Everyone knows cigarettes can kill. Yet 36.5 million adults in the U.S. still smoke.
So after the labels and warnings, the restaurant bans and the grisly ad campaigns, the Food and Drug Administration is exploring a radical approach to helping people quit: regulating nicotine in cigarettes. If the FDA follows through -- something far from certain -- the shift could prompt some to quit or, at least, switch to relatively safer products like electronic cigarettes or vaping.
Peruz Nazli, who sat on a bench near New York's Central Park with cigarette butts around her feet, said she was delighted when she heard about the agency's plans.
"It'll be easier to quit," said the 59-year-old retail worker, who started when she was 14. "People look at us different."
The FDA's initiative may upend the $130 billion American tobacco industry. It's also likely to set off a ferocious lobbying and legal war in Washington, and push the cigarette industry to develop products that rely less on burning carcinogenic tobacco and more on delivering doses of nicotine through cleaner vapor. Smoking-related illnesses cost $300 billion a year, according to the Centers for Disease Control and Prevention.
Interviews with New York smokers suggested that few had taken notice of the proposal announced last week, but many said they would be more likely to switch to new delivery devices than to smoke diluted cigarette after diluted cigarette. Some have already made the change.
Kevin Cleare, 36, who picked up his first cigarette from a junior-high buddy when he was 13, turned to vaping three years ago on his doctor's advice.
He quit smoking cigarettes for the first time three years ago but resumed for a few months amid a stressful breakup before turning to vaping. Now he's "never going back," and vaping looks like a long-term option.
"I'm so disgusted with cigarettes -- the smell, the taste," he said. "This is a fair, reasonable compromise."
Over the past decades, U.S. regulators have banned smoking in many public places, sending smokers outside or into isolated corners. The rate of adult cigarette use has declined by a quarter since 1965 to only 15 percent, according to the CDC. Teens foresee life as a pariah and turn elsewhere, with daily smoking among high school seniors down to 5.5 percent in 2015.
Kids look at smokers and say, "You're crazy. What are you doing?" said Cleare, who works with teenagers at the New York City health department.
Encouraging the remaining wannabes to suck on vape gizmos that resemble digital tape recorders is a planned inconvenience.
"This is just another way in making it less satisfying," said Douglas Kamerow, a senior scholar at the Robert Graham Center for Primary Care Policy Studies in Washington.
Those who stick with cigs are an increasingly gray crowd.
After emerging from a Mercedes-Benz onto a Brooklyn curb, Trevor Carter reached for a cigarette. The car belongs to his daughter. In the back seat is his grandson.
Carter, 68, has smoked for 50 years, a habit he says is harder to break than cocaine or booze, both of which he kicked. If the retired businessman doesn't give up smoking by year-end, he said, his girlfriend will dump him.
"I'm ready, but I can't break the habit," said Carter. But he said he won't try vaping or e-cigarettes, which mimic the traditional item. Instead, he's "trying to quit the natural way."
E-cigarettes are about 95 percent safer than smoked tobacco, according to the U.K. Centre for Tobacco and Alcohol Studies. Vaping atomizers and e-cigarettes heat liquid nicotine, which then becomes vapor. They don't contain carbon monoxide and tar, chemicals in cigarettes that hurt smokers' health. The FDA plan would encourage the use of the stand-ins by delaying further regulation until August 2022, giving tobacco companies a chance to build up a range of alternatives.
After the FDA's announcement last month, shares of the two largest cigarette sellers in the U.S., Altria Group Inc. And British American Tobacco Plc, suffered their biggest single-day drop since the recession, reflecting investors' belief that companies aren't prepared for the new era.
Vivien Azer, a research analyst with Cowen & Co. who follows the industry, said that despite the sell-off, companies are trying to adapt with new products that take them beyond the simple equation of flame plus leaf.
"Everyone seems to be leaning in heavily into 'heat not burn,' " she said.
In one study published in 2015, cigarettes with lower levels of nicotine reduced not only nicotine exposure and dependence, but the number of cigarettes smoked. The research, conducted over six weeks and published in the New England Journal of Medicine, studied 780 people who regularly smoked with no interest in quitting.
For now, younger smokers are caught between eras.
John Mastbrook, 33, a bearded Brooklyn bike messenger, started smoking at 12 in his native Fairfax, Virginia. He vapes from time to time to wean himself from the cigarettes he rolls himself. "It's just a good alternative," he said.
Smoking refugees like Cleare who've switched to vaping recognize, though, that they may still spend their lives tethered to a habit they don't want. He says he's just "trading one vice for another."
"I'm still obviously addicted to nicotine," Cleare said, pausing to cough into his arm.
- (c) 2017, Bloomberg