https://www.asam.org/resources/publications/asam-weekly/asam-weekly-editorial-comment

February 6, 2018

Tobacco Lite

While Native Meso-Americans have been credited with the cultivation and use of tobacco for over two millennia, the middle of the 16th century saw the European popularization of its use. Until this past century, those who have marketed it have been able to emphasize its supposedly beneficial attributes, whether stimulation or relaxation. It has probably helped the successful marketing of tobacco, whether inhaled or chewed, that the average lifespan of man through most of its history has been under 40 years of age. This would certainly have obfuscated, or even altogether prevented the appearance of any bad consequences amongst its users. Nonetheless, by the 19th century, offers to cure nicotine-dependent individuals of “tobacco-ism” had proliferated, with treatment centers such as the Healy Institute even requiring abstinence from tobacco use as a condition for treatment of alcoholism or opioid addiction. While pharmacotherapy may be somewhat more rational now, it certainly had strong advocates throughout the past two centuries. The economic return on tobacco distribution was enormous, even considering the profound populational morbidity, and it is easily understood why: the principal impact on the working population would not be seen until they had reached  the conclusion of their useful life spans. Consequently, most experimental manipulations of tobacco or nicotine-delivery systems have focused on comfort, rather than on safety. And while historical efforts to manage the irritation caused by combusted tobacco have ranged from long cigarette-holders and pipe stems, to filter mentholation, to the hookah or water-pipe, there is no current pretense that any one of these delivery systems reduces the smoke’s toxicity.

This week’s lead article from the lay press describes cigarette manufacturer Phillip Morris’s testimony to the Food and Drug Administration, seeking support for a device that heats but does not fully combust tobacco, ostensibly placing it in a risk category somewhere between the nicotine-vaporizing devices and ignitable, smoke-producing tobacco. In defense of the Food and Drug Administration, their task is to identify risks to public safety; and nicotine products are not regulated as drugs per se. The majority response of the panel investigating the request was soundly critical of the new device.

The company’s description of the product as reducing the risk of tobacco-related disease is an invitation to spectacular sarcasm. It begs a competition for analogies, which prove easy to find: reducing the number of bullets chambered in a revolver prior to a game of Russian roulette is one possibility. The most recent potential simile was the National Football League’s creation of a graded scale for return to play based on the severity of a concussion. Perhaps no analogy serves quite so well as the FDA’s own intention, noted in the article, of progressively lowering the nicotine content of cigarettes so as to produce a type of national “weaning;” a practice, which any dedicated cigarette-smoker will tell you, leads to buying more cigarettes in order to get the same fix. One possible consequence would seem to be a rise in the tobacco companies’ revenues.

Comment;

Big tobacco’s latest scam!

Dr. Raymond Oenbrink
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