RRCs: A SOLUTION FOR A VIRTUAL SLAUGHTER

FORCES International is a global organization with no direct or indirect funding or connections with the tobacco or pharmaceutical industries. It is funded with private donations, membership, and volunteer work. Its constituency consists of smokers and non-smokers who have the common goal of a lifestyle free from state and institutions' interference, and it includes doctors, scientists, writers, economists, researchers, politicians, lawyers, other professionals, as well as lay people from many nations. While it is Libertarian in tendency, FORCES is politically non-partisan, and unaffiliated with any political party. It is solely concerned with liberty, intellectual honesty and the integrity of science, and it is against the use of science as a tool for the control of politics, policies, customs and cultures, economics, and behaviour. Further information about FORCES International can be found at its international  website, www.forces.org.

Introduction The historical context The problem and the responsibilities The solutions Footnotes and bibliography

PDF Version of this article ©  Copyright information / Requests for reprint Consult scientific archives Main site of FORCES International

Introduction

We endlessly hear that smoking kills and that we should quit. We also hear that smoking is addictive to the point that quitting smoking is an almost desperate attempt. Finally, we are bombarded by chilling statistics: five million deaths a year in the world, which will become 10 million or so in 2025 ^[1] because, in spite of all antismoking campaigns, the number of smokers continues to rise.

This short analysis does not intend to examine the effectiveness of antismoking campaigns which, although health authorities keep calling for more of them, seem to be a failure, nor does it intend to examine the arguable methodology used to compute the number of deaths. Those numbers are simply indemonstrable considering the limitations of epidemiology which, by definition, cannot establish causation. Actually, the number of diseases, deaths and social costs are indemonstrable since there is a huge number of factors that can confound the attribution to smoking, and also because of the ignorance of medicine about the precise causes of diseases such as cancer in general, lung cancer in particular, cardiovascular diseases and so on.

Inhaled cigarette smoke contains toxic substances that can harm health. However, given their relatively minuscule presence, to what extent specific substances are actually harmful is a question that science still has to solve. With these premises we shall proceed with the hypothesis that what the propaganda claims is credible.

The historical context

The statistical association between smoking and lung cancer emerged at first in epidemiological studies conduced in Nazi Germany. ^[2] Germany was the first country to impose smoking prohibition in public places with laws and rhetoric that are undistinguishable from those of today. ^[3] Right after the war, other epidemiologists continued the work of statistical association that was started in Germany, and the first results emerged in the USA and in England at the beginning of the 1950s, first thanks to Ernst Wynder and then Richard Doll. ^[4] In 1964, the US Surgeon General officially presented its first report on the statistical correlation between smoking and cancer, ^[5] highlighting that the Report was unable to sanction that causality was scientifically established – a reality that still persists today. Furthermore, the Report made a very important observation, that is, for lung cancer – or for any other disease that is statistically associated with cigarette smoking – the risk seemed proportional to the quantity of smoked cigarettes and, consequently, to the amount of smoke inhaled.

Even neglecting the exaggerations of propaganda, it should be intuitive that those who smoke the equivalent of forty cigarettes a day are at a risk twice that of those who smoke twenty, that they are in turn at risk twice of those who smoke ten and so on – and by “cigarette” here we mean the conventional cigarette that everyone knows. We also must consider that, under a certain threshold (that can be defined as the ability of the body to efficiently get rid of toxics without the phenomena of accumulation and related damage), a minimum quantity of smoke would have very little relevance from the toxicological point of view. It would therefore be licit to conclude that abstention does not mean zero risk and that, below a certain dosage threshold, it should be possible to smoke and have essentially the same results of abstention.

This was the basis upon which the concept of “light” cigarettes came about – cigarettes that could yield a reduced dosage. This concept was responsible for the creation of an extensive research program for less hazardous cigarettes. The research was done with the official cooperation of the US National Cancer Institute and the National Heart Institute, as well as the tobacco industry. ^[6] By the end of the 1970s the scientific and practical elements for Reduced Risk Cigarettes (RRC) – a product of the cooperation between the tobacco industry and public health institutions – had been defined in the research phase, and cigarettes had been developed and were ready for the final phase of production. The fundamental principle was – and still is – that RRCs would have produced smoke with a relatively higher quantity of nicotine and a smaller proportion of other components, through several improvements such as a smaller quantity of tobacco, and the addition of nicotine, filters, techniques to dilute the smoke, and more.

In fact, the research determined that tobacco combustion indeed creates harmful substances but, at the same time, that nicotine not only is harmless but it is also useful to smokers’ functionality, behaviour and pleasure. Furthermore, the research found that inhaled nicotine quickly saturates the smoker’s demand, creating a feeling of satisfaction that prevents the smoker from inhaling more. If more was inhaled a sense of nausea would result, preventing enjoyment. In other words, the amount of smoking is reduced in relation to a greater concentration of nicotine in the smoke.

Hence the concept that the risk reduction of an RRS is a function of the tar to nicotine ratio of the smoke – and could be measured by that criteria. For example, if cigarettes produced smoke with twice the concentration of nicotine, the smoker would inhale half of the smoke volume and thus half of the harmful substances. By progressively reducing the tar/nicotine ratio, the volume of inhaled smoke would be decreased, thus decreasing the risk. Considering that nicotine was, and still is, the key reason why smokers smoke cigarettes, it was further speculated that by increasing nicotine in smoke and by modifying tobacco, alongside with creating a parallel change in taste in the market (induced with massive advertising approved by health authorities), the dosage would have been reduced without taking away the pleasure of smoking.

From the description to this point, one can imagine the enthusiasm that surrounded the possibility of producing RRCs that would be enjoyed by smokers. If, in fact, the far-fetched mortality and disease figures were real, even just halving them would have been a tremendous gain. A plan for marketing and gradual introduction was sketched: the tobacco industry and public health would have cooperated to promote a cigarette based on risk reduction through a technologically sophisticated product. That was quite conceivable; after all, this is what happens to all industrial products, from automobiles to appliances.

But, one dark day, it all came to an end. The RRC concept disappeared completely, together with the programme and the finances for its development. The research groups were dismantled. The official health policy changed suddenly and the approach became abolitionist. The tobacco industry castled on defensive positions. In a few months, the official organs of public health transformed themselves into the antismoking industry we know today. What happened?

First of all, one must keep in mind the prohibitionist component of American culture, the most visible manifestation of which was the alcohol Prohibition of the 1920s. The spread of the antismoking problem world-wide has occurred through the use of the US model, with its prohibitionist baggage, and its tendency to reinforce, rather than solve, the problems it takes on.

In the years immediately following the Surgeon General Report, an abolitionist pole was created in America that wanted cigarette prohibition. Initially, this pole was marginalized by a realistic policy that still recalled the disastrous consequences of the previous prohibition forty years earlier and that tended instead towards risk reduction – that is, towards the production of less hazardous cigarettes. As an expedient, antismokers consciously adopted the rhetoric and methodology created between 1935 and 1943 in Nazi Germany for antismoking and anti-alcohol campaigns, rhetoric that had been abandoned in the 1940s in the face of problems far more real than statistical associations between smoking and cancer.

As had been the case for alcohol, a moralistic American puritanism was at the basis of smoking abolitionism – but this time it could be effectively disguised with epidemiology and enshrouded in science, thus legitimizing its assumptions and intent. It goes without say that abolitionists (later renamed “antismokers”) “hated” smoking, thus could not accept the existence of an RRC that would have perpetuated it. At the same time as research was being conducted on the RRCs, a parallel approach was undertaken by the pharmaceutical industry, which intended to produce “nicotine delivery devices” in substitution for (and in competition with) cigarettes. Furthermore, the pharmaceutical industry was correctly foreseeing and planning for the time that a demonization of cigarettes would induce hundreds of millions of people to become dependant on psychoactive pharmaceutical substances and – once again correctly – they foresaw an enormous expansion of their market. The power of the pharmaceutical industry must be taken into account. Large corporations are opportunistic, but while Big Tobacco is routinely demonized for exploitation of smokers, the exploitation of those same smokers by the eleven times larger pharmaceutical industry is a story that remains to be told. ^[7]

Finally, the spontaneous trend of decreasing cigarette consumption that started about twenty years earlier (the number of smokers had been nearly halved since the 1950s) seemed to indicate that the elimination of cigarettes would be a relatively easy task. Robust campaigns of hysteria and misinformation accompanied by the demonization of the tobacco industry and social “denormalization” of smoking would accelerate the trend enormously. The promotion of the myth of nicotine addictiveness – an addictiveness that could be uprooted with the very same nicotine that caused it -- this time produced by the pharmaceutical multinationals (!) -- would have closed the circle, ensuring the stampede of an enormous clientele from Big Tobacco to Big Pharma. All this would be achieved with the help of the health authorities which, in the meantime, became official partners of the pharmaceutical multinationals at the highest levels for this purpose. For example, this was the case with the World Health Organization. ^[8]

There was only one problem left: how were these entities to obtain the power needed for interference in citizens’ intimate, daily behaviour? After all, the citizen had the absolute right of choice in consuming a legal product, and ultimate control of his health in that sense. The problem was solved at the beginning of the 1980s with the brilliant invention of the passive smoke myth. In reality, passive smoke does not represent a danger for the non-smoker – as is evident from the hundreds of studies, faulty as they are, that have failed to demonstrate danger. But passive smoke is the essential political and psychological element for the social de-normalization of cigarettes because:

• It makes the smoker responsible for others’ harm, thereby justifying both the interference of authorities in personal conduct and the intolerance of the non-smoker on the basis of “self-defence”. This has unleashed authentic, low-key, door-to-door guerrilla warfare among neighbours and colleagues, a new atmosphere of social conflict.

• It provides the perfect excuse for hiding the growing intolerance -- induced ad hoc by the propaganda -- behind a health issue. The smoker becomes one of the biggest lightening rods, a scapegoat for the widespread and growing social discomfort.

• Thanks to the sense of guilt induced in the smoker, his reaction to the elimination of his rights is neutralized. This is a very important element, for political reasons -- and even for reasons of law and order.

The most important reasons why health authorities and antismoking activists consciously turn the meaning of the studies on passive smoke upside down, conning the population, is because this is part of the effort to instigate hatred and absolute intolerance of the habit. Their aim is that, when antismoking is fully integrated into the culture, it will be securely detached from logic and science even if the truth emerges. But, until then, the suppression of the information that the studies on passive smoke indicate the opposite of what the authorities say about them must be absolute.

Thus, any mention of risk reduction cigarettes utterly disappeared from the discourse on the smoking issue, not only for the reasons explained, but for many others that this document is too brief to consider. At first, health authorities financed - and then integrated with - the antismoking industry, and the tobacco industry castled into the extremely defensive positions we see today, giving in to any abuse, fraud or misinformation about their product by the authorities. In spite of all that, we observe a fundamental phenomenon: the consumption of cigarettes could not be further reduced. There are a number of factors which might account for this, but here it is sufficient to mention two. The first is that, ironically, the trend of decline was interrupted by the antismoking campaigns which, instead of accelerating it, stabilized the market because of complex interactions among factors such as personal reactions to the repressive approach, new and different promotional strategies from the tobacco industry, and the reality that it became impossible to forget the smoking issue thanks to restrictions or propaganda - from the brainwashing performed in schools to the (literally) billions of “no smoking” signs, each of them reminding people that smoking exists. The second reason is fundamental, but utterly ignored for reasons of political correctness: smoking is a pleasure and a relief, and many people – notwithstanding the exaggerations and misinformation we hear – choose to undertake a hypothetical risk in exchange for tangible pleasure in spite of the social hatred instigated against them.

This reality notwithstanding, the clear political choice of health authorities is this: it is better to use prohibition and social engineering and have millions of deaths from smoking -- with the hope of uprooting the habit completely in a probably distant future -- than it is to spare their lives with the risk reduction that the RRCs promise and accept the habit of smoking in society. Actually, this approach is not solely reserved to tobacco: over a million people are killed every year by malaria because of the world ban on DDT, whose imagined carcinogenic effects are as well-demonstrated as those of passive smoke – that is, they are not demonstrated at all. ^[9]

The problem and the responsibilities

This irresponsible behaviour that puts obtuse politics before health can be defined as criminal without fear of exaggeration. Given the indemonstrable quantification of tobacco mortality that antismokers keep on defining as real, and considering that RRCs have been available for over 30 years, it is easy to realize that international health authorities, antismoking groups and the tobacco industry are jointly responsible for several millions of deaths per year that could be prevented.

In fact, considering that:

• smoking “causes” five million deaths a year as stated by the health authorities themselves;

• the RRCs could have been adopted since 1980 and today they would be the only available on the market;

• the RRCs would have reduced the risk to half or less

it follows that the antismoking “public health” vocation of the prohibitionist and crusading variety has been responsible, worldwide, for several hundreds millions of deaths in the last 30 years. By the same token, the calculation can be applied proportionally to any country.

From the history given so far, it is clear that health authorities around the world have been aware that the toxics from tobacco combustion (and not the nicotine) are responsible for statistical deaths. Beyond the campaigns of prohibition and fear that scream that “smoking kills”, health authorities have been extremely negligent when it comes to informing the smoker who chooses to keep on with his habit on how to select cigarettes that minimize his risk. Actually this is the crux of the matter. Since everybody has to be convinced that “tobacco [is] deadly in any form or disguise” – the shabby philosophy enunciated these days by the World Health Organization – God forbid that the consumers understand that some cigarettes may be less hazardous than others! God save consumers unions and lawyers from doing anything other than jumping on the antismoking bandwagon in the hope of lucrative lawsuits and free publicity. Finally, God forbid -- for reasons ranging from legal postures to considerations about market share -- that the tobacco industry ranks the hazard of cigarettes.

That notwithstanding, it stands that:

• Once again, the toxics of tobacco combustion – not the nicotine – are responsible for statistical deaths;

• Not only nicotine is not toxic (this is the reason why it is promoted by the pharmaceutical industry with the blessing of the health authorities) but, paradoxically, it is whatsatisfies and limits the desire to smoke, thus limits the risk.

One could argue that the production of RRCs was primarily up to the tobacco industry; the response might be that the industry did not move because of the health authorities. Regardless, the fact stands that the health authorities are responsible for criminal negligence for NOT providing the public with the ability to rank the available cigarettes on the tobacco/nicotine ratio. If they have the power to write “Smoking Kills” on 50% of the surface of cigarette packs they certainly have the power to impose the printing of the T/N ratio as well.

A further indication of their awareness of the information and their consequent negligence is seen in the current obligation to indicate the quantity of tar and nicotine per cigarette on packs (e.g.: 10 mg Tar; 0.8 mg Nicotine). The two data in themselves do not supply any information about hazardousness, which is instead supplied by their ratio (in the example, 10 : 0.8 = 12.5). The information on the two components as currently presented easily misleads the consumer into the belief that the lower the numbers, the safer the cigarettes, which is not necessarily true. Let us suppose that there is a cigarette with half the components, that is, 5 mg Tar and 0.4 mg Nicotine. The T/N ratio would still be 12.5. Why would we have the same hazardousness with just half of the components? Because, due to the exiguity of the nicotine, the smoker would inhale twice as much smoke (or inhale deeper) to obtain the saturation that determines the temporary level of satisfaction – a level that changes from person to person in different ages and even from minute to minute in function of emotions.

The consumer could have an indication of the risk by simply reading the ratio number: the lower the number, the lower the risk – and this is a concept accessible absolutely to everybody. It goes without say that, notwithstanding the current level of hysteria, the constant push of market demand would be for lower and lower numbers, determining a constant decrease in hazardousness. All suppliers respond to market demand because of competition.

Let us make some real life example by randomly taking two brands and examining some of the versions of the same brand. The numbers on tar and nicotine describe milligrams per cigarette.

From the table one can observe that the Marlboro smoker, by simply reading the T/N ratio would be immediately aware that the apparently “lighter” cigarettes are those with the higher ratio – thus the most hazardous – while the “strong” ones turn out to be safer. Today the old nomenclature of definitions such as light, extra-light, etc. are forbidden, but the deduction that they are lighter (in taste, not in hazard) can still be made by reading the amounts of tar and nicotine.

The Pall Mall products present an interesting case. After the prohibition of the definitions, manufacturers were forced to give names to the different types of cigarettes. During our investigation, we asked the tobacconist to put the packs in order of “strength”, from the heaviest to the lightest. That resulted in the order of the table above: New Orleans, Los Angeles, San Francisco, Miami and Manhattan. The tobacconist – as all consumers would do – simply read the numbers on the packs: the lower the numbers, the “lighter” the cigarettes were assumed to be, demonstrating once again the false perception induced by the manufacturers and due to the current climate and health legislation. However, if we calculate the ratio, we observe that the San Francisco are more hazardous than the New Orleans in spite of their smaller numbers. On the other hand, the Manhattan (which the tobacconist, a smoker himself, described as “smoking air” since they contain basically 1/10th of the tar and nicotine of the New Orleans) with a T/N ratio of 10 are far from being proportionally less hazardous, notwithstanding the much smaller amounts of tar and nicotine (and a probably much less satisfying smoking experience).

The labelling of cigarettes as “light” and “strong” etc, originally an idea championed by the anti-tobacco movement and seen as promoting informed choice about health, has, in our opinion, led only to a deep and subtle confusion between taste and hazard. Ironically, in later years, the antismoking movement has sought to place the blame for this exclusively on the tobacco companies’ shoulders.

This situation does not have to lead to the erroneous and summary conclusion that “all and any cigarettes are bad for you”, and that the authorities were right when they forbade the definitions. After all, smoking brings several important benefits to health, even though mentioning them today has become a heresy. Yet, if the statistical methodology used to attribute lung cancer is to be considered valid and indisputable, we must acknowledge that the same methodology is used to determine that smokers suffer much less from exceedingly expensive afflictions such as Alzheimer and Parkinson diseases, ulcerative colitis and many others. ^[10] It is, in fact, only because of the position taken by health authorities that definitions such as “light” have no meaning from the health standpoint and that the disadvantages of smoking outweigh the advantages.

The definitions can in fact be meaningful from a health perspective if the T/N ratio were used. Instead, governments prefer to convince smokers that the only wise choice for them is to quit smoking. The implication is that if they don’t do “the right thing” it is inevitable (perhaps even moral?) that they are either exposed to a risk (one that is preventable even without abstention) and maybe die as a consequence … perhaps rightfully punished for their “no longer socially acceptable” habit? ^[11]

The solutions

It must be noted that the responsibility of health authorities in the statistical slaughter goes beyond what we have observed to this point. For example, obsessed with the paranoia of nicotine addiction (an addiction that, even if real, would not be dangerous), European authorities have established that the maximum nicotine yield of a cigarette must be one milligram. In this way, authorities prevent the production of a less hazardous cigarette through legislation. If it were legal to have just 1.5 mg of nicotine in a cigarette that contains 10 mg of tar, the T/N ratio would be only 6.66 - half of the currently predominant ratio. Theoretically it is possible to do much better – such as obtaining 2 mg of nicotine from a cigarette that would have only 4 mg of tar thanks to the reduction of the tobacco volume and to its technologically advanced treatment. That would abate the ratio to 0.5 – a number that is really worth considering, as it could theoretically put the overwhelming majority of smokers (we dare say all) at or below the statistical threshold for the risk of cancer and other diseases. This would effectively eliminate the danger and would solve the perceived problem of public health without eliminating smoking, and thus without the social and economic repercussions coming from the suppression of the industry and the habit, and without the enormous costs of regulations and enforcement. In a few years the smoking problem could be solved or, at least, hugely reduced.

We believe that the need to pass this information to the public is as pressing as the need to create a culture and a market demanding a risk reduction policy as opposed to abolitionism. We also believe that those who are responsible for this negligence must be made to answer for the damages inflicted on millions of people.

We believe that the first duty of public health authorities is to inform citizens completely and objectively, without paternalism, pedagogy and hysteria. While we reiterate that we maintain a deep scepticism about the reliability of “tobacco-related” death numbers, “attributed” diseases and “social costs” incurred for the habit, it would be illogical to deny the robust evidence of an increased statistical risk. On the other hand, it is obvious that tobacco in general and cigarettes in particular have been a paramount cultural and social phenomenon for over a century, and have been the casual accompaniment to the greatest literary, artistic and scientific masterpieces and technological achievements. Equally significant has been their contribution to physical and emotional comfort and support to billions of smokers in the world. These effects persist today in spite of a stubborn official hostility, testifying to the aspirations to the personal freedom of choice inherent to human nature.

Furthermore, there is a huge difference between smoking a cigarette and inhaling nicotine. Smoking, rather than being an addiction, is part of the expression of the personality of the smoker. It consists of habits, rites, flavour, social gatherings, taste, pleasure, smell, emotional associations, creativity, personal distinction and many other components that make the act of smoking a unique and irreplaceable experience. Such an experience cannot be substituted with chewing gums, inhalers, snuffs, patches – or any other substance or device that cannot even vaguely imitate the experience, nor can it be eliminated with “vaccines” without substantial dangers. Depriving the smoker of his cigarette, in fact, is tantamount to perpetrating psychological and even physical mutilation, and then expecting what’s left to keep on working as a whole. The elimination of this absurd expectation, which causes irreversible social and personal damage, is to be part of a revisited public policy on smoking as well.

Faced with such overwhelming evidence, the duty of health authorities should have been clear and unequivocal since the beginning. An information campaign on the risks of smoking is fully reasonable and justified – but, instead of using demonization and misinformation to reach chimerical results while going on endlessly about mortality and social costs, the feasible priority should have been – and still is – that of risk reduction of the products that are on the market. That is to be done first with accurate information, and then by stimulating the tobacco industry to produce RRCs to abate the statistical risk. In this way, the babbling about millions of virtual deaths could be replaced with the prevention of uncountable actual deaths with products in step with the times and with the available technologies.

The FORCES International Board of Directors

FORCES INTERNATIONAL (Forces, Inc.) is a non-profit educational corporation organized under the laws of the Commonwealth of Virginia, USA. Forces, Inc. has received a charitable tax exemption under Internal Revenue Code 501(c)3. Your contribution is tax deductible.

Mailing address:  PO Box 14347 - San Francisco, CA 94114-0347 USA - Tax US identification number: 542023140