IRA FLATOW, HOST:
This is SCIENCE FRIDAY. I'm Ira Flatow. In a few days, my next guest will be in Florida. He's going there to testify against Big Tobacco in a lawsuit brought by a smoker with health problems. Oh, you didn't know that tobacco lawsuits like this are still going on today? You certainly don't hear a lot about them in the news. But some 8,000 more cases just like this one exist in Florida alone.
My next guest is an historian and an expert on the tobacco industry, and his new book, "Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition," is a 737-page indictment of the tobacco industry, loaded with secrets about smoke and smoking you may have never known, like that filters don't filter, he says, or that cigarette smoke is radioactive and contains Polonium-210, or that only two-thirds of an American cigarette is tobacco, the rest additives, hundreds of them like antifreeze, ammonia, high fructose corn syrup, carob beans, cocoa, licorice.
Did you know that 90 percent of the world's licorice goes into cigarettes? Just a few of the surprising points made in my guest's book. Our number, 800-989-8255 if you'd like to talk about cigarettes and smoking. Or you can tweet us @scifri.
Robert Proctor is author of "Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition." He's also professor of the history of science at Stanford University in California.
Welcome to SCIENCE FRIDAY, Dr. Proctor.
ROBERT PROCTOR: Thank you, Ira. How you doing?
FLATOW: I - you know, I think people think that smoking is done here in this country, but reading this book says it isn't.
PROCTOR: Oh, yeah, yeah. That's one of the biggest myths, is that people don't smoke anymore. But the fact is we still smoke about 350 billion cigarettes every year, just in this year alone, and it's about six trillion worldwide. So that's a huge amount.
FLATOW: How do we compare - you know, we always say oh, well, those Europeans, they're - people in China or someplace, they're smoking, but we're not.
PROCTOR: Well, actually, the French smoke about what we do or even slightly less, surprisingly. The difference is that in the United States, it's really pretty much only the poor now who smoke. And so it's - you know, it's kind of invisible to the rest of us.
FLATOW: And there are 8,000 lawsuits alone in Florida?
PROCTOR: Yeah. That's just in Florida. Those are the so-called Engle progeny cases that's been thrown back from the Florida Supreme Court. And so individual plaintiffs are still, you know, saying they deserve some kind of compensation.
FLATOW: And are they winning?
PROCTOR: The cases seem to be about - so far, most of them have actually gone toward the plaintiffs, yeah. So the plaintiffs are actually winning.
FLATOW: Let's get into some of the interesting facts you put in the book. You write that cigarette smoke is radioactive. How is that?
PROCTOR: Yeah, that's right. Yeah, it's - the cigarette actually contains radioactive Polonium-210, which is the same isotope that killed that spy Litvinenko in London a few years ago, and may have even killed Yassir Arafat. There's an inquiry into that now.
But it comes in through the super-phosphate fertilizers that are mined in Florida, and then they've - they're spread on the tobacco as a fertilizer. And those fertilizers, those super-phosphates, contain uranium. And through the decay chain from uranium to lead, it ends up as polonium and is sucked up into the leaf and even dropped a bit as fallout on the leaf, as well, and ends up in your lungs.
FLATOW: Could that be one of the causes of lung cancer, then?
PROCTOR: Of course. Yeah, of course. In fact, when it was discovered in 1964 that cigarettes were radioactive, that was really the main theory, was this must be one of the factors, at least, that's causing it.
FLATOW: But if radioactivity is coming from fertilizer, doesn't that mean our broccoli is radioactive, too?
PROCTOR: Yeah. It's probably not a good idea to smoke broccoli.
PROCTOR: Of course, the difference is that when you ingest those type of radioisotopes, the alpha radiation has a very low penetration, and so our - in our digestive system, it's mostly just shot out through us, our stomach and our intestines, they slough off cells.
But our lungs don't have that capacity of very, very - you know, a very thin layer. A single cell is separating you from that alpha radiation, and that can cause cancer.
FLATOW: You write that filters don't filter. How is that possible?
PROCTOR: Well, they're not filters at all. I mean, if you think about it, you know, to smoke, you're - there's no such thing as clean smoke. You can clean water, but you can't clean smoke. And if you're actually smoking, what you want is the soot, the tar and the 5,000 other compounds that come along with it.
And the only thing they really do, the filters do, is they can reduce the particle size of the soot, and that just means that the soot's going deeper into your lungs, causing cancer in a harder-to-diagnose and harder-to-treat area. So the actual filters are actually - they're not only doing nothing for your health, they're probably actually slightly hurting it.
FLATOW: Now, you've been researching this book a long time, right?
PROCTOR: Oh, yeah. Yeah, I've been working on this field now for about a quarter of a century.
FLATOW: And where did you get most of these documents that you have, dozens of pages?
PROCTOR: Yeah, there's 80 million pages now. In fact, I just got an email saying there's been over a million new documents added just today. This is from the Tobacco Archives that are housed at UCSF, and you can go online at the Legacy Archive and search these documents. And it's fantastic because you can plug in any word you want, and you'll get, you know, whatever documents are in that.
And I just plugged in Switzerland today, and I got 164,000 documents mentioning Switzerland. So it's like a giant magnet. You pull these needles out of a haystack. It's a wonderful resource.
FLATOW: Do a lot of these documents come from the tobacco industry itself?
PROCTOR: Oh, they're all from the tobacco industry. These are documents that are entirely produced through litigation, and there's no comparable business archive or actually historical archive in the world. And what's marvelous again is they're full-text searchable. So you can search, you know, put in any word you want. And, you know, I've explored them now for almost a decade.
FLATOW: So when I - when you say I'll go back to the filter one, that the filters don't filter, you learned that from the industry or from the tobacco companies themselves.
PROCTOR: Yeah. That's what they were saying, going back all the way to the '30s. In fact, the world's largest tobacco company, The American Tobacco Company, they were basically too honest, and they didn't want to make a filter because they knew they were bogus.
And so they said look, we're not going to do it, and as a result, they eventually went out of business. Other companies would describe them as, you know, thermodynamically impossible. It's really - if you think about it, it's more like a speed bump or something. It can jostle the smoke, but as long as you're sucking in smoke, you know, there's no filtration.
FLATOW: Is true, then, the tobacco industry tried to block the publication of this book?
PROCTOR: Well, they certainly subpoenaed it. They wanted to get all my notes, all my notes, my drafts, everything like that, and I had to spend a fortune in lawyers' fees just to keep them from seizing it.
FLATOW: Why - you go through the score or more of additives into the cigarette. Give us an idea of what else is in there besides tobacco and why.
PROCTOR: Oh, it's unbelievable. Just in cocoa shells alone, there's millions of pounds of that. Millions of pounds of licorice are added, diamonium phosphate, which is a freebasing agent. Chocolate and cocoa are added because they contain the alkaloid theobromine, which is a bronchodilator. They put menthol in there, which is an anesthetic and a cough suppressant, basically makes the poison go down easier.
And those are just some of the things that are in there on purpose, but there's also all kinds of stuff in there by accident. And if you look at the secret documents, it talks about there being shards of plastic and pesticides and bits of wire and even blood of various sorts. So there's all kinds of garbage that's actually in your cigarette.
FLATOW: I remember years ago covering stories back in the '70s about trying to come up with a quote-unquote "safe cigarette" that went nowhere. Is it possible to produce one?
PROCTOR: Well, yeah, if you produce one that couldn't be burned, for example, that would be safer. If you produced a cigarette that no one could light, that would be safer.
FLATOW: What about...
PROCTOR: You know, if you - there are some, you know, more realistic things, like if you were to produce a cigarette with no nicotine in it or extremely low, it wouldn't be able to create and sustain addiction, and so people wouldn't smoke it. So by that virtue, it would be safer.
Or you can raise the pH back up. The smoke pH is now about 6.5 on cigarettes, and that means they're very inhalable. They're very mild. But if you were to raise the cigarette smoke pH back up to eight or above, where it was prior to the 19th century, then people wouldn't inhale tobacco smoke and there wouldn't be any lung cancer.
So those two things alone, taking the nicotine out and raising the smoke pH back up, those would - that would do more for public health than anything in human history.
FLATOW: Of course we would then still have lip cancer or throat cancer or chewing-tobacco-type cancer?
PROCTOR: Yeah, you'd still have those. I mean, yeah, it's - you know, chewing tobacco is less deadly, but it certainly can kill you. But cigarettes, you know, they take the cake.
FLATOW: 1-800-989-8255. Let's see if I can get a quick phone caller in here. Let's go to Washington. Let's go to Will, in Washington. Hi, Will.
WILL: Hi, Ira.
FLATOW: Hi, there.
WILL: How's it going?
FLATOW: Hi, there. Fine. Go ahead.
WILL: I guess the comment that I want to make is that - I've been smoking for about 10 years now, and I actually enjoy it. It's - independent of the chemical addiction to nicotine. It's something that I actually enjoy doing. And I don't necessarily see the tobacco industry as an evil empire. It's a business distributing a product they think the people are engaging in it are aware of what they're doing and getting themselves into.
And I guess - I heard the word prohibition being thrown around. I mean, is the endgame here to have a prohibition on cigarettes? Is that the goal? Is it outlaw-able?
FLATOW: OK, Will, you're concerned. OK, thanks for the call, Will. It's breaking up, there.
PROCTOR: Yeah, well, the smoker, actually, who was on the line there is quite rare. Eighty to 90 percent of smokers regret the fact they ever started smoking. They wish they didn't smoke. It's actually quite rare what the caller was saying. And I think there are a lot of different endgames.
Tasmania, the parliament is considering a law that would ban smoking - the sale of cigarettes to anyone born after the year 2000 to create an entire smoke-free generation. Of course, we've got smoke-free laws of other types. In New York, we've got the high taxes.
But, basically, I think that the sale of cigarettes should be abolished because they are simply too dangerous to be sold. It's a defective, a deeply defective product. They're not inherently dangerous. They're actually dangerous by design. And there are even other ways that you could enjoy...
FLATOW: That's talking with Robert Proctor, author of "Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition." We're going to take a break, and when we come back, Nora Volkow is going to join the conversation to talk about nicotine vaccines and the science of addiction. What's the best way to give it up? So stay with us. We'll be right back.
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FLATOW: I'm Ira Flatow. This is SCIENCE FRIDAY, from NPR.
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FLATOW: This is SCIENCE FRIDAY. I'm Ira Flatow. We're talking this hour about cigarettes and smoking and addiction with my guest Robert Proctor, author of "Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition." We were talking about all the cigarettes that are out there, and one of our last guests, our last phone caller said that he enjoyed smoking.
And Robert Proctor was saying that most people, 90 percent of the people, wish they never started smoking. So what's the best way to quit? Joining us now is Nora Volkow. She is director of the National Institute on Drug Abuse. That's at NIH in Bethesda. She's an expert on addiction and what it does in your brain, what goes on in there when you get hooked.
Welcome back to SCIENCE FRIDAY, Dr. Valkow.
NORA VOLKOW: Thanks for having me here.
FLATOW: Have we made any progress on a nicotine vaccine?
VOLKOW: Well, there's been progress on different strategies for these vaccines. We were very hopeful that a vaccine that had reached the phase three clinical trials would be able to fulfill the outcomes required by the FDA such that we would have a product that we would be able to prescribe for patients. But unfortunately, the outcomes were not reached, and the FDA did not approve the vaccine.
FLATOW: It just wasn't working out, didn't work out.
VOLKOW: Well, what happened was that the vaccine was not sufficiently antigenic, and that means that it did not produce the levels of antibodies that were necessary in order for it to be therapeutically useful. And the patients that did reach those levels stopped smoking, but there were very few of those.
FLATOW: Describe for us what goes on in your brain when you get addicted to something like nicotine.
VOLKOW: Well, nicotine is a difficult drug because what it does, it's actually - when you're smoking, everything that's surrounds you is much more salient, much more exciting. And that's why I'm not surprised that the caller said, well, I like to smoke, because it will make things more rewarding than they usually are.
And that type of response, for example, I predict that he was a relatively young smoker. And if you ask an adolescent, well, why are you (unintelligible) of smoking, they'll give you exactly the same response. So the - and that is also why it can also be so terribly addictive. You become conditioned to experiencing things that are producing pleasure. You start to associate them with smoking cigarettes.
And as a result of that, you crave, you desire the cigarette when you are in a situation where, in the past, you had smoked it. And because cigarette smoking is done on everyday activities, as a result of that, then you find yourself conditioned to everyday activities that are going to trigger the desire of you wanting to smoke.
FLATOW: Like what actually chemically goes on in your brain that creates the addiction?
VOLKOW: Well, it will depend on the type of drugs that you're speaking of, because drugs have very different mechanism of action. So, for example, alcohol facilitates the transmission of inhibitory neurotransmitters or chemicals. Nicotine activates nicotine receptors, and by doing that, it stimulates the firing of dopamine cells. And dopamine cells fire when something is salient and exciting.
And when that happens, you are much more likely to get conditioned to it - that is, to memorize it at an unconscious level, to learn an association between the nicotine and the expected pleasure that you're going to get. And that is initially triggered by the stimulation of the nicotine receptors that then produce the changes in the dopamine system, and that then triggers a cascade of adaptations that strengthen the communications between certain - what we call synapses, which is a communications between neurons to neurons - in brain areas that directly regulate the reward circuitry of your brain.
FLATOW: Here's a tweet that came in from Paula Steiner(ph), who wants to know: If you take out the smoke, is nicotine any worse than caffeine?
VOLKOW: Well, they are very different drugs. Caffeine, actually, you develop tolerance very rapidly. And because of the tolerance effects of caffeine, you are never going to get beyond a certain reward response. And that is much less so the case with nicotine.
But the caller does have an important point, which is that we've come to recognize that the main adverse health effects from smoking cigarettes are not directly related to nicotine, but to all of the chemicals that you are inhaling when you smoke. The addictiveness comes from nicotine, but the adverse medical consequences - like pulmonary disease, cardiovascular disease, cancer, dermatological diseases - all of the adverse consequences from that perspective are associated with the chemicals.
There is a big exception, though, and I want to make a point here, and that's pregnancy. Nicotine is very harmful for the fetus. And so when the mother smokes or takes nicotine by other means, nicotine will reach the brain of the fetus and produce changes that are - can be deleterious to the newborn.
FLATOW: Also with us is Robert Proctor, author of "Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition." And Robert, you write that you've seen a tobacco industry document that says cigarette smoking is not like drinking. It's like being an alcoholic.
PROCTOR: Yeah, that's right. That's from the Imperial Tobacco Company in Canada, one of the secret documents from that treasure trove. Yeah, that's very important to realize, is that cigarettes are fundamentally different from alcohol. Only about 5 percent of people who drink are alcoholics, whereas about 80 to 90 percent of people who smoke are actually addicted. So that's what gives it an entirely different political or ethical calculus from drinking alcohol. Alcohol is essentially a recreational drug. Smoking is not.
FLATOW: Dr. Volkow, are some people more likely to get addicted than others?
VOLKOW: Yes, and that has been recognized for many, many years that drug use, even smoking, runs in families. And from studies, for example, the researchers can generate in animal models, rats, that readily administer nicotine and others that won't, or readily administer alcohol and others than won't.
And so what they are doing is studying the genes that are responsible for these very dramatic differences in the vulnerability to acquire the drug-taking, and then to transition into compulsive use and addiction.
FLATOW: So is tobacco a gateway drug? Does it change your brain and make you crave other drugs, or...
VOLKOW: That's a very important question. And traditionally we have always thought of a gateway drug for marijuana. But recently, studies have shown that, indeed, nicotine can act like a gateway drug. And I'm thinking specifically of a study done by Eric Kandel and his collaborators that shows that exposure to nicotine actually primes the brain to the rewarding effects of other drugs. That is to say, when you expose an animal to nicotine for one week, and then you administer another drug like cocaine, they were much more sensitive to its rewarding effects than those animals that have not been pre-exposed to nicotine.
And they go on and determine what are the molecular mechanisms that have led to this enhanced sensitivity of other drugs, providing the basis of a biological process for the gateway theory regarding the use of nicotine and its facilitation of abuse of other substances.
FLATOW: So what would be the best way to give up smoking? You know, we've had people - I have some tweets coming in from people who say, you know, I gave up the cigarette, but I'm addicted to the patch or other sources. What do you say about that, or what would be the best way to try to give it up?
VOLKOW: Well, I think that there's not such a thing as a recipe that you do A, B, C, you will be able to stop smoking, because there's tremendous diversity among smokers with respect, for example, to the severity of the addiction itself. Another factor that contributes difficulty in stopping smoking is comorbidity. For example, if you have attention deficit hyperactivity disorder, you are more - you are going to have a harder time to stop smoking.
If you're suffering from schizophrenia, you're also going to have a harder time to stop smoking. So these factors need to be entered into account when addressing what will work best for one individual versus the other. What I can say is that there are currently three different overall types of medications that have been proven to facilitate smoking cessation.
All of the nicotine replacement products - which are the patch, the chewing gum, the inhalers - that's one type of strategy that works for some people and not for others. Then you have medication, Chantix, that actually initiated - it used to be an antidepressant - it's an antidepressant, but also is effective against smoking cessation.
And then the last one, which is the one that has had overall the best effects on smoking cessation, is a medication that combines agonist properties for nicotine itself that decreases the craving to smokers, and - but it's not well tolerated by all of them. So - which brings, again, the concept that you cannot prescribe one medication and expect that it will be useful for everybody.
There are also several behavioral interventions that have been proven to be helpful, and in combination with medications, they also appear to provide with better outcomes.
FLATOW: Mm-hmm. 1-800-989-8255. Let's go to the phones, to Trip(ph) in Baltimore. Hi, Trip.
TRIP: Oh, hi, both of you. I have two questions. Does the additives run the gamut to different other forms of tobacco such as pipe tobacco and cigars? And my other question is, why aren't these ingredients required on the package? If people were - and I smoke cigarettes, you know, reminding that I'm smoking plutonium. And I heard there's cyanide and arsenic, things like that. Why aren't they required to be on the package? And I'll hang up, take my...
FLATOW: Let me just ask you, Trip, before you go. If you know there's radioactive gas and it has the other stuff in there, why do you continue to smoke?
TRIP: Well, I enjoy it, just like the younger person said. I quit when I was 18 and picked it back up in my 40s. I just turned 60. And I can stop. I didn't say quit, but I can stop. It's kind of rough for three days, and then it's just that conditioned respond.
TRIP: So I just listen to my lungs. When they say stop for a month or three, then I just do that.
FLATOW: All right, Trip. Thanks for calling. Robert Proctor, why is there - why are there no, you know, ingredients listed on the package?
PROCTOR: Well, the simple industry is - simple answer is the power of the tobacco industry. I mean, we basically live in a world of tobacco or cigarette exceptionalism, where if you were to introduce them as a consumer product today, they would obviously never be approved by the FDA.
You know, if - the smoker also asked about other tobacco products. You know, there's - there are other chemicals put into cigars and chewing tobacco and things like that. But the difference with the cigarette, the reason the cigarette is so much more dangerous and more deadly is that it's used much more routinely than cigars. Cigars are not typically smoked on a daily basis, whereas a pack of cigarettes is basically a daily dose for about 40 million Americans.
So even laws like the Consumer Product Safety Commission, when it was established in 1973, it explicitly excluded any regulatory power over cigarettes because - and so you had this odd situation where you could regulate cigarette lighters for causing fires, or upholstery had to be flame-resistant and things like that. But the deadliest consumer artifact of human history was completely exempt, and it's basically been exempt from almost all regulatory control.
FLATOW: This is SCIENCE FRIDAY from NPR. I'm Ira Flatow, talking with Robert Proctor and Dr. Nora Volkow. Dr. Volkow, why does smoking a cigarette feel so good?
VOLKOW: Well, because it's actually, you're inhaling nicotine, and nicotine - by a method that gets into the brain extremely rapidly, and that activates dopamine cells. And when dopamine cells are activated, there is a sense of saliency, excitement, and it actually energize you, makes you be able to sustain effort, to pay attention, to enjoy things. And that is very pleasurable, and the bottom line is our brain is hardwired to be sensitive to reward. They motivate our behaviors to repeat them.
So when you have a behavior that is experienced as rewarding, that's the way that nature ensures that we will repeat it again. And that's why drugs are so malignant because they directly tackle, they hijack the system that evolved over many, many years of evolution to ensure that behaviors that are necessary for survival would be repeated.
FLATOW: Let's go to the phones, quick call to Sandy in Charlotte. Hi, Sandy.
FLATOW: Hi. Go ahead.
SANDY: I had a question. The previous speaker was talking about the levels of pH(ph) of the nicotine within the cigarette. And now with the new e-cigarette, it claims that you can get lower levels of nicotine, and I guess that's supposed to be healthier for the person smoking. But my question is more for the bystander. It claims that when you're breathing out the smoke, it's strictly water vapor. And I'm wondering how true that is and if the bystander really is safe standing next to that person smoking that e-cigarette.
FLATOW: All right, Sandy. Thanks.
SANDY: Thank you.
FLATOW: You're welcome. Robert?
PROCTOR: There certainly is a lot less vapor expelled from an electronic cigarette. The nicotine is supposed to stay in the lungs, and the exhalation is supposed to be probably just glycerin and water. So there's no doubt those are much, much less deadly. There's not less nicotine, though, by the way. There's no evidence they're any less addictive. They simply don't have the cancer consequences.
FLATOW: Mm-hmm. So basically, the cigarette is - was designed to be a nicotine delivery system.
PROCTOR: Yeah. The secret documents of the industry make that very clear. It's a - they, you know, they talk about - say we used to be a tobacco industry, and then we were a smoke industry and a cigarette industry. And now we're a nicotine delivery industry.
FLATOW: And is big tobacco as strong today as it once was, always was?
PROCTOR: Well, certainly global they are - globally they are. Philip Morris International is a $150 billion company. There are huge industries in China which now produces about 40 percent of the world's cigarettes through its cigarette monopoly. So it's really extremely - still extremely powerful industry.
FLATOW: Mm-hmm. Thank you both for taking time to be with us today.
VOLKOW: Thanks to you.
FLATOW: Thank you, Dr. Volkow. Nora Volkow is director of the National Institute on Drug Abuse at the National Institutes of Health in Bethesda. Robert Proctor, author of "Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition." He's also professor of history of science at Stanford University in California. Transcript provided by NPR, Copyright NPR.