A search of the medical literature on the topic “smoking cessation” finds 32,446 published articles, yet, surprisingly, there are no articles linked to this topic until the year 1980, and only 27 articles were published from 1981 to 1990. Medical researchers primarily focused on smoking cessation in the last three decades -- 1991 to 2000 (4,481 articles), 2001 to 2010 (10,976 articles), and 2011 to the present (16,964 articles). Despite this impressive volume of research, the U.S. still records 480,000 deaths annually due to smoking.
I was interested to learn more about the 1981-1990 period, as it preceded my entry into the field in 1994 (here, here and here). I found that several prominent scientists and academicians, who are strong supporters of tobacco harm reduction, populated that period’s author list. Here they are, followed by PubMed links: John Hughes (here and here), Jed Rose (here), Lynn Kozlowski (here), Ken Warner (here), Jack Henningfield (here), Ray Niaura (here), David Abrams (here) and Saul Shiffman (here). Three of these articles, and their authors, deserve special mention.
Ken Warner’s 1989 article, “Implications of a Nicotine-Free Society,” clearly shows that this University of Michigan professor has been one of the most forward-thinking leaders in the tobacco research and policy field for many years. He understood in 1989 that a “nicotine-free society” was not a panacea, and he boldly criticized both sides in the debate: “The tobacco industry implies that the demise of tobacco consumption would wreak havoc with the economy. By contrast, some antitobacco activists suggest that the end of tobacco use would yield a multibillion dollar fiscal dividend. Each argument is fundamentally flawed. The economic impacts of a nicotine-free society would be modest and of far less consequence than the principal implication: a significantly enriched quality and quantity of life.”
I have some personal insight into Professor Warner’s commitment to tobacco harm reduction. In 1999, US Tobacco made its first grant to the University of Alabama at Birmingham to support my work. I contacted numerous well-known tobacco researchers, offering to fund my own travel in order to make presentations on an alternative approach to cessation for inveterate smokers. The only person to respond was Ken Warner. He hosted my speech and invited colleagues from across the Michigan medical center. It was a rigorous event, at which my research and ideas were seriously challenged. I was, and remain, profoundly grateful to Professor Warner for this amazing opportunity.
Jed Rose at Duke University is another prophet of tobacco harm reduction, and his work long pre-dated and anticipated the recent development of vapor products. Consider his 1990 article, “Low-nicotine Regenerated Smoke Aerosol Reduces Desire for Cigarettes.” His group developed “an aerosol with many of the sensory qualities of cigarette smoke, but with only 3% of the tar and nicotine and none of the carbon monoxide of a typical commercial cigarette… Surprisingly, the smoke aerosol reduced self-reported desire for cigarettes as much as the commercial cigarette. This new method is a promising approach for evaluating the role of sensory cues in smoking, and it may also be useful as a clinical tool for smoking cessation.”
Finally, there is legendary tobacco researcher Lynn Kozlowski (originally at Penn State, now at the University at Buffalo). In 1989, he authored “Reduction of tobacco health hazards in continuing users: individual behavioral and public health approaches.” The article was written for “those smokers who will not stop using tobacco,” for whom “methods are discussed for reducing the risks to health of continued tobacco use… For continuing smokers of cigarettes, fewer cigarettes per day and very-low-tar cigarettes are encouraged, provided filter-vents are not blocked by the smoker. Better yet would be a switch to smoking one or two non-inhaled pipes or cigars each day. Even better would be a switch to use of the minimum acceptable amount of smokeless tobacco or nicotine-containing gum.” Professor Kozlowski even suggested that “public health measures (e.g., social restrictions, differential taxation, changes in package size) may be the most important means of bringing about less hazardous tobacco use among continuing users.”
In 1994 I started counselling inveterate smokers to switch to smokeless tobacco, and in 2017, my research group recommended “differential taxation” to Kentucky legislators to save smokers’ lives. I am proud that our proposal was endorsed by Ken Warner and Ray Niaura.
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