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New home test boosts anti-smoking case

A new home test called TobacAlert has gotten little public notice since it came on the market in November, but word of its existence has provoked strong reactions among bioethicists and anti-smoking activists.
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Martha S. Jones has asthma, so whenever her husband, Bob, lights up at their Woodbridge home, the agreement is that he steps outside.

She used to think that protected her from exposure to the more than 4,000 chemical compounds found in cigarette smoke, 43 of which are known to cause cancer in humans or animals. Then she tried a new do-it-yourself urine test for detecting exposure to secondhand smoke, and her sense of security dissolved.

The test rated her at 2 on a scale of 6 -- one notch below that of a regular smoker. Jones said she was shocked to register such a high level of passive smoke exposure, which she thinks came from nicotine residue in her husband's car and time spent with his smoking friends away from their house. Now she is working -- delicately -- to persuade her husband to quit, she said.

"It gave me an opportunity to say, 'Look, I'm still concerned about this,' and him an opportunity to say, 'Yeah, I am, too, and I want to do something about it,' " she said.

The kit may lead to many such conversations. Called TobacAlert, the test kit has gotten little public notice since it came on the market in November, but word of its existence has provoked strong reactions among bioethicists and anti-smoking activists.

The manufacturer, Nymox Corp. of Maywood, N.J., says the $15 test can be used to measure the secondhand smoke exposure of employees in smoky workplaces and people who live with smokers. One expert says it could be used in child custody cases.

Sneaking a smoke?
The company's medical director, Michael Munzar, says it can show whether teenagers have sneaked cigarettes, athletes have violated no-smoking policies or life insurance applicants have been truthful about qualifying for nonsmoker rates. Munzar said TobacAlert also can be used to monitor the progress of people trying to quit smoking and to encourage them.

Deborah L. Marion of the Wellness Council of West Virginia uses a similar nicotine test available only to medical professionals as many as 40 times a day at health fairs -- to great effect. It's sobering, she said, for smokers to see a numerical value showing the exposure of a spouse or child.

"I was kind of skeptical at first, but I have seen that it raises awareness," Marion said.

The TobacAlerttest doesn't require expensive and time-consuming lab analysis, and results appear in about 15 minutes, Munzar said. The test strip is sensitive enough to detect only an hour of exposure to tobacco smoke in the previous three days.

"This is really bad news for smokers," said Arthur Caplan, chairman of medical ethics at the University of Pennsylvania. The testing could be used to force employers to make workplaces safer, he said. "It's one thing to kvetch; it's another thing to bring in a number."John F. Banzhaf III, executive director of Action on Smoking and Health and a public interest law professor at George Washington University, sees advantages and disadvantages. "I see it as a major new weapon in the nonsmokers' rights movement -- particularly the movement to protect young children," he said.

But he said he worries that low readings might make people think they are safe even though minuscule amounts of some toxins can cause severe reactions in susceptible individuals. "If it is used by people who don't know these things and don't take the time to read the brochure, then it could be misleading," he said.

TobacAlert strips contain microscopic particles of colloidal gold, coated with an antibody that binds to cotinine, a byproduct of the body's reaction to nicotine. Nicotine dissipates in the body within two hours, but cotinine lingers for about three days in blood, saliva and urine. TobacAlert detects as little as six nanograms (billionths of a gram) of cotinine in less than a quarter teaspoon of urine. The test is gauged in whole numbers from zero to 6, with 6 denoting more than 1,000 nanograms. Nymox says people with readings above 100 nanograms -- 3 or above -- are smokers.

TobacAlert verifies use of tobacco in cigarettes, cigars, pipes or chewing tobacco, company officials said. They said TobacAlert compared favorably with lab tests in company studies, and they promised to share details in scientific meetings and journals.

Food and Drug Administration officials said they weren't aware of the product, which Munzar said is not subject to regulatory approval because it does not purport to make a medical diagnosis. The FDA has approved a similar Nymox product called NicAlert that tests for cotinine in urine or saliva, but agency officials say that product requires a prescription.

Visions of '1984'
TobacAlert, which Doyle said uses identical patented technology, is sold as a home test, with a disclaimer that it is for nonmedical use. It is being sold by and, and CVS is test-marketing it in six of its 4,100 stores.

The product may be drawn into charged situations, such as custody disputes, said David L. Levy, president of the Children's Rights Council, a national group trying to protect children from custody battles. " '1984' is encroaching more and more," he said. "The philosophy seems to be that if you can do something, you must do it."

John Crouch, an Arlington family lawyer and a recent chairman of the American Bar Association's child custody committee, said a growing number of judges are considering a child's exposure to secondhand smoke as a factor in custody decisions.

Secondhand smoke is well established by scientists as a cause of disease in nonsmokers. The Centers for Disease Control and Prevention estimates that secondhand smoke causes 3,000 adult nonsmokers to die of lung cancer each year, and some experts say many other deaths result from cardiovascular illnesses triggered or exacerbated by smoke exposure. The CDC says secondhand smoke causes coughing, phlegm, reduced lung function and reddened, itchy, watery eyes for countless people.

In children younger than 18 months, secondhand smoke causes 150,000 to 300,000 respiratory tract infections a year, the CDC estimates. Children frequently exposed to tobacco smoke suffer more respiratory problems and ear infections and are more likely to develop asthma, the agency said. About 60 percent of deaths from sudden infant death syndrome are attributable to exposure to parental tobacco smoke before or after birth, CDC said.

"If you argue in court that secondhand smoke doesn't kill, they will laugh you out of court," said James L. Repace, a Beltsville-based air quality expert who has participated in dozens of battles nationwide over smoking restrictions. Repace said home tests could inspire more suits. "Once people find out they are exposed in such graphic terms, they get upset," he said.

Advances in testing technology leave Caplan, the bioethicist, a bit nostalgic for the time when teenagers had a better chance of fooling their parents.

"We are moving to an age in which we're only going to determine truth through chemistry," Caplan said. "I suspect this continues our policy of, 'Don't believe what I say, believe what I excrete.' "