FDA Head Calls Smoking a "Pediatric Disease"

Photograph, David Kessler Photo Credit: Joseph Piniero

The Food and Drug Administration is still considering regulating the tobacco industry, FDA Commissioner David A. Kessler said during remarks delivered at Columbia Law School's spring Rubin Lecture Mar. 8.

Kessler, who taught food and drug law at the Law School from 1986 until taking over as head of the FDA in 1990, called smoking "a pediatric disease" and said that nicotine addiction poses a major threat to children and should be eradicated much as other significant scourges of childhood have been.

"If we could affect the smoking habits of just one generation, we could see nicotine addiction go the way of smallpox and polio," said Kessler, who is also a pediatrician.

Teen-age Start

"A person who hasn't started smoking by age 19 is unlikely to ever become a smoker. Nicotine addiction begins when most tobacco users are teenagers," he said.

Kessler cited internal tobacco industry documents that have recently come to light to show that companies know that their products are addictive and that the industry uses its $5.2 billion annual marketing budgets to make smoking appeal to young people.

At least 45 million Americans currently smoke, according to federal health officials. It is estimated that about one-third of smokers try to quit every year, but only about 7 percent succeed.

While smoking among adults has steadily declined since 1964--following a landmark surgeon general's report--smoking among young people stalled for more than a decade and then recently began to rise, Kessler said.

Between 1992 and 1993, smoking among high school seniors increased from 17.2 percent to 19 percent, and among college freshmen, it rose from 9 percent to 12.5 percent between 1985 and 1994, he said.

"It is easy to think of smoking as an adult problem," Kessler said. "It is adults who die from tobacco-related diseases. We see adults light up in a restaurant or bar. We see a colleague step outside for a cigarette break."

"But this is a dangerously shortsighted view," he said.

"Nicotine addiction begins when most tobacco users are teen-agers, so let's call this what it really is: a pediatric disease," he said.

Kessler criticized the industry for targeting children and teen-agers with its advertising and promotion and said most young people try cigarettes out of "childish curiosity," a "youthful need to rebel" and "wholly without regard for danger."

Then, he said, they find they cannot quit.

Life Addiction

"It's a ritual that often, tragically, lasts a lifetime," he said. "And it is a ritual that can cut short that lifetime. . . . We owe it to our children to help them enter adulthood free from addiction."

In February 1994, the FDA announced that it was investigating whether to regulate tobacco as a drug.

The agency already regulates nicotine in gum and transdermal patches; Kessler said that if the agency finds that the tobacco industry intends to sell its products as drugs, the FDA may assert its regulatory authority.

Columbia University Record -- March 24, 1995 -- Vol. 20, No. 21