Tuesday, June 22, 2010

Should the FDA Lower Nicotine in Cigarettes?

On June 17, 2010, the Washington Post printed a story titled "FDA should use its power to lower nicotine in cigarettes, former chief says". Following is an excerpt:

David A. Kessler, a former FDA commissioner, said Wednesday that the agency's efforts to date are laudable but "marginal" compared with what the agency has the legal authority to do -- reduce nicotine levels to the point where a smoker no longer craves cigarettes.

"If you do this, you can save 200,000 to 300,000 lives a year," Kessler said. "Everything else pales in comparison."

The Washington Post story is referenced by an allgov.com post titled "Is It Time to Limit Nicotine Levels in Cigarettes?". The first comment to this post begins as follows:

We need to be extremely careful here. While the one year-old Family Smoking Prevention Act forbids the FDA from "requiring the reduction of nicotine yields of a tobacco product to zero," common sense screams that unless the reduction is as close as possible to zero, that smokers will compensate by smoking more cigarettes harder, sucking the smoke deeper and holding it longer.

The remainder of this post contains my response to this statement:

Screaming common sense sometimes turns out to be a screaming misconception. About twenty years ago, I was smoking Kool Mild cigarettes and I bought a book titled "Switch Down & Quit: What the Cigarette Companies Don't Want You to Know About Smoking", by Dolly D. Gahagan. The book gives a method for stopping smoking that involves switching to a slightly lighter brand of cigarette every three weeks or so. I explain it more fully at http://www.econdataus.com/smoke.html. As the book predicted, I did compensate somewhat when I initially switched to a lighter brand. This was especially true for the most difficult switch from 0.3 milligrams nicotine and 3 milligrams tar to 0.1 milligrams nicotine and 1 milligrams tar. But also as the book predicted, I adjusted to every switch within a week or two and slipped back to my old habits as far as the number of cigarettes that I smoked. I also believe that I slipped back to sucking the smoke to the same depth and for the same length of time. What I do know is that the first time that I tried Carltons (0.1 milligrams nicotine and 1 milligrams tar), it was like sucking on air. When I finally switched down to them and adjusted, however, they did taste like normal cigarettes.

Now this method may not work for many people. In fact, when I finally did quit, I had the additional motivation that my company had gone smokeless and I could no longer smoke in the office. However, I did feel as though I had relatively little physical withdrawal when I quit. In fact, it seemed like I had more physical withdrawal when I made the difficult switch described above. I did still have to deal with the strong psychological addiction but I believe that the relatively weak physical addiction made quitting easier. Also, switching down did give me the confidence that I did not NEED a certain level of nicotine and that my body could adapt to a lower level (or, eventually, none at all).

A 2007 story on the Journal of the National Cancer Institute titled "Can Reducing Nicotine Help Wean Smokers?" suggests that, at the very least, the charge that smokers will fully compensate for drops in nicotine is questionable. It states:

If you remove nicotine from tobacco and do it gradually, it may be possible to reduce nicotine dependence, so when adolescents first start smoking, they won't become addicted," he says. But the data appear to point in contradictory directions. Some show that when people smoke lower-nicotine "light" cigarettes, they take bigger, longer puffs. Yet other studies show that sometimes people do not inhale more to compensate when their cigarette has less nicotine.

This suggests that we need to depend on careful research and open debate, not screaming common sense.

Wednesday, March 3, 2010

Can Low-Tar Cigarettes Aid in Quitting Smoking?

A google search of "low-tar cigarettes" results in numerous matches, the majority of which appear to be negative on their usefulness, saying that they are no less hazardous than regular-tar cigarettes. In fact, some of the matching articles suggest that switching to low-tar cigarettes halves the chance of quitting smoking. However, this conclusion is contradicted by some other studies such as this one which states the following:

Smoking and health experts have been concerned that reducing the nicotine content of cigarettes would lead to smoking a greater number of cigarettes and therefore increased exposure to other tobacco smoke toxins, as is seen in smokers of the currently marketed low-nicotine yield cigarettes, Benowitz said. The new research on reduced-nicotine content cigarettes strongly counters that prediction.

Another article, titled "Could FDA reduce nicotine levels in cigarettes?", states the following:

Another strategy might be to reduce the harm from tobacco by lowering the nicotine content/delivery of cigarettes down to the level at which they are no longer addictive. A form of this strategy was proposed in the 1990’s by leading tobacco researchers Professor Neal Benowitz, and Professor Jack Henningfield. The FDA legislation singles out nicotine as the only chemical that cannot be reduced to zero, but this allows FDA the right to reduce the nicotine delivery of tobacco products down to a level just above zero at which they would no longer be addictive.

Hence, there does seem to be some disagreement on the subject. This disagreement may have played some role in the FTC ceasing to release reports on the tar and nicotine content of cigarettes. This Boston Globe article describes this as follows:

The Federal Trade Commission for three decades regularly released reports on the nicotine and tar content of cigarettes -- reports that frequently came under criticism for failing to adequately reflect the amount of nicotine smokers inhale in actual use.

The reports showed that nicotine levels on average had remained stable since 1980, after falling in the preceding decade. The last of those studies was released in September 1999, commission spokeswoman Claudia B. Farrell said yesterday.

The Federal Trade Commission has continued collecting data on nicotine, but she did not know why they have not published reports on the findings.

This brings up the question of whether the FTC should have continued to release this data to the public, even if the data was less than perfect. In any event, this is now the responsibility of the FDA (Food and Drug Administration). Section 915 of the recently passed Family Smoking Prevention and Tobacco Control Act states the following:

(2) may require that tobacco product manufacturers, packagers, or importers make disclosures relating to the results of the testing of tar and nicotine through labels or advertising or other appropriate means, and make disclosures regarding the results of the testing of other constituents, including smoke constituents, ingredients, or additives, that the Secretary determines should be disclosed to the public to protect the public health and will not mislead consumers about the risk of tobacco-related disease.

From the above excerpt, the law appears to give the Secretary of Health and Human Services the power to require tar and nicotine content to be included in advertisements and on package labels but does not mandate that this will occur. Likewise, it does not appear to mandate the disclosure of tar, nicotine, and other ingredients to the public but leaves this to the discretion of the Secretary. Hence, it is unclear as to if or when updated tar and nicotine figures will be released to the public.