Sunday, April 21, 2019

Addiction Expert Kenneth Cummings Explains Smoker’s Nicotine Addiction in Seven–Figure Tobacco Trial

The Trial: Olson v. R.J. Reynolds, a 2018 Florida tobacco trial in which the family of a smoker who died claims an addiction to nicotine caused his fatal lung cancer.

The Expert: Kenneth Cummings, a professor at the University of South Carolina, co-leader of the Tobacco Research Program, and an expert on nicotine addiction, concludes that Floyd Olson, the smoker at the heart of the case, was addicted to nicotine. 

The Verdict: $7.5 million.


By Gary F. Gansar, MD, FACS; Senior Medical Director, AMFS

In a 2018 Florida tobacco trial, Kenneth Cummings, a specialist in nicotine addiction and co-leader of the Tobacco Research Program, testifies for the plaintiff to define cigarette addiction and prove that Floyd Olson, the smoker at the heart of the case, was addicted to nicotine.

Cummings, from the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina, begins by stating without reservation that Olson was “heavily addicted” to cigarettes containing nicotine. He tells jurors the single greatest factor in reaching this conclusion is whether a person is a persistent every day smoker for multiple months, years, and decades. This is further refined by reviewing the number of cigarettes smoked each day, as well as the pattern of smoking. For instance, a heavily addicted patient will wake up in withdrawal since nicotine has a short half-life. An addict typically cannot wait even an hour before consuming his first cigarette after waking, to counter the withdrawal that occurred while he was sleeping. Indeed, Cummings feels that this is the best indicator of addiction.

Cummings goes on to break down cigarette consumption for different types of smokers. A light smoker consumes under 10 cigarettes a day; a moderate smoker, 10-20 daily; and a heavy consumer smokes a pack or more a day. In this case, Olson’s consumption of 3-4 packs a day places him in a pool of less than 3% of the smoking population.

Cummings goes on to explain that secondary criteria  in determining addiction are also important and include age of initiation of smoking, difficulty refraining, withdrawal symptoms on quitting, and use despite known harm. However, he notes that he does not believe it is  necessary for all secondary criteria to be present in order to find a smoker addicted. Age of initiation he says is particularly important because rhe early age of initiation with the drug nicotine will affect the brain’s development.

Cummings then details the Heaviness of Smoking Index as a method of evaluating a smoker’s nicotine dependence. He says 85-90% of regular smokers smoke every day, while persistent, non-daily smokers make up only about 15% of the smoking population. The latter have less dependence and relapse is more common in the former, so they require more intense and frequently multiple modes of therapy in dealing with their addiction.

In treating nicotine addiction, Cummings tells jurors the nicotine patch, a common aid to help smokers quit cigarettes, became available in December of 1992, while the lozenge form of the drug was made available in the late 1990’s. Xyban was introduce as a prescription in 1997 and Chantix became available in 2006. Chantix, he maintains, is presently the best treatment available to the addicted.

Cummings tells jurors Olson began smoking at age 12 and continued to smoke after he had lung cancer, a time frame of more than 40 years. His quit attempts lasted only a day or two.

This, Cummings says, was chronic compulsive use of nicotine.

Cummings’ expertise and testimony in this trial played a key role in the jury finding for the plaintiff and awarding $7.5 million.

 

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Gary Gansar, MD, is residency trained and Board Certified in General Surgery. He previously served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Mercy Hospital and Touro Infirmary in New Orleans, LA. Dr. Gansar also served as Clinical Instructor and Professor of Surgery at Tulane University. He received his MD and served as Chief Resident at Tulane University Medical School. Dr. Gansar joined AMFS as a consulting medical expert in 2011 and has served as Medical Director since Nov. 2015. In this capacity, Dr. Gansar provides consultation, review and guidance to attorney clients.