Action on Smoking and Health A National Legal-Action Antismoking Organization Entirely Supported by Tax-Deductible Contributions    Info About ASH  | ash.org |  To Join ASH

Excerpts from Nicotine Safety and Toxicity
Edited by Neal L. Benowitz. 203 pp. New York, Oxford University Press, 1998. $55. ISBN 0-19-511496-5

The morbidity and mortality associated with cigarette smoking have been documented repeatedly, but the toxicity of nicotine itself is more complex and less well understood. The toxicity of nicotine is relevant to the differences in risk among various tobacco products, and it has emerged as a major issue in the use of nicotine-substitution preparations to aid in the cessation of smoking.

These products are unequivocally effective as aids to cessation, but there is uncertainty about their acute and long-term toxicity. Many smokers and even a few physicians have taken the position that the use of nicotine-substitution preparations merely trades one addiction for another. Moreover, questions were raised about these preparations as a cause of myocardial infarction in people who continued to smoke. These concerns have been laid to rest, but questions about the long-term cardiovascular effects of nicotine and its effect on conception and the developing fetus persist. < They have not been easy to answer.

These questions have become even more important with the emergence of pure nicotine preparations as possible treatments for Tourette's syndrome, major depression, and weight control.

There is also good reason to expect nicotine to be useful in the treatment of Parkinson's disease and sleep apnea. To date, however, ulcerative colitis is the only condition for which controlled trials have actually provided evidence that nicotine is therapeutic.

The Society for Research on Nicotine and Tobacco is an academic group devoted to the study of smoking and smoking-related illnesses. Several years ago, the group sponsored a symposium on the safety and toxicity of nicotine, which was chaired by Neal Benowitz. Panel discussions that are expanded into books are often uneven in quality and lack cohesion. In Nicotine Safety and Toxicity, Dr. Benowitz has avoided both these pitfalls. The chapters in the various sections of the book are by and large scholarly reviews of the information available and are remarkably free of redundancy. Dr. Benowitz himself is the premier authority on the cardiovascular effects of nicotine preparations, and his discussion of the pharmacokinetic and pharmacodynamic aspects reflects his expertise in the area. In addition, there are thoughtful, comprehensive sections on nicotine and cancer and on nicotine and the reproductive system. Other sections address abuse liability, behavioral toxicology, and long-term use of nicotine. In addition to comprehensive discussions by multiple experts in each section of the book, there is a very well written overview of the risks and benefits of nicotine provided by Dr. Benowitz.

There is little question that the benefits of nicotine-substitution preparations as aids in the cessation of smoking outweigh the risks. The long-term use of either gum or a patch to prevent relapse is a more complicated question. There is limited evidence of risk, but there is not much evidence that prolonged use of these preparations actually prevents relapse. The importance of nicotine's safety, especially its long-term safety, is related not only to its role in the cessation of smoking but also to its potential role in the treatment of many clinical conditions. The opportunities to use nicotine as a pharmacologic agent have been widened by the cloning of the nicotine receptor and the recognition of receptor subtypes. This area is developing rapidly, and several agonists of specific nicotine-receptor subtypes are already being investigated in clinical trials. In the not-too-distant future we are likely to see a number of nicotine-like drugs that are parallel to the alpha- and beta-agonists and antagonists of norepinephrine. Dr. Benowitz's scholarly review not only guides us in the use of nicotine products but also points out potential areas of concern in the use of new nicotine-like drugs. This is a useful and timely book.

Alexander H. Glassman, M.D.
College of Physicians and Surgeons of Columbia University
New York, NY 10032

click here to return to ASH's Home Web Page: http://ash.org
click here for more information about Action on Smoking and Health (ASH)
click here to learn the many benefits of joining ASH on-line, over the Internet