Nicotine fixes

Jacob Sullum
Posted: Aug 28, 2001 12:00 AM
Ariva, a pellet flavored with mint and eucalyptus, looks like a Tic Tac, but it's not a candy. Its main ingredient is compressed tobacco. Star Scientific, the Virginia-based company that plans to test-market Ariva later this year, calls it a "cigalett," a cigarette substitute for smokers stuck in places where they're not allowed to light up. Nicorette, a chewing gum that comes in mint and orange flavors, is not a candy either. GlaxoSmithKline, the pharmaceutical company that makes Nicorette, describes it as a form of "nicotine replacement therapy" that helps smokers quit "by reducing nicotine cravings and withdrawal symptoms." Nicotine Water is just what it sounds like: bottled water spiked with nicotine. S & F Garret, which sells the stuff, says Nicotine Water is intended both as a cigarette substitute in smoke-free environments and as an aid to quitting. Neither a tobacco product nor a drug, it's "classified as a dietary supplement." Partly to avoid criticism and regulatory problems, these companies do not want to admit that they are all in essentially the same business. But whatever the manufacturers say, consumers are free to use their products as they please. While sucking on a tobacco pellet is pretty far removed from the ritual of puffing on a cigarette, Ariva may indeed appeal to smokers on airplanes and in restaurants. Some may even use it, Nicorette-style, to make quitting easier -- a possibility Star Scientific doesn't mention, lest the Food and Drug Administration decide that Ariva falls under its purview. The FDA-regulated GlaxoSmithKline, meanwhile, portrays Nicorette as a medicine aimed at "curing" smokers within a few months -- not as a long-term replacement for cigarettes, even though many former smokers use the gum that way, and certainly not as a means of making air travel more bearable for people who continue to smoke. Although Nicorette has been available without a prescription since 1996, its identity is still tied to men in white coats. S & F Garret, the producer of Nicotine Water, apparently has managed to dodge regulation as a drug maker. But it still uses therapeutic terminology -- and adds a clever twist. Calling smoking "a chronic disease, like asthma or high blood pressure," it argues that "hard-core smokers may need nicotine medications for years to control their craving." In other words, Nicotine Water drinkers, like Nicorette chewers, may end up using the product indefinitely. While GlaxoSmithKline downplays this option, S & F Garret embraces it. At the same time, Nicotine Water is openly targeted at smokers who have no intention of quitting but would like something to tide them over during periods of deprivation. None of these companies wants to talk about the possibility that curious nonsmokers might pick up their products. The thought has occurred to some people, however. Connecticut Attorney General Richard Blumenthal calls Ariva "a very dangerous gimmick" that is "designed to lure children into beginning a lifetime of addiction." Other critics worry that cigaletts will make it easier for smokers to maintain their habits by blunting the impact of smoking bans. Ariva will carry a warning stating that "there is no such thing as a safe tobacco product," but it's probably about as safe as tobacco products are going to get. Almost all of the chemicals that cause smoking-related diseases are generated by combustion. Nitrosamines are the only significant carcinogens in the leaf itself, and Star Scientific has patented a curing process that dramatically reduces them. As far as anti-smoking activists are concerned, however, safer is not necessarily better. If enough people continue smoking because of Ariva, or if enough people start smoking after developing nicotine habits with cigaletts, the upshot could be more tobacco-related illness rather than less. And from a "public health" perspective, it's the total number of deaths that matters. That point was emphasized by a National Academy of Sciences committee that recently studied safer ways of consuming tobacco and nicotine. "Although a product might be risk-reducing for an individual's health compared to conventional tobacco products," the committee said, "its use might not be harm-reducing for the population as a whole." But predicting the net impact of a new product on "the population as a whole" is tricky, since it hinges on decisions by millions of individuals acting in what they perceive to be their own interests. People do not always comply with the declared intentions of marketers or the earnest wishes of regulators -- a source of dismay for some and hope for others.