Future of proposed tobacco settlement looks hazy.

T he houses of medicine and public health need to heal their own deep rifts in order to present a united front to interests that threaten to derail a proposed settlement with the tobacco industry, warned the American Medical Association (AMA) and US Food and Drug Administration (FDA) recently. During the National Conference on Cardiovascular Health: Coming Together for the 21st Century, Lonnie Bristow, MD, secretary-treasurer of the AMA, and Mitchell Zeller, associate commissioner for policy at the FDA, agreed most strongly on the point that good legislation is possible only if doctors, public health officials, and policy makers work together to get the most they can from the tobacco industry while it appears vulnerable. The FDA has already begun to regulate the sale of cigarettes, said Zeller. A pilot project to " sting " retailers who sell cigarettes to minors has proven so successful that the agency is poised to extend it to all 50 states, he said. On the negative side, the power of the tobacco lobby continues to make itself felt. Earlier this year, Congress refused to appropriate the $34 million the agency asked for to enforce tobacco regulations. In fact, the Senate, with powerful pro-tobacco members, approved only $5 million. But grassroots lobbying by public health officials changed minds, and the money was passed, Zeller said. But in a recent conference committee to resolve differences between House and Senate bills, only $18 million in new funds was found to fund the enforcement. The agency was forced to take $16 million from other programs to meet its commitment, said Zeller. The proposed tobacco settlement announced by industry and government officials last June has been criticized from people on both sides of the fence, he said. One group wants it passed as is; another thinks it should be jettisoned. President Clinton has proposed modifying it to make it tougher on the tobacco companies, to require stiffer penalties, and to improve attempts to stem teen smoking. Zeller warned that divisions over how to handle the tobacco legislation must be resolved. The medical establishment must stand firm behind the President in the quest for stiff penalties and the funds needed to stem the tide of teenaged smoking. Divisions " benefit only the tobacco industry, " he said. " This industry is desperate for legislation. " He warned that some kind of legislation will proceed, and the public health community must …