CORRESPONDENCE

RESPONSE: Re: It's Time for a Change: Cigarette Smokers Deserve Meaningful Information About Their Cigarettes

Judith Wilkenfeld, Jack Henningfield, John Slade, David Burns, John Pinney

Affiliations of authors: J. Wilkenfeld, Committee on Tobacco Product Change, Washington, DC; J. Henningfield, Department of Psychiatry and Behavioral Science, The Johns Hopkins University School of Medicine, Baltimore, MD, and Pinney Associates, Bethesda, MD; J. Slade, Department of Environmental and Community Medicine, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick; D. Burns, University of California, San Diego School of Medicine; J. Pinney, Pinney Associates.

Correspondence to: Judith Wilkenfeld, J.D., Committee on Tobacco Product Change, 1707 L St., N.W., Suite 800, Washington, DC (e-mail: JWilkenfeld{at}TobaccoFreeKids.org).

We concur with Peeler and Butters that the Federal Trade Commission (FTC) has taken steps in recent years to identify an appropriate approach to risk communication about cigarettes instead of the present FTC test. Moreover, we recognize that the agency did not intend the test to be used by consumers as an indication of dose. However, in the absence of actual dosing information, both consumers and medical professionals have taken the test results to have this meaning (1,2), while knowledgeable persons in the cigarette industry have long known that low-tar claims are misleading. As early as 1968, a senior scientist at Brown and Williamson characterized the low-tar category as "health-image," that is, as creating an expectation of reduced risk without actually being less poisonous (3).

Although, as the FTC comment noted, the sales-weighted FTC tar yield has fallen from 21.6 to 12.0 mg over 30 years, apparent cigarette toxicity has not decreased for cardiovascular disease or chronic obstructive pulmonary disease (COPD) (1). More important, the relative risk of lung cancer among cigarette smokers has actually increased from 11.9 to 23.2 among men and from 2.7 to 12.8 among women from the 1960s through the 1980s (4). Not only is there no compelling evidence of health benefit from the use of low-tar brands, but there is evidence that low-tar advertising messages may have caused harm by permitting the tobacco industry to subvert the antismoking messages of the Public Health Service (1).

The differences in measured yield between "light" and "medium" delivery products reported by Djordjevic et al. (5) are small and without demonstrated health benefit. Djordjevic et al. have also reported the actual uptake of nicotine among an initial subgroup of the subjects reported in the January 19, 2000, issue of the Journal. In this group, creatinine-adjusted cotinine excretion per cigarette smoked was indistinguishable between smokers of "light" brands and smokers of "medium" brands, despite the "actual" yields in these two categories being somewhat different.

Thus, the differences emphasized by the FTC are without demonstrated health benefit. The actual deliveries of the so-called low-tar brands are approximately twice those advertised for the so-called full-strength brands.

Consumers are deceived by low-tar claims (1), and many will die because of their understandable but ill-founded reliance on low-tar advertising. Messages that challenge these claims can help change the attitudes of smokers toward low-tar cigarettes (6). We believe that the promotion of low-tar brands has resulted in more people using cigarettes and in more people being killed by cigarettes than would have happened had the industry not been permitted to aggressively market these brands (7).

The "low-tar" experience should serve as a cautionary tale for the government and the public health community as tobacco companies prepare to market yet other products claimed to be "reduced risk." To avoid repeating the mistakes of the past, we should proceed with an abundance of caution before new claims and new marketing approaches are allowed to be put forward for products that may, or may not, represent genuine public health gains.

In the meantime, the implied health claims of current low-tar products are both unjustified and damaging to the nation's health. Public health agencies need to work together to remedy this serious problem. We hope and expect that the report from the Department of Health and Human Services, requested by the FTC, will provide clear guidance about this important problem.

NOTES

Editor's note: The authors are members of the Committee on Tobacco Product Change, an ad hoc committee that was established to provide a forum for evaluating the consequences of tobacco product change and developing recommendations for tobacco product policy. It received a small unrestricted administrative start-up grant from SmithKline Beecham Consumer Healthcare, Pittsburgh (PA), and is currently administratively supported by the Campaign for Tobacco Free Kids. The Committee is chaired by Judith Wilkenfeld.

Drs. Henningfield, Slade, and Pinney are consultants at Pinney Associates. This role includes consulting for SmithKline Beecham Consumer Healthcare on medications for smoking cessation. All authors have served, and continue to serve, as paid expert witnesses or consultants for plaintiffs who have brought lawsuits against the tobacco industry.

REFERENCES

1 National Institutes of Health (NIH)/National Cancer Institute (NCI) Monograph No. 7. The FTC Cigarette Test Method for Determining Tar, Nicotine, and Carbon Monoxide Yields of U.S. Cigarettes. Report of the NCI Expert Committee. Bethesda (MD): U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute; 1996 (NIH Publ No. 96-4028).

2 Warner KE, Slade J. Low tar, high toll. Am J Publ Health 1992;82:17–8.[Medline]

3 Glantz SA, Slade J, Bero LA, Hanauer P, Barnes DE. The cigarette papers. Berkeley (CA): University of California Press; 1996.

4 NCI Monograph No. 8. Changes in cigarette-related disease risks and their implication for prevention and control. Bethesda (MD): U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute; 1997 (NIH Publ No. 97–4213).

5 Djordjevic MV, Hoffmann D, Thompson S, Stellman SD. Smoking behavior and exposure to select toxic agents among smokers of low- and medium-yield cigarettes. Presentation at the CORESTA Congress; 1998 October 11–15; Brighton, England. Brighton (U.K.): CORESTA; 1998. p. 186–95.

6 Kozlowski LT, Goldberg ME, Sweeney CT, Palmer RF, Pillitteri JL, Yost BA, et al. Smoker reactions to a "radio message" that light cigarettes are as dangerous as regular cigarettes. Nicotine Tobacco Res 1999;1:67–76.

7 Terza JV, Kozlowski LT, Erickson PA, Strasser AA, Giovino GA. Exploring the risk-reduction paradox: modeling the public health effects of low-tar cigarettes. Presentation at the Society for Research on Nicotine and Tobacco (SRNT); 2000 February 18–20; Arlington (VA). Poster PO 2–31.



             
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