Hollings researcher honored for career in tobacco research

When you have a distinguished 40-year career and you’re getting an award for the groundbreaking advances that you’ve made, you can make a generic sort of speech thanking everyone — or you can take the opportunity to lob a few verbal grenades at what you see as misguided tenets of the group that’s honoring you.

K. Michael Cummings, Ph.D., a tobacco control researcher at MUSC Hollings Cancer Center, did both, actually, as he accepted the Doll-Wynder Award from the Society for Research on Nicotine & Tobacco (SRNT).

He thanked his many students and colleagues but also used the opportunity to share his vision on the state of the field and some course corrections brought about by looking back over 40 years of research in the sometimes contentious area of tobacco control. He emphasized the importance of collaboration and having an open mind when it comes to having one’s scientific opinions challenged as well as a willingness to update one’s opinions as new evidence emerges.

He also provided context for the current state of tobacco control and regulation, reviewing a century’s worth of research and public health efforts, including highlighting the pioneering work of Sir Richard Doll, M.D., and Ernst Wynder, M.D., the two scientists SRNT named the award for. Doll and Wynder each published work in the early 1950s that was critical to establishing the causal link between smoking and lung cancer. The Society for Research on Nicotine & Tobacco now gives the Doll-Wynder Award out every three years to someone who has done groundbreaking work in public health, public policy or epidemiological research.

Cummings said his career has consisted of trying to answer four simple questions: Why do people start smoking? How do we prevent youth from taking up smoking? Why do people persist in smoking, even when they know better? And, how do we help people to stop smoking?

“I think the best ideas for research come from the people who are struggling to stop smoking, and it’s just as important for those making public health policies to listen to the target audience that those policies are going to be directed at.”
Michael Cummings, Ph.D.

In the early 2000s, Cummings was involved with a project to digitize and index many millions of pages of previously secret tobacco industry documents, which were placed online for the public and researchers to see. The documents revealed that as far back as the 1950s, the cigarette industry knew and was unconcerned that cigarette smoking caused cancer and was addictive. The documents also revealed that the companies deliberately recruited kids to start smoking and engineered cigarettes in ways to make smoking attractive to beginning smokers and hard to quit for those who did start smoking — all to ensure growing profits.

Cummings also described his work running clinics to guide those who wanted to stop smoking to be able to do so. He shaped his research based on what he learned from the people he was trying to help, since it turned out to be a lot harder to get people off of cigarettes once they got started.

“I learned a lot listening to the people who were trying to stop smoking. Some of them were very smart — they just had an addiction to the nicotine in cigarettes. As a nonsmoker, I was clueless,” he said. “I think the best ideas for research come from the people who are struggling to stop smoking, and it’s just as important for those making public health policies to listen to the target audience that those policies are going to be directed at.”

Cummings criticized those who take an absolutist approach against nicotine vaping or against working with scientists who take funding from industry, including tobacco companies. His criticism also included SRNT, the organization that was honoring him, which doesn’t allow scientists to attend its meetings to present their research. He contends that it’s important to see industry research, since the government is charged with regulating tobacco products and must rely on the research that the industry shares, adding that it must, of course, be vetted, but it should not be ignored.

“I'm not suggesting that people trust industry research,” Cummings said, pointing out that other self-interested industries, like pharmaceutical companies or medical device manufacturers, can publish and participate in scientific conferences. “No one should trust those who have a financial stake in the outcome of research. The idea is don't trust — verify.”

“Tobacco control history tells us that advocacy without facts can lead to unexpected outcomes, with the example of how consumers and public health researchers were duped by assuming that filtered low-tar cigarettes were safer to smoke. It turns out they were not safer, and perhaps even more dangerous because people kept smoking thinking they were better off smoking a cigarette with a filter tip,” he explained. “Looking back, cigarette company documents now have allowed us to understand how cigarettes had been engineered to allow people to get their nicotine fix by adjusting their smoking behaviors in ways that negated the presumed health benefit of a filter and lower machine-measured tar levels.”

Now, with vaping, or noncombustible cigarettes, on the rise, it’s important to understand the effects of these products on public health. In terms of harm reduction, there could be a place for noncombustible tobacco products, like e-cigarettes, to help people who are unable to quit smoking altogether to lower their risk by switching to a less dangerous form of nicotine, he said.

Some advocates don’t see any role for noncombustible cigarettes, but Cummings warned of repeating the mistakes of the past.

“Prohibition doesn't work. We have lots of historical examples that show efforts to ban drugs can lead to bigger problems. The government’s ‘Just Say No’ anti-drug campaign in the 1980s was a failure. ‘Reefer Madness’ didn't really solve the cannabis problem. Prohibition has some serious side effects, such as stimulating illicit products that are sold without any regulation whatsoever,” he said.

“It is very scary when it comes to vaping,” Cummings added.

“A lot of young people, when they're passing the vape pen around, have no clue what they're vaping,” he continued. “So that scares me. And that's why we need strong regulation of all tobacco products. But the story of EVALI — e-cigarette or vaping use associated lung injury — turned out to have nothing to do with vaping nicotine but was caused by vaping THC combined with vitamin E acetate. The problem was traced to illicitly manufactured cartridges that were designed to fit onto a vaping device used for vaping nicotine. EVALI killed 61 people and injured many more people, mostly teenagers and young adults, and should be a wake-up call to public health to push for regulations and not allow an illicit market of vaping products to emerge. Of course, product regulation needs to be science-based.”

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