It is a central tenet of those opposed to tobacco harm reduction as it applies to safer nicotine products that the whole thing is a massive con trick by Big Tobacco to both entice kids to move onto regular daily smoking and inveigle ex-smokers to take up the habit once more. The purpose of e-cigarette promotion they argue, is to ‘boost Big Tobacco profits’. Well as things stand, BT are doing a piss poor job of ‘boosting their profits’; total global turnover of all products among all companies whether Big, Middling or Little Tobacco probably accounts for less than 2% of cigarette sales. Indeed, I have heard that shareholders in some of the biggest companies look askance at their CEO asking, ‘why are the hell are we bothering with this?’
Fear not dear shareholder because government legislators are covering the new product development and marketing spend so you won’t be out of pocket. In the wake of the moral panic over JUUL, the FDA announced a possible ban on all flavoured e-cigarettes. The press release had hardly hit the wires, when shares in the major tobacco companies (who do not manufacture JUUL) took a very healthy 6% upwards hike which according to one analyst gifted a $20 billion jackpot to company shareholders.
Meanwhile half a world away in India, the proposal there to ban e-cigarettes had a similar impact. Such a ban would effectively prevent the India Tobacco Company from getting into the business, but this did not prevent a rise in ITC’s share price when the news broke. The company did launch an e-cigarette in 2014 and put its toe in the world of NRT as well. But neither products took off, while according to one news report, ITC shareholders are keen that the company remains focused on its “bread and butter business”.
The news of a tobacco share price rise was widely reported including with some irony in Bloomberg News, run by the man who funds much of the activity aimed at eliminating evidence-based harm reduction products from the market. Bloomberg Philosophies annual report declares that the organisation “works to reduce preventable deaths from tobacco use”. So sticking to the letter of their statement why won’t they at least devote some of their much-trumpeted $1 bn spend on global tobacco control supporting efforts to encourage current smokers to switch away from cigarettes to non-tobacco products like e-cigarettes – not least because they and one of their ‘partners’ Vital Strategies are also committed to tackling cardiovascular disease, a major cause of which is smoking.
Maybe it’s to do with being hand-in-glove with another ‘partner’, the Campaign for Fun Free Kids, who have been doing their utmost to undermine vaping-based harm reduction by suggesting among other chunks of misinformation that kids with tombstones in their eyes are lurking on street corners waiting for The Man wearing a tobacco industry T-Shirt to roll up packing the latest coyote and cheesecake e-liquid flavouring. They have been vociferous in their condemnation of flavourings and no doubt welcomed the announcement. You might think they and their allies would have been dismayed by the uptick in company shares. But I’m not sure.
It is often said that safer nicotine products represent a disruptive technology and I think this applies no less to the moral landscape of tobacco control. Life used to be so much easier for the anti-tobacco campaigners who had a clear and unequivocal target in the sights of their all-too easily obtainable guns seeing the world purely in terms of fundamentalist black and white, right and wrong. Not any more I’m afraid.
In London recently, there was a meeting of the industry-insider Global Tobacco and Nicotine Forum. This was headlined in the London Daily Express British taxpayers 'should not subsidise scaremongering anti-vaping laws' quoting one of the speakers, Chris Snowdon.
The paper behaves as if Britain still has an Empire and regularly finds yet another story to run about Princess Diana. I hear that the staff are made to sing ‘Rule Britannia’ every morning. (Actually, I made that bit up). But they really don’t like our money going out the country to anybody for any reason. So it was a shock to read that out of nearly 190 signatories to the WHO Framework Convention on Tobacco Control just three countries actually cough up any money; Australia (naturally), Panama (why?) and despite the domestic public health policies around e-cigarettes – the UK. According to WHO budget figures, the UK has stumped up the most money of the three, totalling $15m over the past five years.
There was an interesting article in Forbes Magazine written by Jeffrey Dorfman, a libertarian economist. Most of his data sources emanated from official US government sources, so they come with all the usual health warnings. Even so..
“About 15% of American adults smoke cigarettes. Each year 50% of those smokers try to quit smoking. With the help of e-cigarettes as a substitute, 20% of quitters succeed; without e-cigarettes, only 12.5% succeed. That higher rate of success in quitting smoking by using e-cigarettes means that e-cigarettes increase the number of adult smokers who quit each year by about 4%, or about 0.6% of all adults. That translates into 1.5 million extra million quitters every year thanks to e-cigarettes.
In contrast to adults, only 8% of high school aged teens smoke, while 14% use e-cigarettes. Non-smoking teens have an 8% chance of becoming a smoker in a six-month period, but if they use e-cigarettes, that probability of starting to smoke increase to 31%. This difference means that about 3% more teens try smoking thanks to the “gateway” of e-cigarettes. Based on about 16 million high school aged youth, this translates to an extra 500,000 teen smokers.
At this point, the balance on e-cigarettes is 1.5 million adult smokers turned into ex-smokers versus half a million teenagers trying smoking. If one values all smokers equally, regardless of age, then e-cigarettes are a clear net positive for public health. If you value preventing teens from becoming smokers at any value above three times how much you value getting an adult smoker to quit, e-cigarettes have a negative impact on public health.
However, it gets a little more complicated. It turns out that 32% of high schoolers have tried a cigarette at least once. Comparing that number to the 8% of teens that smoke makes obvious teens are much more likely to quit than adults and might start smoking but quickly give it up.
If teen smokers are not certain to become long-term adult smokers, the public health harm from a new teen smoker might be considerably less than the benefit from helping an adult smoker quit smoking. This seems to be the case, suggesting that FDA should be careful about regulating e-cigarettes too tightly. Unless the FDA can justify weighting new teen smokers created much more heavily than successful adult quitters, cracking down on e-cigarettes could actually have a negative overall impact on public health.
The point of course is that claiming to protect kids by ‘cracking down on e-cigarettes’ gets you many more political brownie points than the bigger, but less sexy public health gain of helping more adult smokers away from cigarettes.
And finally…and with apologies to Buffalo Springfield and an acknowledgement to Professor Chris Lalonde from the University of Victoria in British Columbia.
There's somethin' happenin' here
What it is ain't exactly clear
There's a man with a JUUL, over there
Tellin' me I got to beware
(I think it's time we)
Stop, children, what's that sound?
Everybody look - what's goin' down?
Hope to see some of you in Geneva for the launch of ‘No Fire, No Smoke: The Global State of Tobacco Harm Reduction 2018. Wagons for circling will be provided.