Won't give it up, or can't give it up?

Smoking debate: Tobacco industry suffers setback as US classes cigarettes as addictive drugs

More than 1 billion people - one-third of the world's adult population - are smokers. "They can't all be fools," the Tobacco Manufacturers' Association says in Britain. But are they all addicts?

President Bill Clinton has been persuaded that many of them might be. He has unleashed the might of the Uni- ted States Food and Drug Administration against the sale and promotion of cigarettes and other tobacco products, particularly against teenagers, with an announcement yesterday that they should be regulated as addictive drugs.

Less than half of those who smoke regularly succeed in giving up, despite strong personal and social incentives to do so. The journal Nature recently published the hardest evidence to date of nicotine's addictive properties, showing that it acts on the brain in the same way as addictive drugs, releasing the feel-good chemical dopamine. In addition, studies show that many former drug users who also smoke and want to quit say they find giving up cigarettes is harder than kicking their drug habit.

Dr Martin Jarvis, director of the Imperial Cancer Research Fund's health behaviour unit at University College, London, says that those with the best reason to quit - people with smoking-related cancers and heart disease - are simply unable to do it, a powerful argument that nicotine is an addictive drug.

"Half of those who have had a lung removed and 40 per cent of those with heart disease return to smoking," he said. Up to half of people who have had their larynx (voice-box) removed for cancer try to smoke again, Dr Jarvis said. "The reason they can't persist is they can't inhale but some have been known to try through the stoma [hole in their throat following the operation]. Smoking is a compulsive behaviour that people find hard to stop."

Further evidence that nicotine is addictive is supplied by studies that show that animals will self-administer nicotine - by means of equipment in their cages - once they have been exposed to it.

The arguments against nicotine as a dangerous addictive drug are scientifically threadbare. They rely on semantics which the tobacco industry has used for almost 40 years to dismiss the health risks. It has never admitted publicly that nicotine is addictive or that cigarettes cause more than half the cases of lung cancer. This is despite the findings of the industry's own researchers who knew as early as 1965 that cigarettes were dangerous and addictive, according to internal industry documents which have been leaked to the British and US press. The industry says that the contents of the documents have been quoted out of context.

Michael Prideaux, spokes-man for British-American Tobacco (BAT), the largest tobacco company in the world, has conceded only that cigarette smoking is "habit forming" and that there is statistical evidence linking it with some cancers (more than half of all lung cancers) but no causal link.

Clive Turner, an executive director of BAT, said yesterday that the fact that 11 million people in the United Kingdom had managed to give up smoking indicated that it was not addictive. "It depends how you define addiction," he said.

"People talk very loosely about being addicted to alcohol, sex, gambling, chocolate. What they mean is that they enjoy it, not that they can't give it up. The British Medical Association itself advised doctors not to use the word addiction with smokers, because it implies they won't be able to quit."

To anti-smoking campaigners, here and in the US, President Clinton's move sounds thedeath-knell for the tobacco manufacturers. The industry sees it as a set-back, but despite effective rearguard action in developed countries - paying for cigarettes to be placed in films such as Superman, for example - it is now focusing on the vast markets in developing countries, China and South-East Asia, where health education has yet to make an impact, and three or four cigarettes sell for as little as a cent.