The past, present and future of nicotine addiction
-
0:01 - 0:03I'm going to tell you a story.
-
0:04 - 0:05I'm going to tell you a story
-
0:05 - 0:09about how the deadliest
consumer product imaginable -
0:09 - 0:10came to be.
-
0:10 - 0:12It's the cigarette.
-
0:13 - 0:15The cigarette is the only consumer product
-
0:15 - 0:18that, when used as intended,
-
0:18 - 0:22will kill half of all long-term users
prematurely, later in life. -
0:22 - 0:24But this is also a story
-
0:24 - 0:27about the work that we're doing
at the Food and Drug Administration, -
0:27 - 0:29and specifically,
the work that we're doing -
0:29 - 0:33to create the cigarette of the future,
-
0:33 - 0:37that is no longer capable
of creating or sustaining addiction. -
0:38 - 0:42A lot of people think that
the tobacco problem or the smoking problem -
0:42 - 0:43has been solved in the United States
-
0:43 - 0:45because of the great progress
that's been made -
0:45 - 0:47over the last 40, 50 years,
-
0:47 - 0:50when it comes to both
consumption and prevalence. -
0:50 - 0:51And it's true;
-
0:52 - 0:55smoking rates are at historic lows.
-
0:56 - 0:58It's true for both adults and for kids.
-
0:59 - 1:02And it's true that those
who continue to smoke -
1:02 - 1:05are smoking far fewer cigarettes per day
-
1:05 - 1:07than at any time in history.
-
1:08 - 1:12But what if I told you
that tobacco use, -
1:12 - 1:15primarily because of firsthand
and secondhand exposure -
1:15 - 1:18to the smoke in cigarettes,
-
1:18 - 1:22remains the leading cause of completely
preventable disease and death -
1:22 - 1:23in this country?
-
1:24 - 1:25Well, that's true.
-
1:27 - 1:31And what if I told you
that it's actually killing more people -
1:31 - 1:33than we thought
to be the case ever before? -
1:34 - 1:35That's true, too.
-
1:37 - 1:41Smoking kills more people each year
than alcohol, AIDS, car accidents, -
1:41 - 1:44illegal drugs, murders
and suicides combined. -
1:45 - 1:47Year in and year out.
-
1:48 - 1:50In 2014,
-
1:51 - 1:53Dr. Adams's predecessor released
-
1:53 - 1:55the 50th anniversary
Surgeon General's report -
1:55 - 1:57on smoking and health.
-
1:58 - 2:02And that report upped the annual
death toll from smoking, -
2:02 - 2:05because the list
of smoking-related illnesses -
2:05 - 2:06got bigger.
-
2:06 - 2:08And so it is now conservatively estimated
-
2:08 - 2:13that smoking kills
480,000 Americans every year. -
2:13 - 2:16These are completely preventable deaths.
-
2:17 - 2:20How do we wrap our heads around
a statistic like this? -
2:20 - 2:23So much of what we've heard
at this conference -
2:23 - 2:27is about individual experiences
and personal experiences. -
2:27 - 2:30How do we deal with this
at a population level, -
2:30 - 2:33when there are 480,000 moms,
-
2:33 - 2:37dads, sisters, brothers, aunts and uncles
-
2:37 - 2:41dying unnecessary deaths
every year from tobacco? -
2:42 - 2:45And then what happens
when you think about this trajectory -
2:45 - 2:47for the future?
-
2:47 - 2:49And just do the simple math:
-
2:50 - 2:54from the time of the 50th anniversary
Surgeon General's report five years ago, -
2:55 - 2:57when this horrible statistic was raised,
-
2:57 - 2:59just through mid-century --
-
3:00 - 3:05that's more than 17 million
avoidable deaths in the United States -
3:05 - 3:07from tobacco use,
-
3:07 - 3:09primarily because of cigarettes.
-
3:10 - 3:12The Surgeon General concluded
-
3:12 - 3:19that 5.6 million children
alive in the United States in 2014 -
3:19 - 3:24will die prematurely later in life
because of cigarettes. -
3:24 - 3:26Five point six million children.
-
3:28 - 3:32So this is an enormous
public health problem for all of us -
3:32 - 3:35but especially for us as regulators
-
3:35 - 3:38at the Food and Drug Administration
and the Center for Tobacco Products. -
3:38 - 3:40What can we do about it?
-
3:41 - 3:45What can we do to reverse this trajectory
of disease and death? -
3:47 - 3:53Well, we have an interesting guide
to help unravel issues -
3:53 - 3:57like: How did the cigarette
as we know it come to be? -
3:57 - 4:01What is the true nature
of the tobacco and cigarette business? -
4:02 - 4:03How did the industry behave
-
4:03 - 4:06in the historically
unregulated marketplace? -
4:06 - 4:08And our guide
-
4:08 - 4:13is previously secret internal documents
from the tobacco industry. -
4:13 - 4:15Come with me
-
4:15 - 4:18in a tobacco industry
document time machine. -
4:19 - 4:21Nineteen sixty-three
-
4:22 - 4:27was 25 years before the Surgeon General
was finally able to conclude -
4:27 - 4:30that the nicotine
and cigarettes was addictive. -
4:30 - 4:34That did not happen until
the Surgeon General's report in 1998. -
4:35 - 4:37Nineteen sixty-three
-
4:37 - 4:43was one year before the first-ever
Surgeon General's report in 1964. -
4:45 - 4:47I remember 1964.
-
4:47 - 4:49I don't remember
the Surgeon General's report, -
4:49 - 4:50but I remember 1964.
-
4:51 - 4:53I was a kid growing up
in Brooklyn, New York. -
4:54 - 4:55This was at a time
-
4:55 - 4:59when almost one in two adults
in the United States smoked. -
5:00 - 5:03Both of my parents
were heavy smokers at the time. -
5:04 - 5:07Tobacco use was so incredibly normalized
-
5:07 - 5:10that -- and this wasn't North Carolina,
Virginia or Kentucky, -
5:10 - 5:12this was Brooklyn --
-
5:13 - 5:16we made ashtrays for our parents
in arts and crafts class. -
5:16 - 5:19(Laughter)
-
5:20 - 5:23The ashtrays I made were pretty awful,
but they were ashtrays. -
5:23 - 5:25(Laughter)
-
5:25 - 5:30So normalized that I remember seeing
a bowl of loose cigarettes in the foyer -
5:31 - 5:33of our house and other houses
-
5:33 - 5:37as a welcoming gesture
when friends came over for a visit. -
5:38 - 5:41OK, we're back in 1963.
-
5:41 - 5:43The top lawyer for Brown and Williamson,
-
5:43 - 5:47which was then the third-largest
cigarette company in the United States, -
5:47 - 5:48wrote the following:
-
5:48 - 5:49"Nicotine is addictive.
-
5:49 - 5:53We are, then, in the business
of selling nicotine -- an addictive drug." -
5:53 - 5:55It's a remarkable statement,
-
5:55 - 5:57as much for what it doesn't say
as for what it does say. -
5:57 - 6:00He didn't say they were
in the cigarette business. -
6:00 - 6:02He didn't say they were
in the tobacco business. -
6:02 - 6:05He said they were in the business
of selling nicotine. -
6:05 - 6:07Philip Morris in 1972:
-
6:07 - 6:09"The cigarette isn't a product,
-
6:09 - 6:10it's a package.
-
6:11 - 6:12The product is nicotine.
-
6:13 - 6:17The pack is a storage container
for a day's supply of nicotine. -
6:17 - 6:21The cigarette, a dispenser
for a dose unit of nicotine." -
6:22 - 6:25We'll come back to this
dose unit notion later. -
6:26 - 6:28And R.J. Reynolds in 1972:
-
6:28 - 6:31"In a sense, the tobacco industry
may be thought of as being a specialized, -
6:31 - 6:35highly ritualized and stylized segment
of the pharmaceutical industry. -
6:35 - 6:38Tobacco products uniquely
contain and deliver nicotine, -
6:38 - 6:41a potent drug with a variety
of physiological effects." -
6:42 - 6:45At the time, and for many
decades, publicly, -
6:45 - 6:48the industry completely denied addiction
-
6:48 - 6:50and completely denied causality.
-
6:50 - 6:53But they knew the true nature
of their business. -
6:53 - 6:54And from time to time,
-
6:54 - 6:58there have been health scares
made public about cigarettes, -
6:58 - 7:00going back many decades.
-
7:00 - 7:02How did the industry respond?
-
7:02 - 7:04And how did they respond
-
7:04 - 7:07in this historically
unregulated marketplace? -
7:07 - 7:09Going back to the 1930s,
-
7:09 - 7:14it was with advertising
that heavily featured imagery of doctors -
7:14 - 7:16and other health care professionals
-
7:16 - 7:18sending messages of reassurance.
-
7:19 - 7:20This is an ad for Lucky Strikes,
-
7:20 - 7:23the popular cigarette
of the time in the '30s: -
7:23 - 7:27[20,679 physicians
say "Luckies are less irritating." -
7:27 - 7:32Your throat protection
against irritation, against cough.] -
7:32 - 7:34(Laughter)
-
7:34 - 7:36We laugh,
-
7:36 - 7:38but this was the kind of advertising
-
7:38 - 7:41that was there to send
a health message of reassurance. -
7:41 - 7:44Fast-forward to 1950s, '60s and '70s.
-
7:44 - 7:47And here, again,
in the absence of regulation, -
7:47 - 7:50what we're going to see
is modifications to the product -
7:50 - 7:52and product design
-
7:52 - 7:54to respond to the health
concerns of the day. -
7:56 - 7:59This is the Kent Micronite filter.
-
7:59 - 8:04And here, the innovation, if you will,
was the filtered cigarette. -
8:04 - 8:06[Full smoking pleasure ...
-
8:06 - 8:09plus proof of the greatest
health protection ever.] -
8:10 - 8:13What the smoker
of this product didn't know, -
8:13 - 8:15what their doctor didn't know,
-
8:15 - 8:17what the government didn't know,
-
8:17 - 8:21is that this was a filter
that was lined with asbestos -- -
8:21 - 8:22(Gasps)
-
8:22 - 8:25so that when smokers
were smoking this filtered cigarette -
8:25 - 8:27and still inhaling the chemicals and smoke
-
8:27 - 8:30that we know are associated
with cancer and lung disease -
8:30 - 8:32and heart disease,
-
8:32 - 8:34they were also sucking down
asbestos fibers. -
8:34 - 8:35(Gasps)
-
8:36 - 8:39In the 1960s and the 1970s,
-
8:39 - 8:42the so-called innovation
was the light cigarette. -
8:43 - 8:47This is a typical brand
of the day called True. -
8:47 - 8:51And this is after the Surgeon General's
reports have started coming out. -
8:51 - 8:53And you see the look
of concern on her face. -
8:53 - 8:55[Considering all I'd heard,
-
8:55 - 8:57I decided to either quit
or smoke True. -
8:57 - 8:59I smoke True.]
-
8:59 - 9:00(Laughter)
-
9:00 - 9:03[The low tar, low nicotine cigarette.]
-
9:03 - 9:05And then it says, "Think about it."
-
9:05 - 9:09And then even below that
in the small print -
9:09 - 9:12are tar numbers and nicotine numbers.
-
9:12 - 9:14What was a light cigarette?
-
9:15 - 9:17How did it work?
-
9:18 - 9:21This is an illustration
of the product modification -
9:21 - 9:24known as "filter ventilation."
-
9:24 - 9:26That's not a real filter blown up.
-
9:26 - 9:27That's just a picture
-
9:27 - 9:30so that you could see the rows
of laser-perforated ventilation holes -
9:30 - 9:32that were put on the filter.
-
9:32 - 9:33When you look at a real cigarette,
-
9:33 - 9:35it's harder to see.
-
9:35 - 9:37Every patent for this product shows
-
9:37 - 9:40that the ventilation holes
should be 12 millimeters -
9:40 - 9:42from the lip end of the filter.
-
9:42 - 9:43How did it work?
-
9:44 - 9:47The cigarette got stuck into a machine.
-
9:48 - 9:50The machine started
puffing away on the cigarette -
9:50 - 9:53and recording tar and nicotine levels.
-
9:53 - 9:55As the machine smoked,
-
9:55 - 9:58outside air came through
those ventilation holes -
9:58 - 10:02and diluted the amount of smoke
that was coming through the cigarette. -
10:02 - 10:04So as the machine smoked,
-
10:04 - 10:07there really was less tar
and nicotine being delivered -
10:07 - 10:09compared to a regular cigarette.
-
10:10 - 10:12What the tobacco industry knew
-
10:12 - 10:15was that human beings
don't smoke like machines. -
10:16 - 10:18How do human beings smoke this?
-
10:19 - 10:20Where do the fingers go?
-
10:20 - 10:22(Murmurs)
-
10:22 - 10:23Where do the lips go?
-
10:23 - 10:25I told you that the patent said
-
10:25 - 10:28that the holes are 12 millimeters
from the lip end. -
10:28 - 10:30The smoker didn't even know
they were there, -
10:30 - 10:34but between fingers and lips,
the holes get blocked. -
10:35 - 10:38And when the holes get blocked,
it's no longer a light cigarette. -
10:39 - 10:40Turns out that there's actually
-
10:40 - 10:43basically as much nicotine
inside a light cigarette -
10:43 - 10:44as a regular cigarette.
-
10:44 - 10:46The difference was what's on the outside.
-
10:46 - 10:50But once you block what's on the outside,
-
10:50 - 10:51it's a regular cigarette.
-
10:53 - 10:56Congress put FDA in the business
of regulating tobacco products -
10:56 - 10:5710 years ago this June.
-
10:57 - 11:00So you heard the statistics
at the beginning -
11:00 - 11:04about the extraordinary contribution
to disease and death that cigarettes make. -
11:05 - 11:07We've also been paying a lot of attention
-
11:07 - 11:11to how the cigarette works
as a drug-delivery device -
11:11 - 11:14and the remarkable efficiency
with which it delivers nicotine. -
11:14 - 11:16So let's take a look.
-
11:17 - 11:20When the smoker puffs on the cigarette,
-
11:20 - 11:23the nicotine from that puff
gets up into the brain -
11:23 - 11:25in less than 10 seconds.
-
11:25 - 11:27Less than 10 seconds.
-
11:27 - 11:29Up in the brain,
-
11:29 - 11:32there are these things
called "nicotinic receptors." -
11:33 - 11:34They're there ...
-
11:34 - 11:36waiting.
-
11:36 - 11:39They're waiting for, in the words
of that Philip Morris document, -
11:39 - 11:41the next "dose unit of nicotine."
-
11:43 - 11:46The smoker that you see outside,
-
11:46 - 11:48huddled with other smokers,
-
11:48 - 11:49in the cold,
-
11:49 - 11:51in the wind,
-
11:51 - 11:52in the rain,
-
11:52 - 11:55is experiencing craving
-
11:55 - 11:57and may be experiencing
the symptoms of withdrawal. -
11:59 - 12:02Those symptoms of withdrawal
are a chemical message -
12:02 - 12:04that these receptors
are sending to the body, -
12:04 - 12:06saying, "Feed me!"
-
12:08 - 12:14And a product that can deliver the drug
in less than 10 seconds -
12:15 - 12:20turns out to be an incredibly efficient
and incredibly addictive product. -
12:21 - 12:24We've spoken to so many
addiction treatment experts -
12:24 - 12:26over the years.
-
12:26 - 12:29And the story I hear is the same
over and over again: -
12:29 - 12:32"Long after I was able
to get somebody off of heroin -
12:32 - 12:35or cocaine or crack cocaine,
-
12:35 - 12:37I can't get them to quit cigarettes."
-
12:37 - 12:40A large part of the explanation
is the 10-second thing. -
12:42 - 12:46FDA has it within its regulatory reach
-
12:46 - 12:48to use the tools of product regulation
-
12:48 - 12:53to render cigarettes as we know them
minimally or nonaddictive. -
12:54 - 12:55We're working on this.
-
12:56 - 13:00And this could have a profound
impact at a population level -
13:00 - 13:02from this one policy.
-
13:02 - 13:05We did dynamic population-level
modeling a year ago, -
13:05 - 13:07and we published the results
in "The New England Journal." -
13:07 - 13:10And because of the generational
effect of this policy, -
13:10 - 13:11which I'll explain in a minute,
-
13:11 - 13:14here's what we project out
through the end of the century: -
13:14 - 13:16more than 33 million people
-
13:16 - 13:20who would otherwise have gone on
to become regular smokers won't, -
13:20 - 13:22because the cigarette
that they'll be experimenting with -
13:22 - 13:24can't create or sustain addiction.
-
13:25 - 13:28This would drive the adult smoking rate
down to less than one and a half percent. -
13:29 - 13:31And these two things combined
-
13:32 - 13:38would result in the saving of more than
eight million cigarette-related deaths -
13:38 - 13:40that would otherwise have occurred
-
13:40 - 13:42from the generational impact of this.
-
13:42 - 13:44Now, why am I saying "generational"?
-
13:45 - 13:47It's about kids.
-
13:48 - 13:51Ninety percent of adult smokers
started smoking when they were kids. -
13:52 - 13:54Half of them became regular smokers
-
13:54 - 13:58before they were legally old enough
to buy a pack of cigarettes. -
13:58 - 14:01Half of them became regular smokers
before they were 18 years old. -
14:01 - 14:03Experimentation.
-
14:03 - 14:04Regular smoking.
-
14:05 - 14:06Addiction.
-
14:07 - 14:08Decades of smoking.
-
14:08 - 14:09And then the illness,
-
14:10 - 14:12and that's why we're talking
about a product -
14:12 - 14:16that will kill half of all long-term users
prematurely later in life. -
14:17 - 14:20The generational impact
of this nicotine-reduction policy -
14:20 - 14:22is profound.
-
14:23 - 14:26Those old industry documents
had a word for young people. -
14:26 - 14:29They were described as
"the replacement smokers." -
14:31 - 14:33The replacement smokers
for addicted adult smokers -
14:33 - 14:34who died or quit.
-
14:35 - 14:38Future generations of kids,
especially teens, -
14:38 - 14:40are going to engage in risky behavior.
-
14:40 - 14:42We can't stop that.
-
14:42 - 14:46But what if the only cigarette
that they could get their hands on -
14:46 - 14:48could no longer create
or sustain addiction? -
14:49 - 14:51That's the public health
return on investment -
14:51 - 14:54at a population level over time.
-
14:55 - 14:57Haven't said anything about e-cigarettes.
-
14:58 - 15:00But I have to say something
about e-cigarettes. -
15:00 - 15:01(Laughter)
-
15:01 - 15:04We are dealing with an epidemic
of kids' use of e-cigarettes. -
15:04 - 15:06And what troubles us the most,
-
15:06 - 15:10in combination with the rising numbers
when it comes to prevalence, -
15:10 - 15:12is frequency.
-
15:12 - 15:14Not only are more kids using e-cigarettes,
-
15:14 - 15:18but more kids are using e-cigarettes
20 or more days in the past 30 days -
15:18 - 15:21than at any time since e-cigarettes
came onto the market. -
15:21 - 15:23And at FDA, we're doing
everything that we can -
15:23 - 15:24using program and policy,
-
15:24 - 15:26first to get the word out to kids
-
15:26 - 15:28that this is not a harmless product
-
15:28 - 15:31and to make sure that kids
aren't initiating and experimenting -
15:31 - 15:32on any tobacco product,
-
15:32 - 15:34whether combustion is present or not.
-
15:35 - 15:38But think about e-cigarettes
in a properly regulated marketplace -
15:38 - 15:40as something that could be of benefit
-
15:40 - 15:42to addicted adult cigarette smokers
-
15:42 - 15:44who are trying to transition
away from cigarettes. -
15:44 - 15:48So, I'll leave you with this vision:
-
15:50 - 15:51imagine a world
-
15:52 - 15:55where the only cigarette
that future generations of kids -
15:55 - 15:56could experiment with
-
15:56 - 15:58could no longer create
or sustain addiction -
15:58 - 16:00because of a single policy.
-
16:01 - 16:02Imagine a world
-
16:03 - 16:05where health-concerned cigarette smokers,
-
16:05 - 16:08especially if a policy goes into effect
-
16:08 - 16:12that takes the nicotine levels down
to minimally or nonaddictive levels, -
16:12 - 16:14could transition to alternative
and less harmful forms -
16:14 - 16:16of nicotine delivery,
-
16:16 - 16:18starting with FDA-approved
nicotine medications, -
16:18 - 16:20like the gum, patch and lozenge.
-
16:21 - 16:22And finally,
-
16:22 - 16:25imagine a world and a properly
regulated marketplace, -
16:25 - 16:28whether it's e-cigarettes
or whatever the technology of the day, -
16:28 - 16:30it's not the product developers
and the marketers -
16:30 - 16:32who decide which products come to market
-
16:32 - 16:34and what claims get made for them,
-
16:34 - 16:37it's review scientists at FDA,
-
16:37 - 16:39who look at applications
-
16:39 - 16:42and decide, using the standard
that Congress has entrusted us -
16:42 - 16:44to implement and enforce,
-
16:44 - 16:47whether a particular product
should come to market, -
16:47 - 16:51because the marketing of that product
and the words of our law -
16:51 - 16:54would be appropriate for the protection
of the public health. -
16:54 - 16:57These are the kinds
of powerful regulatory tools -
16:57 - 17:00that are within our reach
-
17:00 - 17:01to deal with what remains
-
17:01 - 17:04the leading cause of completely
preventable disease and death -
17:04 - 17:05in the country.
-
17:05 - 17:07If we get this right,
-
17:08 - 17:12that trajectory,
those 5.6 million kids, -
17:12 - 17:14is breakable.
-
17:14 - 17:15Thank you.
-
17:15 - 17:18(Applause)
- Title:
- The past, present and future of nicotine addiction
- Speaker:
- Mitch Zeller
- Description:
-
Tobacco use remains the leading cause of preventable disease and death in the United States, killing more people each year than alcohol, AIDS, car accidents, illegal drugs, murder and suicide combined. Follow health policy expert Mitch Zeller into the murky depths of the tobacco industry as he details the sordid history of nicotine addiction -- and invites us to imagine a world where policy change helps stop people from becoming addicted in the first place.
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDTalks
- Duration:
- 17:30
Erin Gregory edited English subtitles for The past, present and future of nicotine addiction | ||
Erin Gregory approved English subtitles for The past, present and future of nicotine addiction | ||
Erin Gregory edited English subtitles for The past, present and future of nicotine addiction | ||
Camille Martínez accepted English subtitles for The past, present and future of nicotine addiction | ||
Camille Martínez edited English subtitles for The past, present and future of nicotine addiction | ||
Camille Martínez edited English subtitles for The past, present and future of nicotine addiction | ||
Ivana Korom edited English subtitles for The past, present and future of nicotine addiction | ||
Ivana Korom edited English subtitles for The past, present and future of nicotine addiction |