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Dr. D. t-1. Conning May 15, 1978 ' THE CONCEPT OF LESS :i-1'_A.RJOUS CIGARETTES There are broadly two sets of problems which attend the concept of a safer ciaarette. The first is concerned with the ethical question: "Is it moralily permissible to develop a safe nethod for administering a habit-forming drug when, in so doing, the number of addicts will increase?" The second relates to the technical feasibility of achieving greater safety. To anyone interested in preventive medicine, the first is not a real question, given that substantials n,.cnbers of peopi e do smoke, and are seriously damaged by it. It is thus in the best tradition of preventive medicine to find a mechanism which allows the activity to continue less hazardously. But, where the end product cannot be free of hazard, there could b e a case for prohibition. Certainl'y,,in~the USA you are all well versed in the arguments for banning this, that or the other, where absolute safety cannot be demonstrated, even thouoh it can never be achieved. - It is probably significant that in the USA the demonstrated hazards of smoking have not been given the same vigorous publicity that attends the hypothetical problems with fluorocarbons, for example. The importance of toxicological problems, it seems, is essentially related to the perception of their economic impact, at least in advertising, rather than the biological distress they engender. In: the UK only two issues have excited comparable enthusiasm - smoking, where there has been a real contribution to a cool appraisal of the problem, and fox hunting, where there has not. The question, therefore, becomes: "How feasible wouId: it be to banish smoking from among human activities?" The crusaders would have us believe that it is merely a question of prohibitive expense and a change of image - away from the virile masculine stereotype, or liberated woman, towards weak, degenerate, dependent characteristics. If we can implant this concept

.v: tY ~ 4 N 0 - 2 - in the minds of adolescents, smoking will be banished for ever. This notion does not bear critical examination_ All recorded civilizations have developedithe means to cushion harsh realities by the use of drugs, and most have accepted this as a natural human function. Only over the last 100 years has the use of d'rugs (with the attendant .risk for a small minority) been frowned upon. This disapproval has been based on several, different aspects of the problem, frora a quasi-religious approach ("an assault on the temple of God") to a fearful concern for degraded humanity. .Few have queried the underlying reasons for this consistent htman_ endeavour,'the development of drugs that induce tranquillity or euphoria. Our view is that it is related to the state of receptivity of the- human mind, which is subject to such a multitude of_stimuli that eventually it requires some dampening effect. We learn to provide this, usually by sleep... that is by switching off. But we have also learned that certain chemicals bring relief of the so-called -'stress' which enables the mind to continue in a more enjoyable 'frame.! In this sense, the.use of n3cotine•is noble, for it is- a truly ingenious solution to the management If these arguments are accepted, we may conclude that there is nothing unethical in the concept of a safer cigarette; that the use-of artificial means to control moodis a very human characteristic; that we should not- seek to exTand":but cannot dispel the habit, and, that our real duty lies in of the internal environment. B ut it is, regrettably, associated with O attendant.risks - risks which are unacceptable in our society, but which 10 N lead to a ban of the original product. necessarily should not Rather _ `~ , , . , C1Q ~ we should devote our efforts towards reduction of the perceived risks. OD diminishing the adverse consequences. .

Fa~e 3 The technical'l problem of achieving this is truly.formidable, mainly because of the complex nature of tobacco smoke, andiour lack of knowledge of basic human toticology. Smoking is associated', classically, with three sets of diseases - pulmonary cancer, chronic bronchitis and emphysema (chronic obstructive airway disease) and cardiovascular disease - and despite the expenditure of enormous resources in terms of money, manpower and thought, we have littlie understanding of the proximate constituents of tobacco smoke which result in .these disease processes, or of the mecha'1~is~s involved. That they are multifactorial is certain, but this only adds to our helplessness in the face of immediate hazards. _ The probliem is further compounded by our increasing ability°to •analyse biochemical changes or detect that biochemicall events have occurred, without necessarily understanding the import of the effect.-Thus, it is possible to detect events almost at molecular levels with nodern analytical techniques, but with no understand.ir_g of the biological significance. Hence, it is not at all surprising that given the myriads of chemicals present in tobacco smoke'(over 3000 at the last count), and the multitudes of people willing, for a'fee, to see if smoke has any effect in their pet test systems, the biological effects ascribable to tobacco smoke seem now to involve almost all known biochemical processes. ' How then can we determine what is needed to render tobacco smoke safer? O ~+ . ~ N If we concentrate on the conventional hazards, how can we be sure that in ~ curtailing themwe are not effecting the release of others possibly more onerous. There are a number of approaches we can make: . 1. Simplify the smoke - that is, reduce the total number of chemicals in smoke. Although this suffers from the theoretical handicap that one might merely be concentrating the hazardous group, even if this were so the

~-::~ . c Page 4 numbers would be more easily dealt with. In fact, when the method employed is modification of the tobacco itself by prior extraction, or the use of inert fillers, or the use of synthetic smoking materials, reduction of the total numbers of chemicals is usually accompanied by increased amounts of water vapour and a total reduction in smoke volume. Simplification of smoke by filtration, on the other hand, tends to increase the concentrations of certain constituents of the vapour phase due either to differential passage across the filter, or changed bur-ni,ng temperatures and reduced volume of smoke consequent upon increased puff pressures with little or_no increase in water vapour. It has the great advantage • that it reduces.the particulate phase constituents of smoke- and the con- comitant disadhrantage that this includes nicotine. Obviously, reducedconcentrations of smoke constituentfi result, but there is no control over the rate of reduction and there.can be no guarantee that harmful constituents are decreased. Again, nicotine delivery is also reduced. 2. A second approach is to dilute the inhaled smoke with air. This is usually achieved by increasing the porosity of cigarette papers or by making holes in the cigarette filters - the so-called ventilated! filter. 3. Increased burning temperature has had some success in effective oxidation of some pyrolysis products and appears to be of value in reducing concentrations of the nitrogenous results of protein pyrolysis. Other consequences, particularly in terms of acceptability to the smoker, such as effects on taste and the smoke sensation, are less satisfactory,

r w• t.~+' . Pzde ~. but I believe there is a very fruitful field of research in the incorporation of catalysts into toc•acco. One important practical matter whic.n underlies all of these procedures is the need to develop a cigarette that will be smoked by the confirmed smoker. There is little point in a safer cigarette which is not acceptable-to the client. The main factor in cigarette acceptability is the nicotine content of smoke. This constitutes the all iTnportanL pharmacological effect but also plays a major role in imparting the requisite taste. What is deemedan adequate content of nicotine, of course, varies from smoker to smoker, but there is a tendency to increase the consumption of smoke when the nicotine delivery falls below l mg. per cigarette. This increase in consumption may be by smoking more cigarettes, but is often by the more subtle ploys, for-example, of smoking more of the cigarettes, or inhaling more deeply or increasing the time of retention of smoke in the 1ur_gs - all unconscious adjustments. There is the possibility,'therefore, that reduction of the intake of noxious constituents of smoke might actually require za-~ increase of nicotine delivery. Against this, there is soWe evidence that confirmed smokers who can be induced to move to cigarettes wit?i~lower nicotine content do not readily modify their smoke absorption rates if they return to cigarettes with a smoking habit towards weaker cigarettes in terms of nicotine content. This is a poorly explored aspect o.C smoking which would repay more investigation - that is the reduction of hazards of smoking by an attack greater nicotine content. This might mainly be due to the modified inhalation techniques mentioned earlier, but does hold out hope for a permanent shift in the technique of smoking.

,, Page 6 Inn sunn:ary-, once it is accepted that the smoking habit is another examplie of man's attempt to control his environment by controlling his perception of it, it becomes permissible to explore a m.mber of ways by which smoking can be made safer. A combination of currently available methods certainly could effect very considerable reductions of the hazard. The habit can never be safe and we must guard against the introduction of new hazards by an ignorant attack on those already defined. The development of safer cigarettes will be handicapped by a crusading approach to the 'evils' of smoking and by equating nicotine addiction with the more destructive addictions. In my view, the abolition of smoking itself prabably depends on the development of other better mechanisms to modify the sensitivity of the human organism to its own perceptions of its environment.

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