The Food and Drug Administration on Thursday revealed 13 repulsive warnings it proposes adding to cigarette advertisements and packaging.

The graphic warnings are intended to deter smoking. They include short statements and “photo-realistic color images depicting some of the lesser-known health risks of cigarette smoking.” The depicted health risks include bladder cancer, prominent neck tumors, limb amputation, erectile dysfunction, type II diabetes, blindness, and heart and lung disease. The warnings would replace the standard Surgeon General’s warning, which the agency described as “virtually invisible” to consumers.



























The FDA said the new warnings fulfill a mandate set by a 2009 law called The Family Smoking Prevention and Tobacco Control Act (TCA). The act required the agency to come up with fresh warnings for cigarette packages and ads to address the lingering public health issue.

To this day, cigarette smoking remains the leading cause of preventable disease and death in the US, the agency notes. Smoking is linked to 480,000 deaths per year, which is more than those linked to HIV, illegal drug use, alcohol use, motor vehicle injuries, and firearm-related incidents combined. Smoking-related diseases afflict more than 16 million Americans in total.

The agency tried to fulfill the TCA’s mandate back in 2011, rolling out nine warnings and similarly graphic images. But several tobacco companies challenged the warnings in court, arguing that they were scare tactics and that they violated the First Amendment. The tobacco companies won the case and, in 2013, the FDA officially scrapped its plan and headed back to its Stephen King-inspired drawing board.

Though the latest round of warnings are equally disturbing, the agency appeared more confident they could withstand legal challenges, noting that they’re backed by research and based on facts.

“FDA undertook a comprehensive, science-based research and development process to get these proposed warnings right by developing distinct and clear messages about the risks associated with cigarette smoking and exposure to secondhand smoke,” Mitch Zeller, J.D., director of the FDA’s Center for Tobacco Products, said in a statement.

Tobacco companies are now mulling the new rules. In an emailed statement to NPR, Kaelan Hollon, a spokesperson for Reynolds American Inc. (parent company of R.J. Reynolds) wrote:

We firmly support public awareness of the harms of smoking cigarettes, but the manner in which those messages are delivered to the public cannot run afoul of the First Amendment protections that apply to all speakers, including cigarette manufacturers… [It] is important for FDA to focus on providing information that can produce health benefits for the public, not merely reiterating well-known messages that smoking is dangerous, which the public already understands.

Public comments are open on the proposed warnings until October 15. If they survive, the earliest they might appear on packages and ads is 2021.