New research suggesting teenagers get hooked on low-nicotine chewing tobacco and graduate to stronger brands prompted the American Medical Association Wednesday to call for an immediate government crackdown on tobacco.
The Food and Drug Administration should make tobacco "known as the deadly drug it really is," and force manufacturers to lower the amount of addictive nicotine in their products, said AMA trustee Dr. Randolph Smoak.A group of studies reported Wednesday in the journal Tobacco Control promises to rekindle the debate over FDA regulation of tobacco products as drugs, lending weight to critics' argument that companies manipulate nicotine levels to make their products more addictive. The industry furiously denies the charges and dismissed the new studies as a rehash of old crit-i-cisms.
But this research documents for the first time the pH levels of 17 brands of smokeless tobacco and their resulting increases in "free nicotine" that may be easily absorbed into the bloodstream. It also illustrates how teenagers actually use the products.
"The evidence is now more solid than what we had in the past," said Dr. Ronald Davis, editor of the journal, published by the British Medical Association.
Among the findings:
- Research shows acidic tobacco releases nicotine into the bloodstream far more slowly than alkaline tobacco. A new Swedish Tobacco Co. fact sheet says the industry adds chemicals to increase products' alkalinity "in order to release the nicotine from the tobacco," reported Gregory Con-nol-ly of the Massachusetts Depart-ment of Health.
U.S. firms have denied doing that, and U.S. Tobacco Co. denied that alkalinity even plays a major role in nicotine absorption.
- Two laboratories, at the National Institutes of Health and the American Health Foundation, independently measured the pH levels - the degree of acidity or alkalinity - and free nicotine in top-selling brands. The pH of the mildest, Skoal Bandit, was 1,000 times more acidic than the strongest brand, Copenhagen. The free nicotine increased 17 times as the brands' alkalinity increased.
"It is very unlikely that differences as large as these are inadvertent," said Dr. John Slade of the Robert Wood Johnson Medical School, who analyzed the studies in an accompanying editorial.
However, he acknowledged that people's blood levels never have been measured to ensure saliva or other factors don't impact this free nicotine, "so direct evidence that these predicted differences actually occur is lacking."
- The first brand survey of teen-agers found the youngest users bought the lowest-nicotine Skoal Bandit while older teens used stronger brands. But four years later, only half of the Skoal users still preferred the milder brand - nearly a third had switched to the highest-nicotine Copenhagen, the federal Centers for Disease Control and Prevention reported.