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Dr. Neal Benowitz, professor of medicine at the University of California at San Francisco since 1987, studies the effects of nicotine on the brain and body. Benowitz, who is 55 but looks about 40, is board certified in internal medicine and completed a post-doctoral research fellowship in clinical pharmacology, the study of drug-related problems in humans. Benowitz's credentials are outstanding. He has written 200 peer reviewed articles, many of which were based on his own research; he has also received a few very prestigious medical awards, including the 1997 Ochsner award for his research on addiction, the top award for research in the country.

Dr. Benowitz wrote sections of the 1986 Surgeon General's report on Involuntary Smoking. Benowitz edited the section of the 1988 Surgeon General's report on addiction. Dr. Benowitz has also worked with the National Cancer Institute in trying to measure the amount of tar and nicotine that smokers inhale. He said that the FTC's smoking machine does not correctly predict the amount of tar because it does not accurately imitate a smoker. It takes fewer puffs and does not account for smokers covering the ventilation holes in the cigarette paper.

Having written a section of the 1988 SG's report on smoking among ethnic groups, Benowitz explained that black adult men smoke more than whites, take in more nicotine and therefore have a harder time quitting. He said that blacks smoke more menthol cigarettes, which have a cooling effect that reduces the harshness of the smoke and are therefore easier to inhale. Benowitz also talked about youth smoking; 90% of regular smokers begin the habit before the age of 20. He said the reasons they start vary: peer pressure, to rebel, to imitate adults, to be cool -- but that within 2-3 years, they become addicted. Although they may know the health risks when they start smoking, teens think they will just quit within a few years and are surprised when they cannot quit easily.

Benowitz has done research on how nicotine affects the body, why smokers cannot quit and how to help them quit. Only 3% of smokers quit without help and up to 6% of those who try to quit are successful with a nicotine patch, gum or some other aid. The average person tries to quit 5 times, over a period of years, before succeeding. Benowitz says that only half of his patients with heart disease quit smoking, although he warns them all of the dangers of smoking. Benowitz talked about the concept of compensation, how smokers will draw deeper, take more puffs and cover the ventilation holes when smoking cigarettes with lower tar and nicotine levels. In a study, people who ordinarily smoked 35 cigarettes a day got the same amount of nicotine from 15 cigarettes, as determined by blood tests. They had to cut down to 5 cigarettes a day before the nicotine levels in their blood changed significantly.

Benowitz told the jury that cigarettes are a drug delivery device for nicotine. He explained how cigarette smoke travels through the lungs to the heart to the blood and brain within ten seconds. Nicotine binds with receptors in the brain, blocking them, so that the receptors are unable to talk to each other. He compared nicotine to the cream in Oreo's in this way. In the past, he has suggested to the tobacco industry ways they could lower the nicotine levels in cigarettes so that people would not be addicted but, he says, the industry blew him off.

Dr. Benowitz explained tolerance, a phenomenon that occurs with all drugs that affect the brain. Our observer said the jurors were all taking notes about this concept. Nicotine affects the same area of the brain as heroin and cocaine. He juxtaposed nicotine with caffeine by saying that caffeine does not cause withdrawal symptoms and does not kill the user. He explained that nicotine affects the brain in such a way as to suppress appetite, relax the smoker and affect the mood. When the smoker doesn't get enough nicotine, he suffers withdrawal symptoms like irritability, frustration, anxiety, sleep problems and weight gain.

Benowitz said he has no doubt in his mind that nicotine is addictive and dependency-producing. Very few smokers can quit cold turkey. He said that many Viet Nam vets came home addicted to both heroin and nicotine and were able to quit heroin but not cigarettes.

Mr. Rosenblatt asked Benowitz about a few industry documents. The first was a 1972 memo about a tobacco company study on why people smoke. The author, William Dunn, wrote: "Without nicotine, there would be no smoking," "Nicotine is the product;" "The sole reason of cigarettes is nicotine," and "Cigarettes are the most optimized vehicle to deliver nicotine." An RJR memo dated April 14, 1972 by Claude Teague, a vice president of research and development, said that the tobacco industry is a specialized, highly ritualized pharmaceutical company; that tobacco is a vehicle for the delivery of nicotine; that marketing should be toward keeping smokers habituated. This Teague memo talked about attracting nonsmokers and pre-smokers and said that reducing nicotine levels would be bad for business. The memo also discussed freeing up nicotine by raising pH levels; this would actually raise the nicotine intake of the smoker without registering on smoking machines. Another RJR memo, from 1973, talked about the success of cigarettes with higher pH, which the author said is deliberate and controlled in order to free up more nicotine. Based on his research and his review of industry documents, Benowitz believes that the companies manipulate nicotine levels.

Cross-examination: Mr. Heim spent some time asking Benowitz about nicotine's effect on receptor cells. Benowitz admitted that some foods have the same effect of blocking receptors, but said that people would not eat the amount of food in one day necessary to have the same effect as just one puff of smoke. This line of questioning gave Benowitz an opportunity to reiterate everything he had said about how nicotine affects the brain, even more than some hard drugs.

Benowitz admitted that nicotine does not impair the user as much as heroin or crack, but said that nicotine impairs every other organ in the body. He admitted that smokers are not hospitalized for intoxication, unlike abusers of other drugs. Benowitz also acknowledged that smokers do not experience incapacitating withdrawal symptoms like users of other drugs, such as heroin. I think the industry will bring in its own experts to testify that these are some of the key concepts that make a substance addictive; therefore, nicotine does not fit the definition of addictive.

Benowitz would not admit that the public has known for decades about the dangers and addictiveness of smoking. He said that although the medical community knew, the public did not know until the early to mid-80\rquote s. I think the industry will counteract this testimony through evidence of the "common knowledge" back to the 1940's and 50's, as they have done in other trials.