Foes Rap Studies ‘Vindicating’ Clove Cigarettes : Teen-ager’s Death in Orange County Spurred Concern
British researchers who have completed two new industry-sponsored studies on the possible toxic effects of smoking clove cigarettes conclude that clove cigarette smoke is no more harmful to laboratory rats than conventional cigarette smoke.
Representatives of the clove cigarette industry view the latest unpublished findings as further evidence vindicating clove cigarettes, or kreteks , the pungent-smelling Indonesian imports that have been criticized over the past 18 months as a health threat and as the alleged cause of the 1984 death of an Orange County teen-ager.
Largest U.S. Market
Several doctors and scientists familiar with clove cigarettes, however, remain convinced that the imports, which contain 60% tobacco and 40% ground cloves, are potentially more harmful to humans than regular cigarettes. Southern California is the largest U.S. market for clove cigarettes, accounting for more than a third of all such sales.
A 14-day inhalation study conducted by the Department of Inhalation Toxicology at the Huntingdon Research Centre in Huntingdon, England, showed that rats that had been exposed to clove cigarette smoke experienced “no significant toxicity or pathology” compared to rats exposed to conventional cigarette smoke.
Indeed, the researchers conclude in a written summary that “within this study, there was less evidence of smoke toxicity in the rats exposed to kretek smoke. It is probable that this result is due, at least in part, to the lower tobacco content of the kretek cigarettes. . . .”
Previous Findings
The new findings are in agreement with an earlier one-day inhalation study conducted by the British research center and with the results of a separate short-term inhalation study conducted by the American Health Foundation in Valhalla, N.Y., a nonprofit independent research foundation funded primarily through the National Institutes of Health.
The British research center also conducted a eugenol inhalation study--said to be the first of its kind--in which eugenol, the major component of cloves, was inhaled by laboratory rats in aerosol form (Eugenol is used as a mild dental anesthetic and critics of clove cigarettes believe the substance numbs smokers’ throats.)
In the study, researchers found that only temporary, readily reversible signs of toxicity were noted, including irregular breathing, weight loss and reduced food and water intake. But, according to the researchers, there were no deaths and no evidence of blood in the animals’ respiratory tracts, and the rats were normal in all respects within 48 hours.
The results of the eugenol inhalation study differ sharply from those of an American Health Foundation study in which eugenol was administered directly into the lungs of laboratory hamsters.
In the American Health Foundation study, laboratory animals displayed symptoms similar to those in 12 cases of severe illness believed to be possibly associated with smoking clove cigarettes and reported to the Centers for Disease Control in Atlanta in 1985. Symptoms reported to the CDC included blood- or fluid-filled lungs, a constriction of the air passageways and coughing up blood.
The findings of the as-yet-unpublished British studies were released by the Specialty Tobacco Council, an organization representing the major manufacturers and importers of clove cigarettes in the United States.
The British research was funded by two of the council’s members, P. T. Djarum and House of Sampoerna. The two Indonesian firms are the largest manufacturers of clove cigarettes, but industry representatives say the research laboratory did not know who commissioned the study.
“We now have three clove cigarette vs. ordinary cigarette comparison inhalation studies--two done by the Huntingdon Research Centre and one done by the American Health Foundation--and they all confirm the fact that no one can point to clove cigarettes as creating a problem that might not otherwise be associated, if in fact it is associated, with regular cigarettes,” said G. A. Avram, executive director of the Specialty Tobacco Council.
Avram does not anticipate members of the Specialty Tobacco Council sponsoring any further studies.
Ball Is ‘in Their Court’
“We think that if any more studies are needed, the critics ought to do something,” Avram said. “As far as we’re concerned we have accepted the ball that has been knocked on our side of the court and we feel like it’s been hit back to the other side. I think it’s now up to them to come up with some proof to back up any claims that they make.”
Reaction to the results of the unpublished British studies is mixed.
Dr. Tee L. Guidotti, professor of occupational medicine in the University of Alberta faculty of medicine in Edmonton, Canada, who has studied clove cigarette toxicity, said the British studies “are not bad for what they do, but they don’t ask the essential questions.”
“The two issues essential in understanding the toxicity of this product are the chronic effect and the interactive effects,” he said. “Even though these studies followed the animals for a few weeks, they didn’t follow them nearly long enough to find what the risks are for cancer and for long-term health effects.
“We strongly suspect that if there are human health effects associated with the short-term use of clove cigarettes, that other factors are involved that make the toxicity worse, such as viral infection. We know that’s the case for some exposures. This is an important area to sort out.”
Different Physiological Responses
Guidotti added, “We know from (the American Health Foundation) study for eugenol by the intra-tracheal route, which is not a bad first model for this problem, that there were differences in the response of different species of animals so that when we go from mice to man we have to take into account there are differences and we can’t make that jump too lightly.”
Robert Phalen, director of the air pollution health effects laboratory at the College of Medicine at UC Irvine, said he is “pleased to see that additional studies are being done” on clove cigarettes but has not had time to evaluate the new research.
Phalen, author of “Inhalation Studies,” a professional reference book, noted that although animal toxicity tests are “essential and critical in examining any product for its safety, the animal toxicity tests alone would not be definitive for establishing the safety (of a product) in a broad human population.”
Phalen expressed concern about a small percentage of people who have sensitive lungs. “Even if something is safe for the average person, there will be a segment of the population for which inhaled irritants of any type are unsafe,” he said.
A Call for More Research
Edmond LaVoie, associate division chief of environmental carcinogens at the American Health Foundation and the chief researcher on the organization’s clove cigarette studies, says more research must be done.
“We have no reason, based on our studies, not to pursue this further,” said LaVoie, who has not seen the British studies. “That’s fine if they (the British researchers) have not seen any effect, but we have no reason whatsoever to reduce our investigations in this area.”
With clove cigarettes, LaVoie said, “we’re dealing with something that delivers a lot of material to human lungs and anytime you’ve got that situation, you have to thoroughly investigate both acute and chronic effects. These are all just initial studies no matter how you look at it.”
LaVoie emphasized that a clove cigarette is not a “typical” cigarette. “No cigarette delivers the (amount of) tar that these cigarettes do,” he said. “Such an atypical product has to be examined very carefully.”
The Specialty Tobacco Council, which was formed last year in the wake of media reports on the potential health hazards of smoking the imports, estimates that clove cigarette sales in 1985 dropped to less than half of their peak of 150 million to 170 million individual cigarettes sold the year before. Southern California accounts for about 35% of clove cigarette sales in the U.S.
Council spokesman Charles Ecker said, however, that sales have begun climbing steadily over the past six months. “The increase in sales is, I think, due to people reading about the research studies,” Ecker said, noting that although some stores stopped selling clove cigarettes, “the overwhelming majority of retailers have stood by this product.”
To date, sales of clove cigarettes have been banned in Utah, Nevada, New Mexico and Maryland. A Florida law banning the imports was declared unconstitutional last year. More recently, the Specialty Tobacco Council, a clove cigarette importer, and a clove cigarette retailer filed a lawsuit in Maryland contesting the constitutionality of the new law banning the sale of the imports in that state.
In California, the Legislature last year called upon the state Department of Health Services to appoint a scientific advisory board to evaluate the data from any studies on the possible health hazards of smoking clove cigarettes. The department is required to report the advisory board’s findings to the Legislature no later than Jan. 1, 1988.
Parents Turn to the Courts
In March, 1985, Ron and Carole Cislaw filed a $25-million lawsuit, claiming that the manufacturers, importers and sellers of clove cigarettes were, among other things, negligent in supplying their son “dangerous and defective” cigarettes. The Cislaw’s 17-year-old son, Timothy, a Newport Harbor High School student, developed shortness of breath shortly after smoking a clove cigarette and eventually died of respiratory failure in May, 1984.
Another $25-million lawsuit was filed in July 1985 by a Buena Park woman whose 17-year-old son allegedly contracted a debilitating lung ailment after smoking clove cigarettes.
Eric Lampel, the Santa Ana attorney for both families, said the lawsuits are “viable and pending” but he is awaiting the completion of further studies on the toxicity of eugenol before serving the defendants, who include manufacturers, importers and retail outlets.
No new cases in which clove cigarettes are suspected of causing severe illnesses or allergic reactions have been reported to the Centers for Disease Control in Atlanta, according to a spokeswoman.
Dr. Frederick Schechter of Whittier, a member of the state scientific advisory board and one of the most outspoken critics of clove cigarettes, said that although it’s “laudable” that clove cigarette manufacturers have commissioned studies of the imports, “I have no way of evaluating them. They (the British studies) have not been peer-reviewed or published in any (scientific) journal.”
Added Schechter, a thoracic and cardiovascular surgeon who operated on the Orange County teen-ager who developed shortness of breath shortly after smoking a clove cigarette and eventually died of respiratory failure: “The issue is (that) nothing has changed” regarding the clove cigarette controversy.
