I read with some considerable confusion the recent article by Richter and colleagues1 on reducing toxicant levels as a new Healthy People 2010 objective. I have great respect for these authors but was confused by their position, as it is now clear that smoke yields (tar, nicotine, or the toxicants proposed by the authors) expressed per cigarette have no meaningful relationship with human exposure or risk. The 2004 Surgeon General's report,2 NCI Monograph 13,3 and the World Health Organization4 have all made it clear that differences in these measures expressed per cigarette do not reflect differences in human exposure or differences in actual delivered dose to smokers of different brands. Therefore, it makes little sense to use them to set a reduction in toxicant level goal for Healthy People 2010. Indeed, when similar reductions were mandated for tar, nicotine, and carbon dioxide by the European Union, compliance by the tobacco manufacturers was largely achieved by increasing the amount of filter ventilation,5 a change known to have little or no effect on actual exposure due to compensatory changes in smoking behavior.
I am hopeful that this is simply a case in which newer evidence has overtaken an older recommendation, but I would earnestly ask the authors (and the Healthy People 2010 process) to reconsider their position.