Tobacco and Public Health - TCSC Indonesia

NIGEL GRAY
The first attempt to reduce the harmfulness of the cigarette was the policy of reducing
tar and nicotine yields. This was logical at the time (the late sixties) and should
have been more successful than it was. Tar and nicotine reduction was subverted by the
changes in design of the modern cigarette described by Hoffmann (Hoffmann et al.
2001). These changes involved increases in nitrates and consequently, tobacco-specific
nitrosamines (TSNAs) which have been associated with increases in the relative and
absolute risk of adenocarcinoma of the lung. Together with other design changes
(Kozlowski et al. 2001) which contributed to compensatory smoking the modern,
low-yield cigarette, has not proven substantially less dangerous than its predecessor of
30–50 years (Thun and Burns 2001).
The fact that the low-yield program was not successful is no reason not to persist
with attempts to regulate the content of cigarette smoke. Two areas of regulation
attract interest. Control of smoke levels of carcinogens and toxins, and control of the
driver to inhalation, nicotine.
Control of carcinogens and toxins
The policy objective is to reduce as far as practical the levels of known carcinogens
and toxins in smoke. Such control is best focussed on smoke content rather than the
constituents of the cigarette although certain substances, such as nitrosamines, may be
best controlled at source—the nitrate levels in tobacco and the curing process.
Hoffmann has listed 15 major toxins and 69 carcinogens known to be in cigarette
smoke (Hoffmann and Hoffmann 2001). Clearly these substances are the prime candidates
for reduction. A system has been proposed, based on analysis of cigarettes
actually on the market now, whereby the median of the market levels would become,
over time, the maximum permitted (Gray and Boyle 2002), with the process repeated
over time. Such a regulatory system is practical now as brands already on the market
meet these criteria. There can be no justification for the continued marketing of
cigarettes that are unnecessarily dangerous. If this form of regulation were to limit the
number of brands available substantially, no harm would be done, cigarettes could still
be sold profitably, and the harmfulness of cigarettes should be reduced. This in no way
suggests that the cigarette would be ‘safe’ but it should certainly be less dangerous. Such
an approach has been taken, successfully, to motor car exhausts.
Control of nicotine
Nicotine yields are currently measured by the FTC system, or something analogous.
This system does not represent actual smoking patterns. A comparison of actual smoking
patterns with the FTC method (Hoffmann and Hoffmann 2001) showed that
smokers actually inhale between approximately one and a half to two and a half times
as much nicotine, carbon monoxide, benz(a)pyrene and 4-(methylnitrosamine)-1-
(3-pyridyl)-1-butanone (NNK) than would be inhaled if the cigarette was smoked
according to the FTC parameters.
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