Tobacco and Public Health - TCSC Indonesia

NIGEL GRAY 769
within three major global brands (Gray et al. 2000) varying from threefold within
Camel to ninefold within Marlboro for a single nitrosamine, 4-(methylnitrosamino)-
1-(3-pyridyl)-1-butanone (NNK). Further, an analysis of the Massachusetts
benchmark study (Gray and Boyle 2002) revealed variations between 26 selected US
brands of sevenfold for benz(a)pyrene, eightfold for lead, tenfold for arsenic and fourfold
for NNK. Such a degree of variation may be perceived as inevitable in a market of
900 or so brands, but is unacceptable in any sense for public health.
The obvious regulatory response must be to reduce all the selected list of carcinogens
and toxins as far as possible. If the median of the market as revealed by those 26 brands
(considering 34 substances) were set as the upper limit, then only one brand out of the
26 would survive the regulatory blow unscathed (Gray and Boyle 2002). If one brand
can be manufactured to meet these criteria, more can clearly be made so if required.
This approach would discommode the tobacco industry greatly in the short term but
could be regarded as generous by the public health establishment. The key point is that
it is possible, is reasonable and should be accepted.
The system of measurement needed for this proposal is relatively simple and could
be the existing FTC method or a variant such as that used in parallel with FTC in the
Massachusetts benchmark study or (and better) the two-stage test proposed by
Kozlowski (Kozlowski and O’Connor 2000), but the ultimate measure would be the
amount per litre of smoke of each compound. The principle espoused could deal with
all the accepted major toxins and carcinogens but would be unsatisfactory for nicotine.
Nicotine
Nicotine is the driving force for inhalation and for the degree of compensatory smoking
that occurs. At this time the measurement and labelling of the cigarette does not
provide any reasonable index of the dose that the individual smoker (and smoking
habit) (Djordjevic et al. 1995; Jarvis et al. 2001) obtains.
Two separate questions arise here. The first is how to reduce the ‘elasticity’ of the
cigarette in order to deliver a relatively standard dose. The second is what should
the standard dose range be. A corollary is what measurement system should be used.
Towards a standard dose
The first issue is to find a way of measuring and defining the nicotine dose in such a way
that it provides a reasonable approximation of the amount of nicotine likely to finish up
in the bloodstream of the smoker. This is only conceivable if the cigarette design is made
substantially less elastic, i.e. more difficult to smoke in a compensatory way. A measure
of the amount of nicotine present in the rod of the cigarette could serve but only with
this proviso. Abolition of ventilated filters (Kozlowski and O’Connor 2002) would be
a major step towards this, together with some standization of filters and papers.
In terms of amount, the dose should probably be something close to the amount the
smoker currently seeks, and gets. A study by Jarvis (Jarvis et al. 2001) throws some light