Cigarette smoking continues its rapid decline in Japan while the upward trajectory of smokers seeking alternative nicotine products shows no signs of slowing down. According to PMI a small percentage (calculated variously at between 5—15%) of their IQOS customers are dual users, but the rest have fully converted. The access to the market for companies like PMI afforded by the Japanese government plays a big part in this; advertising is seemingly allowed in any ways the imagination can conceive and is just as ubiquitous as the most aggressive cigarette advertising. Tobacco regulators around the world may choke on the vapour here, but the experience in Japan strongly suggests that putting obstacles in the way of e-cigarette and HNB marketing simply prolongs your cigarette problem.
And it is the HNB products like IQOS that are stealing the march on what could already be termed ‘traditional’ e-cigarettes. A study from San Diego State University Graduate School of Public Health used Google search trends to try and understand the devices' appeal in Japan. The team focused on internet searches for heat-not-burn tobacco, including generic terms and major brands, analysing their relative popularity to all searches from 2015 through August 2017.
They then compared the fraction of all Google queries for heat-not-burn tobacco in Japan to the fraction of all Google queries for e-cigarettes in the United States. The total number of heat-not-burn queries in Japan grew by 1,426 % their first year on the market in 2015. Between 2015 and 2017, the number of queries grew by 2,956 %. Projections based on forecasts from the observed trends suggest that heat-not-burn queries will continue to grow at a similar rate through 2018.
"Heat-not-burn products have quickly become insanely popular," said study co-author Mark Dredze, professor of computer science at Johns Hopkins University. "Two years ago, there were essentially no queries in Japan for heat-not-burn tobacco, but now there are between 5.9 and 7.5 million each month." Moreover, the team found that interest in heat-not-burn tobacco in Japan is growing more rapidly than past interest in e-cigarettes when they were first introduced to market. This suggests that as heat-not-burn tobacco is introduced in new markets, its popularity may even eclipse e-cigarettes.
The politics of public health as applied to alternative nicotine products and Big Tobacco continues to intrigue. The establishment of the Foundation for a Smoke Free World has certainly put the cat among the pigeons and further divided the global public health community.
As revealed in The Cancer Letter, the Foundation has attracted further surprising endorsements. Less than three years ago, John Seffrin was CEO of the American Cancer Society, a virulent anti-industry campaigner who compared industry tactics to al-Qaeda. And now?
“The world needs to act with greater urgency and more creativity to cut the adult smoking rate and prevent cancer, heart disease and lung diseases. The Foundation for a Smoke-Free World will bring new energy, needed resources and significant expertise to the fight. The Foundation will fund critical research to help eliminate gaps in science, and help the global community pick up the pace of progress in providing science-based solutions for the world’s one billion smokers, most of whom seek to quit cigarettes.”
The author Paul Goldberg was intrigued to find out what prompted this dramatic change of heart and so he wrote to John Seffrin, now a public health professor at Indiana State University. The suspicion of course was that Seffrin was receiving industry funding or was somehow connected to the Foundation. But it turned out that he had simply become a convert to harm reduction and realised the enormous potential health impact of the new products.
Another harm reduction convert interviewed by Goldberg is Kenneth Cummings, co-leader of the Tobacco Research Program at the Medical University of South Carolina Department of Psychiatry and Behavioral Sciences. His view was that for John Seffrin and Derek Yach to endorse the Foundation was an action “worth the risk”. He reasoned that, “Though still profitable, tobacco companies have to adjust to new market realities. Thanks to six decades of work, young people aren’t taking up smoking cigarettes at a high rate. Meanwhile, quit ratios among adults haven’t budged in years. We see them at our hospital every day…If you have somebody pulling their chemo bag and they are going to sneak a cigarette out behind the cancer center, which we see, it’s pretty sad. It ain’t a choice. It’s a true addiction.”
Cummings says it’s worthwhile to explore new products as a harm reduction measure for current smokers. “There are alternative nicotine delivery products that don’t have to send you to your local cancer center…Those products may or may not help you stop smoking. There are still debates about that. I’d say the evidence is suggestive rather than affirmative, and part of the reason that hasn’t been done is that we haven’t had randomized trials”.
“It’s a big risk. I give kudos to John Seffrin. He didn’t just stick his neck out. He put his reputation on the line, because if anybody is committed to smoking control, it would be John Seffrin—and Derek”.
Goldberg also spoke with another former Cancer Society official Allan Erickson who runs the National Tobacco Reform Initiative, a small group that includes Seffrin and Yach. Recently, the group published a report calling for tobacco reform which included the recommendation that there was a need to, “Establish a more rational tobacco, nicotine, and alternative products regulatory framework based on their relative risks, and that is adaptable to the increased speed of innovation in new technology development”.
The bottom line even among new harm reduction converts is that you can’t trust Big Tobacco. The industry is in the alternative nicotine product business because they see the way the smoke is blowing. But so what? If it turns out over the longer-term that the new products do have the predicted dramatic impact on public health, even if it means people are still consuming nicotine, as well as quitting, then as the Koran says, an evil is permissible if it prevents a greater one.
And the last word on the subject for this week goes to Derek Yach whose article on the Foundation appears in The Lancet. Yach makes this interesting point,
“ The tobacco industry is just starting on the same path that other so-called dirty industries, such as energy and transport, have been on for many years. Many companies in these industries have been investing in research and development and corporate transformation to respond to investors' and consumers'—especially millennials—demands that they better align their products and services with social, health, and environmental goals. This is the concept of so-called shared value that Michael Porter and Mark Kramer have crystallised in their work at Harvard Business School. The tobacco industry's future survival will depend on transforming itself in this way”
The Adam Smith Institute is a London-based right-wing think tank which is a flag waver for the free-market economy and no fan of government regulation. Here is it’s take on the benefits of new nicotine products
The British Psychological Society had added its weight to the view among leading British health organisations about e-cigarettes as a valid component of smoking cessation programmes.
The Sunday Times reported on a study conducted by the British Economic and Social Research Council who concluded that raising the smoking age limit to 21 could deter teenage smoking.
The survey compared teenage smoking rates in Ireland before and after the age limit was raised from 16 to 18. As a result, there was a significant percentage drop leading the report author to conclude that raising the sales limit showed potential for reducing teenage smoking. He pointed out that while this was becoming more widespread in the USA, no European country had raised the limit about 18.
Clearly this kind of legislation is unlikely to deter those determined to smoke, but I just wonder if it would steal the thunder from those who are adamant that e-cigarettes are a teenage gateway to smoking, if it became a lot harder for teenagers to get hold of cigarettes in the first place. Answers on a cigarette packet, please.
And finally, somebody had produced a song about vaping
which led to a discussion about how vaping has yet to really penetrate mainstream popular culture. Has anybody spotted somebody vaping in a film or seen e-cigarette product placement? I did a quick trawl of the interweb for vaping jokes and to be honest they were either pretty lame or really only understandable to other vapers. I quite liked this one though: