Eliminating nicotine in cigarettes

Abstract

Editor,—I have read and re-read, with great interest and enormous puzzlement, the American Medical Association (AMA) report “Reducing the addictiveness of cigarettes”1 and the accompanying editorial by Clifford Douglas,2 in the Autumn 1998 issue of Tobacco Control. According to the AMA report, “it is technically feasible to manufacture cigarettes with low enough nicotine content to fall below this threshold (of addiction) for most people.” The AMA and the British Medical Association (BMA) have developed a position based on this technical feasibility, but by what mechanism could nicotine elimination be enforced worldwide? Despite its 139 references, the paper appears to avoid discussion of the stages-of-change model. With millions of contemplators and pre-contemplators out there, how would even the most united front of politicians and health authorities achieve such a contentious goal? At its core, the BMA/AMA proposal would force unwilling smokers to give up their satisfying habit. Similarly, tobacco growers and manufacturers in more than 100 countries would be prohibited from marketing almost any currently available cigarette brand. The authors discuss the risks of contraband markets. Until now, such illegal sales have flourished on price differentials, as has been the case here in Canada. If nicotine levels are mandated downwards, but not all countries sign on, then foreign tobacco interests will flood the vacated markets with better “flavoured” products. Contraband high-nicotine sales will soar, with tough-to-track internet merchants flourishing the most. As the authors themselves say, “nicotine-deprived nicotinic receptors can produce powerful, physiologically based drives to reinstate smoking.” High-nicotine strains of tobacco cannot be uninvented. No international convention or protocol can legislate this unhappy fact out of existence. The industry and the health community agree that nicotine is the sine qua non of smoking. That being the case, either we achieve a virtual prohibition of tobacco products, …