E-Cigarette – The next century of smoking.

As the city of New York on 19th December rolled out legislation to ban the use of E-Cigarettes from indoor public spaces where smoking was already banned, it did so to recognise that smoking and ‘vaping’ – the coined term referring to the use of E-Cigarettes – are more or less one and the same. E-Cigarettes or electronic cigarettes look like traditional cigarettes but instead of paper and finely chopped dried brown tobacco leaves, they are metal tubes containing a nicotine liquid solution which vaporises and delivers nicotine to the user with each puff.

Inevitably, E-Cigarettes are cleaner as no paper or tobacco is burnt during use and vapour not smoke is released as user puffs. Likewise, there is no ash and as the tubes are reusable, there is no litter. The key difference however, and major attraction of E-Cigarettes is that they deliver nicotine without carbon monoxide or the carcinogenic tar making up the concoction of about 7000 toxins, which according to the US Surgeon General, accompany traditional smoking.

For these reasons along with clever marketing which has placed the product in the market as an enabler to assist smokers quit, there has been and continues to be a boom in E-Cigarettes and the market for these devices has been estimated by Wells Fargo to reach $10 billion US by 2017.

Many industry analysts suggest that this new tobacco product channel could not have come at a better time for the tobacco industry which thanks to campaigns and ever tighter regulation has been witnessing year on year declines in the smoking population of some key markets.

Historically tobacco was chewed, sniffed, or smoked in pipes and cigars. While early in the twentieth century, cigarettes (slimmer cigars) were but a fraction of all tobacco consumed, a century later, early in the twenty-first century, the amounts of cigarettes consumed by the ever increasing world population had grown to 15 billion cigarettes per day, in a world producing about 6 trillion cigarettes per year.

By the latter half of the last century, however, tobacco had been successfully linked to a plethora of medical conditions first famously outlined in the January 1964 US Surgeon General’s report. To date, 29 other such reports have chronicled a list of “health consequences and diseases”, attributed to smoking. These cancers including tracheal, bronchial and lung or chronic diseases such as coronary heart disease, pulmonary disease and pneumonia are some of the causes of the 6 million annual deaths worldwide, which according to the WHO report on the Global Tobacco Epidemic (2013), are directly linked to smoking.

In what could be construed as recognition of the alarming success of tobacco companies in increasing the number of people addicted to nicotine in the twentieth century, countries comprising the World Health Organization passed Resolution 49.17 in 1996 to create a ‘Framework Convention on Tobacco Control’, FCTC. This convention which targets both demand and supply reduction was adopted in May 2003 and came into force in February 2005. Through the WHO tobacco control program more countries have signed up to implement one or more of the tobacco demand reduction measures popularly known by the acronym, MPOWER. (Monitor tobacco use and prevention policies; Protect people from tobacco smoke; Offer help to quit; Warn about the dangers of tobacco; Enforce bans on tobacco advertising, promotion and sponsorship; Raise taxes on tobacco).

As at 2012, the WHO reports varying levels of commitment to MPOWER tobacco control policies across the world. The highest level is seen in the deployment of cessation program, as some 93% of countries are reported to have policies offering tobacco users help to quit. Further pressures on the tobacco industry includes the increasing number of countries signing up to enforce smoke-free environments (53%) and many more governments having curbs on cigarette advertising (66%). But these pressures would not be worth much without policies aimed at the bottom-line of the tobacco industry and the WHO reports that 77% of countries use taxation as a tobacco control policy.

Thus with 90% of the world governments actively monitoring tobacco use with a view to feeding data captured into the growing efforts geared towards an ultimate smoke-free world, it is a cause for concern for those doing business at various points of the cigarette supply chain because incremental success of global policies like MPOWER will increase challenges to the tobacco industry’s margins and ultimate sustainability which requires a stream of new addicts to replace those who have quit or died.

A case in point for the industry-sustainability challenge being the figures from the US Centre for Disease Control which show that in 2012, the proportion of smoking US adults had dropped to 18% from 24.7% five years earlier. Similarly, in the UK, data from the Office of National Statistics show that the smoking rates across genders and age groups in the United Kingdom all but halved to about 22% in the last four decades. Furthermore, between 1990 and 2009, cigarettes consumption in Western Europe dropped some 26%.

Despite these encouraging statistics to organisations like WHO, ASH and the Lung Foundation, any thoughts of eradicating what the WHO terms ‘the tobacco epidemic’ is quite simply – no pun intended – a pipe dream. There is still a lot of work to do particularly in the lesser developed areas of the world. For example, in the same period that tobacco consumption in Western Europe dropped, it increased in Africa and the Middle East by 57%.

The difference arising not only out of education and regulation but also from the price drop in real terms in some populous smoking regions like India, China and Nigeria as the Tobacco Atlas, compiled by the World Lung Foundation and The American Cancer Association, shows that annual per capita consumption of cigarettes is highest in countries with some of the lowest prices.

Perhaps in recognition of increasing regulation or the facts – that according to WHO, tobacco kills half of its users; or that 80% of the world’s smokers live in low to middle income countries; or that smoking is decreasing in some high to middle income countries; the reaction (to any or all of these factors) by the cigarette industry has been to invest in new products that exploit novel ways of delivering nicotine.

Such novel nicotine products include nicotine water, nicotine lollies, lozenges, snus, orbs and electronic cigarettes. However research into the toxicity of these products is thin and regulation is light when compared to traditional tobacco products. Thus, in the absence of comprehensive research on the use of E-Cigarettes, users currently ‘vaping’ are submitting themselves as guinea pigs to the rapidly growing E-Cigarette marketers. That status however, is one which carries a lot of risk because the contents of E-Cigarettes have been found by the US FDA to contain substances such as diethylene glycol (generally used as antifreeze), which is harmful to humans.

Nevertheless, regulatory bodies such as the US Food and Drug Administration (FDA) which regulates cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco is now seeking to also to add E-Cigarettes to its list of regulated tobacco products. Also, the EU which failed to get E-Cigarettes tightly regulated as medical devices in October, was notwithstanding successful in agreeing on (larger) health warnings on the pack of E-Cigarettes. The EU has also imposed a ban on fruity flavoured tobacco products. In the UK the British Medical Association (BMA) has given a cautious welcome to the Medicines and Healthcare products Regulatory Authority announcement to regulate all nicotine containing products including E-Cigarettes and to press for research into their use.

The debate on E-Cigarettes therefore revolves around the arguments put forward by the likes of Miguel Martin, President of Logic Technology, who argued on CNBC that E-Cigarettes actually help combustion based tobacco users to quit, with the implication that they are on the same side as organisations working towards reducing the far more harmful use of tobacco.

On the other hand, organisations such as The Lung Association find E-Cigarettes a ploy to keep people addicted to nicotine, as they offer different flavours appealing to young people and they argue that by selling E-Cigarettes as a means to quit smoking, the manufacturers are simply trying to sidestep the regulation that applies to cigarettes. However that was an argument debunked by the CEO of Vapor Corp, Kevin Frija, who said in a CNBC interview that he was all for regulation as that would bring clarity to the industry.

It is certain that traditional cigarettes would not disappear from our shops any time soon, but the smart money has already began moving in the direction of E-Cigarettes and other novel ways of consuming an age old product – tobacco. A case in point is the recent agreements reported by Reuters between Philip Morris and Altria, which allow “licensing, supply and cooperation” between the two companies to bring “electronic cigarettes and other “reduced risk” tobacco products” to the US and international market by midway through 2014.

Like digital cameras, touch-based smartphones, Dyson vacuum cleaners, the E-Cigarette is a potential disruptor in the lives of smokers (20% of people on the planet) and considering that after a century of smoking cigarettes, the numbers of cigarettes smoked increased more than a hundredfold. Therefore, early movers currently manufacturing and marketing E-Cigarettes are ensuring that they have a place in the next century of tobacco consumption, that’s if they’re not obstructed by regulators armed with a new set of rules or rejected by upgraded societal norms and etiquette.

Bristol, UK

Categories: Health

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