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Monday, July 3, 2000


How not to give up the cancer sticks: cigarette smoking and Japanese health

Worldwide, tobacco kills 4 million people a year. By 2020, that figure will be 10 million. Tobacco is the single largest source of preventable illness and death. It is a major cause of cancers, cardiovascular disease and lung disease.

If that's not enough to make you sit up and stub out, it causes reproductive health problems too: Blood vessel damage caused by smoking is thought to reduce penis size, and tobacco toxins are stored in the testes, which may affect the production of the male hormone testosterone.

Smoking also results in reduced stamina, gum disease, tooth loss, snoring, gray skin, wrinkles, halitosis, lowered sperm count and damaged sperm.

Smoking levels in Japan have remained high despite a decrease in tobacco consumption in most industrialized countries. Japan is practically smoke-free, though not in the way that many doctors want: In Japan you're free to smoke almost anywhere. Japan also has the highest life-expectancy in the world, and the birth rate is falling.

Add together widespread smoking and an aging population and you have a future tsunami of tobacco-related illness and death. According to Noriyoshi Takei of the Hamamatsu University School of Medicine, an estimated 95,000 people die from smoking-related illness in Japan every year, and the bill for associated illnesses exceeds $10.9 billion. These figures can only rise as the population gets older.

To try and tackle this problem, the Japan's Ministry of Health and Welfare last year proposed to halve smoking and tobacco consumption by 2010. The committee also proposed antismoking measures which have long been standard in many Western countries, such as increased tobacco taxes and bans on advertising.

Writing in The Lancet medical journal, Takei points out that in Britain cigarettes are three times as expensive as in Japan, costing about 750 yen for a pack of 20. Yet the price of one piece of Nicorette (chewing gum containing nicotine, used to help combat nicotine addiction) is more than five times as expensive in Japan as it is in Britain. Nicotine replacement therapy roughly doubles the chance of quitting.

Lobbyists in the Liberal Democratic Party, however, voted down the proposals at the end of February. The detrimental health effects of smoking are still in doubt, they said, after hearing statements from the Japan Tobacco Industry. Such a claim is surprising when even major U.S. tobacco companies have acknowledged the dangers of smoking and are now paying out compensation to diseased smokers. The tobacco industry owns patents on 58 techniques for reducing the levels of toxic chemicals in tobacco smoke, yet not one has been implemented.

Kenji Shibuya, of the Department of Hygiene and Public Health, Teikyo University, concedes that for the moment Japan is losing the fight against tobacco. Still, despite the obvious political decisions which went into rejecting the Health and Welfare proposal, he is optimistic. If a medical argument does not persuade, and if the goal of a healthy life without disability doesn't move the politicians, an economic argument might.

"Losses incurred by the tobacco industry and farmers can be minimized in the long run," says Shibuya. "Tax revenues can be increased even with decreases in sales, since price-elasticity of tobacco is below unity."

Japanese politicians, apparently resistant to the evidence that smoking is harmful, for many years showed a similar stubborn resistance to the contraceptive pill. Perhaps it is not surprising that they showed no such resistance to sildenafil, also known as Viagra. The already-famous antiimpotence drug was granted immediate approval in Japan after it had been passed by the U.S. Food and Drug Administration. Three months later, in June 1999, the contraceptive pill was finally, albeit grudgingly, approved.

Akira Oshima, of the Osaka Medical Center for Cancer and Cardiovascular Diseases, drafted last year's rejected antismoking proposal for the Ministry of Health and Welfare, but is still hopeful.

"Although we are making only small steps toward a smoke-free Japan," he says, "I believe that the situation will change drastically when smoking prevalence among adult males decreases to less than 50 percent. Then we will be able to implement powerful policies like raising tobacco taxes and banning tobacco advertising, as recommended by the World Bank last year."

If, despite the myriad diseases caused by smoking, you still can't quit, there may soon be a drug that can help. Rachel Tyndale and colleagues at the University of Toronto have found a genetic defect that can make people less likely to smoke: a liver enzyme called CYP2A6 that helps to flush nicotine from the body. When the gene and the enzyme are working properly, nicotine is quickly eliminated. For smokers, this means that more cigarettes are needed to maintain the nicotine high.

Tyndale reported in the journal Nature that more nonsmokers had a defective copy of the gene than smokers, and thus were more sensitive to nicotine. They also found that smokers who produced defective CYP2A6 enzyme smoked 20 percent fewer cigarettes than other smokers. If the enzyme could be inhibited by a drug, to mimic the effect seen when the gene is defective, then smokers would become more sensitive to nicotine, require fewer cigarettes, and so reduce their intake and eventually quit.

Tyndale's team is now searching for such a drug.

Rowan Hooper is a researcher at the Laboratory of Wildlife Conservation, National Institute for Environmental Studies, Tsukuba, Ibaraki Prefecture. E-mail comments to rowhoop@nies.go.jp

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