Cigarettes - What’s Your Poison?
If we ate rather than smoked cigarettes, we would expect the packets to list their ingredients to help us make informed healthy choices - perhaps resulting in our avoiding them altogether. But tobacco manufacturers are not obliged to do this.
If the actual contents of cigarettes were displayed, perhaps fewer people would be drawn into a life of nicotine addiction. But with over 7,000 chemical ingredients to list, packets would have to increase in size. Alternatively, they could simply state “product contains traces of petrol, mothballs, car batteries, rat poison, flea powder and paint stripper”.
When tobacco is burned, it releases carbon monoxide and hydrogen cyanide - chemicals people would probably recognise as harmful if they were made aware of their presence. They might also like to know that hundreds more chemicals are added to raw tobacco to control burn rate, prolong shelf life and improve flavour.
In a lit cigarette, nicotine - the source of stimulation and the addictive drug in tobacco - boils on the surface of tar molecules formed of both organic and inorganic chemicals, such as ammonia (found in floor and window cleaner), toluene (found in industrial solvents) and acetone (found in nail polish remover).
Tar, while a boon to motorists, causes lung cancer in smokers. Alongside other chemicals in smoke, it destroys cilia, the tiny whip-like structures that line the airways and fan unwanted particulates out of the lungs. After the cilia are neutralised, tar penetrates deeper and destroys the lungs at a cellular level.
It seems unnecessary to say that tobacco smoke is a known cause of cancer, most obviously in the lung, or that the toxins within it cause disease in the mouth, throat, oesophagus, bladder, kidneys, liver and stomach while increasing the risk of cancer in other sites. Likewise, that smoking causes vascular damage leading to heart attack and stroke, and affects the disease prevention and repair mechanism of DNA, impairing the immune system.
For some time, warning notices and graphic photographic evidence of smoking harm have been displayed on cigarette packets in some countries. Those who continue to smoke have greeted these with (highly appropriate) fatalism and stoic disregard. The move toward plain packaging may be taking longer than expected in the UK, but even when attractively branded packets are banned, smokers continue to buy cigarettes.
In Australia, where plain packaging has been law since 2012, expenditure and consumption have fallen. Importantly, smoking rates for people aged 14 and over fell from 15.1% to 12.8% between 2010 and 2013. For people aged 18 and over, the figures dropped from 15.9% to 13.3%. However, this success may simply reflect a general decline in smoking rates in most developed countries.
The tobacco industry and its investors continue to make profits from nicotine addiction while governments tend to opt for anti-smoking measures rather than considering outright bans of smoking. What if smokers were to switch to electronic nicotine delivery systems (ENDS) that could help them to quit tobacco?
Currently, there seems to be little argument that vapour from these devices is less harmful than smoke (see my presentation E-cigarettes: Cessation Device or Alternative Vice? for more). But tobacco smoking causes death with a latency of between 15 and 25 years. What if ENDS also turn out to hold a twist in the tail? There is an urgent need for more and larger studies into the long-term effects of swapping the chemicals in tobacco smoke for those in the vapour inhaled from ENDS. Even now the direct relationship between nicotine itself and cancer is not well understood.
The implied safety of e-cigarettes has allowed adverts for “smoking” to reappear on television and at sports games. Yet, while avoiding tobacco smoke is likely to be beneficial to health, dual-smoking and consuming nicotine via ENDS are not the same as quitting. Moreover, restrictive policies to regulate and restrict access to ENDS put the potential benefits of switching to them at risk - it may simply be easier to get hold of cigarettes.
Although tobacco smoking levels have dropped amongst young Australians, there is evidence American youth is embracing e-cigarettes with enthusiasm. Most ENDS users also continue to smoke because they remain addicted to nicotine - something not lost on the major tobacco firms that now make and sell e-cigarettes while continuing to oppose tobacco control.
The tobacco situation around the world remains rife with contradictions. Increasing numbers of new smokers, child smokers, state monopolies and sustained, even increased, levels of investment in manufacturing and marketing, make it unlikely that the terrible harms known to be caused by tobacco will be stubbed out any time soon.
11 March is No Smoking Day in the UK. The campaign, run by the British Heart Foundation, aims to reduce tobacco related illness and death by helping people to quit. With tobacco smoking projected to kill 1 billion people globally this century, all efforts to lower this figure are helpful.