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The proposed $368.5bn (£230bn) legal settlement between 40 states and the tobacco industry in the United States was heavily criticised for doing nothing to limit the activities of the tobacco giants abroad.
The tobacco deal (26 April, p 1217) was the hottest political subject at the conference, and organisers said that no other topic had prompted as many submissions. As the domestic market has declined over the past 20 years, cigarette exports have quadruplednearly one third of the cigarettes made in the United States are exported.
"If the settlement goes through, we have the potential to see children on the streets of Manila today paying for Mississippi medical bills in 10 to 20 years time," said Gregory Connolly, director of the Massachusetts tobacco control programme.
The final conference resolution avoided naming the United States directly but called for governments to ensure that any tobacco settlements "do not contribute to an increase in the worldwide epidemic of tobacco related death and disease." Settlements should "not inhibit full public scrutiny of the past, present, and future activities of the tobacco industry" and must protect the legal rights of those not party to the agreement.
Stanton Glantz, professor of medicine at the University of California, and an outspoken critic of the American settlement, said: "If you apply these standards to the US deal, it does not come close to passing."
Frank Chaloupka, an economist at the University of Illinois, said that when American cigarette companies used trade legislation to force open the markets of South Korea, Thailand, Taiwan, and Japan in the 1980s the result was a surge in tobacco advertising and an increase in smoking rates.