Can cigarettes be made less deadly?

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Since it became clear in the 1950s and 60s that cigarettes are deadly when used as intended, there have been various attempts to make them less harmful. These have included the addition of and modifications to filters, and changes in the type of tobacco used. But none of these changes has made a great deal of difference. Part of the problem is that changes that reduce the amount of one toxin often have an opposite effect on the amounts of other toxins in the smoke. Another problem is that changes to the product can affect the way it is used by consumers. The most obvious example here is that as the amount of nicotine in the tobacco decreases, so the smoker takes larger puff volumes in order to get their usual dose. The main lesson from all this is that when humans take any product, burn it, and inhale the smoke into their lungs, it is inevitably going to be very harmful to that individual’s health. Our bodies did not evolve to inhale smoke.

It is partly for this reason that I take the view that the tobacco industry should be given the strongest encouragement to move out of the smoking business entirely, and focus on smokeless tobacco as a way of making money out of nicotine addiction.

However, it’s a reality that cigarettes will be around for the foreseeable future and therefore it makes sense to try to make them less harmful. This month an influential report was published on this topic in the journal, “Tobacco Control” by a World Health Organization study group. The group (called TobReg) proposed a mandated lowering of of permissible toxicants in cigarette smoke. They took the 9 main toxicants, examined the range of levels of these toxicants emitted by international cigarette brands (and there are very wide ranges) and recommended that all cigarettes must emit an amount less than approximately the current median level found in a range of brands. This is analogous to measuring the amount of pollutants emitted by all of the new cars in the world today, and then saying that from some future point in time, all new cars must emit an amount of pollution less than the car that ranks in the middle of the current range. Clearly the standard can be tightened again in the future.

This would mean that for each toxicant, about half of the existing brands would require modification in order to comply with the standard. It means that for 9 toxicants, a far larger proportion of current brands would need to be modified in order to be fully compliant for all 9 toxicants. It should be noted that the toxicant concentrations are expressed in units per milligram of nicotine. This is a wise way to do it, which recognizes that smokers smoke for nicotine, and that it is the ratio of toxins to nicotine that is therefore important. The rationale and many complex details of the proposal are described in the report, which can be accessed for free at:
http://tobaccocontrol.bmj.com/cgi/content/full/17/2/132
A commentary can also be viewed at:
http://tobaccocontrol.bmj.com/cgi/content/full/17/2/73

These proposals are a sensible first step at making cigarettes a bit less harmful. Surprisingly there is even a chance they could be accepted by a major tobacco company. Philip Morris (now split into a separate US and a separate “international” company) may consider that despite all the hassle in complying with such regulations, they may come out smelling of roses (i.e. smelling of money) because they are in a stronger position to make the required technical changes than many smaller companies. They therefore may consider that the regulations present an opportunity for them to gain market share via more efficient regulatory compliance.

It is interesting that the approach taken in this report is almost the opposite of that which has been proposed in the United States, which involves leaving all the toxicant levels as they are, but reducing the nicotine delivery down to levels that will no longer be addictive.

I continue to believe that while both of these approaches have merit, the most direct route for the tobacco industry to stay in business but causing much less harm to health, is for it to be required to focus exclusively on smokeless tobacco products. These have already been shown to be consumer-acceptable, deliver adequate doses of nicotine, but cause far lower levels if ill-health (e.g. no lung cancer or COPD). This approach also avoids the challenging task of enforcing at the individual level. If I’m a policeman walking down the street and I see someone smoking, it is impossible to tell if that cigarette complies with the reduced nicotine or reduced toxicant regulation. If cigarettes are outlawed and only smokeless products are allowed, then enforcement is much simpler.

For smokers, it is important not to sit back and wait for these less harmful cigarettes to come along. This is a long-term project that has only just been proposed. It is highly likely that you will have died of a serious smoking-caused disease long before these proposals result in meaningfully less harmful cigarettes. So the main message remains the same:

The single best thing you can do for your health is to stop smoking completely. There are now a range of effective methods (e.g. quitlines, internet sites, etc) and medicines available that can help you to successfully quit smoking, and you should talk to your healthcare professional about which ones would suit you.
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About the Author


MA, MAppSci, PhD

Dr. Jonathan Foulds is an expert in the field of tobacco addiction.

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