“Cigarette combustion, rather than either tobacco or nicotine, is the cause of a public health disaster.“
This is the first sentence that sets the tone of J.F Etter’s reflection in the Swiss medical review. The professor at the Institut de Santé Globale of the Faculty of Medicine of the University of Geneva in Switzerland is concerned by the emergence of new generation of risk reduction products compared to the traditional tobacco cigarette.
Among new products, he identifies those where tobacco is heated rather than consumed and points out that some of these technologies are developed and owned by the biggest leaders of the tobacco industry, among which Philip Morris (iQOS) or Reynolds (Revo).
In his lines, he discusses several points with regard to breakthrough technologies, the ban of tobacco products, the possible collaboration with tobacco industry in a context that plays in their disadvantage.
Tobacco and nicotine vaporizers, breakthrough technologies
The author recall that tobacco combustion evolved in the XIXe century and that before this period tobacco was mainly snorted or chewed, and this was of lower risk for public health. The mortality drastically increased with the rise of the industrialized tobacco industry that started manufacturing and sell billions of cigarettes worldwide.
Fortunately, the XXIe century sees the emergence of innovations in the domain of risk reduction, after the public became aware of the disaster of smoking tobacco. Among the innovations, one finds electronic cigarettes, personal vaporizers using a propellant and other nicotine vaporizing devices based on chemical reactions (pyruvate). All technologies were revealed a benefit compared to combusted tobacco for whoever is not able to give up abruptly.
There is a gradation in risk reduction among the nicotine delivery products, the most lethal being smoking tobacco and the most innocuous the nicotine patches, according to recent findings. The e-cigarette, in its different itemizations, finds its place in this range and its harmfulness is a matter a debate between people who advocate the absence of long-term impact studies to ban it, in agreement with the “precautionary principle”, and those who pay tribute to this “life saving” method that prove its success in smoking withdrawal and, even if perfectible in the future, already shows little after-effect compared to its combusted tobacco ancestor.
Yes, the combusted tobacco cigarette is gently driven to its end by governments in virtue of various health protection plans, but the tobacco industry struggles to keep alive this fruitful market. It is in this context and given the huge number of people addicted to tobacco, that the tobacco industry is facing a new challenge.
The bad press of the tobacco industry
“An ostracized industry for its scientific misconduct and because it produced so far mainly a deadly product, cigarettes, is diversifying by creating safer products.” writes Jean-François Etter after listing some major contributions of the leader tobacco companies to the e-cigarette market. The following of his reflection is to make the balance between the pro and the cons of an implication of the tobacco industry in the development of the risk reduction tobacco alternatives and their regulation.
This is a new situation for the tobacco industry that has been regarded so far as the devil for, on the one hand, their involvement the tragedy of billions of families, and on he second hand for their maneuverings in politics, science and communication.
Nowadays, the tobacco industry is rich not only with the money that comes from the fruitful market of tobacco cigarettes, but also from their research and development (R&D) teams that increase the scientific knowledge in various domains related to their activities. Of course, their investment in R&D primarily aims at validating their productions in the market of the risk reduction products. The scientific publications become the battlefield between companies for the competitive advantage of a product or another, in a world where advertising can no longer be regarded as a commercial option.
And it is this science, interestingly, that sets the footings for regulation. This science that has become dubious with the possible and effective conflicts of interest.
So are the bases of a philosophical or deontological debate that Professor Etter is stirring up: “Should we support the tobacco industry to accelerate the transition from combustion towards vaporization?”; “Should academic scientists collaborate with the tobacco industry to conduct research projects on these new risk reduction products?”, and finally “What is the place is this industry for the development of the regulation on these products?”
Even if obvious conflicts of interest arise from this situation, the fact is that independent research by universities is not competitive, in terms of fundings, compared to the budgets of industrial research. This is striking when considered the scientific equipment that the industry offers to their researchers, making this field more attractive to researchers than fundamental science in old academic institutions, but this in another debate. And if scientific publications are unavoidable in the context of regulation, most of them are provided by the industry itself, even if the rare scientific outputs from academic institution that show no conflict of interest with the tobacco industry carry more weight in politic decisions.
This tobacco industry already knows that the market of personal vaporizers will be modelled by the regulation, and the same regulation will be elaborated based on the scientific research, the scientific research that is mainly conducted by the tobacco industry. And the same regulation on personal vaporizers will also drastically affect the market of combustible cigarettes. This is the paradoxical situation of a snake eating its tail. And, he adds,”It is paradoxical to ban a scientific publication whose impact of the regulation, on the combustible cigarette’s market and on public health is so important.”
Is the future so dark?
A cloud of hope comes from the scientists themselves, the new actors of this science. The Swiss researcher puts forward that “this industry has changed and people now in charge of these new products (…) have not been involved in the previous frauds.”
And this is without taking into account the founding principles of science: “relighted review, transparency, the discussion between colleagues considered equal, open-mindedness, denial of the arguments of authority and dogma.” Researchers who are now paid by Lorillard or other PMI, BAT… are also competing with their former academic colleagues in terms of career with weapons like impact factors and track records. And, if one relies one the peer-review system as a proof of objectivity in science, this competition would be associated to an overall increase of transparency of this science.
How to deal with conflicts of interest?
In order to circumvent possible issues, the disclosure of conflicts of interest and the registration of the studies in public registries are often considered sufficient, in line with a peer-review process. But more strictness would be beneficial to transparency, advocates Jean-François Etter who anticipates an important time lag before the tobacco industry has completely cleared its name: “given its past behavior, the tobacco industry will have to undergo high standards of honesty and transparency if it wishes to be rehabilitated.”
Other measures would help speeding up the process in a world where the emergence of new technologies is faster and faster. Among these J-F Etter suggests the industry to allow more access to databases and infrastructures to the independent research for observation and control.
However, strategies for risk reduction are often mistakenly interpreted or rejected and J-F Etter anticipates an heavy regulation in this domain. It makes no doubt that the tobacco industry will dominate this market, since they already demonstrate a huge potential for R&D in addition to a redoubtable legal support. Another element for their supremacy will be the lack of concurrence with the disappearance of small manufacturers in the forecasted heavily regulated environment. And in this context, there will be no choice but to consider tobacco industry researchers as allies rather than ennemies, as it has been the case in the past.
The researcher concludes that changes are expected and it would go through open consultations in the presence of the different actors, industry researchers, academic ones, politicians and health professionals.
In a global market of U.S $35 billion (2010’s estimate), which is the combined profit of Microsoft, MacDonald’s and Coca Cola, the tobacco industry is a very powerful lobby. Nevertheless, independent initiative to put brains together are acknowledged, like the Global Forum on Nicotine, a yearly conference that is recognized for the quality of its content. The last event took place in Warsaw, Poland, in June 2015. The next event will be held one month ahead of the implementation of the EU TPD that will probably arouse interesting discussions.
Etter, J. F. (2015). New tobacco vaporizers: how to react?. Revue medicale suisse, 11(478), 1295-1297.