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Photo by: U.S. Food and Drug Administration

Disturbing images may be part of cigarette packaging if new graphic warning labels proposed by the U.S. Food and Drug Administration (FDA) are adopted. Photos of diseased lungs, feet with amputated toes and a sickly boy wearing an oxygen mask are meant to convey some of the established health risks of cigarette smoking.  

Nearly half a million people a year die as a result of cigarette smoking. According to the National Cancer Institute, tobacco use is a leading cause of cancer and cancer deaths. And the risks are not limited to lung cancer. Two of the 13 proposed new warning graphics highlight smoking’s lesser-known links to head and neck cancers and bladder cancer.
Such realistic warnings are already a part of cigarette packs in 120 countries across the globe. But little has changed in American cigarette warning labels since terse Surgeon General’s warnings were added in print 35 years ago.  But these text-only warnings “have become virtually invisible — failing to attract much attention or leave a memorable impression,” the FDA said in announcing its proposal.

Dr. Thomas Brandon, director of the Tobacco Research and Intervention Program at Moffitt.

“The U.S. was a leader in requiring written warning labels on cigarette packs,” said Dr. Thomas Brandon, who directs the Tobacco Research and Intervention Program at Moffitt. “But we have fallen behind the rest of the world where graphic warning labels are now the standard, as recommended by the World Health Organization. Indeed, current movement is toward plain packaging, which excludes brand logos and graphics, further emphasizing the graphic warning. The U.S., once the leader in tobacco control, now has some catching up to do.”

“As a cancer doctor and researcher, I am well aware of the staggering toll on the public health from cigarettes,” acting FDA Commissioner Dr. Ned Sharpless said in a press release on the new warnings. “They cause cancer, heart disease, stroke, emphysema and other medical problems. And they also cause a number of less-known smoking-related risks that youth and adult smokers and nonsmokers may simply not be aware are connected with tobacco products, such as diabetes, blindness and erectile dysfunction.” The release detailed the FDA’s lengthy process to develop and test the text statements and accompanying color images to ensure the proposed warnings would promote greater public understanding of the negative health consequences of smoking.

This is not the first time the FDA has attempted to add graphic images to its warnings on cigarette packs.  A similar 2011 proposal was struck down by the courts when the tobacco industry claimed it violated First Amendment protections of free speech.  There is no word yet on whether a similar legal challenge will be mounted to this proposal.

If adopted, the new warnings cover half of the front and rear panels of cigarette packages and at least 20% of the area at the top of all cigarette advertisements. The FDA is accepting public comment on the changes until Oct. 15, 2019, after which responses and a final rule will be published.