The Hidden Story of How Big Tobacco Invented Freebasing

Review of The Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition.

Part I

It’s easy to think of cigarettes, and the machinations of the tobacco industry, as “old news.” But in his revealing 737-page book, The Golden Holocaust, based on 70 million pages of documents from the tobacco industry, Stanford professor Robert N. Proctor demonstrates otherwise. He demonstrates how Big Tobacco invented freebasing. He shows how they colluded in misleading the public about “safe” alternatives like filters, “low-tar,” and “ultra-lights.” We discover in Lorillard’s archives an explanation of menthol’s appeal to African Americans: It is all part of a desire by “negroes” to mask a “genetic body odor.” Radioactive isotopes were isolated in cigarette smoke, and evidence of the find was published, as early as 1953. He reveals that the secret ingredient in Kent’s “micronite filter” was asbestos. And he charges that the “corruption of science” lies behind the industry’s drive to continue its deadly trade. “Collaboration with the tobacco industry,” writes Proctor, “is one of the most deadly abuses of scholarly integrity in modern history.”

Half of all cigarette smokers will die from smoking—about a billion people this century, if present trends continue. In the U.S., this translates into roughly two jumbo jets crashing, killing everyone onboard, once daily. Cigarettes kill more people than bullets. The world smokes 6 trillion of them each year. (The Chinese alone account for about 2 trillion). Some people believe that tobacco represents a problem (more or less) solved, at least in the developed West.

All of this represents a continuing triumph for the tobacco industry. The aiders and abettors of tobacco love to portray the tobacco story as “old news.” But as Stanford Professor Robert M. Proctor writes in The Golden Holocaust, his exhaustive history of tobacco science and industry: “Global warming denialists cut their teeth on tobacco tactics, fighting science with science, creating doubt, fostering ignorance.”

Checking in at 737 pages, The Golden Holocaust is nobody’s idea of a light read, and at times its organization seems clear only to the author. But what a treasure trove of buried facts and misleading science Proctor has uncovered, thanks to more than 70 million pages of industry documents now online (http://legacy.library.ucsf.edu) as part of the Master Settlement Agreement of 1998. Once the material was finally digitized and available online, scholars like Proctor could employ full-text optical character recognition for detailed searchability. Ironically, this surreal blizzard of documentation was meant to obscure meaningful facts, not make them readily available, but tobacco executives seem not to have factored in digital technology when they turned over the material.

The single most important technological breakthrough in the history of the modern cigarette was flue-curing, which lowers the pH of tobacco smoke enough to make it inhalable. The reason few people inhale cigars, and very few used to inhale cigarettes, is that without some help, burning tobacco has a pH too high for comfortable inhalation. It makes you cough. But flue-curing lowered pH levels, allowing for a “milder,” less alkaline smoke that even women and children could tolerate.

World War I legitimized cigarettes in a major way. Per capita consumption in the U.S. almost tripled from 1914 to 1919, which Proctor considers “one of the most rapid increases in smoking ever recorded.” After World War II, the Marshall Plan shipped a staggering $1 billion worth of tobacco and other “food-related items.” (The U.S. Senator who blustered the loudest for big postwar tobacco shipments to Europe was A. Willis Robertson of Virginia, the father of televangelist Pat Robertson.)

The military, as we know, has historically been gung-ho on cigarettes. And Proctor claims that “the front shirt pocket that now adorns the dress of virtually every American male, for example, was born from an effort to make a place to park your cigarette pack.” In addition, cigarette makers spent a great deal of time and effort convincing automakers and airline manufacturers to put ashtrays into the cars and planes they sold. Ashtrays were built into seats in movie theaters, barbershops, and lecture halls. There was even an ashtray built into the U.S. military’s anti-Soviet SAGE computer in the 50s.

In the early 50s, research by Ernest Wynder in the U.S. and Angel Roffo in Argentina produced the first strong evidence that tobacco tars caused cancer in mice. Roffo in particular seemed convinced that tobacco caused lung cancer, that it was the tar rather than the nicotine, and that the main culprits were the aromatic hydrocarbons such as benzpyrene. Curiously enough, it was influential members of Germany’s Third Reich in the 40s who first took the possibility of a link seriously. Hans Reiter, a powerful figure in public health in Germany, said in a 1941 speech that smoking had been linked to human lung cancers through “painstaking observations of individual cases.”

In the December 1953 issue of Cancer Research, Wynder, et al. published a paper demonstrating that “tars extracted from tobacco smoke could induce cancers when painted on the skins of mice.” As it turns out, the tobacco industry already knew it. Executives had funded their own research, while keeping a close eye on outside academic studies, and had been doing so since at least the 30s. In fact, French doctors had been referring to cancers des fumeurs, or smokers’ cancers, since the mid-1800s. All of which knocks the first leg out from under the tobacco industry’s classic position: We didn’t know any stuff about cancer hazards until well into the 1950s.

Only weeks after the Wynder paper was published, tobacco execs went into full conspiracy mode during a series of meetings at the Plaza Hotel in New York, “where the denialist campaign was set in motion.” American Tobacco Company President Paul Hahn issued a press release that came to be known as the “Frank Statement” of 1954. Proctor calls it the “magna carta of the American’s industry’s conspiracy to deny any evidence of tobacco harms.” How, Proctor asks, did science get shackled to the odious enterprise of exonerating cigarettes? The secret was not so much in outright suppression of science, though there was plenty of that: In one memorable action known as the “Mouse House Massacre,” R.J. Reynolds abruptly shut down their internal animal research lab and laid off 26 scientists overnight, after the researchers began obtaining unwelcome results about tobacco smoke. But the true genius of the industry “was rather in using even ‘good’ science, narrowly defined, as a distraction, something to hold up to say, in effect: See how responsible we are?”

Entities like the Council for Tobacco Research engaged in decoy research of this kind. As one tobacco company admitted, “Research must go on and on.”

A good deal of the industry’s research in the 50s and 60s was in fact geared toward reverse engineering competitors’ successes. Consider Marlboro. Every cigarette manufacturer want to know: How did they do it? What was the secret to Marlboro’s success?

As it turns out, they did it by increasing nicotine’s kick. And they accomplished that, in essence, by means of freebasing, a process invented by the cigarette industry. Adding ammonia or some other alkaline compound transforms a molecule of nicotine from its bound salt version to its “free” base, which volatilizes much more easily, providing low-pH smoke easily absorbed by body tissue. And there you have the secret: “The freebasing of cocaine hydrochloride into ‘crack’ is based on a similar chemistry: the cocaine alkaloid is far more potent in its free base form than as a salt, so bicarbonate is used to transform cocaine hydrochloride into chemically pure crack cocaine.” Once other cigarette makers figured out the formula, they too began experimenting with the advantages of an “enhanced alkaline environment.”
  
(End of Part I)

Photo Credit: http://theloungeisback.wordpress.com/

The Mysteries of the Blunt

Why do so many smokers combine tobacco with marijuana?

People who smoke a combination of tobacco and marijuana, a common practice overseas for years, and increasingly popular here in the form of “blunts,” may be reacting to some unidentified mechanism that links the two drugs. Researchers believe such smokers would be well advised to consider giving up both drugs at once, rather than one at a time, according to an upcoming study in the journal Addiction.

Clinical trials of adults with cannabis use disorders suggest that “approximately 50% are current tobacco smokers,” according to the report, which was authored by Arpana Agrawal and Michael T. Lynskey of Washington University School of Medicine, and Alan J. Budney of the University of Arkansas for Medical Sciences.  “As many cannabis users smoke a mixture of cannabis and tobacco or chase cannabis use with tobacco, and as conditioned cues associated with smoking both substances may trigger use of either substance,” the researchers conclude, “a simultaneous cessation approach with cannabis and tobacco may be most beneficial.”

A blunt is simply a marijuana cigar, with the wrapping paper made of tobacco and the majority of loose tobacco removed and replaced with marijuana. In Europe, smokers commonly mix the two substances together and roll the combination into a single joint, the precise ratio of cannabis and nicotine varying with the desires of the user. “There is accumulating evidence that some mechanisms linking cannabis and tobacco use are distinct from those contributing to co-occurring use of drugs in general,” the investigators say. Or, as psychiatry postdoc Erica Peters of Yale put it in a press release, “There’s something about tobacco use that seems to worsen marijuana use in some way.” The researchers believe that this “something” involved may be a genetic predisposition. In addition to an overall genetic proclivity for addiction, do dual smokers inherit a specific propensity for smoked substances? We don’t know—but evidence is weak and contradictory so far.

Wouldn’t it be easier to quit just one drug, using the other as a crutch? The researchers don’t think so, and here’s why: In the few studies available, for every dually addicted participant who reported greater aggression, anger, and irritability with simultaneous cessation, “comparable numbers of participants rated withdrawal associated with dual abstinence as less severe than withdrawal from either drug alone.” So, for dual abusers, some of them may have better luck if they quit marijuana and cigarettes at the same time. The authors suggest that “absence of smoking cues when abstaining from both substances may reduce withdrawal severity in some individuals.” In other words, revisiting the route of administration, a.k.a. smoking, may trigger cravings for the drug you’re trying to quit. This form of “respiratory adaption” may work in other ways. For instance, the authors note that, “in addition to flavorants, cigarettes typically contain compounds (e.g. salicylates) that have anti-inflammatory and anesthetic effects which may facilitate cannabis inhalation.”

Studies of teens diagnosed with cannabis use disorder have shown that continued tobacco used is associated with a poor cannabis abstention rate. But there are fewer studies suggesting the reverse—that cigarette smokers fair poorly in quitting if they persist in cannabis use. No one really knows, and dual users will have to find out for themselves which categories seems to best suit them when it comes time to deal with quitting.

We will pass up the opportunity to examine the genetic research in detail. Suffice to say that while marijuana addiction probably has a genetic component like other addictions, genetic studies have not identified any gene variants as strong candidates thus far. The case is stronger for cigarettes, but to date no genetic mechanisms have been uncovered that definitively show a neurobiological pathway that directly connects the two addictions.

There are all sorts of environmental factors too, of course. Peer influences are often cited, but those influences often seem tautological: Drug-using teens are members of the drug-using teens group. Tobacco users report earlier opportunities to use cannabis, which might have an effect, if anybody knew how and why it happens.

Further complicating matters is the fact that withdrawal from nicotine and withdrawal from marijuana share a number of similarities.  The researchers state that “similar withdrawal syndromes, with many symptoms in common, may have important treatment implications.” As the authors sum it up, cannabis withdrawal consists of “anger, aggression or irritability, nervousness or anxiety, sleep difficulties, decreased appetite or weight loss, psychomotor agitation or restlessness, depressed mood, and less commonly, physical symptoms such as stomach pain and shakes/tremors.” Others complain of night sweats and temperature sensitivity.

And the symptoms of nicotine withdrawal? In essence, the same. The difference, say the authors, is that cannabis withdrawal tends to produce more irritability and decreased appetite, while tobacco withdrawal brings on an appetite increase and more immediate, sustained craving. Otherwise, the similarities far outnumber the differences.

None of this, however, has been reflected in the structure of treatment programs: “Emerging evidence suggests that dual abstinence may predict better cessation outcomes, yet empirically researched treatments tailored for co-occurring use are lacking.”

The truth is, we don’t really know for certain why many smokers prefer to consume tobacco and marijuana in combination. But we do know several reasons why it’s not a good idea. Many of the health-related harms are similar, and presumably cumulative: chronic bronchitis, wheezing, morning sputum, coughing—smokers know the drill. Another study cited by the authors found that dual smokers reported smoking as many cigarettes as those who only smoked tobacco. All of this can lead to “considerable elevation in odds of respiratory distress indicators and reduced lung functioning in those who used both.” However, there is no strong link at present between marijuana smoking and lung cancer.

Some researchers believe that receptor cross-talk allows cannabis to modify receptors for nicotine, or vice versa. Genes involved in drug metabolism might somehow predispose a subset of addicts to prefer smoking. But at present, there are no solid genetic or environmental influences consistent enough to account for a specific linkage between marijuana addiction and nicotine addiction, or a specific genetic proclivity for smoking as a means of drug administration.

Agrawal, A., Budney, A., & Lynskey, M. (2012). The Co-occurring Use and Misuse of Cannabis and Tobacco: A Review Addiction DOI: 10.1111/j.1360-0443.2012.03837.x

Photo credit:  http://stuffstonerslike.com

A 12 Days of Christmas Blog Meme

Wrapping it up.

From DrugMonkey’s blog: “The rules for this blog meme are quite simple. Post the link and first sentence from the first blog entry for each month of the past year.” (Credit to Janet Stemwedel and John Lynch for the idea.)

Here are the 12 first lines from 2011 here at Addiction Inbox. Click month for full story:

January: Films popular in Europe feature more drinking episodes per movie than their equally popular American counterparts, according to a report by the European Centre for Monitoring Alcohol Marketing (EUCAM).

February: The Director of the Office of National Drug Control Policy issued a warning about the new synthetic stimulants now being clandestinely marketed as bath salts or insecticide.

March: The U.S. Drug Enforcement Administration (DEA) exercised its emergency scheduling authority yesterday to outlaw the use of “fake pot” products.

April: In the first published examination of thirdhand smoke pollution and exposure, researchers at San Diego State University discovered that non-smokers who move into homes purchased from smokers encounter significantly elevated nicotine levels in the air and dust of their new homes two months or more after moving in.

May: What would it be like to have written a drug memoir and an autobiography before you turned 30? Would it seem like the end or the beginning? Are there any worlds left to conquer?

June: The song is not about cigarette addiction, but it could be.

July: Readers may remember the dark day of January 1, 2008, when the U.S. set an all-time record: One out of every 100 adults was behind bars. That’s more than 2.3 million people

August: The cost of addiction treatment is a legitimate medical expense, as long as you are talking about drug and alcohol addiction, which the IRS recognizes as a genuine medical disease.

September: The DSM-V, when it debuts it 2012, is set to replace the category of “Substance-Related Disorders” with a new category entitled "Addiction and Related Disorders." 

October: It’s official: The Obama administration has thrown off the gloves, repudiating Attorney General Eric Holder’s vow of two years ago that the federal government was not interested in prosecuting “state-legal” cannabis activity.

November: They first turned up in Europe and the U.K.; those neon-colored foil packets labeled “Spice,” sold in small stores and novelty shops, next to the 2 oz. power drinks and the caffeine pills.

December: After years of tightening regulation and dramatic declines in the number of adult smokers, Big Tobacco is targeting teenagers like never before.

Photo Credit: http://simplemom.net

End of the Line for Joe Camel?

The tobacco industry’s war against plain packaging.

After years of tightening regulation and dramatic declines in the number of adult smokers, Big Tobacco is targeting teenagers like never before. The fact that they intend to do it with aggressive package advertising has run up against plans in the U.S., the U.K., and Australia to force cigarette manufacturers to use plain packages in a neutral color, with no brand logos, more graphic warnings, and the brand name in simple typeface.

In an orchestrated attack on cigarette regulation in the UK, tobacco giant Philip Morris, the world’s largest tobacco company, filed a flurry of Freedom of Information Act requests in September designed to give them access to proprietary academic research on teenage smoking habits….

For more, read my entire article at THE FIX....

Judge Rules Against Graphic Cigarette Packs

District Court says FDA mandate would violate First Amendment.

Consumers may yet be spared graphic images of diseased lungs and smokers with holes in their throats, after R.J. Reynolds, Lorillard, and other tobacco companies prevailed over the Food and Drug Administration in the U.S. District Court for the District of Columbia today. Judge Richard Leon ruled that forcing cigarette manufacturers to offer their products only in gruesome packages was a violation of free speech, and therefore unconstitutional. The companies were granted a preliminary injunction, while the FDA regroups and lawyers rehuddle.

The judge wrote that “plaintiffs raise for the first time in our Circuit the question of whether the FDA's new and mandatory graphic images, when combined with certain textual warnings on cigarette packaging, are unconstitutional under the First Amendment. Upon review of the pleadings, the parties' supplemental pleadings, oral argument, the entire record, and the applicable law, the Court concludes that plaintiffs have demonstrated a substantial likelihood that they will prevail on the merits of their position that these mandatory graphic images unconstitutionally compel speech, and that they will suffer irreparable harm absent injunctive relief pending a judicial review of the constitutionality of the FDA's Rule.” (Complete ruling available here).

As Josh Gerstein reported at POLITICO, Leon “found that the new warnings, which occupy 50% of the front and back of cigarette packs, convert them into "mini-billboards...for [the FDA's] obvious anti-smoking agenda." Both Health and Human Services Secretary Kathleen Sebelius and FDA Commissioner Margaret Hamburg were also named in the lawsuit.

Judge Leon foresees a slippery constitutional slope if such mandates are allowed to bloom:

When one considers the logical extension of the Government's defense of its compelled graphic images to possible graphic labels that the Congress and the FDA might wish to someday impose on various food packages (i.e., fast food and snack food items) and alcoholic beverage containers (from beer cans to champagne bottles), it becomes clearer still that the public's interest in preserving its constitutional protections - and, indeed, the Government's concomitant interest in not violating the constitutional rights of its citizens - are best served by granting injunctive relief at this preliminary stage.

Graphics Credit: http://pubcit.typepad.com

Cigarette Sadness

The chemistry of sorrow during nicotine withdrawal.

When you smoke a cigarette, nicotine pops into acetylcholine receptors in the brain, the adrenal glands, and the skeletal muscles, and you get a nicotine rush. Just like alcohol, a cigarette alters the transmission of several important chemical messengers in the brain. “These are not trivial responses,” said Professor Ovide Pomerleau of the University of Michigan Medical School. “It’s like lighting a match in a gasoline factory.”

Experiments at NIDA’s Addiction Research Center in Baltimore have confirmed that nicotine withdrawal not only makes people irritable, but also impairs intellectual performance. Logical reasoning and rapid decision-making both suffer during nicotine withdrawal. Acetylcholine appears to enhance memory, which may help explain a common lament voiced by many smokers during early withdrawal. As summarized by one ex-smoker, “I cannot think, cannot remember, cannot concentrate.”

But there is another, less widely discussed aspect of nicotine withdrawal: profound sadness. Profound enough, in many cases, to be diagnosed as clinical unipolar depression.

 Of course, people detoxing from addictive drugs like nicotine are rarely known to be happy campers. But quitting smoking, for all its other withdrawal effects, reliably evokes a sense of acute nostalgia, like saying goodbye to a lifelong friend. The very act of abstinence produces sadness, joylessness, dysphoria, melancholia—all emotional states associated with unipolar depression.

Work undertaken by Dr. Alexander Glassman and his associates at the New York State Psychiatric Institute has nailed down an unexpectedly strong relationship between prior depression and cigarette smoking, and the findings have been confirmed in other work. This sheds important light on the question of why some smokers repeatedly fail to stop smoking, regardless of the method or the motivation.  The problem, as Glassman sees it, is “an associated vulnerability between affective [mood] disorders and nicotine.”

Now a group of Canadian researchers, working out of the Centre of Addiction and Mental Health (CAMH), and the Department of Psychiatry at the University of Toronto, believe they have isolated the specific neuronal mechanisms responsible for the profound sadness of the abstinent smoker.

Writing in the Archives of General Psychiatry, the investigators, who had access to what the CAMH proudly calls the only PET scanner in the world dedicated to mental health and addiction research, gave PET scans to 24 healthy smokers and 24 healthy non-smokers. Non-smokers were scanned once, while heavy and moderate cigarette smokers were scanned after smoking a cigarette, and also after a period of acute withdrawal. Earlier research of this kind had focused on nicotine’s effect on dopamine release. But Ingrid Bacher and her coworkers in Toronto were measuring MAO-A levels in the prefrontal and anterior cingulate regions, two areas known to be involved in “affect,” or emotional responses. When patients suffering from major depressive disorders get scanned, they tend to show elevated levels of MAO-A. The so-called MAO-A inhibitors Marplan, Nardil, Emsam, and Parnate are still in use as antidepressant medications. In general, the higher the levels of MAO-A, the lower the levels of various neurotransmitters crucial to pleasure and reward. A high level of MAO-A would suggest that the enzyme was significantly altering the activity of serotonin, dopamine, and norepinephrine in brain regions involved in mood.

The researchers found that smokers in withdrawal had 25-35% more MAO-A binding activity than non-smoking controls. “This finding may explain why heavy smokers are at high risk for clinical depression," says Dr. Anthony Phillips, Scientific Director of the Canadian Institutes of Health Research's (CIHR's) Institute of Neurosciences, Mental Health and Addiction, which funded this study.

Although researchers involved in these kinds of drug studies almost always claim that the work is likely to lead to new pharmacological therapies, the plain truth is that such immediate spinouts are rare. But in this case, it does seem like the study provides a clear incentive to investigate the clinical standing of MAO-A inhibitors as an adjunct therapy in stop-smoking programs. “Understanding sadness during cigarette withdrawal is important because this sad mood makes it hard for people to quit, especially in the first few days,” said Dr. Jeffrey Meyer, one of the study authors.

As one addiction researcher noted, an associated vulnerability to depression “isn’t going to cover everybody’s problem, and it doesn’t mean that if you give up smoking, you’re automatically going to plunge into a suicidal depression. However, for people who have some problems along those lines, giving up smoking definitely complicates their lives.”


Bacher, I., Houle, S., Xu, X., Zawertailo, L., Soliman, A., Wilson, A., Selby, P., George, T., Sacher, J., Miler, L., Kish, S., Rusjan, P., & Meyer, J. (2011). Monoamine Oxidase A Binding in the Prefrontal and Anterior Cingulate Cortices During Acute Withdrawal From Heavy Cigarette Smoking Archives of General Psychiatry, 68 (8), 817-826 DOI: 10.1001/archgenpsychiatry.2011.82

Photo Credit:http://jenniferonmars.wordpress.com

Does Menthol Really Matter?

Nicotine experts say menthol makes addiction more likely--but differ over what to do about it.

Back in the 1920s, Lloyd “Spud” Hughes of Mingo Junction, Ohio, was working as a restaurant cashier when, legend has it, he smoked some cigarettes that had been casually stored in a tin that contained menthol crystals. Menthol, a compound found in mint plants and also manufactured synthetically, is used medicinally, and as a food flavoring. Back in Spud’s day, menthol was mostly derived by extracting crystals from the Japanese Mint plant. What we know for certain is that the mentholated cigarettes tasted so good to Spud that he patented the mixture. In 1925, the Spud Cigarette Corporation of Wheeling, West Virginia, was born, and Spud Cigarettes quickly became the 5th best selling cigarette brand in America. 

Dr. Neal L. Benowitz, Professor of Medicine and Bioengineering & Therapeutic Sciences, and Chief of the Division of Clinical Pharmacology at the University of California in San Francisco, says that Spud Hughes had “accidentally identified an additive whose pharmacologic actions reduce the irritating properties of smoke generally and nicotine specifically.” Menthol accomplishes this because it acts on receptors involved in the detection of physical stimuli like temperature and chemical irritation. “Menthol contributes to perceptions of cigarettes’ strength, harshness, or mildness, smoothness, coolness, taste, and aftertaste.” That would seem to just about cover it. But no: In their article for the New England Journal Of Medicine—“The Threat of Menthol Cigarettes to U.S. Public Health"—Benowitz and Jonathan M. Samet also claim that “menthol has druglike characteristics that interact at the receptor level with the actions of nicotine.”

And nicotine hardly needs much help establishing its grip over addiction-prone individuals. “It’s not that it’s so intensive,” Dr. Benowitz told me some years ago, when I was researching my book, The Chemical Carousel, “it’s just that it’s so reliable. Nicotine arouses you in the morning; it relaxes you in the afternoon. It’s a drug that you can dose many times per day for the purpose of modulating your mood, and it becomes highly conditioned, more than any other drug, because it’s used every single day, multiple times per day.” Benowitz, along with Dr. Michael Siegel of the Boston University School of Public Health, recently sparked intense debate when they both championed electronic cigarettes as a safe alternative to smoking tobacco cigarettes, despite the FDA’s earlier wish to keep e-cigarettes out of the country. And last month, an advisory report for the FDA by a group that included Benowitz and Samet concluded that mentholated cigarettes were no more harmful, and no more likely to cause disease, than regular cigarettes. A study in the Journal of the National Cancer Institute of 440 lung cancer patients and more than 2,000 matched patients without lung cancer showed no correlation at all between menthol and cancer. In fact, the researchers were surprised to discover that menthol smokers appear to have a lower risk of lung cancer than other smokers. Asked whether menthol cigarettes are more toxic than non-menthol cigarettes, the study's author William Blot of Vanderbilt University definitively responded: “The answer is, no, they are not.”

However, the advisory report suggested that, while menthol cigarettes may not be more dangerous, they might be more addictive than regular cigarettes.  In the May 4 New England Journal of Medicine article, Benowitz and Samet argue that because menthol cigarettes attract younger smokers by making tobacco easier to smoke, and because more of these smokers go on to become lifelong nicotine addicts due to this same cooling effect, "menthol cigarettes increase the likelihood of addiction and the degree of addiction in new smokers." Further adding to menthol’s tendency to create lifelong smokers is the fact that “some consumers, particularly blacks, hold beliefs about implicit health benefits of menthol cigarettes that may interfere with their quitting."

This is a substantial indictment of menthol as a component of cigarettes, despite the belief among some experts that it is much ado about nothing. But if that’s the case, Benowitz and Samet suggest, why has the tobacco industry fought so ferociously to exempt menthol from the list of banned flavorings over the years? And why has the industry so consistently linked its marketing of menthol cigarettes to images of “freshness” and health? The authors estimated that “by 2020 about 17,000 more premature deaths will have occurred and two million more people will have started smoking than would have been the case if menthol cigarettes were not available.” Two million additional cigarette smokers by the end of the decade does not sound especially trivial. Nonetheless, the FDA advisory report that Benowitz helped to shape stopped short of recommending an outright ban on nicotine, saying only that removal of menthol would “benefit public health.”

While not disputing the findings of the FDA Advisory Committee, Dr. Michael Siegel of Boston University expressed dismay that “despite these conclusions, the [committee] did not recommend a ban on menthol cigarettes.” There are almost 20 million menthol smokers in the U.S., Siegel argues. If even a fraction of them quite smoking due to a ban on menthol in cigarettes, “it would have a profound effect on public health.” This is, Siegel insists, precisely why politicians managed to exempt menthol from bans on various flavor additives in the first place. The Black Congressional Caucus had “vigorously denounced the exclusion of menthol” at the time, while Lorillard, maker of Newports--the leading brand of menthol cigarettes--argued that banning menthol would result in the creation of a huge black market.  Because of all this, Seigel charges, Benowitz and the committee simply “punted the issue back to the FDA.” And if anyone harbored doubts about who benefited from this non-action, in Siegel’s view, one need only look at the fact that Lorillard’s stock enjoyed a nice run-up of about 8% after the public announcement of the FDA panel’s recommendations.

Because of all this, Siegel does not believe the FDA will ever ban menthol cigarettes. In his view, the Obama administration doesn’t need the grief of added health care complexities just now, and there is no movement in Congress to make additives an issue. And since the FDA has chosen not to demand the banning of menthol, Siegel thinks the committee’s findings will serve as a convenient smokescreen for Congress. And for the makers of menthol cigarettes, it will be business as usual. A window of opportunity on the menthol issue is now closing, says Siegel, who confesses to difficulty understanding a policy that bans “every other type of cigarette flavoring—including chocolate, strawberry, banana, pineapple, cherry, and kiwi—yet exempts the one flavoring that is actually used extensively by tobacco companies to recruit and maintain smokers… Menthol is a major contributor to smoking initiation and continued addiction, and for this reason, it will continue to enjoy the protection of a federal government that seems afraid to alienate any corporation, whether it’s part of Big Pharma, Big Insurance, or Big Tobacco.”

Photo credit: http://www.nysmokefree.com/

More Vanishing Cigarettes

Churchill, Bette Davis, Don Draper, and Pecos Bill.

In my last post, I highlighted some examples of attacks on cultural history represented by cigarette censorship, to wit: a cigarette taken out of the hand of Paul McCartney, and out of the mouths of Jackson Pollock and Burt Reynolds.

But that is only the tip of the iceberg for cigarette revisionism. Other examples:

--Jean-Paul Sartre. A legendary smoking icon, Sartre was no doubt rolling in his grave over the decision by the Bibliotheque Nationale of France to airbrush away his ever-present cigarette in an exhibition poster marking the 100th anniversary of his birth.

--Winston Churchill. Perhaps the most famous cigar smoker in history, the British Prime Minister suffered the indignity of having his cigar air-brushed out of the famous 1948 photograph of him making the “V” sign for victory. As you can see in the photograph above, that moment in history is no longer with us. Instead, Churchill looks like he is beginning to develop lip cancer.

--Tom and Jerry, Fred Flintstone, and Pecos Bill. Famous cartoon characters who occasionally, for purposes of satire or humor, were seen smoking cigarettes, and whose famous smoking scenes have been edited out by nervous broadcasters over the years. 

--Bette Davis. Another iconic cigarette smoker, she also ran afoul of the U.S. Postal Office (see Jackson Pollock in the post below). When the Post Office offered its Bette Davis stamp in 2008, it was inspired by a still photo from the film "All About Eve." As film critic Roger Ebert wrote at the time: “Where's her cigarette? Yes reader, the cigarette in the original photo has been eliminated. We are all familiar, I am sure, with the countless children and teenagers who have been lured into the clutches of tobacco by stamp collecting, which seems so innocent, yet can have such tragic outcomes.”

--And finally, there is the contemporary case of Don Draper of TV’s “Mad Men,” the only current television show truly obsessed with the cultural significance of smoking.  Indeed, the series opened its first season with a show called “Smoke Gets in Your Eyes,” in which advertising execs devised a pitch for Lucky Strikes. And the arresting title sequence that opens every show ends with a memorable black and white graphic of Don Draper seen from behind, seated on a couch, a cigarette held firmly in hand. “Bizarrely,” write Chris Harrald and Fletcher Watkins in The Cigarette Book: The History and Culture of Smoking, “this pleasure was denied to the man in the Mad Men promotional video for Season 1, when shown on Apple’s iTunes. The original image of a man seen from behind lounging in silhouette, right hand outstretched with a cigarette in it, has had the cigarette digitally removed.” (It has since been restored).

Photo Credit: CORBIS/Stephanie Schaerer

When Presidents Smoke

And a word about famous cigarettes that vanish.

I gave Obama a pretty hard time during the campaign and the first half of his presidency, for sneaking off to furtively field-strip the odd Marlboro. So it seems only fair to take a moment and point out the illustrious forefathers that have paved the way for today’s presidential indiscretions.

The source here is an illustrative and very funny book of cigarette history called, straightforwardly enough, “The Cigarette Book: The History and Culture of Smoking,” by Chris Harrald and Fletcher Watkins.

In the preface, the authors write: “One day the last cigarette on earth will be smoked. One final puff will be sent heaven-bound, leaving a lingering, evanescent smoke-ring…. The ubiquity of the cigarette is astounding. But soon it will be no more.”

A few factoids about U.S. Presidents and smoking:

-- John Quincy Adams. Pipe. A prodigy, he took up smoking at the age of eight.

-- Zachary Taylor. Chewing tobacco. Claimed he could hit White House spittoons from a distance of 12 feet.

-- Rutherford B. Hayes. First killjoy to ban smoking in the White House.

-- William McKinley. “Frantic cigar smoker.” Was known to break open cigars and chew the tobacco.

-- Calvin Coolidge. 12-inch cigars. Mrs. Coolidge, with her secret cigarette habit, may have been the first smoking First Lady.

--Herbert Hoover. “Chain-smoker.”

-- Franklin D. Roosevelt. “Paraplegic chain-smoker.”

-- Harry Truman. Banned smoking at official White House events.

-- Dwight D. Eisenhower. Rolled his own. Quit before the inauguration.

-- John F. Kennedy. “Cuban cigars.” Bought 1,200 of them the day before signing the Cuban embargo. Jackie was, it is said, good for up to three packs of Salems a day.

-- Lyndon B. Johnson. Ferocious cigarette smoker. A habit of 60 smokes a day is assumed to have caused the first of three heart attacks.

-- Gerald Ford. “Pipe. Eight bowls a day.”

-- Ronald Reagan. Did not smoke as president, but will be forever remembered for shilling Chesterfields in the 1940s: “My cigarette is the mild cigarette… that’s why Chesterfield is my favorite.”

In most of these presidential cases, the smokers in question were less than fully candid with the general public about their habits. But even more interesting, and rather chilling, are examples of revisionist censorship—making famous cigarettes in famous photographs mysteriously disappear, for the sake of cultural correctness.

The authors of “The Cigarette Book” start out with a swift punch to the midsection: “A recent poster featuring the famous album cover of Abbey Road (1969) removes the cigarette from Paul McCartney’s hand” (Italics mine, to reify the significance of the offense).

And readers of a certain age will recall (or recall hearing of) (or deny knowing anything about) a nude Burt Reynolds as a Playgirl magazine centerfold in 1972, with a cigarette dangling suggestively from his mouth. But when the image was reissued 35 years later, as part of an HD TV ad campaign, the cigarette, the authors tell us, “had been Photoshopped out of existence. Now it would probably be more acceptable to see his genitals than to see him smoking.” (Then again, maybe not.)

And in 1999, the U.S. Postal Service issued a Jackson Pollock stamp, using an iconic photograph from Life Magazine, showing the artist with a cigarette between his lips. “The Postal Service used the photo, but digitally removed the cigarette.” And perhaps added a little collagen to the lips, as well?

Finally, there is the case of chain-smoker Joseph Stalin, and the insane anti-smoker Adolf Hitler. Hitler had a cigarette removed from a famous photo of Stalin circulated at the time of the non-aggression pact. “Hitler felt it was bad for Germans to see such a ‘statesman’ (Hitler’s term) with a cigarette between his fingers.”

Photo credit: LBJ Library

Put Down Your Cigarette Rag (Don't Smoke)

By Allen Ginsberg (1971)

Dont smoke dont smoke dont smoke

Dont smoke

It's a nine billion dollar

Capitalist Communist joke

Dont smoke dont smoke dont smoke dont smoke

Dont smoke

Smoking makes you cough,

You cant sing straight

You gargle on saliva

and vomit on your plate

Dont smoke dont smoke dont smoke dont smoke,

Dont smoke smoke smoke smoke

You smoke in bed

You smoke on the hill

Smoke till yr dead

You smoke in Hell

Dont smoke dont smoke in living Hell Dope Dope

Dont smoke dont smoke dont smoke

You puff your fag

You suck your butt

You choke and gag

Teeth full of crud

Smoke smoke smoke smoke Dont dont dont

Dont Dont Dope Dope Dope Dont Smoke Dont Dope

Pay your two bucks

for a deathly pack

Trust your bad luck

and smoke in the sack

Dont Smoke Dont Smoke Nicotine Nicotine No

No dont smoke the official Dope Smoke Dope Dope

Four Billion dollars in Green

'swat Madison Avenue gets

t' advertise nicotine

and; hook you radical brats

Dont Smoke Dont Smoke Dont Smoke

Nope Nope Dope Dope Hoax Hax Hoax Hoax

Dopey Dope Dopey Dope Dope Dope dope dope

Black magic pushes dope

Sexy chicks in cars

America loses hope

and smokes and drinks in bars

Don't smoke dont smoke dont smoke,

dont smoke dont dont dont dont dont

choke choke choke choke kaf kaf

Kaf Kaf Choke Choke

Choke Choke Dope Dope

Communism's flopped

Let's help the Soviet millions

Sell 'em our Coffin-Nails

and make a couple billions

Big Bucks Big Bucks bucks bucks

bucks bucks smoke smoke smoke smoke

smoke Bucks smoke bucks Dope bucks big

Dope Bucks Dig Big Dope Bucks Big Dope

Bucks dont smoke big dope bucks

Dig big Pig dope bucks

Nine billion bucks a year

a Southern Industry

Buys Senator Jesse Fear who pushes Tobacco subsidy

In the Senate Foreign Relations Committee

Dope smokes dope smokes dont smoke dont smoke

Cloak cloak cloak room cloak and; dagger

smoke room cloak room dope cloak

cloak room dope cloak room dope dont smoke

Nine billion bucks for dope

approved by Time and Life

America loses hope

The President smokes Tobacco votes

Dont Smoke dont smoke dont smoke dont smoke

Dont smoke nope nope nope nope

30 thousand die of coke or

Illegal speed each year

430 thousand cigarette deaths

That's the drug to fear

In USA Dont smoke Dont smoke Dont smoke

Get Hooked on Cigarettes

Go Fight the War on Drugs

Smoke any other Weed

Get bust by Government Thugs

Dont smoke dont smoke the official dope

If you will get in bed

and give your girlfriend head

then you wont want a fag

Nor evermore a drag

Dont Smoke dont smoke Hope Hope Hope Hope

O Please Dont Smoke Dont Smoke

O Please O Please O Please

I'm calling on my knees

Twenty-four hours in bed

and give your boyfriend head

Put something in your mouth

Like skin not cigarette filth

Suck tit suck tit suck cock suck cock

suck clit suck prick suck it

but dont smoke nicotine dont smoke

dont smoke nicotine nicotine it's

too obscene dont smoke dont smoke

nicotine suck cock suck prick suck tit

suck clit suck it But dont smoke shit nope

nope nope nope Dope Dope Dope Dope

the official dope Dont Smoke

Make believe yer sick

Stay in bed and lick

yr cigarette habit greed

One day's all you need

In deed in deed in deed in deed smoke weed

smoke weed Put something green

in between but don't smoke smoke dont smoke

hope hope hope hope Nicotine dont

smoke the official dope

Dope Dope Dope Dope Dont Smoke

Smoke weed indeed smoke grass yass yass

smoke pot but not nicotine no no

indeed it's too obscene

put something green

in between your lips get hip not square

listen to my wail don't dare smoke coffin nails

ugh ugh ugh ugh the government Drug

official habit for Mr. Babbitt

Dont smoke the official dope

dope dope dope dope don't smoke

Dont Smoke Dont Smoke.

Original version: First Blues: Rags, Ballads and Harmonium Songs

Extended version: http://www.youtube.com/

Photo Credit: http://berkshirereview.net/

Nicotine and the Humphrey Bogart Gene

You can lead a fish to water, but can you make it smoke?

Zebrafish embryo showing axon tracts in green, viewed from lateral (top) and dorsal (bottom) orientations------>

Common denizens of home aquariums, the humble zebrafish may dart about the tank like any other small tropical specimen, but zebrafish have become one of the hot genetic research tools of the moment. The lab rat may have met its match in the lab zebrafish, a popular non-mammalian organism that is currently playing a leading role in government-sponsored research on the genetic aspects of nicotine addiction.

Scientists are fond of these new fishy animal models because zebrafish are cheap, develop rapidly, and are more biologically similar to humans than anyone might naively assume. Their transparent embryos allow researchers to inject flourescent proteins into living animals, and in some cases to track the regulation of gene expression as it is happening.

Research funded by the National Institute on Drug Abuse (NIDA) and  published in the Proceedings of the National Academy of Sciences used zebrafish in a hunt for genes

affecting nicotine exposure. Like rats, the fish show characteristic behaviorial responses to low doses, high doses, and the nicotine sensitization process. According to NIDA, the scientists “induced mutations in particular DNA segments of the zebrafish and looked at changes in the nicotine response profile of mutant carriers compared to their siblings.” The changes in nicotine response observed between the groups were mediated by two genes, which the scientists dubbed bdav/cct8 (bette davis) and hbog/gabbr1.2 (humphrey bogart), named after “celebrities that suffered from tobacco-related cancers.” These two genes, when expressed, caused zebrafish to respond more positively to nicotine.

“We all know how hard it is to quit smoking,” Dr. Ekker told Mayo’s online research magazine, Discovery’s Edge. “What most people don’t know is that genetic differences significantly contribute to the degree of nicotine dependence. We want to understand the genetics behind different responses to nicotine and come up with more effective and individualized treatments for people addicted to nicotine.”

The Mayo Clinic in Minnesota has taken a leading role in developing the fish for research, having established the Zebrafish Core Facility in 2007 under the direction of Dr. Stephen Ekker. Mayo’s zebrafish are now being used in various research laboratories for research in the fields of developmental biology and functional genomics. The fish are now a crucial part of biological research on cancer and heart disease, as well as addiction.

Graphics Credit: http://www.ucl.ac.uk/

Petzold AM, Balciunas D, Sivasubbu S, Clark KJ, Bedell VM, Westcot SE, Myers SR, Moulder GL, Thomas MJ, & Ekker SC (2009). Nicotine response genetics in the zebrafish. Proceedings of the National Academy of Sciences of the United States of America, 106 (44), 18662-7 PMID: 19858493

Can I Smoke in Here?

New tobacco map highlights state differences.

An interactive online map set, showing state-by-state variations in smoke-free laws, cigarette tax rates, and rates of tobacco control spending, has been put together by the Robert Wood Johnson Foundation, and is now available for viewing at the foundation’s Public Health site HERE.

“Users will be able to see whether a state is ahead or behind the curve in protecting and promoting health,” says Michelle Larkin, the leader of the Robert Wood Johnson Foundation Public Health Team. “We know from the research that the two most effective policies to pursue are raising tobacco taxes and putting smoke-free air laws into place,” says Larkin, adding that “these two policies help to prevent youth from ever starting to smoke and they also help smokers quit.”

To that end, the interactive maps that comprise the project can be used to track changes from state to state in smoke-free legislation and taxation rates over time. A third map can be used to track the extent to which states are complying with CDC recommendations for tobacco control expenditures. (Answer: most of them aren’t.)

The hope is that the interactive tobacco map will provide policymakers with a nationwide picture of tobacco policy, using the state-by-state breakdowns to predict trends and to demonstrate how the tobacco control landscape has evolved and changed over the years.

The RWJF Tobacco Map uses data from the Campaign for Tobacco-Free Kids and Americans for Non-Smokers’ Rights.

Nicotine Vaccine Doubles Quit Rate in Human Trials

NicVax still showing promise against cigarette addiction

Nabi Biopharmaceutical announced this week that an experimental vaccine it has been testing against nicotine addiction had shown itself to be effective in human trials. Volunteers were more than twice as likely to quit, compared to a control group whose members were injected with a placebo.

The company-funded study gave volunteers five injections of NicVax, Nabi’s proprietary drug, or else a placebo. In regulatory filings, the company claims that the vaccine triggers an antibody response, which prevents nicotine molecules from reaching the brain. The antibodies bind with the nicotine molecules, making nicotine too large to cross the exceedingly fine blood-brain barrier of the brain. Roughly 15 per cent of smokers who received injections of NicVax were nicotine-free after one year. For comparison, early studies of Chantix as an anti-smoking medication show a quit response rate in the range of 20 per cent for heavy smokers. Studies of NicVax undertaken last year were also positive. It is one of several nicotine vaccines currently under development, and while it is farthest along in the FDA pipeline, it is still a year or two away from any possible commercial introduction.

Vaccines for specific addictive drugs represent one of two different approaches to developing pharmaceuticals for addiction treatment. The other approach, represented by Chantix and Zyban, decreases drug craving by altering the neuroregulation of dopamine and other substances in the brain. In this respect, these two drugs, which are non-addictive, are related to nicotine gums and patches, which also attempt to diminish cravings for cigarettes.

A vaccine like NicVax, however, does not attack the craving for nicotine. It contains no nicotine and is non-addictive. Rather, the vaccine makes the attempt to assuage nicotine cravings an impossible task. And in this respect, NicVax resembles Antabuse for alcoholism--except that the vaccine does not cause the smoker to become seriously ill when he or she takes a puff. . (The company reported that side effects were “well tolerated.”) It simply (or not so simply) cancels out the nicotine high altogether, or at least that is the idea. It is unclear to what extent the antibody reaction prevents nicotine binding in other areas of the body where nicotine-type receptors are found, such as acetylcholine receptors in muscle tissue.

In addition, NicVax must be injected, while Chantix and Zyban or taken orally. “Some people prefer a shot and some people will do anything to avoid one,” Rennard said. “It’s important to have options.”

Stephen Rennard of the University of Nebraska Medical Center, one of the authors of the company’s study, which is funded by a grant from the National Institute on Drug Abuse (NIDA) and is now in midstage, said that when smokers “don’t get the hit they would normally get, it makes it easier for them to quit because smoking doesn’t really do it for them any more.”

The results were presented at the American Heart Association Scientific Sessions in Orlando, Florida. “This double-blind, placebo-controlled trial has demonstrated [that] there is a correlation between antibody level and the ability of patients to quit smoking and remain abstinent over long periods of time,” Rennard told the group. Leslie Hudson, CEO and Interim President of the company, said he was “excited and encouraged.” Nabi Biopharmaceutical, headquartered in Boca Raton, Florida, is traded on the NASDAQ stock market [NABI].

Nicotine Addiction in the U.K.

Study group urges harm reduction strategy for heavy smokers

Britain's Royal College of Physicians (RCP) called upon the government to treat cigarette smoking like any other drug addiction, and faulted its members for failing to offer sufficient help to heavy smokers trying to kick the habit.

Because of that failure, the Academy called for greater access to nicotine substitution products, and the development of safer and more effective nicotine delivery systems for smokers who cannot quit.

The Academy’s report, "Harm Reduction in Nicotine Addiction: Helping People Who Can’t Quit," called for a sweeping overhaul of the country’s nicotine marketing structure "so that harm reduction strategies are in place."

The report’s principle suggestion: "Change nicotine product regulation to make it easier to produce and market medicinal nicotine products."

Jean King, Cancer Research UK's director of tobacco control, said the report highlighted the "stark fact" that cigarettes are freely available, while medicinal nicotine products are heavily regulated.

The report also calls for continued development of new forms of “user-friendly medicinal nicotine substitutes,” as well as relief from burdensome regulations that impede the marketing of new nicotine alternatives—chewing gums, nasal sprays, and patches.

“Smokers smoke because they are addicted to nicotine,” said Professor John Britton, chair of the Academy’s Tobacco Advisory group. “There are millions of smokers who can’t quit, or else are unlikely to quit, and those people need nicotine products that can satisfy their addiction without killing them.”

This methadone-style approach to nicotine addiction is sure to prove controversial. Will it save lives, or will it simply keep nicotine addicts from getting clean? Reuters reports that some British scientists are concerned that an emphasis on cigarette substitution products is at odds with a policy of helping people completely break their addiction to nicotine—which the Royal Academy maintains is still their primary focus.

Smoking in New York City

A Borough-By-Borough Survey

New York City has 240,000 fewer smokers than it did in 2002, according to a recent report released by the city’s Department of Health and Mental Hygiene. City health official Jennifer Ellis told the New York Times that the data represent the sharpest fall-off in cigarette smoking since the department began the surveys in 1993.

The report cited bans on smoking in public places, higher taxes on tobacco products, and a multi-million dollar local advertising campaign as the ingredients that helped lead to the overall reduction in the number of smokers. Based on a citywide survey of adults, Who’s Still Smoking states that as many as 800,000 smokers attempted to quit in the past year, but less than one-fifth of them succeeded.

However, quit rates over the 5-year period varied markedly from borough to borough. Staten Island proved to be the home of the city’s most stubborn and recalcitrant smokers: While the citywide smoking rate dropped by almost 20 per cent, Staten Island’s smoking rate—27 per cent, according to the survey--has remained steady since 2002. Manhattan and the Bronx ended in a virtual tie for first place, with smoking reductions of about 24 per cent, while Queens trailed slightly. Brooklyn came in second to last, with a quit rate of only 13 per cent.

On August 21, the Health Department began a nicotine-replacement giveaway program aimed specifically at Staten Islanders. The 5-week giveaway and associated media campaign will run Tuesdays through Thursdays at the Staten Island Ferry’s Whitehall Terminal.

Men still lead women in smoking, 20 per cent to 15 per cent overall, but the report claims that quit rates are similar for both sexes. Low-income adults and adults without a high school education are more likely to attempt quitting by a slight margin, but less likely to be successful per attempt. One important side note: A separate analysis of survey data showed that only 11 per cent of heavy drinkers who smoke were able to quit in the past year.

The average pack-a-day smoker now spends $2,500 a year to support his or her habit. Health officials stressed that the use of nicotine replacement, either as patches or gum, along with anti-craving medications like Zyban and Chantix, can at least double a smoker’s chances of successfully getting free.

Information in the report was gathered through a random telephone survey of 10,000 adult New Yorkers.

Image courtesy of the National Library of Medicine.

smoking

Book Review (Part 1): "Women Under the Influence"

Women and Cigarettes: “The Virginia Slims Woman is Catching up to the Marlboro Man.”

“Compared to boys and men, girls and women become addicted to alcohol, nicotine, and illegal and prescription drugs at lower levels of use and in shorter periods of time, develop substance-related diseases like lung cancer more quickly, suffer more severe brain damage from alcohol and drugs like Ecstasy, and often pay the ultimate price sooner. Yet 92 per cent of women in need of treatment for alcohol and drug problems do not receive it. Stigma, shame, and ignorance hide the scope of the problem and the severity of the consequences.”

--Joseph A. Califano, Jr.

“Women Under the Influence,” with a Foreword by former Health, Education and Welfare Secretary Joseph Califano, appeared in print last year, but is well worth a second look. The result of studies undertaken at Columbia University’s National Center on Addiction and Substance Abuse, and collectively written by that group, “Women Under the Influence” gathers together a decade’s worth of research on the gender differences researchers have thus far been able to identify in the addict population.

The same genetic and biological mechanisms that predispose certain men toward alcoholism and other forms of drug addiction do the same in women. Young women with family histories of alcoholism will, like Pavlov’s dogs, salivate more intensely at the sight of alcohol than women from families without addiction histories. Studies of female twins also confirm the behavioral link between major depressive disorder and substance abuse. Women who have suffered from major depression are three to six times more likely to suffer from alcoholism than those who have not. Despite these and other commonalities, however, women and men often follow different arcs of addiction on a drug-by-drug basis.

We begin with cigarettes, since it is with nicotine that women have lately shown the ability to achieve a grisly parity, or in some cases even outdo men in the damage done by nicotine. About one American woman out of five smokes. While rates of lung cancer in men have been slowly declining since 1980, the number of women with lung cancer has increased 600 percent over the past 70 years. More women now die of lung cancer than the combined fatalities from breast cancer, ovarian cancer, and uterine cancer. As Antonia C. Novella, former U.S. Surgeon General, put it: “The Virginia Slims Woman is Catching up to the Marlboro Man.”

80 per cent of female smokers began smoking before the age of 18, and women did not begin smoking in large numbers until the late 1940s, thus producing a delayed epidemic of lung cancer in women. To make matters worse, the Columbia group concluded that “At the same level of exposure to tobacco smoke, women have a greater risk of developing lung cancer than men.” Up to three times more likely, according to some studies. Moreover, women who smoke more than 20 cigarettes a day face an 80 per cent greater risk of developing breast cancer, compared to non-smoking women.

Women who smoke heavily have four times as many heart attacks as non-smoking women. Add in oral contraceptives, and the risk of heart attack increases by 1,000 percent.

Women who smoke have more respiratory disorders. Wheezing rates are consistently higher for women than for men, at all age levels. Women smokers develop more crow’s feet around the eyes than men who smoke. Female pack-a-day smokers suffer a steady accretion of bone density and a concomitant increase in rates of osteoporosis. And the fact that nicotine is an effective appetite suppressant is an open secret, as a couple of generations of chain-smoking supermodels have demonstrated.

Cigarette companies are increasingly placing their bets abroad, among a new generation of young women in countries like China, where authorities estimate that as many as 20 million Chinese women have taken up smoking over the past ten years. In “Lung cancer in U.S. women: A contemporary epidemic,” published in the Journal of the American Medical Association (JAMA 291(14):1767), J.D. Patel et. al. suggest that “Curtailing the increase in tobacco use among women in developing countries represents one of the greatest opportunities for disease prevention in the world today.”

The silver lining, if there is one, is that a majority of women still choose not to smoke.

Women Under the Influence--purchase info

End of Part One.

What's Wrong With This Picture?

A bit of cognitive dissonance, perhaps?

The situation could easily be reversed, but cigarette manufacturers mostly advertise in magazines, not newspapers. Otherwise, we might be reading about the dangers of consuming too much alcohol in casinos, while looking at an ad for a new brand of cigarettes.

New World Nicotine: A Brief History

“Drinking the Smoke”

The prototypically North American contribution to the world drug trade has always been tobacco. Tobacco pipes have been found among the earliest known Aztec and Mayan ruins. Early North Americans apparently picked up the habit from their South American counterparts. Native American pipes subjected to gas chromatography show nicotine residue going back as far as 1715 B.C. “Drinking” the smoke of tobacco leaves was an established New World practice long before European contact. An early technique was to place tobacco on hot coals and inhale the smoke with a hollow bone inserted in the nose.

The addicting nature of tobacco alarmed the early missionary priests from Europe, who quickly became addicted themselves. Indeed, so enslaved to tobacco were the early priests that laws were passed to prevent smoking and the taking of snuff during Mass.

New World tobacco quickly came to the attention of Dutch and Spanish merchants, who passed the drug along to European royalty in the 17th Century. In England, American tobacco was worth its weight in silver, and American colonists fiercely resisted British efforts to interfere with its cultivation and use. Sir Francis Bacon noted that “The use of tobacco is growing greatly and conquers men with a certain secret pleasure, so that those who have once become accustomed thereto can later hardly be restrained therefrom.” (As a former smoker, I am hard pressed to imagine a better way of putting it.)

Early sea routes and trading posts were determined in part by a desired proximity to overseas tobacco plantations. The expedition routes of the great 17th and 18th Century European explorers were marked by the strewing of tobacco seeds along the way. Historians estimate that the Dutch port of Amsterdam had processed more than 12 million pounds of tobacco by the end of the 17th Century, with brisk exports to Scandinavia, Russia, Prussia, and Turkey. (Historian Simon Schama has speculated that a few enterprising merchants in the Dutch tobacco industry might have “sauced” their product with cannabis sativa from India and the Orient.)

Troubled by the rising tide of nicotine dependence among the common folk, Bavaria, Saxony, Zurich, and other European states outlawed tobacco at various times during the 17th Century. The Sultan Murad IV decreed the death penalty for smoking tobacco in Constantinople, and the first of the Romanoff czars decreed that the punishment for smoking was the slitting of the offender’s nostrils. Still, there is no evidence to suggest that any culture that has ever taken up the smoking of tobacco has ever wholly relinquished the practice voluntarily.

A century later, the demand for American tobacco was growing steadily, and the market was worldwide. Prices soared, with no discernible effect on demand. “This demand for tobacco formed the economic basis for the establishment of the first colonies in Virginia and Maryland,” according to drug researcher Ronald Siegel. Furthermore, writes Siegel, in his book “Intoxication”:

"The colonists continued to resist controls on tobacco. The tobacco industry became as American as Yankee Doodle and the Spirit of Independence…. British armies, trampling across the South, went out of their way to destroy large inventories of cured tobacco leaf, including those stored on Thomas Jefferson’s plantation. But tobacco survived to pay for the war and sustain morale."

In many ways, tobacco was the perfect American drug, distinctly suited to the robust American lifestyle of the 18th and 19th Centuries. Tobacco did not lead to debilitating visions or rapturous hallucinations—no nodding out, no sitting around wrestling with the angels. Unlike alcohol, it did not render them stuporous or generally unfit for labor. Tobacco acted, most of the time, as a mild stimulant. People could work and smoke at the same time. It picked people up; it lent itself well to the hard work of the day and the relaxation of the evening. It did not act like a psychoactive drug at all.

As with plant drugs in other times and cultures, women generally weren’t allowed to use it. Smoking tobacco was a man’s habit, a robust form of relaxation deemed inappropriate for the weaker sex. (Women in history did take snuff, and cocaine, and laudanum, and alcohol, but mostly they learned to be discreet about it, or to pass it off as doctor-prescribed medication for a host of vague ailments, which, in most cases, it was.)

Excerpted from The Chemical Carousel: What Science Tells Us About Beating Addiction © Dirk Hanson 2008, 2009.
By Dirk Hanson

Brain Injury Stops Smokers Cold

In a research development that the director of the National Institute on Drug Abuse (NIDA) calls nothing short of “ming-boggling,” stroke victims lost all desire for cigarettes after suffering damage to a tiny structure in the forebrain. The stroke victims who smoked were seemingly freed from nicotine addiction by damage to the insula, a part of the brain that has not previously been a primary target of addiction research.

Along with the nucleus accumbens, the amygdala, and other structures in the limbic system, certain regions of the cerebral cortex are also implicated in active addiction. Now, said NIDA’s Dr. Nora Volkow, “Everybody’s going to be looking at the insula.”

Researchers at the University of Iowa and the University of Southern California collaborated on the brain injury study, published in the January 26 issue of Science. Neuroscientist Antoine Bechara of USC had learned of a stroke patient known only as N.

A heavy smoker from the age of 14, N. quit cold after a stroke at age 28, telling doctors: “My body forgot the urge to smoke.” A striking percentage of smokers with similar damage to the insula had apparently quit smoking after the injury just as effortlessly as had Patient N.

The role of the insula in brain activity is not well understood, but neurologists believe that the structure may help integrate subcortical inputs into coherent emotions and conscious urges.

No one is suggesting brain surgery for nicotine addiction, but researchers hope to discover ways of interfering with the operation of the insula, perhaps by means of a targeted drug. However, it is not yet clear what other functions the insula may perform, and whether the damage that seemingly eliminates the cigarette urge might also eliminate more positive urges and emotions as well.

Sources:

--Naqvi. N.H., et. al. “Damage to the insula disrupts addiction to cigarette smoking.” Science 315 531-534. Jan 26, 2007.

--Brownlee, Christen. “Addiction Subtraction: Brain damage curbs cigarette urge.” Science News 171 51. Jan 27, 2007.

--Carey, Benedict. “In Clue to Addiction, Brain Injury Halts Smoking.” New York Times. January 26, 2007.