Jury Still Out on Safe Tobacco

(HealthScout) -- Modified tobacco products that go easy on tar and nicotine might sound like a good middle ground for smokers who want to reduce their risk of cancer and other illnesses.

But there's no evidence any of these products offer a safer alternative to smoking.

That's the conclusion of a panel of smoking experts convened by the Institute of Medicine (IOM), who called today for more regulation of, and research into, products promoted as being able to reduce the health damage from cigarettes.

"It is feasible to reduce the risk of tobacco-related disease by reducing exposure to the toxic substances in tobacco," says Dr. Stuart Bondurant, chairman of the IOM panel. "But it has not been proved that any [products] on the market today reduce illness or death."

Allowing companies to promote "safer" cigarettes without fully understanding the way the work could lead to more -- not fewer -- deaths if nonsmokers and people who've quit start using the products, says Bondurant, a University of North Carolina researcher.

False sense of security?

"The overall effect of these new products on the population could be negative," says Bondurant, who led the IOM panel that in 1999 found no link between breast implants and chronic diseases. The latest committee was requested in 1999 by the U.S. Food and Drug Administration.

"Unregulated claims may lead people to use them thinking they're safe. The net effect might in fact be adverse," says Dr. Robert Wallace, an epidemiologist at the University of Iowa and another panelist. "We're very worried about that."

One in four American adults -- or some 47 million people -- smoke cigarettes and 70 percent of them want to quit, the report says. Yet fewer than 3 percent of them succeed each year.

The Centers for Disease Control and Prevention estimates that some 400,000 Americans die each year from smoking-related illnesses, chiefly lung cancer and heart disease. Despite the advent of filters on cigarettes, as well as low-tar and low-nicotine tobacco products, that figure hasn't changed much in the last half century.

The reason doesn't bode well for the new generation of modified cigarettes, experts say.

Simply put, nicotine is a highly addictive drug, and smokers smoke to maintain a level of the chemical in their body that's satisfying. If they're getting less of the drug in a cigarette, they'll likely smoke more, exposing themselves in the process to the hundreds or thousands of cancer-causing agents present in burning tobacco.

The panel, which did not identify any particular products, acknowledged that the key question they raised -- but could not answer -- was which government agencies should regulate harm-reduction products, and how aggressively.

Whatever regulatory scheme does evolve ideally would be tough enough to deter false or misleading marketing while lenient enough to allow companies to research and develop products that might be less dangerous for smokers, Bondurant says.

Panel member Dr. Peter Shields, a cancer geneticist at Georgetown University's Lombardi Cancer Center, says it's conceivable that tobacco companies could one day offer smokers two tiers of cigarettes, a low-harm line and a fully toxic variety. If the less toxic products were indeed less dangerous, "we would have to accept that," Shields says.

The group notes that many smokers have switched, wholly or in part, to nicotine gums and patches to satisfy their cravings. But, they say, using these products for many years may carry its own set of hazards.

"Using nicotine replacement products to aid in [smoking] cessation is safe," says Dr. Dorothy Hatsukami, an addiction expert at the University of Minnesota an a panel member. "However, we really don't have evidence at this point in time whether long-term use of these products is safe, and whether using them to cut back is safe."

Studies show that people who use nicotine replacement products do continue to smoke, and while they may smoke less, it's not clear whether doing so trims the risk of cancer and other health problems, Hatsukami says.

Dr. Gilbert Ross, medical director of the American Council on Science and Health, a nonprofit consumer group, says the principle of reduced-harm cigarettes is a good one, at least in the short run. "It's a reasonable short-term goal if there was any truth in it," says Ross.

Vector Tobacco is a New York company hoping to market two kinds of modified cigarettes. One, an ultra-low-tar version, could be available as early as this year, says Brandy Bergman, a company spokeswoman. That product contains at least 70 percent fewer polycyclic aromatic hydrocarbons, or PAH's, a family of chemicals that cause cancer, Bergman says.

Vector is also developing a genetically altered tobacco plant that's "virtually free" of nicotine and nitrosamines, another class of carcinogens in cigarettes, Bergman says. The company plans to combine the two products into a cigarette that could be used as a cessation tool.

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For more on the harmful effects of tobacco use, check out the Centers for Disease Control and Prevention.

To learn more about children and tobacco, check out Campaign for Tobacco-Free Kids.

For more information on how to prevent other diseases, use
PreventDisease.com's "Quick Prevention Resources".