The past, present and future of nicotine addiction | Mitch Zeller

The past, present and future of nicotine addiction | Mitch Zeller


I’m going to tell you a story. I’m going to tell you a story about how the deadliest
consumer product imaginable came to be. It’s the cigarette. The cigarette is the only consumer product that, when used as intended, will kill half of all long-term users
prematurely, later in life. But this is also a story about the work that we’re doing
at the Food and Drug Administration, and specifically,
the work that we’re doing to create the cigarette of the future, that is no longer capable
of creating or sustaining addiction. A lot of people think that
the tobacco problem or the smoking problem has been solved in the United States because of the great progress
that’s been made over the last 40, 50 years, when it comes to both
consumption and prevalence. And it’s true; smoking rates are at historic lows. It’s true for both adults and for kids. And it’s true that those
who continue to smoke are smoking far fewer cigarettes per day than at any time in history. But what if I told you
that tobacco use, primarily because of firsthand
and secondhand exposure to the smoke in cigarettes, remains the leading cause of completely
preventable disease and death in this country? Well, that’s true. And what if I told you
that it’s actually killing more people than we thought
to be the case ever before? That’s true, too. Smoking kills more people each year
than alcohol, AIDS, car accidents, illegal drugs, murders
and suicides combined. Year in and year out. In 2014, Dr. Adams’s predecessor released the 50th anniversary
Surgeon General’s report on smoking and health. And that report upped the annual
death toll from smoking, because the list
of smoking-related illnesses got bigger. And so it is now conservatively estimated that smoking kills
480,000 Americans every year. These are completely preventable deaths. How do we wrap our heads around
a statistic like this? So much of what we’ve heard
at this conference is about individual experiences
and personal experiences. How do we deal with this
at a population level, when there are 480,000 moms, dads, sisters, brothers, aunts and uncles dying unnecessary deaths
every year from tobacco? And then what happens
when you think about this trajectory for the future? And just do the simple math: from the time of the 50th anniversary
Surgeon General’s report five years ago, when this horrible statistic was raised, just through mid-century — that’s more than 17 million
avoidable deaths in the United States from tobacco use, primarily because of cigarettes. The Surgeon General concluded that 5.6 million children
alive in the United States in 2014 will die prematurely later in life
because of cigarettes. Five point six million children. So this is an enormous
public health problem for all of us but especially for us as regulators at the Food and Drug Administration
and the Center for Tobacco Products. What can we do about it? What can we do to reverse this trajectory
of disease and death? Well, we have an interesting guide
to help unravel issues like: How did the cigarette
as we know it come to be? What is the true nature
of the tobacco and cigarette business? How did the industry behave in the historically
unregulated marketplace? And our guide is previously secret internal documents
from the tobacco industry. Come with me in a tobacco industry
document time machine. Nineteen sixty-three was 25 years before the Surgeon General
was finally able to conclude that the nicotine
and cigarettes was addictive. That did not happen until
the Surgeon General’s report in 1998. Nineteen sixty-three was one year before the first-ever
Surgeon General’s report in 1964. I remember 1964. I don’t remember
the Surgeon General’s report, but I remember 1964. I was a kid growing up
in Brooklyn, New York. This was at a time when almost one in two adults
in the United States smoked. Both of my parents
were heavy smokers at the time. Tobacco use was so incredibly normalized that — and this wasn’t North Carolina,
Virginia or Kentucky, this was Brooklyn — we made ashtrays for our parents
in arts and crafts class. (Laughter) The ashtrays I made were pretty awful,
but they were ashtrays. (Laughter) So normalized that I remember seeing
a bowl of loose cigarettes in the foyer of our house and other houses as a welcoming gesture
when friends came over for a visit. OK, we’re back in 1963. The top lawyer for Brown and Williamson, which was then the third-largest
cigarette company in the United States, wrote the following: “Nicotine is addictive. We are, then, in the business
of selling nicotine — an addictive drug.” It’s a remarkable statement, as much for what it doesn’t say
as for what it does say. He didn’t say they were
in the cigarette business. He didn’t say they were
in the tobacco business. He said they were in the business
of selling nicotine. Philip Morris in 1972: “The cigarette isn’t a product, it’s a package. The product is nicotine. The pack is a storage container
for a day’s supply of nicotine. The cigarette, a dispenser
for a dose unit of nicotine.” We’ll come back to this
dose unit notion later. And R.J. Reynolds in 1972: “In a sense, the tobacco industry
may be thought of as being a specialized, highly ritualized and stylized segment
of the pharmaceutical industry. Tobacco products uniquely
contain and deliver nicotine, a potent drug with a variety
of physiological effects.” At the time, and for many
decades, publicly, the industry completely denied addiction and completely denied causality. But they knew the true nature
of their business. And from time to time, there have been health scares
made public about cigarettes, going back many decades. How did the industry respond? And how did they respond in this historically
unregulated marketplace? Going back to the 1930s, it was with advertising
that heavily featured imagery of doctors and other health care professionals sending messages of reassurance. This is an ad for Lucky Strikes, the popular cigarette
of the time in the ’30s: [20,679 physicians
say “Luckies are less irritating.” Your throat protection
against irritation, against cough.] (Laughter) We laugh, but this was the kind of advertising that was there to send
a health message of reassurance. Fast-forward to 1950s, ’60s and ’70s. And here, again,
in the absence of regulation, what we’re going to see
is modifications to the product and product design to respond to the health
concerns of the day. This is the Kent Micronite filter. And here, the innovation, if you will,
was the filtered cigarette. [Full smoking pleasure … plus proof of the greatest
health protection ever.] What the smoker
of this product didn’t know, what their doctor didn’t know, what the government didn’t know, is that this was a filter
that was lined with asbestos — (Gasps) so that when smokers
were smoking this filtered cigarette and still inhaling the chemicals and smoke that we know are associated
with cancer and lung disease and heart disease, they were also sucking down
asbestos fibers. (Gasps) In the 1960s and the 1970s, the so-called innovation
was the light cigarette. This is a typical brand
of the day called True. And this is after the Surgeon General’s
reports have started coming out. And you see the look
of concern on her face. [Considering all I’d heard, I decided to either quit
or smoke True. I smoke True.] (Laughter) [The low tar, low nicotine cigarette.] And then it says, “Think about it.” And then even below that
in the small print are tar numbers and nicotine numbers. What was a light cigarette? How did it work? This is an illustration
of the product modification known as “filter ventilation.” That’s not a real filter blown up. That’s just a picture so that you could see the rows
of laser-perforated ventilation holes that were put on the filter. When you look at a real cigarette, it’s harder to see. Every patent for this product shows that the ventilation holes
should be 12 millimeters from the lip end of the filter. How did it work? The cigarette got stuck into a machine. The machine started
puffing away on the cigarette and recording tar and nicotine levels. As the machine smoked, outside air came through
those ventilation holes and diluted the amount of smoke
that was coming through the cigarette. So as the machine smoked, there really was less tar
and nicotine being delivered compared to a regular cigarette. What the tobacco industry knew was that human beings
don’t smoke like machines. How do human beings smoke this? Where do the fingers go? (Murmurs) Where do the lips go? I told you that the patent said that the holes are 12 millimeters
from the lip end. The smoker didn’t even know
they were there, but between fingers and lips,
the holes get blocked. And when the holes get blocked,
it’s no longer a light cigarette. Turns out that there’s actually basically as much nicotine
inside a light cigarette as a regular cigarette. The difference was what’s on the outside. But once you block what’s on the outside, it’s a regular cigarette. Congress put FDA in the business
of regulating tobacco products 10 years ago this June. So you heard the statistics
at the beginning about the extraordinary contribution
to disease and death that cigarettes make. We’ve also been paying a lot of attention to how the cigarette works
as a drug-delivery device and the remarkable efficiency
with which it delivers nicotine. So let’s take a look. When the smoker puffs on the cigarette, the nicotine from that puff
gets up into the brain in less than 10 seconds. Less than 10 seconds. Up in the brain, there are these things
called “nicotinic receptors.” They’re there … waiting. They’re waiting for, in the words
of that Philip Morris document, the next “dose unit of nicotine.” The smoker that you see outside, huddled with other smokers, in the cold, in the wind, in the rain, is experiencing craving and may be experiencing
the symptoms of withdrawal. Those symptoms of withdrawal
are a chemical message that these receptors
are sending to the body, saying, “Feed me!” And a product that can deliver the drug
in less than 10 seconds turns out to be an incredibly efficient
and incredibly addictive product. We’ve spoken to so many
addiction treatment experts over the years. And the story I hear is the same
over and over again: “Long after I was able
to get somebody off of heroin or cocaine or crack cocaine, I can’t get them to quit cigarettes.” A large part of the explanation
is the 10-second thing. FDA has it within its regulatory reach to use the tools of product regulation to render cigarettes as we know them
minimally or nonaddictive. We’re working on this. And this could have a profound
impact at a population level from this one policy. We did dynamic population-level
modeling a year ago, and we published the results
in “The New England Journal.” And because of the generational
effect of this policy, which I’ll explain in a minute, here’s what we project out
through the end of the century: more than 33 million people who would otherwise have gone on
to become regular smokers won’t, because the cigarette
that they’ll be experimenting with can’t create or sustain addiction. This would drive the adult smoking rate
down to less than one and a half percent. And these two things combined would result in the saving of more than
eight million cigarette-related deaths that would otherwise have occurred from the generational impact of this. Now, why am I saying “generational”? It’s about kids. Ninety percent of adult smokers
started smoking when they were kids. Half of them became regular smokers before they were legally old enough
to buy a pack of cigarettes. Half of them became regular smokers
before they were 18 years old. Experimentation. Regular smoking. Addiction. Decades of smoking. And then the illness, and that’s why we’re talking
about a product that will kill half of all long-term users
prematurely later in life. The generational impact
of this nicotine-reduction policy is profound. Those old industry documents
had a word for young people. They were described as
“the replacement smokers.” The replacement smokers
for addicted adult smokers who died or quit. Future generations of kids,
especially teens, are going to engage in risky behavior. We can’t stop that. But what if the only cigarette
that they could get their hands on could no longer create
or sustain addiction? That’s the public health
return on investment at a population level over time. Haven’t said anything about e-cigarettes. But I have to say something
about e-cigarettes. (Laughter) We are dealing with an epidemic
of kids’ use of e-cigarettes. And what troubles us the most, in combination with the rising numbers
when it comes to prevalence, is frequency. Not only are more kids using e-cigarettes, but more kids are using e-cigarettes
20 or more days in the past 30 days than at any time since e-cigarettes
came onto the market. And at FDA, we’re doing
everything that we can using program and policy, first to get the word out to kids that this is not a harmless product and to make sure that kids
aren’t initiating and experimenting on any tobacco product, whether combustion is present or not. But think about e-cigarettes
in a properly regulated marketplace as something that could be of benefit to addicted adult cigarette smokers who are trying to transition
away from cigarettes. So, I’ll leave you with this vision: imagine a world where the only cigarette
that future generations of kids could experiment with could no longer create
or sustain addiction because of a single policy. Imagine a world where health-concerned cigarette smokers, especially if a policy goes into effect that takes the nicotine levels down
to minimally or nonaddictive levels, could transition to alternative
and less harmful forms of nicotine delivery, starting with FDA-approved
nicotine medications, like the gum, patch and lozenge. And finally, imagine a world and a properly
regulated marketplace, whether it’s e-cigarettes
or whatever the technology of the day, it’s not the product developers
and the marketers who decide which products come to market and what claims get made for them, it’s review scientists at FDA, who look at applications and decide, using the standard
that Congress has entrusted us to implement and enforce, whether a particular product
should come to market, because the marketing of that product
and the words of our law would be appropriate for the protection
of the public health. These are the kinds
of powerful regulatory tools that are within our reach to deal with what remains the leading cause of completely
preventable disease and death in the country. If we get this right, that trajectory,
those 5.6 million kids, is breakable. Thank you. (Applause)

100 comments

  1. Check out Salt, Sugar, Fat by Michael Moss for a look at Philip Morris’ foray into the junk food industry – big tobacco owned Kraft foods for years.

  2. My father smoked 2 1/2 packs a day. He died of cancer at age of 51. My mother is longer with us due to cancer she did not smoke. I do wonder how much to be blamed by second hand smoke from my father. I never really new father because he passed when I was young. My mother I miss beyond imagination. My brother was a heavy smoker he had lung cancer the nicest brother one can ever have is now not with us.Yes cigarettes changes people's lives. Gina in lights

  3. Nicotine is a wonderful drug. When one is tired and wants a pick me up… smoke a cigarette. When one is anxious and needs to calm down….smoke a cigarette. The cost of the use of this drug far exceeds the benefits in the long run unfortunately.

  4. I’d love to see one of these where they expand more on e-cigarettes, because like he said, kids will always be rebellious and so the blanket statements made here on how it’s important for them to not be in the possession of kids is pointless. when are we going to see actual research on e cigarettes’ effects? they’ve been saying theres not enough research for years now

  5. But there is no actual evidence linking tobacco to cancer it is all associational through epidemiological studies. More likely to be people's bad diets feeding cancer growth.

  6. 480,000 people kill them selves with cigs a year but 2,600,000 babies have been killed via abortion just this year! This is wrong and needs to be stopped instead of Nazis against jews its Nazis against babies!

  7. Quit drinking after 40 years…piece of cake, pharmaceutical narcotics after 2 years was a bit tougher. But after dozens of attempts I still can’t shake the nicotine habit, the tobacco industry has done its job well.

  8. im pausing this seconds in to say that the very last thing i did before clicking the notifications tab to watch this was to light amy hookah. sadness.

  9. … And you can thank an aboriginal from the Americas for tobacco… So much for small pox, and any disease a Western European could dream up… Just leveling the playing field … Wanna do the Marijuana stats ? 😉 … Didn't think so …

  10. Nicotine isn't even very harmful. It's the other crap in cigarettes and the tar that kill. Nicotine is the misunderstood red headed step child of legendary proportions.

  11. Say what you will, Lucky Strikes are delicious smelling and tasting. Beats a “vape” or “e-cig” any day. 👌🏻

  12. 🦋we should all be Leary of anything man made – so important to pay attention to your habits

    Satan knows your weaknesses and will use your bad habits to make you miserable like he is

  13. I quit smoking in 2001. It was the 18th of November, a Sunday morning. Best decision of my life. In my opinion quitting cold turkey and really persisting is the best way to quit. Cutting down May seem like a good alternative but you keep feeding your body nicotine. And I really think your mind and your body Benefit a lot more when you actually manage to overcome your own cravings. And I’ve heard all the excuses, and that’s exactly what they are… excuses. Just quit, it’ll be the best decision of your life

  14. I smoked for 13 years

    vape for 4

    tomorrow I celebrate a month without nicotine …

    My advice, leave your additions, do what you want but without being hooked on anything

  15. I started smoking at twelve years old. Both my parent's were smokers. I quit at 29 year's old im almost 31. It's took almost me dieing to quit. Several clasped lungs. I never wanted to smoke! That's how addictive it is. I hope this comes true.

  16. Hogwash. There are way too many people who smoke all their life and live longer than anybody around them. In fact, the longest living person in France at one point was a lady who smoked since she was 14 and died at like 128.

    I guess TED is trying to divert our attention away from war and famine.

  17. Born in 1961 Every family member smoked I started @ 5 yrs old! At one point up to 3 packs a day!!! Scary that I haven't been able to quit!

  18. In 1970 I was ten-years-old and free cigarettes came in the mail, I didn't quit until almost three years ago; quit if you smoke, wish I had earlier.

  19. This is one of those small (but important) things that I am jealous of Americans. You were consistent enough to damage your smoking lobby to make it the unreasonable and undesirable selfharm that it is.

    Sadly we are very far from it in Germany. The youth is getting it more or less and is far less affected – but concerning a huge part of the adults (especially women) we are basically waiting for them to naturally die and free the cities from all the smoke.

  20. An uneducated person would watch this and think nicotine causes cancer. It does not.

    Nicotine by itself is not a carcinogen. Nicotine is additive yes, but does not cause the illnesses and death. You know what else is an addictive chemical like nicotine? Caffeine. 🤔 e-cigarettes while not completely safe are night and day compared to cigarettes and should be a critical component in getting people off combustion cigarettes.

  21. "5.6 million children, later in life, will die prematurely from cigarettes"… so you mean, 5.6 million adults. Children generally don't stay children, but thanks for the obvious attempted manipulation

  22. Has anybody heard about the new t cell that attacks cancer and not just the cancer from cigarettes but the cancer from our pollution 😳

  23. For decades Republicans hammered "there is no proof" smoking was harmful and how smog devices would price cars out of reach. Those old lies seem so quaint today.

  24. Whew, glad I avoided cigarettes. As for cigars, I enjoy one or two a day as a treat, kind of my reward making it through another day. I also do not drink and make every effort avoiding stress.
    Doctors say I have a strong heart and clear lungs. So I figure at my age (64), and all things fair, I'll take the George Burns approach. If cigar smoking snuffs me out at the tender age of 100 years old. That's a chance I'll take.
    Other's may not agree, and I respect that as their right. I just ask the same in return.
    Here's a fun fact, I can remember as a kid the doctor giving me an example as he puffed on his Camels. Hey, even I have limits regarding decorum.

  25. This sounds bad, but considering the following. There are seven billion humans infesting this planet now, and growing. We are causing rapid climate change, which is part of and and an accelerant to the mass extinction we humans are causing. To that I say smoke up.

  26. They complain they cost too much cause of taxes and that they dont have any money cause wages so low…then they complain that the hospital wait times are too long when they get sick even tho we pay their bill. So they elect someone who promises to slash taxes and make more jobs at lower wages….and they still have the same damn problem only the wait times at the hospital are even longer. The politicians they elect blame the last government for everything…and things just get worse and worse and worse for the smoker. And by the time that party they've elected 5 times in a row starts to no longer make sense they are dead or too sick to do anything.

  27. Lucky strikes are sometimes called “GI Killers” cause they were standard issue for U.S. servicemen. And they probably killed more American soldiers than WWII.

  28. I can't even believe cigarettes are legal but look at the money second hand smoke that is illegal in public places go figure and look at the cover-up look at the division of our two party system I could say so much have a good day

  29. I am pretty clueless when it comes to tobacco (even though I do smoke lol), but is there a product that gives you the same physiological nicotine kick/relief without having to actually smoke it?

  30. Too bad smoking is not killing more. It's nature's way of ridding (or at least reducing) the world of the human cancer.

  31. I was able to stop smoking cigarettes 3 years ago thanks to vaping. I had to reach 28mg of nicotine in my vape juice through experimenting for the first 3 months to completely eliminate my craving for a real cigarette, but since then i have weened myself down to 3mg of nicotine in the vape juice I use, and hopefully it stays legal long enough that I will have eliminated my consumption of nicotine altogether.

  32. So my question is why do you have to be 21 to bye nicotine quitting products such as gum, patches, and cough drops. Kids want to quit but don’t have the resources. People who were able to bye nicotine products 4 weeks ago can no longer bye there ecigs so they have decided to quit but don’t have access to these products designed to help them quit.

  33. i am not smoke. what i hate is the smoke.
    if smokers change to vape or nicotine gum, i will be ok with that.
    they don't care what nicotine's effect to them. so, i dont need to care too as long as no smoke bothers me

  34. Kudos for not demonizing e-cigarettes (for adults). It’s a no-brainer as far as a trade off. I quit cigarettes in 2007 for good. Picked up vaping a few years ago. Why? Well, I just like it. Yeah I’m addicted…pick your poison! At least I’m not a drunk and it gets me by.

  35. Lol. They’re trying everything they can the fda… really… what about all the POISON in processed foods and ingredients that are allowed to be in foods. Isn’t that more of a concern for kids and health instead of smoking.

    Also cigarettes are very cheap in the states. Increase the price make it a taxable thing.

    Also I find it strange that he did not talk about anything relating to EMOTIONS and reasons why people even choose to smoke.

  36. Considering the comments, next up a talk about how cigars are even worse than cigarettes would be great. P.S. I've never touched a cigarette in my life and never will.

  37. Wow the black market cigarette industry is going to be huge!
    I wonder how hard it is to grow tobacco?
    It's going to be a goldmine.

  38. Unfortunately market regulation would inspire a black market for nicotine products – a completely unregulated and even more dangerous market. While I completely agree about destructive nature of tobacco, big government is even more destructive.

  39. Though I know better, I am totally chain smoking while watching. Hopefully my last pack.

    Edit: honestly, if I couldn’t buy them at every store I buy things from, I wouldn’t smoke. And I would vote for legislation/legislators enacting legislation that would make it so I couldn’t.

  40. The interesting thing is that now there is a safer alternative to get your fix for nicotine. It has also helped people quit nicotine altogether. But, local governments all over the country are banning the safer alternative which pushes people right back to the old cancer causing cigarettes. Is it because they get money from cigarette sales or is it population control?

    Also… nicotine is very similar to caffeine. Minus the bs in cigarettes, nicotine itself is not really harmful in small doses just like caffeine.

    Also… if you’re worried about kids, ban flavored alcohol. This isn’t about kids health.

  41. Garnet Perry book on Amazon will set the world straight on this topic. Set me straight that's for sure. This guy in the video along with the world's so-called "experts" are as dumb as they come.

  42. If anyone believes that they will make healthy cigarettes your delusional, death is a business
    Healthcare is a business ect..

  43. I quit smoking 14 years ago and I did it cold turkey. Unlike cigarettes, when you’re on a diet you have to eat but when you quit smoking you don’t have to smoke anymore. I suffer through the cravings until my body didn’t crave it anymore it took me two months. Then I was fine. No patches, no clinics, no counseling. Only God, healthy eating to cleanse my body, water, and I.

  44. I'm not addicted to nicotine but rather to the process of smoking itself. My work requires hours of waiting, watching, standing by so it gets boring or stressful and since there's no internet where i work you have to rely on some time killers or just something to clear your mind. We know what ban on alcohol and drugs did – crime. People just need freedom and information.

  45. My grandad once told me “I quit smoking at the age of 7 and started again at 11 because I was afraid of getting caught at school” he is 64 quit at 60 and is still alive

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