Martyn McLaughlin: New route to divert users from taking tobacco road

Meeting Scottish Government ambitions for a cut to just five per cent of Scots smoking by 2034 may need a change in emphasis, with new moves in the US suggesting cigarettes with lower levels of nicotine could be the answer.
Meeting Scottish Government ambitions for a cut to just five per cent of Scots smoking by 2034 may need a change in emphasis, with new moves in the US suggesting cigarettes with lower levels of nicotine could be the answer.
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Change is in the air as cuts in nicotine levels are touted as the best way to wean smokers off their habit, says Martyn McLaughlin

For decades, Big Tobacco’s shareholders have relished confounding their critics, withstanding advertising bans and legislative pressure to remain one of the world’s most profitable industries.

Last year, the trade’s five leading firms shipped 2.27 trillion cigarettes, registering profits of £27 billion and providing investors with dividends north of £14bn. Its hubris is well-founded, but change is in the air.

It has received little in the way of publicity, but at the weekend, one of the world’s largest regulatory bodies announced what may well prove to be the most significant public health policy of the 21st century.

In a speech on the future of tobacco control, Scott Gottlieb, the commissioner of the US Food and Drug Administration, said the federal agency must “recognise the 
potential for innovation to lead to 
less harmful products” and “envision a future where cigarettes lose their addictive potential.” Nicotine, he added, “lives at the core of both the problem and the solution to the question of addiction.”

The FDA, Gottlieb says, is taking tentative steps towards controlling the amount of nicotine contained in cigarettes. Coupled with the subtext of his speech – a promise to tread lightly over the regulation of e-cigarettes and vaping devices – the shock announcement hit the tobacco industry where it hurts the most. Within 24 hours, shares in major firms such as British American Tobacco and Altria plummeted, wiping more than £19bn from their combined value.

The FDA’s move is a defining moment, one which constitutes a major shift in the regulation of tobacco, away from the longstanding abstinence-only approach to a philosophy based on harm reduction. The change is not only welcome, but timely.

Here in Scotland, where nearly half the adult population smoked at the turn of the 1970s, efforts to wean the nation off the tabs have been much-vaunted, particularly over the course of the past decade.

The ban on smoking in enclosed public spaces has had a profound impact on the nation’s health. At the time it came into force in 2006, over a quarter of adults (25.4 per cent) were smokers. After four years, the number fell to 23.8 per cent, and it now stands at 21 per cent, according to the latest Scottish Health Survey. The proportion may lag behind the figure in England (18 per cent), but undoubtedly represents progress.

But the rate at which it is being achieved warrants further scrutiny. Delve deeper into the plethora of official spreadsheets and grim numbers stand out, such as the fact over a third (35 per cent) of adults in the most deprived quintile of the Scottish Index of Multiple Deprivation are smokers, or the statistic which shows 17.3 per cent of pregnant women smoked at the time of their antenatal booking.

You might argue these numbers, stark as they may be, run against the grain, and are indicative of our persistent problems with poverty. You would not be wrong, but there are other figures amongst the data which give cause for concern.

Remember that statistic that just 21 per cent of adults in Scotland now smoke? The same figure was recorded in 2013. The following year, meanwhile, the number actually fluttered up to 22 per cent before coming down a point.

As things stand, the Scottish Government’s goal of reducing smoking prevalence to 5 per cent or less by 2034 seems ambitious to the point of verging on unrealistic. The SNP may point to the sharp fall in the number of smokers since it came to power, but its latest proposals – making it an offence to smoke within 15 metres of a hospital building, and making prisons smoke free – are unlikely to make inroads towards that target.

It would be rash to draw a conclusion from just three years’ worth of data, but the plateau in smoker numbers sends a clear warning that action similar to that being put forward by the FDA is needed if smoke-free society is to be more than a pipe dream.

The US agency does not have the legal power to ban tobacco or dictate that its products should be free from nicotine, but it has a mandate to order manufacturers to reduce it to “non-addictive” levels. Westminster and Holyrood can easily legislate along similar lines.

Tobacco lobbyists would pose the biggest obstacle, but not the only one. There needs to be a strategy to counter the risk of a tobacco black market, and much more needs to be done in the way of research.

A study two years ago by the New England Journal of Medicine dispelled the notion that people would smoke more low-nicotine cigarettes in order to get their hit. In fact, its preliminary conclusions found that the reduction in levels of the drug actually helped people cut down on the amount they smoked.

It was a startling discovery, but what proved most striking about the New England study was incidental; it was the first large-scale clinical trial to examine the effects of reduced nicotine on smoking behaviour. A solitary study is not enough to ward off fears that the law of unintended consequences will come to pass, and ten-a-day smokers will suddenly burn through two packs.

Further research, then, is imperative, especially over what exactly constitutes a non-addictive level of nicotine, but the promise – and principle – of the FDA’s ideas is sound. The Scottish Government has shown before that good public health policy assists people instead of judging them. It should closely follow the smoke signals across the Atlantic.