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Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction C Time Line of Tobacco Events Science Products Policies or Regulation 1700s • Cigarettes are first made from scraps of cigars 1761 • Dr. John Hill reports in Cautions Against the Immoderate Use of Snuff on two case histories and observed that (“snuff is able to produce swellings and excrescences”) in the nose, and he believed these to be cancerous 1807 • Cerioli isolates the “essential oil” or “essence of tobacco” 1828 • Posselt and Reimann isolate nicotine from tobacco 1843 • Melsens describes nicotine’s chemical empirical formula
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Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction Science Products Policies or Regulation 1854–1856 • Cigarette popularity grows between 1854 and 1856 during the Crimean War 1881 • James Bonsack of Virginia patents the first cigarette-making machine. 1893 • Pictet and Crepieux synthesize nicotine 1900 • Brosch appears to be the first investigator involved in experimental tobacco carcinogenesis. He applies tobacco (“juices”) to guinea pigs, observing epithelial proliferation 1913 • Camel brand is produced by R.J. Reynolds in 1913 1928 • Lombard and Doerring find an association between heavy smoking and buccal cancer 1938 • Pearl, a statistician and biometrician at Johns Hopkins, publishes the first statistical analysis comparing the health of smokers and nonsmokers and finds that individuals who smoked could expect shorter lives 1950 • Epidemiological studies report that lung cancer is particularly prevalent among cigarette smokers 1950 • Filters introduced
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Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction Science Products Policies or Regulation 1954 • Doll and Hill publish The Mortality of Doctors and Their Smoking Habits in the BMJ 1954 • Winston by RJR features a filter (cellulose acetate) and reconstituted sheet tobacco • Tobacco Industry Research Committee is formed 1954 • Industry faces first liability lawsuit by lung cancer victim claiming negligence and breach of warranty. Suit is dropped 13 years later 1956 • RJR introduces Salem as its first filter-tipped menthol cigarette Early 1960s • More porous cigarette paper is introduced 1960 • Ban on advertising tar and nicotine levels as less harmful 1960–1966 1962 • Royal College of Physicians reports that lung cancer is prevalent among smokers in Smoking and Health 1964 • Surgeon General’s report concludes that smoking causes cancer and other serious diseases 1964 • Public Health Service establishes the National Clearinghouse for Smoking and Health (NCSH), later to become the Office on Smoking and Health 1965 • Federal Cigarette Labeling and Advertising Act is passed requiring warning labels on all cigarette packs but not on advertisements. The act also requires the Secretary of Health, Education, and Welfare to issue annual reports to congress on the health consequences of smoking
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Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction Science Products Policies or Regulation • Federal excise tax on smokeless tobacco products is repealed. 1966 • The Cambridge Filter method is ultimately adopted by the Federal Trade Commission 1967 • Surgeon General’s report concludes, “Cigarette smoking is the most important of the causes of chronic nonneoplastic bronchiopulmonary diseases in the United States.” The report also identifies measures of morbidity associated with smoking Late 1960s • Expanded or “puffed” tobacco appears in cigarettes 1968 • National Cancer Institute begins work on a safer cigarette by establishing the Less Hazardous Cigarette Working Group 1969 • Surgeon General’s report makes solid conclusions regarding the relationship between maternal smoking and infant low birthweight. It also defines evidence of increased incidence of prematurity, spontaneous abortion, stillbirth, and neonatal death • Use of chlorinated pesticides begins to be faded out
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Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction Science Products Policies or Regulation Early 1970s • Ventilated filter tips are used and modified to be longer with increased efficiency • Introduction of puffed, expanded, and freeze-dried tobaccos 1971 • Surgeon General’s report finds smoking associated with cancers of the oral cavity and esophagus 1971 • Broadcast ads for cigarettes banned 1972 • Surgeon General’s report studies immunological effects of tobacco and tobacco smoke, and identifies carbon monoxide, nicotine, and tar as smoke constituents the most likely to produce health hazards from smoking 1972 • Officials declare that airlines must create nonsmoking sections 1973 • Surgeon General’s report presents evidence on the health effects of smoking pipes, cigars, and “little cigars” 1975 • Surgeon General’s report issues further evidence regarding health effects from involuntary (passive) smoking, especially the relationship between parental smoking and rates of bronchitis and pneumonia in children’s first year of life 1975 • RJR introduces NOW with lower-tar and nicotine while preserving tobacco taste 1977–1978 • Surgeon General’s report focuses on health effects of smoking on women, noting in particular the effects of oral contraceptives and smoking on the cardiovascular system
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Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction Science Products Policies or Regulation 1979 • Surgeon General’s report addresses the role of adult and youth education in preventing smoking habits. Report also reviews health effects of smokeless tobacco • Bandury conference and report 1980 • Surgeon General’s report projects that lung cancer in women will surpass breast cancer as the leading cause of cancer mortality in women. Report also notes prevalence of smoking by adolescent females 1981 • Surgeon General’s report examines the health consequences of lower-tar and nicotine cigarettes. Concludes that lower-yield cigarettes decrease the risk of lung cancer, but have little effect on rates of cardiovascular disease, chronic obstructive pulmonary disease, and fetal damage. The report also reviews risks related to various additives and their combustion. The Surgeon General reinforces the fact that there is no safe cigarette 1981 • Insurers offer discounts on life insurance premiums to nonsmokers
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Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction Science Products Policies or Regulation 1982 • Surgeon General’s report releases epidemiological evidence from a study of nonsmoking wives and their smoking husbands, finding that the risk of lung cancer in wives was not causal, but a possible serious public health problem. Report notes possible low-cost smoking cessation interventions 1983 • Surgeon General’s report evaluates health consequences of smoking for cardiovascular disease, declaring cigarette smoking as one of the three primary causes of coronary heart disease 1984 • Surgeon General’s report examines health effects of smoking on chronic obstructive lung disease (COLD). Smoking accounts for 80–90% of COLD deaths in the United States 1984 • Nicotine-based chewing gum approved as an aid to quitting 1984 • Warnings strengthened on cigarette packages and ads • San Francisco requires business to accommodate nonsmokers 1985 • Surgeon General’s report focuses on smoking and hazardous substances in the workplace. Smoking alone is found to be a greater risk than the average workplace environment. Workplace exposure to asbestos and other such substances is found to compound health risks
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Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction Science Products Policies or Regulation 1986 • Surgeon General’s report states that “Involuntary smoking is a cause of disease, including lung cancer, in healthy nonsmokers.” Report further notes the health of children of smokers and nonsmokers, as well as the exposure to smoke of passengers in smoking and nonsmoking sections of airplanes • A special report of the advisory committee appointed by the Surgeon General examines the health effects of smokeless tobacco, concluding that it too leads to nicotine addiction and can cause cancer 1987 • Tobacco Institute Testing Laboratory (TITL) assumes cigarette-testing responsibilities from the Federal Trade Commission Test Center using its approved methodology 1988 • Surgeon General Koop’s report states that nicotine (cigarettes and other forms of tobacco) are addicting 1988 • Government bans smoking on short domestic airline flights 1989 • Surgeon General’s report reports that cigarette smoking is a major cause of cerebrovascular disease (stroke). Report also addresses the future of nicotine addiction in light of new nicotine delivery systems test marketed in 1988 Late 1980s • RJR Premier is developed and introduced to the public
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Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction Science Products Policies or Regulation 1990 • Surgeon General’s report identifies the health benefits of smoking cessation: “Smoking cessation has major and immediate health benefits for men and women of all ages.” Report examines life expectancy, smoking-related diseases, and reproductive health issues of smokers and former smokers 1990 • Smoking banned on interstate buses and domestic airline flights of six hours or less 1992 • Nicotine patches introduced • 97.5% of cigarettes in the U.S. have filters 1993 • Vermont bans smoking in all indoor public places 1994 • Surgeon General’s report looks at “preventing tobacco use among young people.” Report examines and discusses age at first initiation, issues or problems encountered with youth cessation, tobacco as a “gate-way drug,” effect of advertising, and school-based tobacco use prevention programs 1994 • Major U.S. cigarette companies release a list of 599 additives used in the manufacture of cigarettes 1994 • Executives of seven largest U.S. tobacco companies swear in congressional testimony that nicotine is not an addictive and deny manipulating nicotine levels in cigarettes • Amtrak bans smoking on short-and medium-distance trips • Brown and Williamson documents provide evidence that tobacco executives discovered smoking risks before the surgeon general made declaration • Mississippi files first of 24 state lawsuits seeking to recoup millions from tobacco companies for smokers’ Medicaid bills
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Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction Science Products Policies or Regulation 1996 • RJR Eclipse test marketed in United States, Germany, and Sweden 1996 • Liggett Group settles claims with five state attorneys-general and promises to help them against other companies 1997 • Federal judges rules that government can regulate tobacco as a drug, but industry is allowed to continue advertising • Landmark settlement, subject to congressional approval, calls for restrictions on cigarettes and on tobacco maker’s liability in lawsuits. Industry is required to spend $368 billion over 25 years, run antismoking campaigns, issue bold health warnings on packs, decrease advertising, and pay fines if youth smoking doesn’t drop significantly • Mississippi is first state to settle, agreeing to $3.6 billion deal with tobacco companies • Florida settles at $11.3 billion
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Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction Science Products Policies or Regulation 1998 • Surgeon General’s report examines tobacco use among U.S. racial and ethnic minority groups: African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics. Concludes that cigarette smoking is one of the major health hazards among different racial and ethnic groups. Tobacco use and patterns of use vary among these groups as well 1998 • Phillip Morris Accord presented at a poster presentation at the Society of Toxicology in Seattle 1998 • Texas settles with industry at $15.3 billion over 25 years • Tobacco executives testify before Congress that nicotine is addictive under current definitions of the word and smoking may cause cancer • Minnesota and Blue Cross/Blue Shield of Minnesota settle at $6.6 billion with the tobacco industry • Senate vetoes a proposal of $1.50 tax increase per pack on cigarettes • McCain Universal Tobacco Settlement Bill dies in congressional filibuster. Bill addressed tobacco product regulation of ingredients, sales, and advertising. It also addresses education and nicotine addiction prevention • 46 states welcome a $206 billion settlement with the tobacco industry over health care costs for treating sick smokers 1999 • Star Tobacco introduces new cigarettes with low-nitrosamine tobacco and activated-charcoal filter, but is unable to make health claims 1999 • Justice Department sues the tobacco industry to recover billions of government dollars spent on smoking-related health care, accusing cigarette makers of a “coordinated campaign of fraud and deceit”
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Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction Science Products Policies or Regulation • Government and tobacco industry lawyers present oral argument to the Supreme Court over whether the Food and Drug Administration (FDA) can regulate tobacco as a drug and crack down on cigarette sales to minors 2000 • National Institute for Environmental Health Sciences publishes ninth report on Carcinogens including ETS as one of the known human carcinogens • Surgeon General’s Report, Reducing Tobacco Use, published 2000 • Phillip Morris introduces cigarettes with “safer” paper • Star Tobacco—new cigarettes produced in Virginia and Kentucky with low-nitrosamine tobacco, but without health claims 2000 • Tobacco farmers sue cigarette makers for $69 billion, claiming they conspired to undo the federal system that regulates tobacco prices • Supreme Court rules, 5–4, that FDA lacks authority to regulate tobacco as an addictive drug • New York state imposes fire-safety standards on cigarettes
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Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction REFERENCES Associated Press. 2000. Major events in fight vs. tobacco. The New York Times, March 21. 2000. Feder BJ. 1996. A safer smoke or just another smokescreen? Reynolds courts support for a new product. The New York Times. April 12, 1996:(Business Day);D1. Gorrod JW, Jacob P III. 1999. Analytical Determination of Nicotine and Related Compounds and Their Metabolites. PAF2. Amsterland, Netherlands: Elsevier Science B.V. Hoffmann D, Hoffmann I. 1997. The changing cigarette, 1950–1995. J Toxicol Environ Health 50(4):307–364. NIH (National Institute of Health). 1996. The FTC Cigarette Test Method for Determining Tar, Nicotine, and Carbon Monoxide Yields of U.S. Cigarettes. Monograph 7. NCI Smoking and Tobacco Control. Bethesda, MD: National Institutes of Health, National Cancer Institute. R.J. Reynolds Tobacco Company. 1988. Chemical and Biological Studies: New Cigarette Prototypes That Heat Instead of Burn. Winston-Salem, NC: R.J. Reynolds Tobacco Company. U.S. DHHS (U.S. Department of Health and Human Services). 1964. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service. Atlanta, GA: U.S. Public Health Service. U.S. DHHS (U.S. Department of Health and Human Services). 1973. The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services. U.S. DHHS (U.S. Department of Health and Human Services). 1982. The Health Consequences of Smoking: Cancer; A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. U.S. DHHS (U.S. Department of Health and Human Services). 1986. The Health Consequences of Involuntary Smoking: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Wynder EL, Hoffman D. 1979. Tobacco and health: a societal change. NEJM 300(16):894–903.
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