VIRTUALLY SAFE CIGARETTES

Book review

The good idea that became heresy

Whatever happened to the search for a safer cigarette" People under the age of 40 are probably too young to remember, but until the late 1970s, serious research was conducted in the United States into how to reduce smoking risks through the analysis of and engineering of cigarettes. The Smoking and Health Program was the creation of the National Cancer Institute. Participants and advisors included a wide array of scientists from government and academia as well as industry – including Dr. Ernst Wynder of the American Health Foundation, one of the earliest researchers to link smoking and lung cancer. Summarily dismissed by today’s anti-smoking activists as yet another dark plot by the Evil Empire of the tobacco industry, the promising work of this group and the insights it provided into the phenomenon of smoking have been consigned to politically correct oblivion. In his new book, Virtually Safe Cigarettes: Reviving an Opportunity Once Tragically Rejected, former Smoking and Health Program director Dr. Gio Batta Gori seeks to set the record straight – and to make the case for renewing this avenue of research.

For anyone interested in tobacco issues from either the scientific or  political points of view, Gori’s book is essential reading. It delivers a concise account of the program’s work that is sufficiently detailed as a primer for interested scientists, yet fast-moving and succinct enough to keep the layman interested. Topics covered include the role of nicotine in smoking – and the importance of controlling nicotine-tar ratios in any less hazardous cigarette that might be developed -- as well as suggestions about the development of testing protocols. For those wishing to pursue the subject further, extensive appendixes provide the list of published studies funded by the Smoking and Health Program, a list of consultants and their institutional affiliations, information on experimental cigarettes developed for the program, and other details.

Why bother with any of this research, anti-smokers will immediately ask. Why doesn’t everyone just quit instead" As Dr. Gori points out, not everyone does quit, and how this fact is addressed is what separates realistic health policy development in a liberal and tolerant society from an all-or-nothing moralism that in the end distorts even the health objectives it purports to uphold. What we should be asking, he contends, is why deny the prospect of harm reduction to those who continue smoking"

Unfortunately, the Smoking and Health Program did not reach its final goal of producing a safer cigarette acceptable to smokers in the real world. Its work was cut short -- literally in mid-experiment -- when the shift to an abolitionist "smoke-free" public health posture was adopted by the Carter administration. But it left behind an important legacy of groundwork, which could, and should, the author argues, be picked up and carried on in the interests of curtailing the risks posed to smokers. Such work should be done not under the auspices of existing regulatory agencies like the FDA, where the agency’s lack of authority and lack of a suitable mandate to cover such a task has already been demonstrated. Instead, he suggests the creation of a special-statute regulatory unit specifically enabled to pursue "a policy of progressive risk reduction rather than a search for virtual safety."

Gori contends that a revival of the search for safer cigarettes is particularly timely and pertinent now. The state, despite its constant war cries for a smoke-free society, has in effect rejected prohibition for good reasons. With the massive U.S. tobacco settlement in place, the government has more of a vested interest than ever before in tobacco revenues, recognising simultaneously that a cigarette ban would usher in a black market to soak up those revenues and more in a context of chaos and criminality. The rationale for the intransigent attitude towards tobacco harm reduction strategies that government and coercive public health advocates have long embraced – that safer cigarettes send the "wrong message" when the goal is a fast track to a "smoke-free" society – is difficult to credibly sustain in view of the realities. In fact, it increasingly appears to be a callous and negligent posture towards smokers, Gori argues:

"America is not smoke-free by the year 2000, as could have been predicted, and it may come to pass that the blind inflexibility of abolition will be a cause of lasting regret. Indeed, the 20 year long opposition to moderation and to the introduction of even partially less hazardous cigarettes ought to count for a sizeable fraction of premature deaths among smokers who did not quit," he writes. The point is made more vivid in the context of the scientific evidence he presents. The same epidemiology that links smoking and cancer also clearly shows risk thresholds, suggesting that safer cigarettes could make real contributions to health outcomes.

Ironically, the same government now resigned to tobacco and benefiting mightily from its proceeds still shrilly insists that discussion of smoking harm reduction is arch-heresy. It’s hard to argue with Gori’s comment that "as we stand at the threshold of a third millennium, it may be high time to grow up."

Researchers and others who read this book may be persuaded. The question is, will they have the courage to speak up"

- Anne MacDiarmid