Cutting back versus completely quitting is a hot new debate among tobacco specialists. Quit and your body starts healing. But when heavy smokers refuse to quit, the theory embraced by some has been that helping them to smoke less surely must be healthier than doing nothing.
A major drug company even is poised to sell Europeans nicotine inhalers to help heavy smokers not quit but just drop below, say, a pack a day - very different than how Americans use such medicines.
Now one of the first studies to test that theory suggests just cutting back instead of quitting won't help your health.
It's a surprise finding and won't settle the controversy. But the Mayo Clinic's study - which found levels of toxins in heavy smokers' bodies didn't decrease when they cut smoking in half - is getting serious attention.
"That's very important because what it means to the lay public is that if you reduce (daily cigarettes), we're still not sure how much benefit you're going to get," says John R. Hughes, a well-known University of Vermont smoking expert. "So don't fool yourself."
About 48 million Americans smoke, an addiction that kills 400,000 each year. Smoking causes heart disease, lung diseases like emphysema, and lung cancer, and also increases people's risk of seven other cancers.
Quit smoking and those risks start dropping. Seventy percent of smokers say they want to stop, but only about 35 percent try in any given year. It can take repeated attempts to finally succeed.
Yet many smokers won't try to quit. Hence the "harm reduction" theory: if hard-core smokers could go from, say, 40 cigarettes a day to 20 - helped by long-term nicotine-replacement therapy - maybe they'd be somewhat healthier.
Or would it just deter them from ever quitting, without significant benefit?
Pharmacia Corp. is investing in the theory. Its studies say up to 30 percent of smokers who refuse to quit cut their smoking in half by using nicotine inhalers, nasal sprays, gum and under-the-tongue pills to curb cravings between cigarettes.
Here, nicotine replacement is approved only for short-term smoking cessation. But Denmark in 1998 let Pharmacia market those products for smoking reduction, too. The company says three more European countries just issued similar approvals, which it will unveil early this year when it begins more widely marketing the harm-reduction concept. (Nicotine patches, however, remain just for quitting because they supply continuous nicotine.)
"If they reduce the consumption significantly, then one will see a health benefit," says Pharmacia's global policy director David Graham.
But the Mayo Clinic study found no health benefit when hard-core smokers cut their puffing in half.
The problem: People apparentlsmoked their remaining cigarettes harder, trying to suck in more addictive nicotine from each one and consequently inhaling more carcinogens.
Dr. Richard Hurt recruited 23 people who smoked between 40 and 50 cigarettes daily but refused to quit, to see if nicotine inhalers helped them cut back to 10 cigarettes a day.
Then he measured levels of two potent cancer-causing chemicals and two other cigarette toxins - carbon monoxide and a byproduct of cyanide - in smokers' bodies.
On average, smokers cut their daily cigarette intake in half after three months of trying, but only two got down to 10 a day. Weeks later, their smoking inched up again.
Only one cancer-causing toxin decreased slightly as smoking dropped. Yet those chemicals dissipate within weeks when smokers quit completely.
Hughes cautions that larger studies must prove whether cutting back really could help some people's health. Even if it doesn't cut cancer risk, Hughes suspects it could be a confidence-building step for some smokers to eventually quit completely, something he's studying.
But "we know heavy smokers can quit cold-turkey" if helped by the right dose of nicotine patches and other medicines such as antidepression pills that fight the smoking urge, Mayo's Hurt says.
So for now, he advises that New Year's resolution ought to be to quit, not just cut back: "Set a date and go for it."
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