The science of regulating cigarette smoke is the subject of two papers in this issue of the Journal.1,2

Ten points set out the strands of the scientific argument for regulation:

Beyond these new perspectives on smoke science, regulation of tobacco products involves other issues—of power and control, public safety, consumer rights, and Government’s duty of care towards smokers. Despite regulation, new brands will still be launched, and smoking will remain a dangerous activity.

Cigarette regulation is about power—who should control the toxicity of cigarette smoke—the Ministry of Health, or the cigarette firms? Leaving the responsibility with the smoker, by publishing toxicity ratings on the packet, assumes smokers will read the fine print and be able to source a less dangerous brand. The unregulated cigarette market, however, provides little choice. Cigarette firms have ignored the reports of their own scientists for 40 years on the safety advantages of charcoal filters.2 As the firms have not protected their own customers, the time is right for Government to use its latent powers and regulate cigarette smoke toxicity in the public interest—of smokers.

Cigarette regulation is about the public safety of ¾ million citizens inhaling unduly dangerous cigarette smoke an average of 200 times a day. These people populate doctors’ waiting rooms, and die at twice the rate of nonsmokers of the same age.3 The case for regulation is self-evident. For example, the carcinogenic tobacco-specific nitrosamines (TSNA) varied by a factor of 66 across the top 10 New Zealand cigarette cigarette brands when tested unburnt.5 And New Zealand’s favourite ‘mild’ cigarette, Holiday Extra-mild, emerged as the most toxic of 37 international brands for which comparable data were obtainable.1

Cigarette regulation is about the consumer rights of smokers. No regulation, absolutely none, yet governs the inherent risk of cigarettes and their smoke, though Parliament in 1990 gave the Ministry of Health the necessary powers in the Smoke-free Environments Act. Smokers, who pay Treasury over $5.40 in tax per packet, are entitled to some toxicity controls. For some mental health staff in secure units, work exposure to second-hand smoke is now recorded on each occasion; cigarette smoke is an official workplace hazard.

In contrast, smokers’ rights are not protected. The cigarette firms’ tests of their own brands by their own laboratories have seldom been audited independently by Government, and they only test nicotine, carbon monoxide, and tar for printing on the packet. This information is virtually useless. The nicotine yield accounts for less than 1% of the variance in nicotine absorption;6 carbon monoxide accounts for less than 1% of total cigarette smoke toxicity.1 Tar is a proxy measure for the 18% of total cigarette smoke toxicity associated with smoke solids,1 but low-tar cigarettes are found to emit more toxicants overall, not less.1,2 The Ministry of Health now has the opportunity to regulate to ban misleading labels, and reduce the offending toxicants in the smoke.

In reviewing the Smoke-free Environments Regulations, the Ministry of Health may decide to regulate for graphic health warnings on tobacco packets, to ban certain misleading descriptors, fully test tobacco product emissions, and publish the results. These are desirable aims, but insufficient by themselves. Disclosure alone has its limits—all brands contain the same leading toxicants in their smoke.1 Cigarette smoke is dangerously and defectively toxic. Only regulated limits on harmful smoke constituents can reliably decrease smoke toxicity.

Regulation of smoke is part of Government’s duty of care towards its addicted smoker- taxpayers—who contribute over $850 million annually in excise. Smokers, whether unwilling, unable, unready to quit, or recent relapsers, face either giving up on their nicotine, or continuing inhalation with a one-in-two risk of dying early.3 Smokers face this ‘quit or die’ dilemma in increasing numbers. In the age group 35 years and over, in which nearly all smoking deaths occur, smoking prevalence decreased slightly (20.4% to 19.2%) between 1996 and 2002,7 but the numbers smoking increased by 33,000 (10%) to 377,000, due to ageing of the population. Among Maori, the numbers at risk are also increasing, as smoking prevalence has stayed at around 50% since 1990.

Regulation of smoke toxicity provides a third way of sorts out of this dilemma. Strong regulation could save an estimated 80 smokers a year from fatal cancers,2 out of 1700 cigarette cancer deaths a year.3 Cardio-respiratory toxicity can also be reduced, but the health gain cannot be estimated.

Finally, despite regulation:

As long as cigarettes remain legal to sell, Government will not stop cigarette firms introducing low emission brands—unless they make false product claims. New brands with apparently lower toxicity are being test-marketed and one is to be released in Australia within 12 months. Brands of this type when introduced, could halt the recent decline in adolescent smoking. The total smoking control programme may need to be activated further to meet this challenge.

Old or new, all brands need regulated limits on their toxicity. Health groups can lobby for firm and expeditious regulation. Regulations control the carcinogens permitted in manufactured food and beverages, and manufactured tobacco products should be no exception.

New Zealand is in a position to become the first country to effectively regulate cigarette smoke toxicity. Continuation of the present state of affairs—unregulated, unduly-toxic cigarette sales—is disastrous. ‘Failure to act in these circumstances is negligence’.9 Regulation is long overdue.

Author information: Murray Laugesen, Public Health Physician, Health New Zealand Ltd, Devonport, Auckland; Jefferson Fowles, Senior Scientist, ESR (Institute of Environmental Science and Research) Ltd, Porirua

Potential conflict of interest: The authors are co-inventors for a patent Apparatus and methods for testing toxicity of cigarette smoke, NZP 537968, 28 January 2005.

Correspondence: Dr Murray Laugesen, Health New Zealand Ltd, PO Box 32 099, Devonport, Auckland. Fax: (09) 446 0647; email: laugesen@healthnz.co.nz