NLTCN-National Networks Interview with Mr. Joseph A. Califano, Jr.

On April 4th, 2012, Jeannette Noltenius of the National Latino Tobacco Control Network (NLTCN), on behalf of the National Networks for Tobacco Control and Prevention, had the honor to interview Mr. Joseph A. Califano, Jr., Founder and Chairman Emeritus of The National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia). CASA Columbia is an independent, science based, non-profit research organization affiliated with Columbia University focused on transforming society’s understanding of and response to substance use and the disease of addiction. Mr. Califano has held many posts in the US Government including US Secretary of Health, Education, and Welfare from 1977 until 1979. He founded CASA Columbia in 1992. He graduated from College of the Holy Cross, and attended Harvard Law School. He is an Adjunct Professor of Public Health at Columbia University Medical School. Among his many books are: How to Raise A Drug Free Kid –The Straight Dope for Parents, High Society – How Substance Abuse Ravages America and What To Do About It, The Triumph and Tragedy of Lyndon Johnson, and a memoir, Inside –A Public and Private Life.

Jeannette: You and CASA Columbia have been leading the charge on alcohol, tobacco and other drugs issues. Why have you been so engaged in tobacco control issues throughout your career?

Mr. Califano: When I became Secretary of Health, Education, and Welfare (HEW), we wanted to do health promotion and disease prevention. We interviewed over 100 physicians for jobs about this new area and they said: "you can’t have serious programs unless you go after smoking.” In 1977 we conducted a survey and found that 90% of adults who were hooked on cigarettes started before age 21. Half of the people who smoked tried to quit in the previous year. This led to the decision to mount a really serious campaign and to make it a very public campaign. In January 1978 we announced that tobacco was public enemy #1 and slow-motion suicide. A new Surgeon General’s report on the 15th anniversary of the first Surgeon General’s report was planned for publication in January 1979. Clearly, tobacco is the #1 cause of preventable disease and premature death in this country. The original Surgeon General’s report in 1964 had indicated that smoking caused lung cancer and that possibly smoking caused heart disease. A tremendous amount of research had been done since then, and in this new report (1979) we could say that it also caused cardiovascular disease, emphysema and other diseases. When I worked as President Johnson’s chief domestic policy assistant in 1964, we had other very serious issues to address since we were at war with southern states over segregation. We were trying to get schools and hospitals desegregated in states like Kentucky, Virginia, North Carolina and these states had lots of tobacco, they grew tobacco, so addressing the results of the 1964 Surgeon General’s report wasn’t very politically feasible at that time.

Jeannette: Last month the Surgeon General’s office released the 37th report on tobacco, Preventing Tobacco Use Among Youth and Young Adults. Members of the National Networks were disappointed that it did not highlight our #1 concern, which is menthol.

Mr. Califano: When the legislation proposing to give the FDA some authority over tobacco was being considered, Dr. Louis Sullivan—former HHS Secretary under President George H. W. Bush—and I were appalled that all flavoring were banned except menthol. We made some waves with our Citizens’ Commission to Protect the Truth, and went to see Henry Waxman. We spoke to him and he said: "we can’t pass the bill if we ban menthol because Philip Morris and the tobacco companies would withdraw their support and we can’t pass a bill without their support.” Then the House Committee pushed a provision to establish a Scientific Committee to look at menthol at the FDA. This TPSAC Committee made a direct recommendation (2011) that the FDA should ban menthol.

When the Surgeon General’s report came out last month (March 8th, 2012), I was amazed that the report contained a whole series of facts about menthol, but yet the Surgeon General—who used the word "alarm” over youth smoking—did not make an obvious recommendation to ban menthol. One of the most incredible facts in the report is that smoking of menthol cigarettes among youth is significantly increasing, while other cigarette use is decreasing. And yet, there is no mention that menthol be banned as a flavoring. The Surgeon General’s report only says "mentholated cigarettes deserve special note.” The most important single thing to be done about youth smoking is to ban menthol flavoring. We have got to get that done.

Until the Department of Health and Human Services (DHHS) and the Obama administration and FDA ban menthol flavoring, one can’t take them seriously about caring to do something about youth smoking.

Jeannette: What other issues related to tobacco are of concern to you?

Mr. Califano: On top of youth smoking, why are we in the public health community so concerned? We now have a situation where the National Institute on Drug Abuse (NIDA) says that the gateway drug is nicotine, not marijuana. Eric Kandel, the Nobel Prize winner, has a recent paper published about addiction. This study showed that when some mice were given cocaine, they immediately got hooked. Other mice were given cigarettes to get hooked on nicotine first and then the researchers gave them cocaine. The mice who were only given cocaine were able to recover, but the mice that were hooked on nicotine first and then cocaine, they couldn’t get them to recover from their addictions. They went crazy. Now we have serious scientific evidence about the relationship between smoking and cocaine. Nicotine makes the grip of other drugs even tighter on people.

Jeannette: What actions would you suggest for members of the National Networks?

The National Networks have to:

• Keep demanding that the FDA act on recommendations of the Scientific Tobacco Advisory Committee. There’s been tremendous delay since the recommendations were made last spring. The FDA needs to agree with those recommendations and remove mentholated cigarettes from the market.
• Demand to start taxing mentholated cigarettes at higher rates than regular cigarettes. With more and higher taxes kids won’t be able to afford them. Tobacco companies must also be called out so as not to direct advertising at young African Americans, Hispanics, Asians and Pacific Islanders and all youth. It’s the most important thing we can do so kids don’t start smoking and those that smoke, stop.
• Keep the heat on. If you’re serious about getting young people to stop smoking or not to start, you have to get mentholated flavoring out of cigarettes. That pressure has to be put on the Secretary of the Department of Health and Human Services (DHSS) and the FDA.
• Contact reporters interested in the FDA and suggest that they write articles focused on menthol.
• Contact members of Congress and let them know that you care about this issue.

Jeannette: Any final words?

The data is clear. The incredible thing is the awful facts about menthol are in the Surgeon General’s Report. Half of high school smokers smoke menthol cigarettes. They are the cigarettes of choice among youth. Mentholated flavoring increases the addictive potential of smoking among young people.

Jeannette: Thank you for being with us today.

Source: National Latino Tobacco Control Network –Red Latinos Saludables Sin Tabaco