Monica Kraft, MD

Two court decisions in August highlighted the importance of the ATS’s advocacy mission. The first decision focused on cross-state air pollution and the second on cigarette package labeling.

In both cases, the decisions of the U.S. Court of Appeals-D.C. Circuit set back the Society’s efforts to advance lung health. But we are undeterred and will continue to work with the responsible government agencies and other groups who share our interest in fighting air pollution and reducing cigarette smoking.

In a split decision, a panel of judges voted 2-1 to vacate the EPA’s Cross-State Air Pollution Rule (CSAPR). The EPA estimated that by 2014, CSAPR would have contributed to a reduction in power plant SO2 emissions by 73 percent and NOX emissions by 54 percent from 2005 levels. The rule would have yielded $120 billion to $280 billion in annual health and environmental benefits in 2014, including the value of avoiding 13,000 to 34,000 premature deaths.

The second ruling also had a split decision of 2-1 to strike down the graphic warnings on cigarette packages required by the 2009 Family Smoking Prevention and Tobacco Control Act. The FDA estimates that these warning labels, which were set to begin appearing this month, would have reduced the number of smokers by more than 200,000 by next year.

At issue is whether the existing scientific literature proves graphic warning labels reduce smoking rates. The majority rejected research showing that graphic warning labels were more effective than existing labels. They believe that thinking about quitting doesn’t mean smokers actually quit.

This issue will likely end up in the U.S. Supreme Court because another federal court-the U.S. Court of Appeals for the Sixth Circuit-had ruled in favor of graphic warning labels.

The ATS participated in both cases as amicus files, noting the impact air pollution and tobacco use has upon public health. The ATS has urged the Department of Justice, acting on behalf of EPA and FDA, to appeal these decisions.

As a health care professional, I don’t think there is anything more frustrating than waiting for a change that will improve the lives of my patients and prevent future illness. While legal and regulatory changes often come slowly, the only way they come at all is if we continue to fight for what’s right.

The ATS Washington, D.C. Office works with our members and our unique patient arm, the ATS Public Advisory Roundtable, to doggedly advance the health interests of our patients as well as the professional interests of our members. And, though, a battle may be lost, we are winning the war.

To cite a few recent examples, the ATS has fought successfully for pulmonary rehabilitation as a Medicare benefit, allowing passengers to use portable air concentrators on airplanes, and for major increases in international tuberculosis funding.

At the same time, we continue to advance our members’ professional interests and work to establish fair reimbursement rates so that patients will have access to proper medical care. And we continue to educate our political leaders about the medical and economic value of research, so that there now exists a bipartisan coalition of elected officials who support biomedical research.

I strongly believe more can-and should-be done. Respiratory disease, as all of us know too well, is under-recognized, so we must bolster our efforts to bring visibility to this issue. This will mean bolstering our communications and patient education activities as well as our advocacy efforts.

I think all of us can take pride in the fact that we are the only respiratory society that advocates in Washington for clean air, tobacco control, and other actions that directly affect patients’ health