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.
A 48-year-old female presents with complaints of irregular vaginal bleeding and postcoital bleeding. Images from a PET/CT and pelvis MRI reveal characteristic findings. What is your diagnosis?
