Select Committee on Health Minutes of Evidence

Memorandum by British American Tobacco

THE TOBACCO INDUSTRY AND THE HEALTH RISKS OF SMOKING (TB 28)

NICOTINE AND ADDICTION

  189.  Many claim that smoking is an "addiction", and that it is the nicotine in tobacco smoke which is responsible for promoting and maintaining addiction through its pharmacological effects on the central nervous system. In reality smoking behaviour is more complex and detailed analysis does not support a claim that people smoke solely for the pharmacological effects of nicotine.

  190.  Simply put, smoking provides a range of pleasures at the cost of real and serious long term health risks. Why smokers choose those pleasures, notwithstanding the risks, is a complex behavioural question, the answer to which, to some extent, is doubtless unique to each smoker. Although each smoker balances the benefits versus the risks of smoking and comes to their own conclusion, there are common factors which play a role in the analysis.

  191.  Clearly, there are pharmacologically-based pleasures to be derived from smoking, as has been well-documented in the public literature for decades. There are many reasons why the basis for smoking behaviour cannot be simply the pharmacological effects of nicotine, but in the simplest terms, if it were, then smokers would choose only high nicotine delivery cigarettes, and nicotine replacement therapies would be as satisfying as cigarettes—but neither is true.

  192.  The sensory stimulation from cigarettes, such as aroma and taste, and the social and cultural aspects of smoking, clearly play an important role in smoking behaviour. Moreover, the scientific literature demonstrates that the pharmacological effects of nicotine on the central nervous system are quite mild, milder even than the effects of other pleasurable substances, such as alcohol and coffee.

  193.  It is probably the combination and interaction of these pleasures which make modification of smoking behaviour difficult for some. But in analysing why smoking may be difficult to quit, only to look at the nature and strength of the pleasures associated with smoking is to ignore the other half of the equation. The nature and strengths of the perceived incentives for quitting are equally important.

  194.  While, for many non-smokers, the avoidance of long-term smoking risks is a more than adequate incentive not to smoke, for some smokers the short-term pleasures of smoking simply seem to outweigh concerns about the long-term risks. Unlike other pleasurable activities, such as drinking alcohol or hang gliding, there is no short-term risk of serious acute injury from smoking, nor is there the risk of breaking the law, such as with the use of illegal drugs or driving after drinking alcohol.

  195.  At the end of the day, successful quitting turns on motivation. Smokers for whom the pleasures associated with smoking outweigh the incentive of long-term risk avoidance are motivated to continue smoking. Smokers for whom the converse is true are motivated to quit. This is an individual choice about lifestyle, which seems inappropriate to subject to the value judgements of third parties. It is worth comparing this with the examples of dieting and exercise. Most people know the long-term health benefits of a sensible diet and regular exercise, yet it is hard to keep to a low fat diet or a weekly exercise regime. At the same time, it would be hard to accept that third parties should seek to impose sensible diets and exercise regimes on informed adults, beyond giving encouragement through public education and the provision of appropriate facilities.

  196.  It has become common usage to describe many pleasurable activities, which some people find hard to give up or prefer not to give up, as "addictions". People say they are addicted to particular foods, using the internet, taking exercise, watching certain television programmes, or even to working. Often these are pleasurable activities well within the control of the individual, yet they may be undertaken to excess. Often, the term "addiction" can be used to provide social support to the individual for carrying on doing something that they know might not be of benefit in the long-term, or that they simply prefer to do above other choices.

  197.  Some substances determined to be addictive, such as heroin and alcohol, can produce effects not seen with cigarette smoking. Heroin and alcohol used by individuals can produce intoxication, clearly defined and life-threatening withdrawal syndromes, and "tolerance" (where more and more of the substance is needed for the same effect), cigarette smoking does not.

  198.  British American Tobacco recognises that, by current popular concepts of addiction, smoking can be seen to be addictive. However, despite the fact that many people find it difficult to quit, there is nothing in cigarette smoke that removes the ability of someone to stop smoking, once they have the motivation to do so.

Early scientific literature

  199.  The pharmacological effects of nicotine have been described in the scientific literature since at least the late 1800s, and "as early as the 1920's and 1930's, some investigators were concluding that nicotine was responsible for the compulsive use of tobacco products" (US Surgeon General, "The Health Consequences of Smoking: Nicotine Addiction", p 10, 1988).

  200.  By the middle of this century, some scientists were comparing smoking with the use of addictive narcotic drugs. In the Lancet, Johnston reported that "smokers show the same attitude to tobacco as addicts to their drug, and their judgement is therefore biased in giving an opinion of its effects on them" (Johnson, "Tobacco Smoking and Nicotine", Lancet, 2:742, 1942) and, in a basic text on tobacco science, Shmuk observed that "the physiological effect of nicotine on the human organism is such as to induce the addiction to smoking and bring about general consumption of tobacco" (Shmuk AA, "The Chemistry and Technology of Tobacco", p 587, 1953).

  201.  The claim that cigarette smoking leads to addiction is very old. It has been pointed out that:

"Scholars of the seventeenth and eighteenth centuries wrote of the addictive nature of smoking and drew comparisons between tobacco, opium, and alcohol use" (Henningfield JE, "Behavioural Pharmacology of Cigarette Smoking" in Thompson, et al (ed.s), Advances in Behavioural Pharmacology, p 197, 1984).

Public health views of smoking and addiction

  202.  There was no rush, however, to the conclusion by public health authorities that nicotine caused smoking to be addictive under a scientific definition of addiction. The US Surgeon General, in 1964, drew a clear distinction between, on the one hand, the use of substances such as nicotine and caffeine and, on the other, the use of narcotic substances which (i) are intoxicating; (ii) create physical dependence; and (iii) are required in ever-increasing doses to achieve the same effect ("tolerance") (US Surgeon General, "Smoking and Health", 1964).

  203.  The Royal College of Physicians 1962 report on smoking and health was less lucid on this issue. The authors of the report used the terms "addiction" and "habit" interchangeably, which reflected the way those terms were used within the scientific community, and indeed within British American Tobacco, at that time:

"The discomforts that ensue when smoking is stopped may thus be genuine withdrawal symptoms due to addiction to nicotine, but are also those to be expected when any well-established and pleasant habit is discontinued, particularly one which has become a valued element in everyday life and is regarded as a prop or solace" (RCP, Smoking and Health, London p 41, 1962).

  204.  It was not until his 1988 report that the US Surgeon General altered his definition of addiction, and re-classified smoking as addictive (US Surgeon General, The Health Consequences of Smoking: Nicotine Addiction, 1988).

  205.  The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, commonly referenced as DSM-IV, is the standard text used by most clinicians to diagnose, communicate about, study and treat various mental disorders. DSM-IV contains a short section on nicotine-related disorders. DSM-IV generally takes a relatively flexible approach to the definition of "substance dependence". For example, it permits substance dependence to be defined with or without "physiological dependence" (tolerance and withdrawal). Whilst determining that nicotine can cause dependence, it states: "Some of the generic Dependence criteria do not appear to apply to nicotine, whereas others require further explanation" (American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, p 243, 1994). It also states that "Whether other Nicotine Withdrawal symptoms play a major role in relapse of smoking is debatable" (ibid, p 246). It is also interesting to note that of all substances classified as producing dependence, nicotine is the only substance that DSM-IV determines does not cause intoxication (ibid, p 177).

  206.  Most public health authorities now choose to determine that cigarette smoking is an addiction. As people realise, and it is important that they should, once someone chooses to start smoking, they may find it difficult to quit. However, it is equally important that smokers who have decided to quit realise that there is nothing in smoking that will stop them quitting as long as they have the motivation to quit. We believe that labelling cigarettes "addictive" and smoking an "addiction" risks giving smokers who want to quit the impression that it is more difficult to quit than it really is.

Nicotine's role in smoking

  207.  Turning to the question of nicotine's role, nicotine is, of course, a naturally occurring component of the tobacco plant. Nicotine concentration varies between different tobacco crops, different individual plants, and different parts of each plant and, like all manufacturers of tobacco products, British American Tobacco buys tobacco leaf from various countries and blends it to maintain the flavour and sensory characteristics of its brands from year to year, thereby meeting its customers' expectations and preferences. British American Tobacco offers a range of tar and nicotine yields in its cigarettes around the world. However, as tar yields have declined over the years, nicotine yields have declined too, because the techniques used to reduce tar also reduce nicotine.

  208.  British American Tobacco acknowledges that, as has been well known for over a century, nicotine has mild pharmacological properties which are an important part of the enjoyment of smoking. Nicotine is also, however, one of a number of components of tobacco smoke responsible for the sensory stimulation of the peripheral nervous system which smokers seem to find pleasurable. These peripheral effects of nicotine are often over-looked.

  209.  Most significantly, nicotine seems to be uniquely responsible for the catch or hit in the back of the throat which is known as "impact", and which is without doubt an important sensation when it comes to smoking enjoyment. While other smoke components contribute to the body or flavour of smoke, nicotine's distinctive contribution of impact is an essential part of the overall sensory experience. An analogy can be drawn with the bubbles in carbonated soft drinks, which also stimulate the peripheral nervous system. The bubbles make an essential contribution to the overall sensory experience, not because of their own flavour, but because most consumers would say that a cola without the bubbles is not a cola because it lacks an expected and essential sensory component of a cola drink.

Product development

  210.  Although nicotine certainly makes an essential contribution to smoking enjoyment, British American Tobacco's product design does not primarily focus on nicotine. New products are developed with a tar yield target, often governed by local regulatory requirements. Of course, experienced product designers will know what the nicotine yield of the new product is likely to be, and indeed nicotine and water yields must be measured in order to calculate tar yield, which is defined as particulate matter, free of water and nicotine.

  211.  Volunteer smoking panels are used to test the acceptability of new designs. These panels rate cigarettes according to sensory attributes such as taste, impact and harshness. Marketing decisions are based on panel reports and consumer testing which focuses on the same kinds of acceptability parameters.

  212.  Indeed, all British American Tobacco's product testing with smokers focuses on taste, flavour, and sensory cues. It is hard to see how it could be otherwise, because smokers do not seem to (and do not seem able to) distinguish between cigarettes on the basis of their pharmacological properties. For example, an English smoker may reject a French-style cigarette with exactly the same nicotine (and tar) yield as his regular brand, purely on the basis of the flavour and sensory "style" of the product. The pharmacological effects delivered would, presumably, be the same.

  213.  Cigarettes are made from natural materials that are inherently variable. However, British American Tobacco, like every cigarette manufacturer, uses technological means to manufacture consistent products. Nicotine levels are measured to ensure product consistency and that published figures are correct. The allegation that we alter the amount or nature of nicotine in order to addict smokers is simply not true; neither are the allegations that cigarettes are" "spiked"" with added nicotine.

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Prepared 28 February 2000