Tobacco researchers at the University of Minnesota are thinking
what they once thought unthinkable.
Maybe there is a hard-core group of smokers
who simply can't quit, and maybe it's time for Plan B: satisfy their craving for nicotine
using alternative products without eliminating their use of tobacco.
Faced with a smoking rate that hasn't
budged for more than a decade, the university's tobacco research center is using a $9
million federal grant to find out whether there is a less harmful way to smoke.
"I have become discouraged that we
can't improve our success rates beyond a certain point," said Harry Lando, a
University of Minnesota epidemiologist who has long studied nicotine addiction. "It's
critical to look for alternatives for people who simply are not quitting."
The idea is controversial among public
health researchers because they fear that it might encourage some people to start smoking
and might stop others from quitting. But pressure to find answers is building, researchers
The pressure is building because some
tobacco companies already are offering nicotine alternatives for smokers.
"It's critically important that
research be conducted to answer these questions because the tobacco companies are already
moving there," said Scott Leischow, a tobacco control researcher with the National
Cancer Institute (NCI).
The new, unregulated nicotine products
include Omni and Eclipse cigarettes, which promise fewer carcinogens, and mint-flavored
Ariva tobacco lozenges.
The U.S. Food and Drug Administration (FDA)
last month warned three Internet pharmacies not to sell nicotine-laced lollipops and lip
balm as ways to quit or reduce smoking. The FDA said the products were being sold without
a prescription and contained a form of nicotine not tested for safety and effectiveness in
Researchers don't know whether any of the
products will be less harmful than cigarettes, or whether reducing tobacco use lowers
health risks. But scientists at the university's Transdisciplinary Tobacco Use Research
Center are conducting more than a dozen studies to address those and other questions.
That is why Candy Mahoney of Minneapolis
drives to a bland office building near the university campus every two weeks to give blood
and urine samples, and to report how much she has been smoking.
Mahoney sometimes wears a nicotine patch --
but not because she is quitting. She is trying to cut down on her smoking. Researchers
gave her the patch for this research because it has FDA approval.
Lead researcher Dorothy Hatsukami, a
university psychologist and nicotine addiction specialist, wants to know if the 150 people
in the study can use the patch to reduce smoking by at least 75 percent and if that
translates into less tobacco toxins in their bodies.
Mahoney's progress has been swift -- and
painful. With the help of the patch she has cut down from 30 to seven cigarettes a day in
six weeks, she said. She had promised her kids she would quit when she was 40. She is now
48, and her expectations are more realistic. "I am hoping I can quit, but I'm not
saying I'm going to," she said.
The research won't be published for a year
or two, and so far the results appear mixed, Hatsukami said. There has been a drop in
cigarette toxins in some people who cut down, but not in others, she said.
University epidemiologist Deborah Hennrikus
is leading another study to find out whether mothers who don't quit can learn to protect
their young children by not smoking around them. If some can accomplish that, she said, it
might give them the resolve to quit.
It worked for Judy Vavreck-Vollmers, 36, a
waitress from Inver Grove Heights who joined the study last November. Her second baby,
Eva, was born 10 months ago. Although she smoked through both pregnancies, at the time she
agreed to participate in the study, she had already stopped smoking in the house.
A counselor gave her nicotine gum,
suggested she set small goals for cutting down, and advised that she not smoke in the car
with her kids.
On Feb. 27, early in the pregnancy of her
third child, she stopped.
"I think about it every day," she
said of her nicotine craving. But she reminds herself that she has been smoking for 20
years -- longer than some of her young co-workers have been alive.
Underlying this research is a question that
is the subject of an upcoming NCI report -- are hard-core smokers somehow different than
people who have stopped?
About half of adults who ever smoked have
quit, experts said. Dr. Richard Hurt, director of Mayo Clinic's Nicotine Dependence
Center, is among those who believe that genes play a role, at least in susceptibility to
"Some experimented with cigarettes and
did not become smokers," he said. "They are genetically different compared to
those who smoke a few cigarettes and are hooked right away."
Regardless of how many cigarettes it takes,
he said, the process and the end result are the same for most people. Nicotine exposure
changes the structure of the brain, building receptors that demand to be fed, he said.
Smokers tend to have lower incomes, less
education and a range of other personal issues, experts say. People who are unemployed,
depressed, schizophrenic, alcoholic or drug dependent smoke at higher rates than people
who don't have such problems, said Dr. David Burns, a tobacco researcher at the University
of California in San Diego.
That makes some experts believe it's harder
for them to quit, yet there is no clear evidence one way or the other, Burns said. In any
case, he said, "We will have a large population smoking for an extended period of
Some companies are thinking along the same
"Our business plan is formed around a
mission to explore ways to reduce the harm associated with tobacco use," said Sara
Troy Machir, director of communications for Star Scientific Inc., the Virginia-based maker
of Ariva tobacco lozenges and other smokeless tobacco products.
These new products with their messages
about being less harmful are perplexing to public health experts. Several anti-tobacco
groups have challenged the claims that such products are less harmful. Even so, the
products are forcing public health experts to consider what messages they should convey to
Because such tobacco products are
unregulated by the FDA, companies can make claims without putting their products through
independent review by the FDA or other researchers, Hatsukami said.
Hatsukami and others at the university have
launched a study that examines the level of toxins in Omni smokers' bloodstreams. Omni
claims its smoke has fewer carcinogens compared to other cigarettes.
Public health experts are mindful of what
happened with low-tar, low-nicotine cigarettes. They proved to be nothing of the kind, she
said. Smokers simply adapted by smoking more often or more intensely, she said.
"It was in some ways a public health
disaster because people were led to believe that they were safer when they were not,"
she said. "Hopefully, we won't be replicating that."