A Health Debate That Won't Die

By Anastasia Toufexis

The fact that puffing on a cigarette is an unhealthy activity is no longer seriously disputed, even by the tobacco industry. Much of the current medical debate has shifted to two related questions: Is nicotine addictive? And how dangerous is environmental tobacco smoke?

Tobacco companies insist that nicotine, which is contained in varying amounts in all cigarettes, does not create a habit so powerful that it impairs a person's ability to quit. But the overwhelming consensus in the scientific community is that nicotine is an addictive substance. A Surgeon General's report has concluded it is as addictive as heroin or cocaine.

There is evidence that some cigarette-company researchers have long known that it is the nicotine that appeals to smokers. A 1972 internal memo by a Philip Morris scientist contended that "no one has ever become a cigarette smoker by smoking cigarettes without nicotine." That was proved again a few years ago, when the company introduced the nearly nicotine-free Next. The public wasn't interested. The industry claims smokers turn away from such cigarettes because they lack "taste" or "flavor." But researchers maintain that these cigarettes taste no different; they lack the kick nicotine provides. A 1992 study found that people who puffed Next cigarettes didn't show the brain-wave changes that smokers ordinarily exhibit.

Tobacco companies have heavier artillery when it comes to challenging the EPA's 1993 report that labeled environmental tobacco smoke, or ETS, a carcinogen. They charge that the report -- a review of 30 epidemiological, animal and laboratory studies conducted during the past two decades -- is fundamentally flawed. The Congressional Research Service and some independent scientists have also criticized the report.

The EPA found that fumes rising from the tips of lighted cigarettes (as opposed to the smoke that users exhale) is the most hazardous, with high concentrations of 17 carcinogens. The agency also concluded that environmental smoke produces serious respiratory illness in young children.

Critics note, however, that the EPA didn't consider a threshold level for smoking damage. Scientists know cells have the ability to repair damage to their DNA. Can cells fix tobacco-induced changes, and at what level of pollution does the repair mechanism become overwhelmed? The agency regarded all smoke exposure as dangerous and the effects as cumulative. EPA scientists admit that the danger of getting a whiff of tobacco at the baseball stadium is generally not the same as driving in an enclosed car with a chain smoker. "I'd expect the ballpark risk to be minimal," concedes a researcher.

The agency also neglected the possibility that other factors besides ETS might have played the major role in inducing lung cancers and respiratory illness. Even if one accepts the agency's assessment, say critics, the risk of developing lung cancer from ETS is only about the same as the chance of dying in a bicycle accident.

EPA supporters respond that several comprehensive reviews of ETS -- by the Surgeon General, the National Academy of Sciences, and the National Institute for Occupational Safety and Health -- support the report's conclusions. More corroborating studies have come since the report's release, including one that firmly links ETS to heart disease. The question, as always, is at what level the danger of exposure becomes a cause for action.

With reporting by Deborah Fowler/Houston and Dick Thompson/Washington