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Key Challenge for Antitobacco Activists

Key Challenge for Antitobacco Activists

I read with interest the commentary by Drs. Michael S. Givel
and Stanton A. Glantz, regarding state-level disbursement of monies generated by
the Master Settlement Agreement with Big Tobacco, which appeared in the February
2002 issue of ONCOLOGY.[1] Unfortunately, the authors omitted the key challenge
facing antitobacco activists. Although they accurately depicted underfunding of
tobacco control programs (~5% of total annual allocated payments)—far lower
than levels recommended by the Centers for Disease Control and Prevention
(~25%)[2]—they failed to analyze the deceptive nature of how the remaining
funds are being categorized.

Immediately following announcement of the Master Settlement
Agreement, I cowrote a commentary for the Philadelphia Inquirer,[3] addressing
these deficiencies and predicting precisely what would transpire. Big Tobacco
bought immunity from a major category of liability lawsuits. And Big Tobacco
bought off the state governments, purposefully failing to mandate that their
"blood money" be directed at fighting the cause of the litigation,
smoking.

Unclear Results

Certain states, including Pennsylvania, heralded plans to
ensure that these monies were escrowed and spent solely on health-related
pursuits. Yet, it was unclear whether such appropriations were supplementing
funds that would otherwise not have been made, or whether they were supplanting
dollars that would then be redirected to other budgetary items.

Unfortunately, no state is mandated to support tobacco
control, cancer control, public health, or even overall health care. My suit[4]
failed to accomplish this—despite an appeal to the US Supreme Court—because
the courts refused to grant me standing, despite the fact that I had also filed
an action that proved I met the legal standard ("a case or controversy ripe
for adjudication at this time"). As a result, there was never an
opportunity to modify the contents of the Master Settlement Agreement.

Medical Legacy

The implications are profound. No private citizen can attempt
to enforce the provisions of the Master Settlement Agreement when Big Tobacco
violates it, as it already has (repeatedly). And no taxpayer can sue when this
money is diverted to other pursuits (including road construction) that the
legislature favors. Our inability to obtain any stipulation from the parties
(considering how the Attorney General "ran interference" for Big
Tobacco) remains the medical legacy of this ongoing payoff.

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