More Smoke From the Tobacco Industry

February 8, 2007

Commentary By: Elizabeth Ross, PGY-3

Cigarette manufacturers have been steadily increasing the nicotine content in cigarettes over the last 7 years.  The news broke in August of this year when the Massachusetts Department of Public Health discovered that the level of nicotine that smokers typically consume per cigarette had risen about 10 percent.

The Harvard School of Public Health recently re-analyzed the data with the goal of ascertaining how the tobacco industry managed the increase in nicotine content.  The investigators found that not only was the concentration of nicotine in the tobacco increased but also that the design of the cigarettes was altered so that there would be an increase in the number of puffs per cigarette.  They also sought to determine if there was any difference in the nicotine content across the different market categories.

The study found the three most popular cigarette brands with young smokers – Marlboro, Newport and Camel – delivered significantly more nicotine than they did six years ago.  Also, nicotine levels were shown to increase regardless of whether the cigarettes were labeled regular, light, ultra-light or menthol. Ninety two of 116 brands tested had higher nicotine content when comparing the level from 2004 to 1998, and  52 of those brands had increases of more than 10 percent.

The effect of more nicotine is unclear.  Some experts believe that though the increase may not make smokers consume more cigarettes, it may make it more difficult to quit and perhaps make new smokers more easily addicted.  In fact, it has been shown that smokers compensate for changes in nicotine level to get a relatively constant nicotine dose so more nicotine may lead one to smoke fewer cigarettes and thereby inhale less tar and other carcinogenic pollutants that are found in cigarettes.

Whether or not more nicotine may actually be less detrimental to the public's health, the fact is that tobacco companies still lie about it.

There is no regulation over nicotine content or cigarette design.  Only three states require tobacco companies to submit information about nicotine testing.  Currently, the FDA has little regulatory control over the tobacco industry and many public health groups are lobbying for there to be more, especially Campaign for Tobacco-Free Kids.  However, no proposed bills call for the complete removal of nicotine.

Does this mean we as doctors need to increase the dose of nicotine supplements when trying to help our patients quit?
I believe there should be legislation requiring tobacco companies to disclose information about nicotine content and product design and the only way to do this is to grant the F.D.A. the authority to regulate the tobacco industry.  Also, the only way to truly deal with the addictive effects of nicotine and to take the power out of the tobacco industry's hands is to remove nicotine from cigarettes entirely.


Harvard School of Public Health Press Release

Full Report

NYTimes, 1/28/07

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