Doctors call for nicotine in cigarettes to be reduced

British and American doctors have called on their governments to reduce nicotine in cigarettes to non-addictive levels. At the same time the leaders of seven health organisations in the United Kingdom have asked for an overhaul of the current arrangements for testing and regulating the tar, nicotine, and addictive agents in cigarettes.

A report from the American Medical Association's council on scientific affairs in the latest issue of Tobacco Control(1998;7:281-93) recommends that the addictiveness of cigarettes should be reduced within five to 10 years; there should be more research on producing less addictive cigarettes; tobacco products should be labelled more accurately, with a clearer indication of nicotine content; the monitoring of trends in the use of tobacco and other products containing nicotine should be stepped up; and access to smoking cessation treatments should be expanded.

The past chairman of the American Medical Association's scientific council and editor of Tobacco Control, Dr Ronald Davis, told a press conference organised by the BMA, which is supporting the report's recommendations, that although the “landmark report in public health” was aimed at United States agencies, the recommendations applied equally to Britain. Until now, he said, public health efforts had focused on policies to discourage tobacco use by raising taxes, reducing advertising, creating smoke free zones, and by education, school programmes, and smoking cessation treatments. The new report calls for “a new strategy–a strategy that focuses on the product itself.” Dr Davis said, “If our two governments heed the advice to take action to reduce the addictiveness of tobacco products the impact would be felt worldwide. Millions of lives could be saved.”

The report concludes that eliminating nicotine is feasible–Philip Morris proved that with its product “Next”–and that a nicotine reduction strategy would help to prevent addiction among adolescents and help people to give up smoking. The problems of compensatory “oversmoking” and possible black market sales could be avoided by providing alternative forms of nicotine delivery with little or less risk to health. These include nicotine gum, patches, oral inhalers, and nasal sprays. The regulations for these are much tighter than those governing cigarettes.

In a joint letter to Britain's minister for public health, the leaders of the Royal College of Physicians, the British Heart Foundation, the Cancer Research Campaign, the Imperial Cancer Research Fund, the Health Education Authority, the BMA, and Action on Smoking and Health (ASH) point out that there are minimal controls over additives, such as ammonia and flavouring and burning enhancers, and they want these banned or subject to tests. They say that the tar and nicotine yields measured by machines are misleading and should be abandoned as a basis for labelling and regulation. The letter points out that most evidence shows little or no health benefit to the claims of low tar, light, or mild cigarettes and the branding should be banned.

Asked what the reaction of the tobacco companies would be to the report, the director of ASH, Mr Clive Bates, said that publicly most companies still denied that nicotine was addictive, maintaining that it was important for taste or flavour.

At another joint press conference the BMA, ASH, and the World Development Movement have this week urged the British prime minister to include a commitment in the forthcoming tobacco white paper to tough international controls on tobacco marketing to stop companies using aggressive tactics to target women and children in the developing world (see p 1264).