More needs to be done to combat Smoking and the disease burden it inflicts on society, U.S. Surgeon General Richard Carmona testified on Tuesday in the government’s racketeering case against cigarette makers.

“There is clearly work that needs to be done in the future,” Carmona told U.S. District Judge Gladys Kessler as the government laid out a case for changes in the tobacco industry if the judge concludes it violated racketeering law.

Carmona cited a 2004 report on the health consequences of smoking by his office that said tobacco-related death and disease would continue “until tobacco prevention and control efforts worldwide are commensurate with the harm caused by tobacco use.”

The government charges cigarette makers deceived the public for years about the dangers of smoking.

The companies deny they illegally conspired to promote smoking and say the government has no grounds to pursue them after they drastically overhauled marketing practices as part of a 1998 state settlement.

Later witnesses to be called by the government will propose sanctions such as forcing cigarette companies to spend billion of dollars to fund a national smoking cessation program.

An appeals court in February barred the government from seeking $280 billion in past industry profits as a penalty.

Carmona, a former U.S. Army medic, spent much of the day parrying questions from tobacco industry lawyer David Bernick who told Kessler the 2004 Surgeon General’s report had not mentioned several possible remedies to be raised by government witnesses.

Carmona conceded that many of the anti-smoking efforts were handled at the state level. But he said there also have been some nationwide anti-smoking initiatives he had supported.

In any case, Carmona said the 2004 report was not intended to be a comprehensive list of all possible remedies. “We want to just set the path that needs to be taken in the future.”

Targeted in the lawsuit, filed in 1999, are Altria Group Inc. and its Philip Morris USA unit; Loews Corp.‘s Lorillard Tobacco unit, which has a tracking stock, Carolina Group; Vector Group Ltd.‘s Liggett Group; Reynolds American Inc.‘s R.J. Reynolds Tobacco unit; and British American Tobacco Plc unit British American Tobacco Investments Ltd.

Bernick also questioned whether there was a personal motive behind Carmona’s views on smoking.

He cited a speech several years ago in which Carmona told an audience that his parents had both died prematurely from smoking-related diseases and that he had suffered respiratory problems as a child because of secondhand smoke.

Carmona said his parents’ illness had “put a real face on the hazards of smoking.” But he said he was not testifying for personal reasons. “I’m here for the public,” Carmona said.