Originally posted at Science Progress

What are they Smoking
We Need the FDA to Regulate the Tobacco Industry
by Michael Stebbins, Ph.D.

I recently learned that that a friend of mine has been driving his father several times a week to treatment for his smoking-related cancer, and yet there is a Marlboro Light balanced in my left hand as I type this. I hate cigarettes, and after 16 years of addiction to nicotine and countless attempts at quitting, I believe it is time for me to take drastic measures (more on that at the end of this piece).

I didn’t start writing this column about my friend’s father’s cancer or my addiction. I set out to write about legislation that could finally bring parasitic tobacco companies under the control of the Food and Drug Administration and the astonishingly shortsighted opposition to placing basic health and safety regulations on products that have been proven dangerous.

Currently the FDA can regulate my mouthwash, but not the cigarettes that made my breath stink.

In 1996, the FDA actually tried to assert regulatory power over tobacco products, but the tobacco companies fought back and ultimately the Supreme Court unanimously ruled in 2001 that Congress had not granted the FDA the power to do so. Enter the Family Smoking Prevention and Tobacco Control Act, introduced last year by Senators Edward Kennedy (D-MA) and John Cornyn (R-TX) in the Senate, and Congressmen Henry Waxman (D-CA) and Thomas Davis (R-VA) in the House. The bill would reinstate the 1996 rule and expand the FDA’s power to restrict the marketing of cigarettes, to children in particular.

A superficial glance at the bill reveals that it fails the logic test by requiring an agency charged with protecting the health of Americans with regulating a deadly product without the authority to ban it outright. But the alternative, of leaving Big Tobacco to freely manipulate their product to keep me and the rest of my stinky-fingered brethren addicted, is unacceptable.

Indeed, a 2007 study by the Harvard School of Public Health¹ confirmed a previous study by the Massachusetts Department of Public Health showing cigarette companies deliberately increased the amount of nicotine in the average cigarette by 11.6 percent between 1997 and 2005. So during the time period that I and many other Americans were trying to quit smoking, Big Tobacco was bumping up nicotine levels to make it even more challenging.

Since cigarette ingredients are unregulated, they were neither required to seek approval before increasing the amount of an addictive chemical nor to inform their customers. That’s the kind of regulatory oversight the FDA could bring to this drug-peddling industry.

Cigarettes are unregulated drug delivery systems.

It’s common knowledge that cigarettes are far more than dried tobacco leaves, and that the companies that produce them have misled the public for years. But somehow we don’t think of cigarettes as highly engineered nicotine delivery systems. It is the nicotine-induced blast of dopamine and other neurotransmitters that keeps me coming back for more, so, naturally, improving the drug delivery mechanism will increase addiction. And that is the key. Cigarettes are unregulated drug delivery systems.

A recent report by several respected health organizations, including the American Heart Association and the American Lung Association, details many of the clever advances that make the modern cigarette an engineering marvel. Case in point: Philip Morris, which manufactures my brand of cigarettes, discovered that adding ammonia-based compounds to cigarettes increased the absorption of nicotine. That’s the same principle as crack cocaine. Genius!

The addition of ventilation holes in the filter paper is another brilliant bit of engineering designed to dilute the smoke so the machines that test for tar levels register lower amounts, and the cigarettes can be marketed as “light.” The problem is, smokers functionally draw on cigarettes differently than the machines to maintain nicotine levels, and there is no net health benefit, just smooth smoky goodness². The best part about these companies is that they continue to innovate. A recent Wall Street Journal article detailed the many wonderful products that Phillip Morris has developed, including a high-tar, high-nicotine cigarette and shorter cigarettes for those who just need a quick fix³.

Fear Itself
Like cigarettes marketed to minorities and children, opposition to the FDA regulating tobacco comes in a variety of flavors. Dr. Andrew von Eschenbach, the Commissioner of the FDA, told the Associated Press last year that the FDA “approve(s) products that enhance health, not destroy it,” and that if regulated the FDA could unintentionally make a decision on cigarettes that could make “the public health radically worse.” In a Senate hearing last year, von Eschenbach also expressed concern that “the public will believe that products ‘approved’ by the Agency are safe and that this will actually encourage individuals to smoke more rather than less.”

Yet the bill now in Congress does not mean the FDA will be approving cigarettes. And the public, while foolish enough to start smoking, is not so foolish as to believe that smoking is okay because the FDA regulates it.

The fear that the FDA could make things worse scares the hell out of me. Are we to believe that the FDA is incapable of making rational decisions about cigarettes, but rational ones about all other consumer products they regulate? It is also irrational to think that forcing companies to lower the amount of nicotine in cigarettes or to remove the ammonia compounds that help deliver it to the brain faster could cause people to smoke more cigarettes, especially in light of a study by the National Cancer Institute that found that gradually lowering the level of nicotine in cigarettes does not cause smokers to smoke more or inhale more.

Senator Mike Enzi (R-WY) is perhaps the most outspoken opponent of the bill in Congress, and along with eight Republican colleagues on the Senate Health Education Labor and Pensions Committee, he voted against it. Enzi has referred to the bill as a “public health disaster” because it does not allow the FDA to kill the tobacco industry completely.

He also claims that the bill is a peace offering to Big Tobacco because Philip Morris has expressed support. But the support by one of the biggest offenders is not an indication that the bill is a public health disaster and does not preclude passing additional laws that aim directly at stopping people from smoking or putting Big Tobacco out of business.

To that end, Enzi introduced the Help End Addiction to Lethal Tobacco Habits Act, which he touts as an alternative to having the FDA regulate tobacco. At its heart, the bill is a kind of cap-and-trade program that allows companies to divest from the tobacco industry over a period of 20 years. Keep in mind that Enzi’s bill is not mutually exclusive from the Kennedy-Cornyn, Waxman-Davis Family Smoking Prevention and Tobacco Control Act, which has 55 cosponsors and has passed the Senate twice before—virtually guaranteeing that it will pass when brought to a vote.

This brings up the second and perhaps more important point regarding Enzi’s alternative bill; he has failed to convince a single Senator that it is worthwhile enough to co-sponsor.

The Family Smoking Prevention and Tobacco Control Act will be considered by the House Energy and Commerce Subcommittee on Health this week, and the full committee is likely to consider it in the next couple of weeks. But ranking subcommittee member Joe Barton (R-TX) now claims that part of the bill might be out of their jurisdiction because the user fees charged to tobacco companies are adjusted for inflation over time and thus, in his view, constitute a new tax. The House parliamentarian will surly resolve this minor jurisdictional issue before next week. Then we may hear much of the same hollow and often embarrassing opposition from many in congress, including Rep. Steve Buyer (R-IN), who invoked the slippery slope argument at a House hearing on the bill last fall, stating “What are we going to do? Outlaw Halloween, Valentines day, the Easer bunny?…That gets pretty ridiculous when you think about all that.” I have and it is.

What is clear is that this brand of specious opposition will be far less decisive than the over 600 public advocacy groups that support it. With over 430,000 Americans dying of tobacco-related deaths each year, one would suppose that in most districts, more constituents have died from cigarettes over the years than would oppose the bill today.

I hate the fact that I am at the mercy of a tobacco company that has engineered their product to keep me addicted. And I hate the fact that my friend has to bring his father to chemotherapy because of cigarettes. But the fact that cowardice has prevented our government from protecting us from such manipulation makes me physically queasy.

Sen. Enzi is correct—having the FDA regulate tobacco will not get rid of cigarettes. But it sure will make it a lot harder for more dangerous products in development and currently sold abroad to make it to the United States. And if Big Tobacco has to stop developing their products for and advertising them to children, then please explain to me again how this bill is worse for us than a pack of Luckys.

Smoke-by-numbers
An estimated 20.8 percent of all adults (45.3 million people) smoke cigarettes in the United States.

In the United States, cigarette smoking is responsible for about one in five deaths annually, or about 438,000 deaths per year; on average, these people die 13 years younger than non-smokers.

For every person who dies of a smoking-related disease, 20 more people suffer with at least one serious illness from smoking.

Annually, cigarette smoking costs more than $167 billion, based on lost productivity ($92 billion) and health care expenditures ($75.5 billion).

In 2005, the latest year with available data, the cigarette industry spent almost $13.11 billion, or more than $36 million per day, on advertising and promotional expenses.

Each day in the United States, approximately 4,000 people between the ages of 12 and 17 years initiate cigarette smoking.

In the United States, 23 percent of high school students are current cigarette smokers.

Among adult smokers, 70 percent report that they want to quit completely, and more than 40 percent try to quit each year.

Michael Stebbins is the Director of Biology Policy for the Federation of American Scientists, President of the SEA Action Fund and author of Sex, Drugs and DNA: Science’s Taboos Confronted. He quit smoking as of the publication of this piece and will donate $1000 to the American Heart Association for every cigarette he smokes from now until the end of the year. You can track his progress at SexDrugsandDNA.com.

Notes

[1] Connolly, GN, et al., Trends in Smoke Nicotine Yield and Relationship to Design Characteristics Among Popular U.S. Cigarette Brands, 1997-2005, A Report of the Tobacco Research Program Division of Public Health Practice, Harvard School of Public Health, January 2007.

[2] National Institutes of Health, Risks Associated with Smoking Cigarettes with Low Machine-Yields of Tar and Nicotine; Report of the NCI Expert Committee, National Cancer Institute, Smoking and Tobacco Control Monograph 13, October 2001.

[3] “Philip Morris Readies Aggressive Global Push,” The Wall Street Journal, January 29, 2008.