Tobacco Documents Online

Le'ss-toxic cigarette stirs controversy' Abstinence isn't'the only solution for addicts, says anNCJ official' C Hopelesaly addicted smokers: re+ ceired an offer of practical help from a hational!Cancer Institute of- ficial IasCmonth. At the,annual meet- iag of the National Academy of'Sei- ences' Institute: of Medicine, virologist Gio B. Gbri argued far a~ "pragmatie" approacti~ to reducing deaths related to smoking-that is, making cigarettes: less harardous, rather than relqing, solely on, ats tempts to get smokers to quit or Con- gress to ban tobacco. Butcardiovascu- lar epidemiologist John W. Farquhar of Stanford'University fears that em- phasis on a less toxic product may sabotage prevention programs and': undermine the efforts of'smokers who want to quit. Thus smokers now have their own, equivalent of the alcoholics' Rand re- port-tbe,controversial study suggest- ing total abstinence may not,be nec- essary for all lalcohoiics (see page 33): Of approximately 3,000 components of'cigarette smoke, six-tar, nicotine; carbon ~ monoxide, nitrogen oxide, hy- drogen cyanide, and acrolein-are as- sociated with :mortalitc from 11 spe• cific diseases ranging: from lung cancer to, emphysema and bronchitis, said Dr. Gori. The,deputy director of' the \ational'Cancer Institute's divi- sion of cancer cause and prevention added that there is less clear indica- tion for the other components. "The technoldgy required to reduce hazardous components in cigarette smoke has been established,"'said Dr. Gori. "The tobacco industry is begin- ning to utilize these procedures in manufacturingtoday's cigarettes." More important, the public seems to be: accepting these lbw-,,ar ciga- rettes, he pointed out. "Tar yield in today's cigarettes is nearly one third that delivered in 1'9a5'products and nicotine levels have decreased by one half: Conceivably;, there are lowerr limits to acceptatiility;, and the suc- cess of some new er: cigarette brands, containing from 1 mg to 8 mg of'tar and from 0.1 mg to 0.8 mg of'nicotine, MEDICAL WORLD WEN1S/Nor.mbsrlq; 1976 indicates that these limits might be quite low." If'the tobacco industry could make and sell cigarettes with~certain lower levels of hazardous smoke, oompo- nents, starting, for example, in 1980 with a, 10% impnovement each year for ten~ years untili "critical values"' are reached, the relative risk for smokers would be only 1.08'the risk of nonsmokers, Dr. Gori contended. (With present brands,, the average risk for smokers is some ten times greater than for nonsmokers.) By the year 2fl08; he saidJ,we have the poten- tial to prevent, 300,000 to 600,000 premature deaths every year. The critfical', values given by the NCI official are daily intake limits of 150 mg of'tar, 11 mg of' nicotine, a 4.8% increase over baseline car- box}-hemoglobin, levels from carbon monoAde,, 950 iAg of' nitrogen 1 o~de, 1,500 pg of hydrogen cyanide, and!4&0 µg of'acrolein. Tar„carbon monoxide, and nicotine are, the worst of these components, Dr. Gori said„ e-Kcept as they affect lung clearance,mechanisms. "Tar is a mixture of many chemicals i and is commonly understood to contain most smoke carcinogens; it also contains other irritants anditoac materials off unidentified properties," he ex- plained. "C9rbon~ monoxide is Iinked'' to the development of cardiovascular disorders and to acute toxicity phe- nomena.,The anoxia it'produces' may precipitate sudden death when an in- suf$cient,myocardium,is overly stim- ulated by nicotine:" Carboxyhemoglobin levels are, not directly, proportional to the CO deliv- ery per cigarette, Dr. Gori said, but, vary with individual respiratory d}- namics and the number of inhaled puff's: The 4.8A:Iimit could be reached by smoking 35I cigarettes a day of a brand delivering 2 mg of CO per ciga- rette or only five cigarettes of a brand having 15 mg of'C0. Though nieotine, is "a recognized' dangerous: alkaloid~'-Dr. Gori,said, its: "chronic effects ~ are, still less than clear'." If' for no other reason, how- ever, it is important because its "overwhelming pharmacologic contri+ butions"-addictive qualities plus smoke satisfaction-strongly affect smoking behavior. Using his critScal, values, Dr, Gori estimated' that dail}; critical cigarette consumption, for disease mortality from "all causes"' was between one and two eigarettes on the "low" side and from three to four cigarettes on~ the "high" side. But the studies on, which these figures were based, he noted, were for cigarettes' manufacr turedlbefore 1960, wwhen tarievels av- eraged 43' mg per cigarette; nicotine;. 3'mg; CO, 23'mg, nitrogen oade,?:rd pg; hydrogen cyanide, 410 ug; and acrolein, 130 µg.,The strength of to- day's cigarettes is nearly half of what, it was 15'years ago, he said. In fact, "the upper values: for selected smoke components are in the nnge, of fea- tS

C CIGARETTE muww aible market and manufacturing real- ities," although they may requiree smokers to change patterns of accept, ance; he added. Dr. Goril emphasized' in his paper thatl "obviously it would be erroneous to interpret these critical values as in, dicators of'safe smoking leveli, when the experimental and statistical un, certainties of the epidemiologic studl ies sur7eyed are notorious. rllsoa no statistical sophistication could pro- duce or defend a strict implication,ofn safety in these estimates, and' special provisions would still be necessary for such : high-risk groups as coal, ura- nium; and asbestos workers: "However; theoretical controvers,y should not; be allowed to dilute the compelling pragmatic message of these data; a rapid shift in general cigarette consumption~patterns, toward this range of' critical i values, could reduce the current epidemic proportions of' smoking-related dis- eases to minimal levels in a f'ew dec,- ades The expectation is: reinforced because current tech- nology can produce cigarettes that if consumed' at a rate of: ten to 2fl units per day will deliver smoke within the suggested range of critical intake. This, technology can be applied! on a masa scale by skilled cigarette rnanu, facturers," he: said. The cigarette industry has appar- ently interpreted Dr. Gori's critical values as indicating, "safe smoking levels," despite: his warning that it would be "erroneous." The focus has been almost:excllisively, on,tar: f Fted Tanzer, a WTashingtonlawyer representing the Tobacco Institute at the Institute of Medicine meeting, told MwN the cigarette industry is al- ready moving toward these lower 1ev- els "voluntarily" and saw no reason why it would not continue=if' smokers, accept the resulting products. Dr. Alexander W. Spears, senior vice president for operations and re- search at P. Lorillard Co., a cigarette manufacturer, said be felt the 5 mg of' tar in Kent Golden Lights and in True cigarettes (both Lorillard prod- ucts), already met Dr. Gori's critical values as: did all,other cigarettes of' equal'or less tar content. Anticipating the, green light, Dr., 24, Gori's paper wQuld' give heavy smokerslooking,for an excuse to con- tinue smoking -as the Rand report al- legedly; has given heavy drinkers- some members of' the Institute of Nfedicine, audience were quick to chal- lenge it Dr. Farquhar, professor of medicine at Stanford Univeraity, and director of the, Stanford! Heart, Dis- ease Prevention Program, noted that, about 60% of' heavy smokers have in- dicsted!a desire to quit smoking and that Dr. Gori's critical I values would' undermine their determination. "A million smokers have been stopping, permanently each, year for the past six to ten years," Dn Farquhar told M,w.r~ "There has been,a'revolution' in health habits that should not, go unnoticed, and it,would be wrong to think that nothing is working: There is room for both approaches;,but let's not de-emphasize :in any way the ef - fort to stop smoking:"' From the standpoint of taate;,he says, he doubts the new, cigarette would be accepted. "One can predict; that smokers who are already ad- dicted to the present quantity of tar and nicotine in cigarettes will find it very difficult to adjust."' The Stanfor& epidemiologist, who headed a campaign ia~nortbern Cali- f'ornia to educat'e consumers about risk factors in heart disease and to change their eating and smoking habits;, hasi this~ "Conservative and, cautious" advice: "New smokerss should not experimentl with the less hazardous cigarettes; ad'dictedd smokers should' seek help in giving up ~ smoking aompletelybecause they willl have to struggle to adjust to the new cigarette, anyway." However, he does note one possiblee advantage. "The new group of smokers becoming addicted now would become dependent on the new cigarette,,insteadiof'the one we now have." The drawback to that;, he points out~ is that the results of smok- ing the dess-hazardous cigarette won't be known for another 30 years.. The NCI's Dr.,Gori says be hadI ex- pected the controversy and even wel, comes it. "If we can keep this idea alive," he:says, "we might be aFile to get the:public interested enough to demand less-bazardous cigarettes."