-
sponsorship
Can smokeless tobacco coax people away from cigarettes?
I've written several posts defending that possibility. But a new report from the National Survey on Drug Use on Health blows a huge spitball of chaw all over the idea. Here's the key paragraph from Smokeless Tobacco Use, Initiation, and Relationship to Cigarette Smoking: 2002 to 2007:
Combined 2004 to 2007 data indicate that, among persons who had used both smokeless tobacco and cigarettes in their lifetime, 31.8 percent started using smokeless tobacco first, 65.5 percent started using cigarettes first, and 2.7 percent initiated use of smokeless tobacco and cigarettes at about the same time ... Some initiates of smokeless tobacco use may be cigarette smokers who are substituting smokeless tobacco as a way to quit smoking. Among daily smokers who initiated smokeless tobacco use, 88.1 percent were still smoking daily 6 months later.
That's pretty damning. To begin with, smokeless tobacco seems to be luring people to cigarettes at nearly half the rate it's luring people from cigarettes. Not the world's greatest bargain. But the killer number is that 88 percent. If smokeless tobacco is just supplementing cigarettes instead of helping smokers quit, then it makes no sense as an avenue for improving public health.
Am I looking at the data the wrong way? Should I be more excited about the 12 percent who went smokeless and dumped the death sticks? Let me know.
I'm still open to alternative mechanisms for delivering nicotine and weaning people off smoking. But if the tobacco industry wants any slack in selling these products, it had better work on them until they show results in terms of smoking reduction. The fist of Big Brother is coming down on cigarettes all over the world. If you tobacco shareholders want a viable business model for the future, squeeze your company's executives harder to ditch the smoke and the carcinogens.
-
sponsorship
For the last two days, we've been talking about how to take the smoking out of nicotine. How about taking the nicotine out of smoking? Can it be done?
Actually, scientists are already beginning to do it. The latest report, by Kazufumi Yazaki and colleagues, appears in this week's Proceedings of the National Academy of Sciences. They identify a gene, Nt-JAT1, that controls nicotine distribution in tobacco plants. "We will proceed now with experiments to raise tobacco plants that have no nicotine in their leaves," Yazaki tells the Daily Telegraph.
Great. But wait a minute. What exactly will this accomplish?
"There are a lot of people who want to quit and have tried to stop, but say they miss the sensation of having a cigarette in their mouth," Yazaki argues. Tobacco modified to block or eliminate the key transporter gene could produce nicotine-free cigarettes. These would give you the smoke you crave without further addicting you to nicotine. Yazaki thinks this will help people quit.
Really? Low-tar, low-nicotine cigarettes have been around for a long time. Smokers are now suing tobacco companies for marketing these cigarettes as relatively safe. The suit says that to get the same nicotine fix from low-nicotine cigarettes, smokers "unconsciously engage in compensatory behaviors" such as smoking more sticks, inhaling more deeply, or delaying exhalation. So nicotine reduction doesn't end up reducing the damage. And remember, these cigarettes are low-nicotine and low-tar. A low-nicotine, regular-tar cigarette would, on this theory, cause even greater damage, since you'd have to inhale more carcinogens to get the same fix.
On the other hand, there's some evidence that smokers wouldn't compensate this way. And, as we discussed yesterday, nicotine replacement therapy operates on the principle that some addicts can gradually reduce their nicotine consumption till they're off the drug altogether. But nicotine replacement products don't just deliver the drug. They change the delivery system. They get rid of the cigarette.
That's where the nicotine-free tobacco project really breaks down. Yazaki's team thinks "it would also be good for nonsmokers if tobacco smoke did not contain nicotine." Well, maybe. But what really endangers and angers nonsmokers is the smoke, not the nicotine. If you just block the nicotine gene in tobacco plants, you aren't touching the delivery system or the carcinogens. Smokers are still smoking, the rest of us are still inhaling the smoke, and we're still getting sick. It's great that you're taking away the product's chemical addictiveness. But that's just another reason to ban smoking everywhere, as we're already doing. Smokers won't need it, and the rest of us can't stand it.
In short, nicotine-free cigarettes don't make sense as a business plan. Yazaki says that his research grant is about to run out and that he's thinking of asking Japan Tobacco to sponsor him. Good luck with that. Addiction is what makes tobacco such a profitable business. Eliminate the nicotine, and the pusher loses his grip on the "consumer." That's why tobacco companies are trying to do exactly the opposite: keep the nicotine while eliminating the cigarette.
Nicotine-free tobacco may end up doing the world a lot of good. But if so, that good won't come from cigarette production. It'll come from the use of tobacco plants to make medical products such as insulin and vaccines. Take out the nicotine, take out the carcinogens, and tobacco is a different animal—or, rather, a different plant—altogether. Put that in your pipe. And don't smoke it.
-
sponsorship
Yesterday we talked about the tobacco industry's escape from the anti-smoking movement. The escape relies on two factors: that tobacco can be engineered into new, smokeless forms, and that the core of the tobacco business is addiction, not cancer.
One way to defeat the industry is by using the same factors. You isolate tobacco's addictive ingredient, nicotine, and engineer it into new forms. But instead of engineering the dose to sustain addiction, you design it to gradually liberate the addict.
Case in point: Barack Obama. Last week in the Wall Street Journal, Melinda Beck advised him to break his cigarette habit by turning to alternative nicotine products.
Nicotine soothes the primitive fight-or-flight response while focusing attention, and it releases dopamine like a pleasurable reward. Nicotine withdrawal can make it harder to think, concentrate and remember, as well as causing irritability, impulsiveness and aggressiveness. ... Nicotine-replacement therapy—with gum, lozenges, a patch or an inhaler—can alleviate those withdrawal symptoms, provided you're getting enough. You've been chewing nicotine gum for months now, but researchers have found that some smokers need more nicotine replacement than others to stop their cravings.
Nicotine alone is better than any tobacco product with residual carcinogens. As Beck points out: "Overdosing on nicotine replacement can make you feel nauseous and light headed and raise your heart rate, but it doesn't appear to cause cancer; it's the tar and various additives in tobacco that do that."
Does nicotine replacement work? Sometimes yes, sometimes no. A study of 3,300 smokers, published in the February issue of the American Journal of Preventive Medicine, found that quitting rates were low but that nicotine gum helped significantly. The study was double blind, randomized, and placebo-controlled.
Subjects were instructed to gradually reduce their smoking while increasing their gum use over the course of up to 8 weeks. Once they had achieved initial abstinence (no smoking for 24 hours), gum was to be used in accordance with the current FDA-approved directions for cessation. The study was conducted under over-the-counter conditions, with no counseling provided.
The results:
Though most study participants failed to quit completely, those who used the nicotine gum were more successful—with 26 percent achieving total abstinence within eight weeks of treatment, compared with 18 percent in the placebo group. Among those quitters, nicotine-gum users were more than twice as likely to stay continuously abstinent for a month afterward—10 percent, versus 4 percent of those in the placebo group. ... Six percent of nicotine-gum users were continuously abstinent for six months, while the same was true of 2 percent of smokers in the placebo group.
Guess who funded the study? GlaxoSmithKline. Why? Because it engineers and sells nicotine replacement products. This is the drug war of the future: the addiction industry vs. the pharmaceutical industry. Both sides sell drugs. Both design their drugs to work with the physiology of addiction. If we're lucky and the tobacco industry continues to move away from cigarettes, the nicotine war won't be about cancer anymore. It'll be about liberation from addiction.
-
sponsorship
The war on tobacco is advancing. Smoking is losing. But tobacco is escaping.
How? Look at two articles published yesterday. A front-page story in the New York Times examined a new smoking ban in Belmont, Calif., which forbids lighting up even in your own apartment. The rationale: Smoke from your apartment drifts into your neighbors'. Studies have shown that secondhand smoke harms others. Science is dissolving the distinction between your space and mine.
So tobacco is doomed, right?
Wrong. Smoking may be doomed, but tobacco is evolving into more elusive prey. Or, perhaps I should say, a more elusive predator. As Kevin Helliker reports in the Wall Street Journal, the industry is going smokeless.
Altria Group Inc., the nation's largest cigarette maker, this month completed its $10.3 billion purchase of UST Inc., the biggest smokeless-tobacco maker and owner of the Copenhagen and Skoal brands. Reynolds American Inc., which owns Conwood Co., a discount smokeless purveyor, this month announced that the Camel Snus brand has performed well enough in test markets to warrant national distribution.
Consumers—heck, let's just call them what they are, addicts—seem to be going with the transition. According to Helliker:
[M]ore Americans are continuing to give up smoking, helping to push cigarette consumption down about 3% each year. ... Morgan Stanley estimates that U.S. consumers spent $4.77 billion on smokeless tobacco in 2007 versus $78 billion on cigarettes. Smokeless-tobacco sales have been increasing about 5% or more a year. ... "There are probably in excess of 400,000 adults switching to smokeless each year," says Seth Moskowitz, a spokesman for Reynolds American.
Two months ago, I called smokeless tobacco "carcinogenic, addictive, and gross." But guess what? It's becoming less gross:
For many people, smokeless tobacco conjures up an image of a wad of chewing tobacco bulging from the cheeks of users who spit brown juice. Instead, recent products consist of dissolvable pellets or tiny pouches of tobacco that reside invisibly in the mouth and induce no spitting.
And it's becoming less carcinogenic:
One recent study showed that some newer brands, with names like Ariva, Camel Snus and Marlboro Snus, have sharply lower levels of a dangerous carcinogen than do older varieties of smokeless tobacco, such as Copenhagen and Skoal. Britain's Royal College of Physicians, which sets health standards in the United Kingdom, has said smokeless tobacco is between one-tenth and one-one thousandth as hazardous as smoking, depending on the specific product.
So now we're down to addictiveness. And that, too, is adjustable:
The December study also found that Marlboro Snus contained a very low level of nicotine. By contrast, Camel Snus offers a jolt of nicotine that "has the potential to satisfy those smokers who are looking for a substitute to smoking, and to keep them addicted to this product," the authors said.
Which leaves us with two very tough questions. First, does society have any business restricting tobacco products purely on grounds of addiction? New regulations in Boston protect "the younger population" by forbidding the sale, at colleges and professional schools, of "any substance containing tobacco leaf, including but not limited to cigarettes, cigars, pipe, tobacco, snuff, chewing tobacco and dipping tobacco." Does that make sense, even when the products are dissolvable pellets increasingly purged of carcinogens? And if addiction per se is evil, what about caffeine?
Second, should we even want to purge the nicotine from tobacco? The aforementioned study (which, according to Helliker, was federally funded and performed by scientists with no financial connections to the tobacco industry) implies, sensibly, that the less nicotine you put in a smokeless product, the less likely it is to "satisfy" nicotine addicts and lure them away from cigarettes. We permit and even encourage the use of nicotine gum and lozenges to wean people from smoking. What exactly is the moral difference between a lozenge and a pellet?
Tobacco is evolving and escaping for two fundamental reasons. One is that it can be engineered into new forms. The other is that the problem targeted by legislation—the weed's tendency to cause cancer—isn't essential to the tobacco business. What's essential to the tobacco business is addiction. Addiction is a nasty business, deliberately enslaving people while pretending that they "choose" the product. But if you're going to target that practice, then you'd better come and take all the coffee and Diet Coke from Slate's Washington office. We have some "younger" folks here.
Slate V's Grand Unified Weekly: A NASA scientist's dire warnings, prenatal screening for autism, and measuring virtual gravity
-
sponsorship
Be careful how you justify a war on drugs. Drugs can be modified so that your arguments no longer apply.
That's what the anti-tobacco movement is now learning. In state after state and country after country, smoking has been banned in public places: bars, restaurants, even apartment buildings. Everywhere, the rallying cry for these measures is that other people have a right not to breathe your smoke. Smoking is harmful to them, so you have to stop.
Except now you don't have to. You can keep using tobacco, but in a way that doesn't get into other people's eyes, throats, and lungs. The Associated Press reports:
[T]he folks who created Joe Camel are hoping Camel Snus will become a hit with tobacco lovers tired of being forced outside for a smoke. ... Snus—Swedish for tobacco, rhymes with "noose—is a tiny, tea bag-like pouch of steam-pasteurized, smokeless tobacco to tuck between the cheek and gum. Aromatic to the user and undetectable to anyone else, it promises a hit of nicotine without the messy spitting associated with chewing tobacco. ... With more public bans on puffing, [tobacco companies] say smokers need socially acceptable alternatives. ... "There's no secondhand smoke. There's no spitting. We see it as a win-win," says [an R.J.] Reynolds spokesman.
Undetectable to anyone else. No secondhand smoke. There goes your rationale for ordering people to stop using tobacco. "At least two tobacco companies besides Reynolds are also test-marketing snus," says the AP. What are you going to about it? What can you say?
In the AP article, public health advocates try to make a case against snus. It's "a second addiction," they argue. It can cause cancers of the mouth and pancreas. It's just an industry scheme to find "replacement smokers" for the millions of customers its death sticks have killed.
Well, good luck with those arguments. Of course snus is addictive, but that alone isn't sufficient grounds for banning things. As for its health effects, even the top scientist at the American Cancer Society tells AP, "If all smokers switched to snus tomorrow, in a few years we'd certainly see less heart disease, less lung disease and fewer cancers." And why exactly should we be upset if the tobacco industry has figured out a way to keep itself alive by keeping its customers alive?
I'm not endorsing snus. It's carcinogenic, addictive, and gross. I'm just not sure those are good reasons for restricting it the way we've restricted cigarettes. And I say this as a lockstep fascist for laws against smoking in public. If you aren't smoking—if you're just sucking, or whatever it is—I don't really see what basis I have for making you take your bad habit elsewhere.
If, on the other hand, you're a nonsmoker who's aggressive enough to wage a cigarette-like war on snus, where will you stop? Do you imagine that tobacco and its core product, nicotine, won't be engineered into new forms? Already, AP reports that Reynolds is "developing dissolvable tobacco strips, orbs and sticks that it will start test-marketing early next year in Portland, Indianapolis and Columbus, Ohio." Are you going to ban strips and orbs?
Look, I'm no fan of drugs. I don't even drink coffee. My advice is to stay away from all tobacco products. But if you choose a tobacco product that basically leaves me alone, I'll show you the same courtesy.