Reduced Risk

Reduced Risk Cigarettes

How Tobacco Control Has Trampled the Opportunity to Save Untold Millions of Lives

Professional damn foolishness on the subject of tobacco and health can require caustic description. A condemnatory tone is proper and necessary in discussing the issue of interference in the development of reduced risk cigarettes by staunchly abolitionist Tobacco Control advocates. As noted by the philosopher and psychologist Doctor Vincent-Riccardo Di Pierri, in his book Rampant Antismoking Signifies Grave Danger: Materialism Out of Control, correction of monomaniacal Tobacco Control psychology, from within the ranks of lifestyle epidemiologists, or the public health bureaucracy, or from the medical profession, is not to be expected. These supposed experts have for so long “dumbed themselves down” with what Di Pierri calls “statistics madness” that they have lost all sight of reason. The preference is strong among nearly all of them for the idiocy of fanaticism. A return of reason could now only be forced upon them from outside. It is high time we all got angry about the miserable situation, and moved, to fix it.

Lifestyle epidemiology has always been sorely prone to intellectual folly and societally damaging misuse; its debased methods derive from the work of eugenicists such as Francis Galton, Karl Pearson, and Ronald Aylmer Fisher. The public health bureaucracy, in common with bureaucracies generally, is likewise naturally prone to woefully thoughtless rigidity. That medical practitioners should become caught up in such a technocratic nightmare is sadly unsurprising when one considers the history of medical complicity in pseudo-sciences such as the old American “race science”, which justified black slavery, or the worldwide influence of medically-endorsed and hateful eugenics mere decades ago, which reached its criminal apogee under the synonymous appellation of “race hygiene” in Germany.

Laudable advances in medicine and its practice, over the past century, are among the great boons of the period. But the descent of the medical profession into partnership with eugenics, and now with base practices of lifestyle epidemiology, has occurred within the same period. A good general review of how well, and how poorly medicine can be practiced, is provided in Doctor James Le Fanu’s popular book The Rise and Fall of Modern Medicine. The medical community can perform well. It can also perform dismally. Dismal indeed has been its thinking, and its advocacy on the tobacco issue, since about the nineteen-sixties. The blocking of reduced risk cigarettes is a prime example of egregious advocacy by Tobacco Control.

There always have been, and always will be, fanatical elements wishing to abolish practices they consider impure, such as sexual license, or drinking, or smoking. Anti-tobacco fanaticism experienced a resurgence after the US Surgeon General’s Report of 1964 and gained considerable ground within a decade thereafter.

In the late 'sixties the US National Cancer Institute had commissioned its Director of Tobacco Research, the toxicologist and epidemiologist Doctor Gio Batta Gori, to assemble a blue ribbon panel of worldwide experts in various disciplines, to the purpose of developing, with the coöperation of the US tobacco industry, a modified design of the cigarette.

Cigarette smoking is the riskiest form of tobacco smoking because cigarette smoke is typically inhaled. The higher risk with cigarettes is particularly noticeable in regard to lung cancer. It was believed that smoking, widely enjoyed worldwide for centuries, and for millennia in the Americas, was no more likely to go away than was the drinking of alcoholic beverages. The disastrous experience of alcohol Prohibition in the US (1919–1933) was still fairly fresh in American minds.

Alcoholic beverages cannot be made much safer than they are since the element in them that is potentially dangerous is the alcohol itself. The case with cigarettes is altogether different. Nicotine is a mild stimulant and not harmful in itself. The 1964 Surgeon General’s report stressed that the use of nicotine via smoking, even amongst regular users, though habituating for some, did not meet the definition of addiction. Of course the fanatics now insist that it does.

That matter is moot, as in practice, cigarette smokers regulate their smoking so as to derive the mild effects of nicotine, at once soothing and beneficial to concentration of the mind, according to their mood, and will temporarily desist from smoking when nicotine levels get too high in their systems.

The harmful element in cigarette smoke is what makes the smoke visible: the “tar” or microscopic matter within the smoke. Both tar and nicotine contribute considerably to the characteristic flavor of tobacco. There is also a quantity of water vapor in cigarette smoke. Gori’s team decided that cigarettes could be made vastly less dangerous by increasing the level of water vapor, drastically decreasing the level of tar, and, crucially, maintaining the level of nicotine such that smokers would not tend to smoke more cigarettes or to smoke their cigarettes more intensely.

Research went on for several years. Prototype cigarettes were made and tested by various means. It was decided by the late ‘seventies that modified cigarettes could be made in the short term which would reduce risk by about half, and it was believed that over time, further improvements could ultimately reduce risk to about a quarter of that produced by conventional cigarettes. The risk of a typical cigarette habit could be reduced to a level comparing to the estimated “risks” of moderate indulgence in such conventional products as snack foods and soda pop.

The revolutionized nature of the new product was such that this risk reduction could be effected with or without cigarette filters; the modified tobacco element itself reduced tar to a minimal level. The increase in water vapor and decrease in tar diminished flavor but it was thought that this could be overcome over time.

Plans were made to improve the new cigarettes in terms of flavor and to introduce them to the market advertised as reduced risk cigarettes. They would be more expensive to produce, but it was discussed that, if taxed at a lower rate than are conventional cigarettes, they could be sold at a similar or somewhat lower price at retail.

Conventional cigarettes, it was predicted, could be phased out of the market over a period of years. With risk ultimately reduced by 75%, lifetime risk to the average smoker would be virtually eliminated, while the incidence of lung cancer and other related afflictions would be very drastically reduced, even amongst chain-smokers.

That was the state of things in 1979. By that time fanatical elements in the health professions, including at the National Cancer Institute (NCI) in particular, had gained great sway. They killed the project. The tobacco companies were forbidden against introducing any new product with any advertised indication of reduced risk.

The mantras of “there is no such thing as a safe cigarette” and “quit now” have been chanted by the fanatics ever since. The de facto message is “quit or die.” Those messages have been hammered into the public for decades now. The development of safer cigarettes, back in the ‘seventies, is never mentioned by the orthodox medical “authorities”, and remains little known amongst the public.

Smoking rates were dropping steadily in the ‘seventies. The ideologues convinced themselves that, by firmly denying the value or acceptability of moderation in smoking, and likewise denying the very possibility of less risky cigarettes, they could, with an iron fist, reduce cigarette consumption down to their ever-favored quantity of zero. Soon the militant Surgeon General C. Everett Koop was predicting “a smoke-free society by the year 2000.” It didn’t happen. Smokers have been denied enormously less risky cigarettes for decades now.

Doctor Gori, reflecting on the abrupt termination of the safer cigarette project, commented: “The new policy was: Smokers shouldn’t be helped – smokers should be eliminated.” He has condemned the morally blind abolitionist crusade, and the enormous harm it has done to smokers worldwide by blocking the introduction of safer products, consistently to this day.

In 2001, the Institute of Medicine of the US National Academy of Sciences, revisited the question of reduced risk cigarettes. They endorsed the very same design that was suggested by the NCI research of the ‘seventies and suggested such cigarettes be licensed and released promptly. The tobacco control establishment has stonewalled. Nothing has been done.

The abolitionists continue to condemn the idea of reducing risks of smoking; to them the very idea of safer cigarettes is an anathema: an impediment to the ideal of smoking eradication which they pursue with all the quasi-religious zeal of yesteryear’s bible-thumping temperance lecturers.

The anti-tobacco religionists also viciously condemn Doctor Gori for working with the tobacco industry (that was his assignment from the NCI: you do not change the recipe without consulting the cook.)

In continuing research, independently and for the tobacco industry, Gori and a number of his colleagues have calmly adhered for more than thirty years now, in the face of unceasing vituperative fanaticism, to urging government and the industry finally to reëstablish coöperation to a morally compelling end. As Doctor Gori wrote in 2004:

An implicit but clear premise of the Institute of Medicine report [of 2001] is that smokers – loaded with exorbitant taxes – are entitled to compassionate public health assistance as others are, and should not be cast out, punished, and denied available help.

Indeed, it is unimaginable that public health and legislative authorities should resort to curbing tobacco use by murdering smokers – as they seem inclined to do. The unavoidable implication is that a continuing official reluctance to endorse the development of LHCs [Less Hazardous Cigarettes] is not ethically tenable and amounts to a culpable dereliction of public duty.

This is even more true currently, because an assortment of governments in the U.S. receive around $40 billion annually from tobacco, against less than $9 billion received by the entire industry. It is governments that benefit from and control the tobacco trade far more than the tobacco industry, which has been virtually nationalized by taxation and the Master Settlement Agreement with the states.

At the same time, the cigarette industry should actively seek official approval for developing and promoting LHCs, as a defense against legal challenges if it fails to heed the Institute of Medicine instructions, and as a responsibility of due diligence and concern for smokers.

Key to success would be a realistic FDA [US Food and Drug Administration] acting under an enabling statute, free of undue pressure from prohibitionist and industrial interests.

Predicting the future dynamics of risk reduction remains problematic, but technological achievements already on the table could realize in about a decade the Institute of Medicine prediction that "regression of risk ... might eventually bring a smoker to a risk level equal to some lower level of life-time exposure to conventional products." ...

Men of good will have no choice but to embrace the wisdom of less-hazardous cigarettes. Then public health justice will be restored; a majority of world adults who smoke will benefit immensely; and a most awkward and distressing controversy will be extinguished.

Gori referred in this 2004 piece to the potential for the Food and Drug Administration to take control of this situation and to release safer cigarettes urgently. The FDA did, by act of Congress, take control of tobacco products in July of 2009.

In the years since no move has been made on less hazardous cigarettes. The FDA has instead concentrated on trying to get gruesome photographs of corpses and dismembered body parts put onto US cigarette packages. They are fighting this issue gradually through the court system.

As Gori put it: “Indeed, it is unimaginable that public health and legislative authorities should resort to curbing tobacco use by murdering smokers – as they seem inclined to do.” They remain so inclined. They even want to glory in color pictures of the corpses.

The fanaticism of the tobacco control movement took firm hold in the health professions and in government decades ago. Its hold in these precincts only increases over time. Correction of fanatically-driven and gross misdirection in the sciences and in government is not likely ever to come from within the related professions or agencies. Health professionals who question the fanatical orthodoxy face violent reaction, sure destruction of their careers, from the medical establishment.

Until the nineteen-nineties the tobacco industry defended itself vigorously. Since that time the government, and the law, have taken a firmly adversarial stance against the industry, for instance in coming to accept the statistical evidence of lifestyle epidemiology as “proof” of “causation.” The industry has reacted by appeasement, most particularly in the United States, where all the tobacco giants agreed in 1998 to a so-called Master Settlement Agreement, which effectively gags them against any criticism of healthist dogma.

Doctor Alvan Feinstein, in a 1992 critique published in the journal Toxicologic Pathology, commented on the tyrannical domination of health professions and agencies by anti-smoking zealots:

[I]n the current fervor of anti-smoking evangelism, what young scientists would want to risk their careers and what older scientists would want to risk their reputations by doing anything that might be construed as support for the "bad guys" of the tobacco industry? What governmental agency would fund research in which the established "accepted" anti-smoking doctrines were threatened by a study proposed by someone – an obviously deranged skeptic – who wanted to do an unbiased, objective investigation?

The governmental agencies that fund scientific research were once expected to be above the battle, uncommitted, and devoted to seeking truth. For diverse political, social, and fiscal reasons, however, those agencies have often in recent years become mechanisms of advocacy rather than scholarship, pursuing goals of policy rather than science.

... Besides, the "bad guys" sometimes turn out to be correct. Galileo was assailed by the Church when he doubted Earth’s centrality in the solar system; Semmelweiss was denounced by obstetricians when he said their inadequately cleansed hands were transmitting disease; Florence Nightingale was detested by the British establishment when she campaigned for better sanitation of water and sewage; and Joseph Goldberger was deemed a fanatical nuisance when he questioned an esteemed epidemiologic commission’s report that pellagra was an infectious disease.

Just as "bad guys" are sometimes right, the "good guys" are sometimes wrong. The history of medicine and public health is replete with the errors (sometimes harmful blunders) committed by revered, respectable leaders in the field. The most recent memorable public events were the unnecessary, fallacious hysteria about Agent Orange, and the needless evacuation of homes (and harm to lives) by residents of an entire town in Missouri, responding to the mistaken zeal of a governmental agency.

The "bad guys", of course, are not always right, but if they are denied a fair and proper scientific hearing, neither society nor science will benefit. Society is entitled to make political decisions based on advocacy. The scientific basis for those decisions, however, should depend not on political advocacy, but on scholarship – no matter how it is produced or by whom.

Vincent-Riccardo DiPierri describes contamination of government and the judiciary by the fanatical medical establishment (which he describes as “medico-materialist”) thus:

The redefining of law, then, is not the result of science or judicious consideration, but sets the severely flawed medico-materialist framework, particularly statisticalism, as the "standard" for legal evidence and argument: The law now represents the anti-smoking, medico-materialist view ... – by definition – as infallible. ... It also has the effect of removing all legal defense from the tobacco industry. Understandably, the tobacco industry, with essentially no hope of victory on these terms, has attempted to contain the "fallout" with a global settlement.

Until this redefinition, the tobacco industry relied on the idea of assumed risk by smokers and the increased taxation/insurance imposed on smokers. While no more was made of the idea of risk, this minimalist approach sufficed. However, by not properly questioning the medico-materialist view over the last decades and relying on the bare minimum in approach, the tobacco industry has now been caught out by the improper enshrining of low-order statistical risk as a legal maxim. This should highlight that the tobacco industry has very little insight into the smoking habit or medico-materialism; in many instances it is its own worst enemy.

The tobacco industry has indeed become an enemy to itself. By appeasing fanatics it has become an enemy to its customers as well. It is the people who suffer the most from anti-tobacco fanaticism. A condemnatory tone is very proper and perfectly necessary in discussing these issues. A return of reason can now only be forced upon empowered fanatics from outside their corrupted precincts. It is indeed high time we all got angry about the miserable situation, and moved, to fix it.