops is focused on reducing tobacco-related disease rather than continuing the profitability of American tobacco companies. That participation requires articulation of the core elements essential to an acceptable agreement. If resolution of the public health issues surrounding continued sale of tobacco products can be reached in the United States, it may provide a model for similar resolution in other countries.

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