The modern cigarette, an unregulated disaster

The modern cigarette is an unmitigated public health disaster, more so than tobacco used in any other form. Together with other types of tobacco product, cigarettes are responsible for several million global deaths annually and expected to cause about 10 million annually by 2030. Modern cigarettes are uniquely efficient nicotine delivery devices because of sophisticated technology that controls such elements as pH and droplet size, and consequently provides rapid absorption and a rapid nicotine "fix" while using less tobacco, but many more additives, than its Second World War predecessor.

Australia is at the forefront of the battle to control diseases caused by tobacco through the use of regulation of marketing and vigorous antismoking campaigns.

The result is that “only” about a fifth of Australians smoke, and index diseases such as lung cancer and heart disease are declining in prevalence. There is, however, a strong social-class factor evident among continuing smokers, with the less educated and less well remunerated being over-represented in this population.

Given Australia’s exemplary role in the regulation of cigarette marketing, it is bizarre that no regulations at all are applied to the product or its emissions. In this respect Australia is no different to most other countries as, apart from meaningless restrictions on tar, nicotine and carbon monoxide in Europe, no country worldwide has established control over cigarette emissions. A potential exception may be the United States, which currently has a bill before Congress that would empower the Food and Drug Administration to regulate cigarette emissions.

The World Health Organization is moving to change this with its publication, The scientific basis of tobacco product regulation. This technical report sets out a practical rationale for regulating tobacco smoke, and makes specific recommendations for setting upper limits for two of the best understood carcinogens, the tobacco-specific nitrosamines, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) and N-nitrosonornicotine, with the indication of more proposals to follow, plus discussions of design features that contribute to toxicity and marketability, such as candy flavourings, and recommendations for future research.

Consumer products of virtually all types are regulated. Controls apply to almost every marketed product, from the proportion of rat droppings permitted in wheat, to the amount of fat allowed in sausages, and even to the amount of mint allowed in nicotine replacement therapy.

With this background, it seems astonishing that the federal Minister responsible for drug and alcohol policy recently rejected claims that a new tobacco product (a “heatbar” which heats but does not burn tobacco) should be subject to regulation and said there were no plans to even investigate the product. This product is unlikely to be any worse than other tobacco products. It may even be an improvement, but we won’t know if it is not to be investigated.