Just days away from the scheduled completion of the talks, Thailand, Saudi Arabia and other developing countries complained that the U.S. delegation was using strong-arm tactics and financial threats to try to force through its will.
"At this critical juncture, the United States government is working methodically to weaken virtually every aspect of this treaty," said John Seffrin, chief executive officer of the American Cancer Society. "We call on the U.S. government to observe the first rule of the Hippocratic Oath: Do No Harm."
"The time has come for the United States to stand aside and allow the rest of the world to complete a treaty strong enough to change the course of the tobacco epidemic," Seffrin said.
A U.S. delegate rejected the criticism and said his team was negotiating in "good faith."
"We are making a very sincere effort to bring home a treaty which can be signed and ratified," said Terry Pechacek, of the Centers for Disease Control and Prevention, CDC.
Government representatives have until Friday to agree on the so-called Framework Convention on Tobacco Control.
Since negotiations opened in October 1999, more than 13.3 million people have died of cancer, heart disease and other smoking related ailments. The World Health Organization, which is sponsoring the talks, expects the annual toll to soar to 10 million by 2030 because of a surge in deaths in China and other developing countries.
The vast majority of countries want the treaty to introduce sweeping restrictions against tobacco, including a total advertising ban and tough labeling controls to introduce graphic images of health problems and to stop use of terms such as "mild" and "light."
Developing nations also want the agreement to state that health should be given priority over trade in international law — thus protecting them from potential U.S. action in the World Trade Organization if they try to impose restrictions on cigarette imports.
The United States — home to the world's biggest cigarette exporter, Philip Morris — has flatly rejected an advertising ban, saying it would violate constitutional principles of free speech. In view of this, the current draft text would allow countries with constitutional objections to impose restrictions, while other nations would introduce a complete ban after three years.
But there is particular anger at perceived U.S. attempts to water down many other parts of the treaty — such as on labeling — and insistence on the right to use reservations to exempt it from individual provisions it doesn't like.
Thailand's Hatai Chitanondh said that the U.S. delegation had told the meeting that it would stop funding anti-tobacco programs and transferring know-how if it didn't get its way on exemptions.
"It's very arrogant," complained Chitanondh. "The United States has the technology and sophisticated tobacco control programs and yet they are behaving like this toward the rest of the world."
A member of Saudi Arabia's delegation, who asked not to be identified, said his government took offense at a U.S. State Department letter stressing that the tobacco treaty should not seek to undermine the WTO's free trade provisions.
U.S. officials in Geneva and Washington did not immediately respond to the specific allegations despite repeated telephone calls. At the outset of the talks, U.S. Health and Human Services Secretary Tommy Thompson said the United States was fully committed to a "strong and dynamic" treaty.
The American health groups disagreed.
"I am ashamed of the role my government has played in the negotiations," said Alfred Munzer of the American Lung Association.
"It has clearly sacrificed long-term improvement in global public health to serve the interests of an industry whose product is responsible for four million deaths annually from cancer, heart disease and emphysema."
In a public statement last year, Pechacek said current estimates put the human cost of American smoking at half a million lives a year and the financial tab at more than $157 billion. Smoking-related diseases are believed to kill about 1,200 Americans a day.