For many public health advocates, the $10.1 billion tobacco buyout awaiting President Bush's signature was the one that got away. Until a few days ago, activists had a bill that included some regulation of the tobacco industry by the federal Food and Drug Administration. Instead, FDA oversight was stripped last week during closed-door negotiations between the Senate and House of Representatives.

Gone were provisions to restrict tobacco marketing, ban candy-flavored cigarettes and give the FDA authority to strengthen warnings on packages. Gone, too, were requirements for companies to list ingredients and disclose scientific information on their products to the FDA.

The FDA has no authority to require changes in the chemical makeup of cigarettes. The scuttled oversight provision would have provided that ability, advocates said.

"It's a sad day for public health," said Paul G. Billings, vice president for national policy and advocacy for the American Lung Association in Washington. "We had an opportunity to make change. It was squandered by the U.S. Congress."

Tobacco-related illnesses kill 440,000 people a year in the United States, according to anti-smoking advocacy groups.

In North Carolina, tobacco-related health costs run $1.9 billion a year, said Sally Herndon Malek, head of the Tobacco Prevention and Control Branch in the state's Division of Public Health.

Last year, nearly 25 percent of adults and 27 percent of high school students in North Carolina smoked, according to the state.

"That's just a huge drain on our wonderful population," Malek said.

The buyout that passed Congress on Monday was a historic moment for tobacco farmers. It will wipe out the depression-era quota program that regulated how much tobacco can be grown in the United States and artificially propped up tobacco prices.

Growers and quota owners will get cash from tobacco companies in return for the quota they owned or the leaf they grew in 2002. Farmers hope to sell more of their newly inexpensive leaf to tobacco companies, which now buy largely from overseas growers.

The buyout wasn't considered possible until it was attached to a massive corporate tax bill moving through Congress. But few supporters thought the buyout could get past the Senate without the FDA oversight provision.

That changed last week when House and Senate leaders went into a conference committee, hashing out final details of the corporate tax bill. When they emerged, the FDA provision was gone. The bill passed the House last week and the Senate on Monday.

The issue of FDA oversight is especially touchy in North Carolina, where anti-smoking activists are careful to say their public health battle is not with tobacco farmers, but rather the manufacturers of cigarettes.

"Tobacco farmers in North Carolina are good, hard-working people trying to make a living," Malek said. "Most of them have lost loved ones [to tobacco-related illnesses]."

On Tuesday, she and advocates from across the state gathered at a state conference in Durham to teach local anti-smoking organizations how to change tobacco policy in their communities.

"We're about changing social norms, and it's about having to work with the culture and history of tobacco in North Carolina," Malek said. "I think, in many ways, North Carolina is at a crossroads."

The state is home to farmers and tobacco companies, including R.J. Reynolds of Winston-Salem.

R.J. Reynolds opposed the most recent FDA provision because it sealed Philip Morris' dominance, said spokesman David Howard. The company would agree to regulations that would still allow it to market its products to adult smokers, he said, but would oppose anything that forces the company to release proprietary information about its cigarette blends.

$6 billion industry

Together, the industry and farmers have an economic effect on the state of nearly $6 billion, said Blake Brown, an agricultural economics professor at N.C. State University.

Still, advocates in North Carolina were working in recent months to influence the state's congressional delegation on the buyout's details. They sent hundreds of e-mails and phone calls to the state's congressional delegation about the FDA regulations, said Lynette Tolson, North Carolina director of advocacy with the American Heart Association.

Democrats generally supported FDA oversight; Republicans didn't unless it was required to get the buyout through, she said.

The impact of the FDA regulations would have been significant, Tolson said. The oversight focused largely on marketing and informing the public, but that's a critical front, she said, when advocates are trying to get vulnerable teenagers from taking up smoking.

The oversight provision drew controversy in recent weeks when it was reported that anti-tobacco advocates in Washington, D.C., had quietly negotiated with Richmond, Va.-based Philip Morris to support the regulations.

Critics said the oversight would have ensured Philip Morris' market dominance by restricting smaller companies' advertising.

"I was thrilled it wasn't included," said Adam Goldstein, an associate professor of family health at UNC-Chapel Hill and director of its Tobacco Prevention and Evaluation programs.

"The proposed benefits wouldn't do enough for public health," he said. "The public health gains were all theoretical."

Goldstein said the regulations also would have benefited Philip Morris by giving the company a stamp of legitimacy from the FDA.

Now, he said, Philip Morris has less leverage and public advocates can renew their fight for better FDA regulations.

And the buyout might result in fewer tobacco farmers in the state, giving them less leverage in public policy, he said. "It allows us to dream," he said.

That's already begun. Sens. Edward Kennedy of Massachusetts and Mike DeWine of Ohio managed to get a unanimous voice vote from the Senate on Sunday night on a separate bill that would let the FDA regulate tobacco. The bill was sent on to the House, but it isn't expected to find much of a foothold there.

In North Carolina, health advocate Adam Searing sees the buyout as an opportunity during next year's General Assembly session.

Now that tobacco farmers have their buyout money, perhaps legislators will be more welcoming of an increase in the cigarette tax, said Searing, project director of the N.C. Health Access Coalition.

"I wonder how that will play out," he said.

Staff writer Barbara Barrett can be reached at 829-4870 or

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