There has been a major change in America on tobacco in the past two years. After a tremendous push in the 1990's to regulate tobacco products and restrict American tobacco companies' expansion abroad, there has been no effort under the Bush administration to regulate tobacco through the Food and Drug Administration (FDA)) or to encourage states to adequately fund proved tobacco control programs. In addition, during the negotiations on the World Health Organization's (WHO) Framework Convention on Tobacco Control, the US has shown little leadership in tackling tobacco as the global health scourge. We have learned a great deal about tobacco control in this country, yet we also bear responsibility for much of the dissemination of tobacco use throughout the world. Our movies glamorize smoking, the multi-national tobacco companies based in the US aggressively market their products to the developing world, and the US refuses to consider binding international obligations based on public health principles to control tobacco use.

Even with all the talk of war and bioterrorism, it makes no sense to be weak on domestic or international tobacco control. Each year tobacco use results in more than 400,000 smoker deaths, another 50,000 or so nonsmoker deaths, and $75.5 billion in direct U.S. medical care costs. It is also estimated that there will be 10 million annual tobacco fatalities worldwide by 2030. Years of scientific research and policy advocacy have taught us how to reduce tobacco's devastating impact on societies and economies-we just are not doing it.

The Framework Convention on Tobacco Control is the first international treaty effort to address the global problem of tobacco use. However, U.S. negotiators have taken weak positions on restricting passive smoking, banning the misleading labeling of cigarettes, banning all advertising and promotion of tobacco products, and raising taxes to reduce consumption. Tobacco products are unlike any other traded product; when used as directed, they kill. Therefore, we need strong international agreements to control this cross-border hazard. The Department of Health and Human Services (HHS) should work harder with Congress and the White House, where there is substantial influence by the tobacco industry, to show good faith in this multilateral effort. In fact, many of the interventions addressed by the Convention are based largely on scientific evidence developed here in the United States. Right now, the U.S. is embarrassingly weak in support of many proved actions to prevent and control tobacco use, in particular the banning of all tobacco advertising and promotion and support for strong actions to ban exposure to passive smoke.

It's time to show more leadership in Framework Convention negotiations beginning next week in Geneva. It's time for our government to listen more closely to public health professionals both inside and outside government, to the tobacco control advocacy groups, and to our international partners on this issue. It's time to do the right thing.