E: Cigarettes: Cure Or Cash-Cow?

Will the multi-billion pound industry for electronic cigarettes revolutionise our health or just damage our wallets?

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On the 11 June, Japan Tobacco International – who own numerous iconic brands, including Camel —–bought the UK’s biggest electronic cigarette imprint, E-Lites. Fifteen days later, Philip Morris International – makers of Marlboro – followed suit, when it added the UK’s second largest distributor, Nicocigs, to its growing portfolio of brands. If you combine E-Lites’ reported market share in 2013, with Nicocigs’ current stake (as estimated by Philip Morris) the significance of both deals becomes clear. Two tobacco companies secured approximately 67 per cent of the British e-cigarette market, in the space of fifteen days.

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Philip Morris and Japanese Tobacco’s competitors will be Imperial Tobacco (whose subsidiary, Fontem, supplies its brand Puritane, exclusively, to Lloyd’s Pharmacies). Meanwhile, British American Tobacco – who own Lucky Strike – sell their vaporizer brand Vype, via Boots. With the exception of the China National Tobacco Cooperation (a state-owned cigarette manufacturing monopoly) each of Big Tobacco’s “big four” now owns a substantial stake in the British market for electronic nicotine.

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Known specifically as electronic nicotine delivery systems (or ENDS), electronic cigarettes work by heating liquid nicotine, which is then mixed with compressed air (or vapour). A preservative and in-house flavouring are added, and then the mixture is inhaled. Each puff contains several harmful chemicals, but only a fraction of the 4000 found in regular tobacco, with no carbon monoxide or tar. E-cigarettes are being viewed as a preferable alternative to smoking. The UK charity ASH has calculated that around 2.1 million British users “smoke” e-cigarettes to stop, substitute or cut back on their tobacco intake. Since 2012, 700,000 users per annum have bought into the trend.  

But while the devices have been lauded in some quarters, they’ve also caused a rift between public health professionals. One group views electronic cigarettes as an innovation with significantly fewer risks than tobacco. They argue that if smokers can replace their current addiction with electronic nicotine, the product could save millions of lives.

An opposing camp takes a very different line. They agree that e-cigarettes are likely to benefit “established” smokers; but they also believe that the tobacco industry’s primary purpose is to recruit news consumers at the same time. Additionally, they argue that the health risks of electronic cigarettes remain unknown, while the possibility that they help us to give up smoking is unproven.

Tensions are running particularly high, because electronic cigarette manufacturers are coming to terms with one of their biggest challenges, arguably, since the first e-cigarette was invented in 2003. The EU’s Tobacco Products Directive – which is the cornerstone of smoking legislation in Europe – didn’t mention the vaping phenomenon; so the revised directive, which was published in April 2014, gave e-tobacco tobacco manufacturers across Europe significant cause for alarm.     

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Under the new directive (which member states must enforce by 2016) weaker electronic cigarettes can still be sold as normal, provided they disclose their ingredients, and carry warnings (such as ‘This product contains nicotine which is a highly addictive substance’) that cover at least 30 per cent of the packet.

Meanwhile, “stronger” products (or those which contain more than 20mg/ml nicotine, and make up the bulk of the electronic cigarettes currently on sale in Britain) must obtain medical licenses, like those which pharmacies need, in order to continue selling their wares.

Complicating a complicated situation still further, the new EU law effectively provides member states with the guidelines for electronic cigarette regulation, but gives each country ultimate control over how they are enforced. Great Britain is taking a particularly hard line, and has announced that it plans to regulate all e-cigarettes as medicines (or ‘MHRA licensed Nicotine Containing Products’) across the board.   

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As electronic cigarettes are currently unregulated and growth is propelled by high-revenue advertising campaigns, news of regulation was met with industry animosity. However, it was the revelation, through leaked minutes of a meeting held on 6 December 2013 by the World Health Organisation’s Framework Convention on Tobacco Control, which suggested that the WHO was considering regulating electronic cigarettes in the same manner as tobacco, that prompted industry outcry. 

The World Health Organisation advises governments on how to respond to health trends. Therefore, an anti-e-cigarette recommendation could literally destroy the e-cigarette industry’s credibility overnight; but the biggest visible challenge to this suggestion came from a UK based group of 53 “specialists in nicotine science and public health policy,” who wrote directly to the WHO.

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In a letter addressed to the organisation’s Director General, Dr Margaret Chan, the doctors implored the WHO to be lenient when considering whether to control electronic cigarettes with existing tobacco legislation. While “tempting”, this rationale could permanently harm smokers, by halting “…products which could be among the most significant health innovations of the 21st Century.” 

Staunch opponents of electronic cigarettes immediately chased the WHO with a powerful letter (which received substantially more signatures but substantially less publicity). Using 43 citations, 123 international experts comprehensively explained how the tobacco industry has cynically manipulated an industry that showed no interest in helping smokers but prioritised share-price, instead.

“The aggressive marketing and promotion of e-cigarettes to youth is well-documented and evidence from the US and Korea shows rapid growth in youth e-cigarette use, including disturbing rates among youth who have never smoked a cigarette,” the doctors write. “One manufacturer warned parents that ‘kids may be particularly vulnerable to the flavoring in its products’”.  

Since 1974, the prevailing attitude amongst British smokers has been the belief that nicotine itself does not kill — and that ballooning mortality rates are caused by carbon monoxide and tar. So when presented with a popular solution to the world’s tobacco problem, why are some doctors dismissing electronic cigarettes as a heist? Have groups so accustomed to battling cynical conglomerates begun to oppose anything that resembles a cigarette?

Simon Capewell, a Professor of Clinical Epidemiology at the University of Liverpool, explains that his position on electronic cigarettes, one that is shared by the Faculty for Public Health, is anything but a knee-jerk response from what he jokingly refers to as “a bunch of public health conservatives, who simply want to regulate everything and stop everyone from having a good time.”

Their fear is that the e-tobacco industry is an “accelerating juggernaut”; one that is motivated exclusively by profit. Electronic tobacco was worth $1 billion globally in 2013. In 2014, a worldwide turnover of $3 billion is projected. Sales for several conventional cigarette brands in the UK fell by as much as 20 per cent in 2012, while old tobacco continued its languorous 6.4 per cent year-on-year decline. By contrast, the new industry grew by 950 per cent.

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At the heart of Professor Capewell’s opposition to the industry buyout of electronic tobacco is a key WHO resolution known as Article 5.3 (of The Framework Convention on Tobacco Control). This may sound like a technicality of health law but the resolution (which specifically states, that “[a] fundamental and irreconcilable conflict of interest between the tobacco industry’s interests and public health policy interests” is observed) reiterates a fundamental point. While doctors safeguard our health, tobacco companies serve their shareholders. Their interests are diametrically opposed. For historical reasons (such as those which Christopher Buckley immortalised in his 1994 satire of the tobacco industry, Thank You for Smoking) Big Tobacco is the last partner to turn to in the fight against nicotine. Those who fear its motives need only point to the sins of the past.

Public health embraced cigarette filters and “low tar” cigarettes as harm reduction strategies before manufacturers provided evidence. Manufacturers, meanwhile, were well aware that these technologies did not actually reduce harm. In fact, they were designed “to promote cigarette sales by reassuring a concerned public that the new products were safer…The negative consequences of these acts remain in cancer and heart disease hospital wards throughout the world.”

Professor Capewell argues that we are passing up the chance to contain a possible epidemic. Few would question the fact that for established smokers e-cigarettes are almost certainly safer than conventional tobacco. However, he believes the manner in which the industry appeals to this group is “a manifest distraction.” 

Most of us wonder why governments and academics are arguing over how to “control” a trend that’s helping millions. The e-cigarette question resonates not only smokers but also those who believe in the same libertarian principles that saw so called “common-sense parties” like UKIP effect their recent electoral earthquakes.  

Capewell and others like him suggest that big corporations are less interested in this point than they let on.

“What tobacco companies are really prioritising is the recruitment of new smokers,” Capewell adds. “They are looking to get new people hooked and addicted…the whole point of the tobacco companies buying up the e-cigarette companies is that they can then control the price of both products. Having reached that point, they can then titrate their prices, to maximise profit from place to place, and year to year.”

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Professor Capewell is a leading figure in the public health community and not a conspiracy theorist. His argument is not only corroborated by the Faculty for Public Health’s new Policy Statement on Electronic Cigarettes, but reiterated in the letter to the World Health Organisation signed by experts from around the world. They have recently been joined by the British Medical Association and several others, all of which state clear examples of e-tobacco’s agenda.

If its priority is really to provide smokers with a less harmful alternative to tobacco, why are 200 brands selling 200 different flavours, with images and strap-lines which are startling similar to tobacco adverts? When British American Tobacco’s subsidiary, CN Creative, opened the Vype Social nightclub as part of its £3.6 million campaign to promote the e-cigarette didn’t its message of “Sociability Reborn” appeal to some who were not smokers?        

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One, a senior British lecturer who has been drawn into interactions with the industry and does not wish to be named, neatly sums up the debate: “When journalists were put onto me, I would talk to them about the measures which were needed in order to study, let’s say, the effects of electronic cigarettes… That’s not a quick discussion. If they phone a publicist, he will say, ‘Regulation? Yes, we’ve got a couple of early studies. I’ll send them… Now, these studies may be of no value to anybody, but to that journalist they look fine. He’s going to quote them, and I don’t blame him.”        

Ian Siragher is the CEO of Agenda1 Analytical Services, a commercial laboratory that has worked on the development of several electronic cigarettes. Siragher will not disclose his clients, but instead observes some general trends he feels are worth considering, not least because they show how regulation is the only way to ensure that users vape safely.

Using a rough equation, Siragher approximates that one drop of typical liquid nicotine is the same — or 2.5 times stronger — than a packet of cigarettes. Sophisticated filters, puff size and other personal characteristics, mean the size of the nicotine hit varies wildly. Siragher believes that it’s very difficult to gauge with any degree of accuracy just how much nicotine is reaching a user’s lungs.   

“When you smoke a cigarette you get broadly the same dose of nicotine with each cig. When you fill up and puff on an e-cig, much of the sense of scale about the amount of nicotine absorbed is lost.” 

Siragher goes on to say he thinks these new products are safer than cigarettes, but also “that we are leaping from one bad thing to something we are not sure about. By enforcing reasonable control standards we might be able to capture the good in a more quantifiable and less uncertain way.”

Electronic cigarette manufacturers seem to broadly favour regulation in some form. Indeed, one positive aspect of the wholesale buyout of the business might be the production of safer products.

Jeff Holman is chairman and CEO of the American company Vapor Corp, whose brands include Krave, VaporX, Hookah Stix and Alternacig. On 9 June, Vapor Corp became the second publically traded company on the NASDAQ, engaging in what they describe as “the electronic cigarette and Vaporizer space”.

Holman is fanatical about “pure play”, or the idea that his company are the only ones giving a straight message to both consumers and investors. He believes that recent legislation from the US Food and Drug Administration (FDA) has been a positive step for the industry. 

“The FDA was true to its word when it indicated that the proposed set of regulations would be based upon science. The basic tone of the proposed regulations is to restrict access to minors, which we are in complete agreement with and have been since day one. A very important dynamic, however, is that the FDA does not appear to be attempting to restrict access to adults. Products will have to carry a nicotine warning.”

The European market is not yet subject to any such restrictions. New laws for ordinary tobacco (which were approved on 26 February) will require picture warnings to cover 65 per cent of their products’ packets. Flavoured cigarettes will be banned — including menthols — and nicotine levels will be capped. The continued tightening of restraints on tobacco are eliminating the purpose of branding. We are witnessing the cigarette’s last stand.

But the decline of tobacco is being matched by the rise of electronic cigarettes. The same conglomerates that own these products are enjoying unprecedented freedom in the way they promote them. By October 2014, when the World Health Organisation decides whether to control e-cigarettes in the same way as tobacco, they won’t just be fighting smokers, but the new forces of nicotine. Trusting them, at this very early stage, is not only premature but crushingly naïve.

“There were 30 flavours; now there are 50. Strawberry, honey? Bubble-gum? Just for adults? Who are we kidding here?” Professor Capewell wonders. “This is when we get into the real safety issue. Imagine if even 10 per cent of those children become addicted to nicotine, of which half then become lifelong smokers. That equates to tens of millions across the globe. Isn’t that a public health disaster in itself?”

Esquire Weekly, our new iPhone and iPad edition, containing 100 per cent original content, is published every Thursday on the Apple Newsstand. Get your copy today by downloading the Esquire UK app to your iPad and buying an individual copy for 99p or taking out a three-month, six-month or year’s subscription (all of which include digital copies of the monthly magazine).


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