Typhoid vaccines ready for implementation.

n engl j med 361;4 nejm.org july 23, 2009 403 is narrowly tailored to focus on smoking prevention in the nation’s young, will survive any such legal challenge. The long-term impact of the Family Smoking Prevention and Tobacco Control Act on the health of the public will depend critically on its implementation through strict regulations, rigorously enforced. FDA Commissioner Margaret Hamburg and Principal Deputy Commissioner Joshua Sharfstein promise to be strong advocates for rigorous enforcement. In a recent article in the Journal, Hamburg and Sharfstein laid out their new mission.2 They regard the FDA as a public health agency whose purpose is not just to regulate the nation’s food and drug supplies, but to protect the health of American citizens. Hamburg has also indicated that she is eager to undertake the regulation of tobacco and said in an interview, “We now have an opportunity to really make a difference with what is probably the No. 1 public health concern in the nation and the world.”3 Few threats to the health of the public are as onerous as tobacco. Each year more than 435,000 Americans die of tobacco-related illnesses, principally heart, vascular, and lung diseases. Tobacco use is also associated with substantial morbidity and diminished quality of life. More than one in five Americans still smoke, an astonishing figure given the overwhelming evidence of harm. In addition to excess morbidity and mortality, tobacco adds considerably to health care costs at a time when reducing costs is a national priority. The total annual health care expenditures caused by smoking run to $96 billion.4 Along with other critical prevention goals, such as controlling obesity and increasing levels of physical activity, the elimination of cigarette smoking is central to improving the health of our citizens and mitigating the growth of health care costs. The Family Smoking Prevention and Tobacco Control Act of 2009 comes at a propitious moment in U.S. history. We strongly support the FDA’s new leaders and urge them to implement the act aggressively. As a medical journal, we are committed to eliminating the public health threat tobacco represents to American society and the world.