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• How do you know this wont make things even worse? (updated)
  Clive Bates
  Published on: 13 May 2016

• Published on: 13 May 2016

  How do you know this wont make things even worse? (updated)

  • Clive Bates, Personal contributor

  It's a relief to see the authors backing away from the previously advocated "remove-the-nicotine" approach to regulating cigarettes. This was a strategy that would surely have killed millions more as toxin-to-nicotine ratios worsened during a phase-out, while smokers continued to seek their established satisfactory nicotine dose. Making even dirtier delivery systems for nicotine was never the greatest public health idea, and no...

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  It's a relief to see the authors backing away from the previously advocated "remove-the-nicotine" approach to regulating cigarettes. This was a strategy that would surely have killed millions more as toxin-to-nicotine ratios worsened during a phase-out, while smokers continued to seek their established satisfactory nicotine dose. Making even dirtier delivery systems for nicotine was never the greatest public health idea, and now, thankfully, it has become a 'Prior Proposal'.

  But as the authors say, there is good reason to stop tobacco companies having a free hand to do whatever product engineering they like. They have been given a unique exemption from virtually every law and norm of consumer protection and product safety. It is entirely right to stop them making products much more attractive than they would otherwise be - ie. systematically narrow the terms of the broad exemption they have.

  But are there also dangers with the new proposal? If smoking is a behaviour based on seeking satisfaction from nicotine, isn't there a danger that reducing the addictiveness (ie. the pharmacological impact) will mean smokers seeking more nicotine for the same satisfaction? If more nicotine is required, then more toxins would be likely to be absorbed along with it, and so more harm caused.

  Is there any evidence that, over time, it has become harder to quit smoking because the products have been engineered to be more 'addictive'? (I realise this might be difficult to gather). Have temporary withdrawal symptoms become more severe over time? These are the real harms associated with the addictiveness itself (as opposed to the co-exposure to toxins), so I think we ought to know what the behavioural changes have been before advocating a regulatory change.

  Have all the strategies for subverting regulatory interventions available to smokers who are seeking a nicotine fix been considered...? Breaking off filters, switching to hand-rolled or cigars, compensatory smoking behaviour, bootlegging etc.

  I don't know the answers to these questions. But to me, they say "not so fast". An approach to harm reduction that reduces the potency of the drug delivery system must consider the behavioural responses to these modifications, and this seems to me to be even more complex and risky than a more straightforward harm reduction strategy focussed on reducing toxins (which is probably pointless for combustible tobacco anyway).

  Finally, is reducing addictiveness always right? If you could find a way to increase the addictiveness of medicinal nicotine or even smokeless tobacco, so that they compete better with cigarettes in nicotine delivery while doing orders of magnitude less harm, you may be able on to something that really would save millions of lives.

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  Conflict of Interest:
  None declared.

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