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

The study by Djordjevic et al. (1) in this issue of the Journal elegantly demonstrates that the Federal Trade Commission (FTC) method of testing cigarettes for tar and nicotine provides tobacco companies the opportunity to mislead their customers. The study provides fresh insights as to the means by which human biology and tobacco engineering interact to cause the problem. The article reveals that smokers adjust a variety of their smoking behaviors, such as puff frequency, depth of inhalation, and ventilation hole blocking, thereby ingesting high levels of nicotine and tar irrespective of the advertised yields of the cigarettes. Moreover, the results show that cigarettes branded as “lights” can provide deliveries of tar and nicotine that are similar to those of the regular versions. It is highly unlikely that the small differences in tar and nicotine deliveries found across brands have any toxicologic significance. A few observations about the FTC method may help to understand the importance of the study by Dordjevic et al. as well as its implications for regulatory actions. The FTC method was actually adapted from methods developed and used by the tobacco industry in the 1930s as a means of objectively comparing cigarettes for developmental and manufacturing purposes (2). The FTC’s intent was to bring order to the chaotic tar-derby advertising claims of health benefit in the 1960s. Furthermore, the FTC method was intended to provide the basis for advertising that could enable consumers to select cigarette brands on the basis of tar and nicotine yields. As reported by C. L. Peeler, Associate Director, FTC, the latter goal was consistent with the conclusions of the 1964 Surgeon General’s Report that urged that smokers who were unable to quit should make every effort to reduce their dose of tobacco smoke (3). This recommendation flowed from a robust scientific literature that demonstrated a dose–response relationship between tar exposure and cancer risk (3). Numerous studies (4,5) have since reconfirmed the dose– response relationship, even though it is also more clear than ever before that tobacco smoke is so toxic that there appears to be no safe level of smoke exposure. In response to the public health literature, in 1970, the FTC proposed rules that would have required disclosure of tar and nicotine yields in advertising. But, to avoid regulation, the major cigarette manufacturers agreed to voluntarily place FTC tar and nicotine ratings in advertising (3). In addition, because low tar and nicotine ratings can be an effective selling message, manufacturers often do list the ratings on the packages for those brands in which the tar and nicotine ratings are very low (e.g., <5 mg of tar and <0.5 mg of nicotine) (6). Thus, in support of the then-current public health thinking, but ultimately unwittingly, the FTC provided the tobacco industry with a very powerful and persuasive selling message in which the industry’s own documents show was deliberately used to “reassure smokers” and to provide an alternative to quitting (7,8). As a consequence of human biology, the business interests of the tobacco industry, and a nearly complete absence of accountability by the industry, the FTC’s intentions were undermined. The method does not differentiate among cigarettes in a meaningful way. On the biologic side was the fact that most cigarette smokers become addicted to nicotine. They generally come to require nicotine dosing at levels that are high enough to sustain dependence but not so high as to cause acute noxious effects, i.e., one cigarette every 20–60 minutes (9,10). This leads to the behavioral phenomenon generally termed “compensation,” whereby cigarette smokers tend to adjust their smoking behavior to sustain their preferred level of nicotine intake, even when faced with challenges, such as limitations on smoking opportunities, increased cost of cigarettes, and reduced nicotine delivery per puff (9,11–14). The main toxicologic problem of such compensation is not the maintenance of nicotine exposure per se but that, along with sustained high levels of smoke intake, come high levels of tar, carbon monoxide, and other toxins. Nonetheless, when people who are motivated to quit or reduce their smoking are given guidance that enables them to gradually reduce their smoke intake (e.g., by behavioral methods of reduction), it appears plausible that reductions could be achieved and sustained and that these might facilitate efforts to quit (15–17). Tobacco companies do not provide their customers with guidance that could help them avoid compensatory smoking, e.g., avoiding taking extra puffs, deeper inhalations, covering ventilation holes, smoking down to the filter, and smoking more cigarettes (12). In fact, recently disclosed documents make it clear that the interests of tobacco companies in keeping their customers hooked on nicotine led to extensive efforts to design cigarettes to exacerbate the problem by virtually ensuring that compensation would occur, even if the consumer wanted to reduce his or her tar and nicotine intake (7,8,18). This is termed “elastic dosing potential” by the tobacco industry (19), and this deliberate design feature is what enabled subjects in the study by Djordjevic et al. to achieve such high dosages of tar and nicotine from cigarettes claimed to be low and light.