The U.S. Food and Drug Administration has struck panic among tobacco companies by announcing a comprehensive proposal to reduce the amount of nicotine in cigarettes to non-addictive levels. This is aimed at striking at the root of the problem of smokers getting addicted, and being unable to quit the habit. While the proposal is at an early stage and it may take a while before it gets implemented, if at all, it outlines a powerful strategy. Nicotine does not directly cause cancers and other diseases that kill people, but is extremely addictive. By keeping smokers addicted for the long term, nicotine exposes them to nearly 7,000 chemicals, many of them deadly, every time they smoke. Reducing nicotine in cigarettes to non-addictive levels would therefore have multiple benefits — reduce the likelihood of new users (those in the 15-24 age group) getting hooked to cigarettes, increase the chances of habitual smokers being able to quit, and cut smoking-related disease and death burden overall. In the U.S. alone, nearly half a million smoking-related deaths are reported each year. While more studies are required to establish clear causality, a paper published in the New England Journal of Medicine in 2015 showed smokers using reduced-nicotine cigarettes lit up fewer cigarettes a day compared with those smoking standard cigarettes.
The FDA, however, has no plans to regulate nicotine content in electronic cigarettes and other nicotine-replacement products, which are seen to be alternatives to help smokers quit the habit. A study published a few days ago in the journal BMJ found that a “substantial increase” in e-cigarette use among adult smokers had led to a “significant increase” in the quitting rate among smokers. By making it illegal a year ago to sell e-cigarettes to children, the FDA has effectively addressed the growing concern about children taking to vaping. Yet, the U.S. has much to learn from India on tobacco control measures. While India is yet to prohibit the sale of e-cigarettes to minors, it has followed most of the measures mentioned in the WHO Framework Convention on Tobacco Control guidelines. Unlike the U.S., India banned tobacco advertisements long ago, introduced pictorial warnings (covering 85% of the front and back of packages of tobacco products), and prohibited the use of descriptors such as light, mild and low as well as the sale of flavoured cigarettes. Threatened by the dwindling number of young smokers, there is the possibility that tobacco companies will target developing countries such as India with renewed vigour. While they may pull out all the stops to subvert or dilute tobacco control measures, the government should remain resolute in not losing the gains made in the last few years — the number of tobacco users reduced by more than eight million between 2010 and 2016.