Each year, tobacco use kills nearly 500,000 Americans (430,000 smokers and 53,000 from secondhand smoke)[1]—more than the combined annual number of national deaths from the acquired immunodeficiency syndrome, alcohol(Drug information on alcohol), automobile accidents, murders, suicides, and fires. The annual cost of treating tobacco-related diseases is about $89 billion.[2]
Recent reports by the Institute of Medicine and the Centers for Disease Control and Prevention (CDC) concluded that the best available evidence from states such as California, Massachusetts, and Florida indicate that large-scale aggressive state tobacco control programs can rapidly reduce cigarette consumption.[3,4] In California, the reduction in smoking was accompanied by substantial reductions in lung cancer rates and deaths from heart disease.[5,6]
If states made a significant and comprehensive effort to fund aggressive anti-tobacco media campaigns, community programs to encourage nonsmoking, quality cessation programs, and school programs (as the CDC recently recommended regarding best practices for state tobacco control),[7] tobacco use could be reduced by nearly 50% in 1 decade.[2]
By 1998, all states had enough funds (billions of dollars) from legal settlements with the tobacco industry to conduct such a national effort. Nevertheless, the states have spent very little on tobacco control programs. This failure to establish such programs is consistent with the tobacco industry’s long-standing strategy of seeing that the money that might be used for tobacco control is used for anything else. Thus, reductions in preventable tobacco-related illnesses and deaths have been minimal.
With vigorous political organizing efforts in all states, progress can be made in reversing the dismal current record on tobacco control funding. The basis for this reversal lies in understanding the historical, legal, and political framework of how the tobacco settlements occurred, how the settlement funds have been allocated, and what might be done to organize in response to these political and legal realities.
State Tobacco Lawsuits and Settlements
In 1994, Mississippi, Florida, Texas, and Minnesota were the first states to file lawsuits to recover Medicaid costs expended in treating sick and dying smokers on behalf of the taxpayers (who had traditionally borne these costs). These lawsuits were filed under new legal theories (and sometimes specific enabling legislation) that focused on class action suits on behalf of large numbers of smokers and statistical evidence rather than on the traditional approach of individual wrongful death cases.
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
