FDA goes after cigarettes’ nicotine
In July, the U.S. Food and Drug Administration (FDA) announced a road map to reduce tobacco and tobacco-related disease.
Nicotine, the addictive chemical in cigarettes, is at the heart of this plan.
“Lowering nicotine levels could decrease the likelihood that future generations become addicted to cigarettes and allow more currently addicted smokers to quit,” the statement read.
In a 2015 multisite study published in the New England Journal of Medicine, Tidey and her colleagues found that people who were given low-nicotine cigarettes for six weeks cut back on how many cigarettes they smoked each day.
They were also more likely to try to quit smoking. These were all people who said at the beginning of the study that they had no intention of quitting.
Reducing the nicotine levels may also keep people from becoming addicted to nicotine in the first place, especially among teens experimenting with cigarettes.
The FDA reports that almost 90 percent of adult smokers picked up the habit before the age of 18.
“We don’t know what the tobacco companies might do to try to get around nicotine reduction. They might increase other components of cigarettes to try to get teens hooked on cigarettes,” said Tidey. The FDA doesn’t have a specific timeline yet for when nicotine levels will be reduced. “We’re excited about the FDA’s announcement. But we wish the time frame was a little clearer,” Robin Koval, CEO of nonprofit Truth Initiative, told Healthline.
Koval is also concerned that the FDA has delayed regulating cigars, pipe tobacco, and hookah tobacco until 2021, and electronic cigarettes until the year after.
“If these products are not fully regulated until 2022,” said Koval, “that’s a full generation of young people who will grow up with these products — which we know appeal to them — not being fully and well-regulated.”
Can Big Tobacco really be anti-smoking?
Earlier this month, Philip Morris International Inc. pledged $80 million a year over 12 years to set up a foundation aimed at reducing the smoking of traditional cigarettes.
The Foundation for a Smoke-Free World would fund research, evaluate which cigarette alternatives help people give up cigarettes, monitor progress toward smoking reductions, and help prepare tobacco farmers for reduced demand.
The irony of a company that sells cigarettes creating a foundation to end cigarette smoking isn’t lost on many experts. “There’s deep skepticism among tobacco control experts and tobacco researchers about this new initiative,” said Tidey. “Tobacco companies are definitely driven by a profit motive. And they have a long track record of deception and lies in order to sell this product.”
Koval said it feels like a “contradiction in terms, for tobacco companies to advocate for a smoke-free world, while they’re aggressively promoting with billions of dollars a year their combustible products that kill half their users. All while actively opposing the efforts of the tobacco control community at every opportunity.”
Stanton Glantz, PhD, professor of medicine and director of the University of California San Francisco’s Center for Tobacco Control Research and Education, estimated that Philip Morris’ contribution to the new foundation amounts to only 0.1 percent of the company’s revenues and 1 percent of its profits.
Some health experts are concerned that tobacco companies will find new products to replace dwindling cigarette profits. According to Bloomberg, 3 million smokers have already switched to Philip Morris’ IQOS device, which heats rather than burns tobacco.
The company has applied for FDA approval to market the device as a way for people to reduce their risk of smoking-related diseases.
There’s some truth to this. But it’s a question of which is worse — inhaling lots of toxic chemicals, or just some. According to the National Cancer Institute, tobacco smoke contains more than 7,000 chemicals. At least 250 of them are known to be harmful. Philip Morris markets the IQOS device as containing fewer toxins — giving users the taste of tobacco without cigarette smoke or ash.
However, tests done by independent researchers found that IQOS smoke still contained harmful chemicals, although at lower levels than found in cigarette smoke. Some also question whether IQOS will actually help people quit smoking, or just become a new source of nicotine for current smokers and new users.
“We don’t know long-term whether these products will be meaningful in helping smokers — who have been unable or unwilling to quit for other reasons — to actually quit,” said Koval. “Or how many younger people they may trap.”
She’s also concerned that the Marlboro-branded heat sticks used in IQOS are just another way to keep the brand alive. “This creates potential new avenues to advertise the Marlboro brand,” said Koval. “And also to elevate the brand name and put it in places where it maybe has not previously been allowed to be.”
Will we see a smoke-free generation?
According to the Centers for Disease Control and Prevention (CDC), cigarette smoking rates among American adults have fallen steadily over the past 50 years — from 42 percent in 1965 to 16 percent in 2014.
After rising in the early 1990s, smoking rates among high school students fell from a high of 36 percent in 1997 to 15 percent in 2013.
“I think there is great progress that has been made,” said Koval, pointing to efforts like public education campaigns, cigarette taxes, and clean air laws.
However, “that progress could happen even faster if the industry stopped opposing things that we actually know work,” she added.
Not all groups in the United States have seen such dramatic declines in smoking rates.
Researchers estimate that people with mental illness consume almost half of all cigarettes smoked in the United States. They’re also less likely to quit smoking than people without a mental illness.
There are many reasons this group is still burdened by tobacco.
“They aren’t offered treatments. There are more barriers for them getting treatments. And they don’t seem to succeed with things that are easily available, like quit lines or going cold turkey,” said Tidey.
There’ve also been concerns that a person’s mental illness symptoms will worsen if they try to quit smoking. However, research shows that this isn’t true.
For people who have trouble quitting smoking, alternatives to traditional cigarettes may be an important stepping-stone.
“This is a harm-reduction approach,” said Tidey, “trying to get people off the combusted products by making them less addictive, and then shifting people to a safer product. Then down the line, trying to get them to give up that alternative product.”
As for whether we’ll achieve a smoke-free generation, Tidey said, “I’m very hopeful, but I’m not holding my breath.”
There’s one change, though, that might get us there much sooner.
“If Philip Morris and other tobacco companies want a smoke-free world, it’s in their power to create that tomorrow,” Koval said. “Just stop selling combustible cigarettes and we’d be there.”