U.S. Appeals Court Upholds Block on Graphic Cigarette Warning Labels

Smoking is Bad. PERIOD.

A federal appeals court on Friday upheld a decision barring the federal government from requiring tobacco companies to put large graphic health warnings on cigarette packages to show that smoking can disfigure and even kill people.

In a 2-1 decision, the U.S. Court of Appeals in Washington affirmed a lower court ruling that the requirement ran afoul of the First Amendment’s free speech protections. The appeals court tossed out the requirement and told the Food and Drug Administration to go back to the drawing board.

Some of the nation’s largest tobacco companies, including R.J. Reynolds Tobacco Co., sued to block the mandate to include warnings to show the dangers of smoking and encouraging smokers to quit lighting up. They argued that the proposed warnings went beyond factual information into anti-smoking advocacy. The government argued the photos of dead and diseased smokers are factual.

The nine graphic warnings proposed by the FDA include color images of a man exhaling cigarette smoke through a tracheotomy hole in his throat, and a plume of cigarette smoke enveloping an infant receiving a mother’s kiss. These are accompanied by language that says smoking causes cancer and can harm fetuses. The warnings were to cover the entire top half of cigarette packs, front and back, and include the phone number for a stop-smoking hotline, 1-800-QUIT-NOW.

In the majority opinion, the appeals court wrote that the case raises “novel questions about the scope of the government’s authority to force the manufacturer of a product to go beyond making purely factual and accurate commercial disclosures and undermine its own economic interest — in this case, by making ‘every single pack of cigarettes in the country (a) mini billboard’ for the government’s anti-smoking message.”

The court also wrote that the FDA “has not provided a shred of evidence” showing that the warnings will “directly advance” its interest in reducing the number of Americans who smoke.

Tobacco companies increasingly rely on their packaging to build brand loyalty and grab consumers — one of the few advertising levers left to them after the government curbed their presence in magazines, billboards and TV.

“It’s a significant vindication of First Amendment principles,” said Floyd Abrams, an attorney representing Lorillard Tobacco. “There’s never been any doubt that the government could require warnings on products that can have dangerous results. And what the court is saying is that there are real limits on the ability of the government to require the manufacturer of a lawful product to denounce the product in the course of trying to sell it.”

The FDA declined to comment on pending litigation and the Justice Department said it would review the appeals court ruling. Public health groups are urging the government to appeal.

Joining North Carolina-based R.J. Reynolds, owned by Reynolds American Inc., and Lorillard Tobacco, owned by Lorillard Inc., in the lawsuit are Commonwealth Brands Inc., Liggett Group LLC and Santa Fe Natural Tobacco Company Inc.

Richmond, Va.-based Altria Group Inc., parent company of the nation’s largest cigarette maker, Philip Morris USA, which makes the top-selling Marlboro brand, is not a part of the lawsuit.

The case is separate from a lawsuit by several of the same tobacco companies over the 2009 Family Smoking Prevention and Tobacco Control Act, which cleared the way for the more graphic warning labels and other marketing restrictions. The law also allowed the FDA to limit nicotine and banned tobacco companies from sponsoring athletic or social events or giving away free samples or branded merchandise.

In March, a federal appeals court in Cincinnati ruled that the law was constitutional. The contradiction of the decisions could mean the case would be settled by the U.S. Supreme Court.

Is Eating Eggs Really as Bad for Your Heart as Smoking?

Is your breakfast omelet harming your heart? A recent study by researchers at Western University in Canada found that the more egg yolks people ate, the thicker their artery walls became — an indicator of heart disease risk — and that the effect was almost as bad as from smoking cigarettes.

In the study, the researchers measured carotid plaque build-up in the arteries of 1,231 men and women, average age 62, who were seeking care at cardiovascular-health clinics. Participants filled out questionnaires detailing lifestyle habits including medication use, cigarette smoking and egg-yolk consumption. The researchers gauged how much people smoked and how many egg yolks they ate over time, by calculating their “pack-years” (the number of packs of cigarettes people smoked per day multiplied by the number of years they spent smoking) and “egg-yolk years” (how many egg yolks they ate per week for how many years).

After about age 40, participants’ plaque began building up steadily, but among the participants who ate the most eggs — three or more yolks per week — that build-up increased “exponentially,” the study found. As people’s egg-yolk years went up, so did their plaque accumulation — an association that was independent of factors like gender, cholesterol levels, blood pressure, smoking, body mass index and diabetes.

Among the 20% of participants who ate the most eggs, the carotid plaque build-up was about two-thirds that of the study’s heaviest smokers. The researchers concluded that the plaque increase from eating eggs “follows a similar pattern to that of cigarette smoking.”

Arterial accumulation of plaque is a key risk factor for heart attack and stroke. As plaque builds up, it thickens artery walls and narrows the space through which blood can flow, forcing the heart to pump harder. If plaques become unstable, they can break off and form clots, which can halt blood flow to either the brain or the heart, causing stroke or heart attack.

The authors argue that their findings should quell doubts over the link between high dietary cholesterol and heart disease. “The prevailing tendency to ignore dietary cholesterol as a risk factor for coronary heart disease requires reassessment, including the consumption of cholesterol from eggs,” the authors wrote.

The government’s dietary guidelines recommend that adults consume no more than 300 mg of cholesterol a day. One whole egg contains about 180 mg of cholesterol, nearly two-thirds of your daily recommended ma.

“The mantra ‘eggs can be part of a healthy diet for healthy people’ has confused the issue. It has been known for a long time that a high cholesterol intake increases the risk of cardiovascular events, and egg yolks have a very high cholesterol content,” study author Dr. David Spence, a professor of neurology at western’s Schulich School of Medicine & Dentistry, said in a statement. “In diabetics, an egg a day increases coronary risk by two- to five-fold.

However, the study’s findings raised brows among other health experts, ABC News reports:

Cardiologists say the study shouldn’t be taken so seriously because the research is flawed.

“This is very poor quality research that should not influence patient’s dietary choices,” said Dr. Steven Nissen, who chairs the department of Cardiovascular Medicine at the Cleveland Clinic Foundation, in an email. “It is extremely important to understand the differences between ‘association’ and ‘causation’.”

Nissen said the researchers relied on patients to recall how many eggs they consumed, but asked them once and assumed it remained constant, which isn’t reliable. He said the way researchers measured patients’ plaque has come under “considerable criticism,” and that researchers failed to adjust for other dietary factors.

Indeed, it’s possible that the people who ate a lot of eggs also tended to eat a lot of other high-fat, high-salt or high-cholesterol foods. Or maybe they also tended to exercise less.

The researchers say that while further studies are needed to flesh out the association, people at risk for heart disease should still refrain from eating egg yolks on a regular basis.

The study is published in the journal Atherosclerosis.