Could FDA require tobacco companies to cease selling products emitting carbon monoxide?

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Carbon monoxide (CO) is a clear, odorless gas that is produced by burning any carbon-based substance. So when tobacco is burned and inhaled, one of the 4,000 or more chemicals that enters the body is CO. When the smoke is inhaled into the lungs, CO is rapidly absorbed into the blood stream. CO binds to the hemoglobin in the red blood cells 200 times more effectively than oxygen does. The result is that many of these blood cells that were designed to carry oxygen to different parts of the body, instead bind to the CO, forming carboxyhemoglobin (COHb). This means that the heart has to do more work to supply the necessary amount of oxygen to the body. There is good evidence that high levels of carbon monoxide in the blood of smokers is one of the main factors causing smokers to have increased rates of cardiovascular diseases (such as angina and heart attacks). Other factors include platelet aggregation increasing the “stickiness” in the blood, stimulated by oxidant gases in cigarette smoke, and increased myocardial oxygen demand caused by nicotine. But it is clear that the reduced oxygen supply caused by carbon monoxide is a major factor. For example, increasing blood CO levels (either by smoking non-nicotine cigarettes or inhaling CO) has been shown to reduce the amount of exercize required to cause angina (chest pain) in patients with a history of angina.
(see: http://circ.ahajournals.org/cgi/content/abstract/61/2/262 )

Tobacco smoking is by far the largest determinant of CO levels in the blood, with smokers typically having blood COHb levels around ten times higher than non-smokers. So the idea that you might as well smoke because there is so much pollution in the air anyway is just nonsense. See this link for a study of this in a population sample:
http://www.biomedcentral.com/1471-2458/6/189

The legislation that was passed 8 months ago giving the US Food and Drug Administration the right to regulate tobacco products, allows FDA to require tobacco product manufacturers to take out any chemical (except nicotine) that appears to be harmful to public health. This can include not only chemicals IN the product, but also chemicals emitted by the product and absorbed by the user during normal use. Given the kind of evidence described above, it would seem highly likely that if it were to be reviewed by the FDA scientific advisory committee, it would conclude that CO is a chemical emitted by cigarettes that is harmful to the individual consumer, and also that limiting the industry to selling products that do not emit carbon-monoxide would be very likely to improve public health. I don’t believe there would be any controversy over the scientific evidence on CO from cigarettes and cigars, or the benefits of banning CO-emitting products.

However, the controversy would arise over whether or not the FDA legislation really empowers FDA to do this. It is highly likely that such a move would immediately result in tobacco company lawyers claiming that such a requirement is in effect a ban on at least 2 classes of products (cigarettes and cigars), and that the legislation does not give FDA the right to ban whole classes of products. This is something that would be decided by lawyers and possibly ultimately by politicians. But here is another view of the possibilities:

The legal definition of a cigarette in the United States is as follows:

“Any roll of tobacco wrapped in paper or in any substance not containing tobacco; and any roll of tobacco wrapped in any substance containing tobacco which, because of its appearance, the type of tobacco used in the filler, or its packaging and labeling, is likely to be offered to, or purchased by, consumers as a cigarette.”

By this definition, electronic cigarettes (e-cigarettes) could be classified as cigarettes. In fact just last month a U.S. judge ruled that e-cigarettes were cigarettes and not drug delivery devices (actually over-ruling the claims of FDA). For more details on this, cut and paste the following link:

http://www.e-cig.org/2010/01/19/what-does-judge-leons-ruling-against-the-fda-mean-for-electronic-cigarettes/

So if e-cigarettes are judged to be cigarettes, and they don’t emit carbon-monoxide (which they don’t), then FDA requiring tobacco companies to cease selling CO-emitting products would NOT in fact be a ban on a class of products. It would simply be a sensible way of reducing the harm to health from certain tobacco products, just as the legislation was intended to do. Of the big smoked tobacco manufacturers want to stay in business they could (and should) switch to focus exclusively on making and selling products that deliver nicotine without simultaneously delivering carbon-monoxide, such as e-cigarettes and smokeless tobacco.

At that point FDA could require the companies to minimize the amount of harmful chemicals being emitted by these products, even although over 90% of the harms from tobacco would already have been eliminated by taking out the burning part of the process. Some people reading this may think it sounds naïve or even crazy. But maybe its not. The federal government and the states would likely ramp up the taxes on e-cigarettes and smokeless tobacco to make sure their revenue is not affected too much, and cigarette and cigar manufacturers would focus on exports and on sales to sources they know will smuggle them back into the country. So in reality, traditional cigarettes would still exist, but they just wouldn’t be used nearly as widely in the United States, just as marijuana is still smoked, but not as regularly as cigarettes.
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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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