What's in a Cigarette?
by K. H. Ginzel, M.D.

For those who still don't know — let me emphatically state that cigarette smoking is a true addiction! To grasp this well-documented fact, one really doesn't have to study all the supporting scientific evidence. One simply needs to consider that no other drug is self-administered with the persistence, regularity and frequency of a cigarette. At an average rate of ten puffs per cigarette, a one to three pack-a-day smoker inhales 70,000 to 200,000 individual doses of mainstream smoke during a single year. Ever since its large scale industrial production early in this century, the popularity of the modern cigarette has been spreading like wildfire. Here is the first, and perhaps the most significant answer to the title question: Addiction is in a cigarette.

Probing into what makes a cigarette so irresistible, we find that much of the recent research corroborates earlier claims: It is for the nicotine in tobacco that the smoker smokes, the chewer chews, and the dipper dips. Hence, nicotine is in a cigarette.

In contrast to other drugs, nicotine delivery from tobacco carries an ominous burden of chemical poisons and cancer-producing substances that boggle the mind. Many toxic agents are in a cigarette. However, additional toxicants are manufactured during the smoking process by the chemical reactions occurring in the glowing tip of the cigarette. The number is staggering: more than 4,000 hazardous compounds are present in the smoke that smokers draw into their lungs and which escapes into the environment between puffs.

The burning of tobacco generates more than 150 billion tar particles per cubic inch, constituting the visible portion of cigarette smoke. According to chemists at R. J. Reynolds Tobacco Company, cigarette smoke is 10,000 times more concentrated than the automobile pollution at rush hour on a freeway. The lungs of smokers, puffing a daily ration of 20 to 60 low to high tar cigarettes, collect an annual deposit of one-quarter to one and one-half pounds of the gooey black material, amounting to a total of 15 to 90 million pounds of carcinogen-packed tar for the aggregate of current American smokers. Hence, tar is in a cigarette.

But visible smoke contributes only 5-8% to the total output of a cigarette. The remaining bulk that cannot be seen makes up the so-called vapor or gas phase of cigarette "smoke." It contains, besides nitrogen and oxygen, a bewildering assortment of toxic gases, such as carbon monoxide, formaldehyde, acrolein, hydrogen cyanide, and nitrogen oxides, to name just a few. Smokers efficiently extract almost 90% of the particulate as well as gaseous constituents (about 50% in the case of carbon monoxide) from the mainstream smoke of the 600 billion cigarettes consumed annually in the U.S. In addition, 2.25 million metric tons of sidestream smoke chemicals pollute the enclosed air spaces of homes, offices, conference rooms, bars, restaurants, and automobiles in this country. Hence, pollution is in a cigarette.

The witch's brew of poisons invades the organs and tissues of smokers and nonsmokers, adults and children, born as well as unborn, and causes cancer, emphysema, heart disease, fetal growth retardation and other problems during pregnancy. The harm inflicted by all other addictions combined pales in comparison. Smoking-related illness, for example, claims in a few days as many victims as cocaine does in a whole year. Hence, disease is in a cigarette.

The irony is that many of the poisons found in cigarette smoke are subject to strict regulation by federal laws which, on the other hand, specifically exempt tobacco products. "Acceptable Daily Intake," ADI, is the amount of a chemical an individual can be exposed to for an extended period without apparent detriment to health.

In addition, there is the chemical burden from sidestream smoke, afflicting smokers and non-smokers alike. Based on the reported concentrations in enclosed, cigarette smoke-polluted areas, the estimated intakes of nicotine, acrolein, carbon monoxide, nitrogen dioxide and formaldehyde peak at 200, 130, 75, 7, and 3 times the ADI, respectively. The high exposure to acrolein is especially unsettling. This compound is not only a potent respiratory irritant, but qualifies, according to current studies, as a carcinogen.

Regulatory policy aims at restricting exposure to carcinogens to a level where the lifetime risk of cancer would not exceed 1 in 100,000 to 1,000,000. Due to a limited database, approximate upper lifetime risk values could be calculated for only 7 representative cigarette smoke carcinogens. The risk values were extraordinarily high, ranging from 1 in 6,000 to 1 in 16. Because of the awesome amount of carcinogens found in cigarette smoke and the fact that carcinogens combine their individual actions in an additive or even multiplicative fashion, it is not surprising that the actual risk for lung cancer is as high as one in ten. Hence, cancer is in a cigarette.

Among the worst offenders are the nitrosamines. Strictly regulated by federal agencies, their concentrations in beer, bacon, and baby bottle nipples must not exceed 5 to 10 parts per billion. A typical person ingests about one microgram a day, while the smokers' intake tops this by 17 times for each pack of cigarette smoked. In 1976, a rocket fuel manufacturer in the Baltimore area was emitting dimethylnitrosamine into the surrounding air, exposing the local inhabitants to an estimated 14 micrograms of the carcinogen per day. The plant was promptly shut down. However eagerly the government tries to protect us from outdoor pollution and the carcinogenic risk of consumer products, it blatantly suspends control if the offending chemical is in, or comes from, a cigarette. Hence, hypocrisy is in a cigarette.

But there is still more in a cigarette than addiction, poison, pollution, disease, and hypocrisy. A half century of aggressive promotion and sophisticated advertising that featured alluring role models from theater, film and sport, has invested the cigarette with an enticing imagery.

Imagery which captivates and seduces a growing youngster. The youngster, indispensable for being recruited into the future army of smokers, does not start to smoke cigarettes for the nicotine, but for the false promises they hold. Hence, deceit is in a cigarette. In summary, no drug ever ingested by humans can rival the long-term debilitating effects of tobacco; the carnage perpetuated by its purveyors; the merciless irreversibility of destiny once the victim contracts lung cancer or emphysema; the militant denial on the part of those who, with the support of stockholders and the sanction of governments, legally push their lethal merchandise across borders and continents killing every year two and one-half to three million people worldwide. All things added together: death is in a cigarette.

K. H. Ginzel, M.D., is Professor of Pharmacology and Toxicology at the University of Arkansas. His work is concentrated in the area of nicotine and its effects.