I know. I borrowed the title from jewel robber extraordinaire Dick Puddlecote. He won’t mind. It is, in fact, thanks to the illustrious Puddlecote that I became aware of another pile of utter rubbish.
A quick glance at the PubMed abstract piqued my (slightly addled) science brain. I’ve written about the very low nicotine cigarette debacle before, and that (at the time) Ms Cramer of RSPH had given a talk at the E-Cigarette Summit (2015) on the idea of “de-nicotinised” e-cigs and how, by some miracle, that led to fewer cigarettes being smoked but more vaping (the ol’ self-titration theory being proven once again).
Puddlecote has mentioned, a couple of times, the whole thing surrounding VLNC in the US is nothing more than a thinly veiled attempt at coercion. He goes on to remind his readers that Tobacco Control conveniently forgets the whole low-tar cigarettes were instigated – by them – through legislation.
Lest anyone forget, the nicotine content of cigarettes sold in the EU is already legislated to be no greater than 1mg per cigarette – as per the original Tobacco Products Directive (2001/37/EC). Although I have no hard evidence, I suspect that the average number of cigarettes smoked by your average smoker in the EU radically increased once the new limits came into force. In fact, our so-called-friends at ASH; then headed by none other than Clive Bates, criticised the tobacco industry for marketing “low-tar” cigarettes, only for the original TPD (which of course included sock-puppet lobbying from ASH) to include a limit on the tar per cigarette (of 10mg).
Bless them, these people really do have short memories, don’t they? They go on a rampage about the tobacco industry “misleading” the public with the infamous “lights” debacle, yet lobby the powers that be for the very same thing! Couldn’t make it up!
Which brings me to this latest tripe.
The authors, of which there are 18 on this paper, claim the following rather disingenuous but bold statement:
A national policy is under consideration to reduce the nicotine content of cigarettes to lower nicotine addiction potential in the United States.
Which says it all really doesn’t it? We’re going to be seeing a lot of “science” like this thanks to the announcement from Gottlieb. There will be a lot of cash from NIH and the like thrown at “proving” that VLNC is actually a good idea; when we all know that it is – like most vaping ‘research’ from the US – nothing more than a boondoggle, but then, the US agencies are used to wasting taxpayer cash on utter crap.
Reducing the nicotine content of cigarettes may decrease their addiction potential in populations that are highly vulnerable to tobacco addiction. Smokers with psychiatric conditions and socioeconomic disadvantage are more addicted and less likely to quit and experience greater adverse health impacts. Policies to reduce these disparities are needed; reducing the nicotine content in cigarettes should be a policy focus.
Once again, a bold, unequivocal conclusion claiming that reduced nicotine content in cigarettes “should be a policy focus”. Remember, the EU has already mandated low nicotine content because (in the words of former ASH Director Clive Bates):
an important package of public health measures aimed at ensuring that the single market operates with a high level of health and consumer protection, as required and justified by the Amsterdam Treaty.
Yet, for all the intent of believing reduced nicotine content to be part of an important “public health package” it hasn’t done anything to convince smokers to really give up smoking, all it has done is cause smokers to smoke more – which is only a boon to Tobacco Control as it keeps their trough overflowing with taxpayer cash to waste.
Naturally, the conclusion doesn’t match the study text (when does it ever?) so let’s take a look shall we?
The first item that pops out is the mean number of cigarettes smoked was 15.8 per day (+/- 7.5) across 169 participants with a mean nicotine dependence (calculated from the Fagerström Test for Nicotine Dependence) of 5.0 (+/- 2.2) indicating a moderate dependence – just for kicks, I would score a 9 on the test if I were a smoker, as I can still remember what it was like to be a smoker.
Furthermore, the breath CO level (22.4 ppm +/- 11.9) categorically puts the participants in the regular smoker bracket. So we have 169 participants that are moderately dependent on nicotine (or maybe just the ritualistic side of smoking) that regularly smoke a pack a day or less.
Herein lies the first problem. Moderate regular smokers are likely to be the ones to smoke more for pleasure than for any other reason. These are the ones that don’t agree with bans and other such nonsense, but shrug their collective shoulders as the stigma surrounding smokers increases through punitive measures. These are also the types of smokers that probably wouldn’t care if the nicotine, or tar was lowered.
I have written about the cigarettes used in this study before, and the chosen nicotine levels for this particular group were the 15.8mg and 0.4mg variants. The latter representing the supposed dose that “causes” addiction (of 0.7mg/g). As mentioned above, I doubt that these participants care about the reduced nicotine, and that’s pretty much what the paper says:
No significant changes were noted across doses in smoking topography.
However, the participants were graded on a nicotine withdrawal scale to test the dependence level:
Each of the doses significantly reduced nicotine withdrawal symptoms and craving on the MNWS (Minnesota Nicotine Withdrawal Scale), although duration of effects was greater at higher doses.
In a nutshell, the duration of lack-of-withdrawal was, unsurprisingly, longer on the higher “dose” cigarettes (15.8mg).
RESULTS: Among the 169 daily smokers included in the analysis (120 women [71.0%] and 49 men [29.0%]; mean [SD] age, 35.6[11.4] years), reducing the nicotine content of cigarettes decreased the relative reinforcing effects of smoking in all 3 populations. Across populations, the 0.4-mg/g dose was chosen significantly less than the 15.8-mg/g dose in concurrent choice testing (mean [SEM] 30% [0.04%] vs 70% [0.04%]; Cohen d=0.40; P<.001) and generated lower demand in the Cigarette Purchase Task (α=.027 [95% CI, 0.023-0.031] vs α=.019 [95% CI, 0.016-0.022]; Cohen d=1.17; P<.001).
Here’s the other kicker.
When they wished to smoke, they used a computer mouse to click on 1 of 2 icons on a screen representing the 2 cigarettes available that session. After 10 clicks on the icon, they could take 2 puffs of the associated cigarette.
In the final phase of the test, the authors compared only the 15.8 and 0.4 mg options. They also included an ever-increasing click-count for participants to get a puff or two on the “high-dose” cigarette:
Puffs from the low dose were always available by clicking that option 10 times, but the number of clicks necessary to earn puffs from the highest dose started at 10 and increased each time it was chosen to 160, 320, 640, 1280, 2400, 3600, 4800, 6000, 7200, and 8400 clicks.
Even then the low-dose option was chosen significantly less often than the higher dose option, as shown in the chart below, with the exception of phase three where to get a puff or two on a 15.8mg cigarette participants had to click thousands of times on an icon on a computer.
Now, how about repeating this test with smokers that would be scored 8+ on the Fagerström test eh?
Now, of course, this paper doesn’t stand on its own. A couple of recent articles in both the
“specialist journal” comic Tobacco Control (a BMJ journal), and the Lancet (home of the McKee smear piece) are fully supportive of this farce:
Cigarette makers today keep the nicotine at 1%–2% by weight, having found this to be the sweet spot for creating smoker ‘satisfaction’ (one of several industry code words for nicotine addiction). Reducing this percentage by a factor of ten—to 0.1% or 0.2%—would make it very difficult for cigarettes to create or sustain addiction. Reducing it even further would make addiction virtually impossible.
This would essentially eliminate the cigarette as an engine of addiction, while preserving many of the other reasons people smoke—to ponder the wafting of the fumes, for example, or to obtain some form of oral gratification. Or to emulate Johnny Depp or Keira Knightley. Smokers would be able to start or quit at will, without suffering the robbery of choice that defines addiction.
Y’see, nicotine is addictive – or so these ex-spurts would have us believe.
Last week, the US Food and Drug Administration (FDA) announced a multiyear roadmap to begin regulating the amount of nicotine allowed in tobacco products. Researchers, including tobacco control advocates, have proposed nicotine reduction as a way of decreasing levels of tobacco use, and the USA may be the first country to seriously discuss using this form of regulation to produce a potentially less addictive form of tobacco. In the wake of the FDA announcement, it was widely reported that other countries, including the UK, Canada, New Zealand, and Finland, have suggested that they would consider nicotine reduction policies for manufacturers.
Again, the author of the Lancet piece completely forgets that the EU has already mandated a maximum nicotine content, set in the original Tobacco Products Directive (2001/37/EC Article 2) and kept in the revision (2014/40/EU Article 3).
No doubt there’ll be a lot more of this type of shenanigans over the next few years, and I suspect that Gottlieb is looking at the EU TPD as a “softer option” in comparison to the current Deeming regulations, and I fully expect that the revision of the Deeming (whenever it appears) to have an upper limit to nicotine for e-cigs, and no doubt onerous testing (a la TPD) on flavours; which is already present as gold-pressed latinum in the existing Deeming.
Naturally, folk are excited about the direction the FDA are travelling:
Overall, though, this new FDA plan is certainly a breath of fresh air. If carried through with courage and conviction, it could save more lives than any other act of a governmental agency in all of human history. The magnitude of the harms is that great. We hear a lot about tobacco endgames: this one could be a game-changer.
It’s fine when they do it eh?