ASH Daily News for 16 September 2008

Dying for a fag?: How the search is on for a smokeless alternative to cigarretes

Nicotine is largely harmless but cigarettes are lethal . Now, the search is on for ways to deliver the pleasure without the risks.

Smoking has been so much part of our culture for so long that it is hard to imagine a world without it. Yet that is exactly what the Royal College of Physicians (RCP) called for last week. The RCP suggested that, with a concerted effort, smoking could be eliminated within 20 years. To achieve this, two things would have to happen, the college said. First, curbs on smoking would have to be strengthened, principally by ramping up taxes on tobacco. But second, and more important, access to nicotine in other, safer, forms has to be greatly increased.

This latter demand chimes with developments under way in the tobacco industry. This week, the Marlboro cigarette empire Altria bought the USA's biggest maker of chewing tobacco, UST, for $10.4bn (£5.8bn). The deal confirms the tobacco industry's interest in diversifying out of cigarettes into "smokeless" products. UST makes Skoal – tea bag-like pouches of tobacco that are held between the cheek and gum, allowing nicotine to be absorbed.

British American Tobacco is also investing heavily in the search for safer ways to deliver nicotine. BAT paid £2bn to take control of the Swedish company ST, which makes Snus – also pouches of tobacco for sucking. Evidence suggests that sucking a pouch of tobacco is 90 per cent less harmful than inhaling cigarette smoke. But the products are banned in the EU on the grounds that they are, er, carcinogenic, and that to replace one carcinogen with another, albeit one less lethal, is unwise.

Meanwhile, investigations are under way into alternative ways of delivering nicotine that will satisfy the most hardened of addicts. As more smokers give up, those who puff on are the ones who require most support to quit. Nicotine gum and patches won't cut it; these are addicts who need the "hit" that only a lungful of smoke supplies.

Nicotine is the closest we are likely to get to the perfect drug. Its effects are diverse; it stimulates, calms and enhances feelings of pleasure, but has few side effects. Its great advantage over other drugs is that its effects are mild. It is pleasurable only within a narrow range of concentrations in the blood. That is what makes it safe.

Only the instrument of its delivery – the cigarette – is lethal. A device that delivers nicotine quickly, efficiently and safely could earn a fortune. But regulations on the sale of medicinal nicotine are so tight that they keep prices high – seven days' worth of nicotine patches costs £17 – and the development of innovative products low.

Professor John Britton, consultant respiratory physician and chief author of the RCP report, said: "The ideal product would be a nicotine inhaler like an asthma inhaler, that delivered a hit of nicotine as close as possible to the experience of smoking a cigarette.

"But the companies [makers of nicotine gum and patches] don't want to do it and the regulatory restrictions make it difficult to get it on to the market. There is no competition. That is why we need a Nicotine Regulatory Authority."

The anomaly in the existing law is glaring. Tobacco companies are permitted to sell nicotine to the public in the form of (lethal) cigarettes, yet it is illegal to sell alternative nicotine products without a licence. Nicotine patches and chewing gums available on prescription and, now, sold over the counter are strictly regulated medicinal products designed for short-term use by people trying to quit. They do not deliver the hit required to satisfy hardened smokers. Tobacco companies have experimented with smokeless cigarettes, nicotine sprays and other devices, without success. Smokers say the products have been unpleasant to taste, difficult to use and hard to smoke.

What is needed is a medicinal nicotine product designed not as a short-term crutch to support the quitter, but for long-term use as part of a "harm reduction" approach. This idea is backed by the Royal College of Physicians and by Ash, the antismoking charity, but it causes disquiet among some public health experts who blanch at the prospect of condoning nicotine dependency.

Yet an effective medicinal product would be a better option than chewing tobacco. The evidence suggests that nicotine is, if anything, less harmful than caffeine – if it carries less risk than a cup of coffee, where's the problem in making it freely available in a more attractive form? And many in the health field are suspicious of the tobacco industry, believing that the promotion of sucking pouches is another way to keep us hooked on tobacco.

There are signs that the Government may be willing to listen. Close readers of its cancer reform strategy, published last year, noted that the Department of Health said it would consult on measures "to reduce the significant harm to health caused by smoking for those who are addicted to nicotine and not able to quit altogether".

Britton, who is the head of the Department of Public Health at the University of Nottingham, points to the lives such a strategy could save. Of the 10 million current smokers in Britain, half will die prematurely if they do not quit.

He says: "If these people can be encouraged to use a safer product instead, the impact on public health would be huge. If we end up with a society in which a lot of people use a safe nicotine product every day, so what?"

Source: The Independent 16th September
Link: http://tinyurl.com/6jvqq5

Cancer Research UK launches campaign to protect children from tobacco

Through 'Out of Sight, Out of Mind', the charity is aiming to protect the next generation from this deadly addiction and is calling on people across the UK to sign up to a petition to support its aims. Research shows that the younger people start to smoke, the harder they find it to quit and to stay quit for good, a worrying statistic as over 80 per cent of smokers start before the age of 19.
The focus of the new campaign is on protecting children from cigarette advertising that makes smoking look glamorous and attractive. Despite the ban on cigarette advertising and marketing, children continue to be exposed to cigarette advertising on a daily basis because of loopholes in the ban. The charity wants the Government to close the existing loopholes and protect children by preventing tobacco being displayed in shops at the point of sale, prohibiting the sale of cigarettes from vending machines and making plain packaging for tobacco products compulsory.

Jean King, Cancer Research UK's director of tobacco control, said: "It's a shocking fact that half of all long-term smokers will die from smoking. What's even more frightening is that the majority of smokers could be putting themselves in this fatal situation at an age when they are easily influenced.

"We have launched this campaign to help protect all children from the dangers of tobacco. We know that many underage smokers buy cigarettes from vending machines. We also know that attractive branding makes cigarettes more appealing to young people and dilutes the impact of health warnings. We want to keep cigarettes out of sight and out of mind to help prevent young people from taking up smoking in the first place."

To support Cancer Research UK's campaign visit the CancerCampaigns website. http://www.cancercampaigns.co.uk/

Source: News Medical 15th September
Link: http://tinyurl.com/6awn28

Smoking during pregnancy shows mixed effects

Smoking during pregnancy appears to affect children's birthweight, and possibly their risk of becoming overweight, but it may not directly harm other aspects of physical and cognitive development, a large study suggests.

The findings, from a study of nearly 53,000 U.S. children born in the 1960s, found that those whose mothers smoked during pregnancy were at higher risk of low birthweight -- a link that studies have long noted. There was also evidence, albeit weaker, that these children were more likely than children of non-smoking women to be overweight by age 7.

Some past studies have found this link as well, though researchers can only speculate on the reasons; one theory is that nicotine may affect the fetal brain in a way that influences appetite control later in life. On the other hand, the current study also found that mothers' smoking did not appear to directly affect other aspects of their children's development -- including intelligence, school performance and the risk of behavioral problems.

An initial look at the data did show associations between smoking during pregnancy and various developmental problems. But those links disappeared when the researchers factored in the family environment -- such as parents' income and education, and whether the child lived with both parents. The findings suggest that other characteristics of families in which mothers smoke during pregnancy are what strongly influence children's long-term physical and cognitive development, rather than smoking per se.

None of this, however, diminishes the harm that smoking can cause, according to lead researcher Dr. Stephen E. Gilman, of the Harvard School of Public Health in Boston. "Smoking still causes cancer; smoking still causes heart disease, And we still find a strong effect of smoking on birthweight, and we know that low birthweight can have negative consequences," Gilman told Reuters Health.

Low-birthweight infants are more likely to have medical problems shortly after birth, and some studies have linked low birthweight to a higher risk of certain health conditions later in life, such as high blood pressure and diabetes.

Gilman and his colleagues based their findings on data from a study that followed 52,919 U.S. children from birth to age 7. During pregnancy, their mothers reported on their smoking habits; and also provide information on family income, marital status, education, family history of mental illness and other factors that could affect their children's development.

A unique aspect of the study, Gilman noted, is that it included more than 2,000 sets of siblings whose mothers had smoked during one pregnancy but not the other. If maternal smoking, itself, affects children's IQ, school performance and other aspects of development, then differences should be apparent among these siblings. The study found no evidence that this was the case, however.

Still, nothing about the findings changes the advice to women, according to Gilman: If they smoke, they should quit, for the sake of their own health and their babies'.

SOURCE: American Journal of Epidemiology, September 1, 2008.

Source: Yahoo news 12th September
Link: http://tinyurl.com/6cjj9g  

The TRUTH Anti-Tobacco Campaign to Feature Body Bag Display at Saturday's Real Salt Lake Game

To remind people of the dangerous - and often deadly - ramifications of using tobacco, The TRUTH anti-tobacco campaign is creating a body bag display during Real Salt Lake's home game this Saturday, September 20, against CD Chivas USA. The body bags will be displayed at the south side of Rice-Eccles Stadium throughout the game. 

"The exhibit is meant to visually convey the deadly results of using tobacco," said David Neville, marketing coordinator, Tobacco Prevention and Control Program, Utah Department of Health. "Tobacco use is responsible for numerous deaths each year - something we think the public should be aware of."

Those deaths are quantifiable. As the banner next to the body bag display shows, nearly 440,000 people die every year in the U.S. from tobacco-related causes, or equivalently, 50 every hour of every day. In fact, more than 1,100 people die each year in Utah from tobacco-related disease. The display is part of the ongoing efforts of The TRUTH anti-tobacco campaign to expose the immediate and long-term dangers of tobacco use.

"Over the course of the soccer game, based on those statistics, roughly 100 people will have lost their lives to tobacco-related causes," said Neville. "That's a staggering statistic, made evident through the body bag exhibit, that we hope people will take seriously."

Source: Oursports Central 15th September
Link: http://tinyurl.com/6r6utf