The Great Nicotine Debate

Abstract

F ood and Drug Administration Commissioner David A. Kessler issued what amounted to a battle cry in February when he reported indications that cigarette manufacturers fortify low-tar brands with nicotine. Why would they do this? To ensure that all the nation's 50 million smokers maintain their addiction to tobacco, he said. If true, it means that the tobacco industry is deliberately fostering a physical need for a product that kills 434,000 Americans each year, according to the U.S. Surgeon General's latest estimates. Indeed, smoking-related illnesses accounted for nearly one in five U.S. deaths in 1990most of them from heart disease and cancer states a report in the March 31 NEW ENGLAND JOURNAL OF MEDICINE (NEJM). An April 7 follow-up on cigarettes' economic toll by the same University of Colorado School of Medicine team estimated that a smoker's average lifetime medical costs exceed a nonsmoker's by $6,000. In response, the House Subcommittee on Health and the Environment convened a trio of hearings in March and April, and more planned. Kessler and several congressmen also have renewed calls for greater regulation of tobacco perhaps as a drug or for nicotinefree cigarettes. Arguing that it does not add nicotine to cigarettes, the tobacco industry maintains that these recent salvos constitute nothing less than a move to prohibit the sale and use of cigarettes. Make no mistake, says James W Johnston, chief executive officer (CEO) of RJ Reynolds Tobacco in Winston-Salem, N.C., Forcing manufacturers to produce products that smokers find unsatisfying and unacceptable [such as nicotinefree cigarettes] is backdoor prohibition. Similarly, he says, Advocating that the FDA regulate cigarettes as a drug which would effectively ban cigarettes from the market is clearly backdoor prohibition. If cigarettes so dangerous, argues Johnston, then Congress should vote for prohibition and be prepared for the consequences. However, Henry Waxman (D-Calif.), chairman of the subcommittee, denies that prohibition is at issue. In fact, the exsmoker supports a bill by Mike Synar (D-Okla.), a member of the subcommittee, that would give FDA regulatory authority over cigarettes something it does not now have but would prohibit the agency from banning them. Those who sell aspirin, cars, and soda are all held to strict standards when