By October 2012, all cigarette packs in the USA will show graphic images and stern warnings about the dangers of smoking, the Food and Drug Administration announced Wednesday.
The possible pictures include women blowing smoke in children's faces, diseased lungs, a cancer-riddled mouth and a smoker puffing through a tracheotomy hole in his neck. They will cover half the space on packaging and will also be shown on all cigarette ads, FDA Commissioner Margaret Hamburg said.
"Some of the images are very, very powerful," Hamburg said. "That is the point."
The FDA has posted 36 possible pictures on the agency's website and will pick one to run with each of the nine warning statements the government will require on packaging and ads.
In a statement, Philip Morris, the largest U.S. tobacco company, said it plans to actively participate in the rulemaking and public comment process.
The agency will publish a final rule about the new warnings next June, and cigarette-makers must add them to all packages by late 2012.
The warnings on cigarette packs, such as "Cigarette Smoke Contains Carbon Monoxide," haven't been changed in 25 years.
"The American warning label is pitiful," says Gary Giovino, chairman of the University of Buffalo's Department of Community Health and Health Behavior. "It's one of the most anemic in the world."
Giovino, formerly an epidemiologist in the Centers for Disease Control and Prevention's Office of Smoking and Health, called the new warnings "a step in the right direction." But, he says, they're "not going to undo all the damage that's been done by decades of marketing and deception."
The 2009 Family Smoking Prevention and Tobacco Control Act limits what the FDA can do to reduce smoking rates, says John Banzhaf, executive director of Action on Smoking and Health, an anti-smoking group.
Kathleen Sebelius, secretary of the Department of Health and Human Services (HHS), could use her authority to go further, says Banzhaf, a law professor at George Washington University in Washington, D.C. For example, he says, Sebelius could require that smokers pay higher health insurance premiums and that all recipients of HHS funds ban smoking -- both steps that are more likely to cut smoking rates than graphic warnings.
A lawsuit filed by several tobacco companies could block the new warnings. "We are challenging the legality of requiring larger and graphic warnings," David Howard, a spokesman for R.J. Reynolds, the country's second-largest tobacco company, said Wednesday.
Ronald Milstein, Lorillard's senior vice president for legal and external affairs, said the lawsuit could lead to changes in the proposed warnings.
Geoffrey Fong, principal investigator of the International Tobacco Control Policy Evaluation Project, said it's important to change the warning labels regularly to keep smokers' attention. In 2000, Canada became the first country to add images to text warnings on cigarette packages, but it hasn't changed them since.
Fong says his research has found a "dramatic decline in label effectiveness in Canada" over the years.
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