Re: E-cigarettes and the marketing push that surprised everyone
Clive Bates is mesmerized by potential health gains in the rise of ecigarettes but won’t countenance any of the serious downsides. He counsels calm about teenage uptake because teenagers have always experimented with adult practices. But he fails to mention that successful tobacco control has reduced teenage smoking to its lowest ever levels (just 4.7% of Australian 12-15 years olds smoke) [1]. This is something not lightly traded.
Bates says we should all be assured that “normal controls” on ecig advertising like those that now apply to alcohol will fix any excesses of “truth and fairness”. Meanwhile, a few teenagers have discovered something Bates appears to have forgotten about: the internet where the normal controls are anything goes. He is apparently being serious here.
The best case scenario for ecigs is now well rehearsed but yet to deliver their promise in critical ways: rapid and spectacular migration from incontestably far more dangerous cigarettes, driven by an unprecedented consumer acceptable nicotine delivery system; negligible harm to others from the exhaled vapour; children who would have taken up cigarettes, taking up ecigs instead; few children “currently” adopting ecigs who would have never started smoking; no ex-smokers nostalgically returning to nicotine via ecigs; and horrible tobacco caused diseases eventually declining far more than now.
The two most important studies on whether ecigs in fact do help people quit cigarettes have failed to go anywhere remotely near the self-selecting anecdotal enthusiasms of those users who have successfully stopped smoking. The recent New Zealand trial showed ecigs were as dismal as NRT in getting people off cigarettes [2] and the only cohort study found no differences between smokers and ecig users in cigarette cessation[3].
A worst case scenario plays somewhat differently. Bates’ heroic ecig start-up cottage industry entrepreneurs successively become instant multi-millionaires as the global transnationals buy them out, as they have always done with minnow cigarette producers. The new owners’ business plans see ecigs as an “as well as” addition to, not an “instead of” to cigarettes, so that nicotine dependent people can dose themselves across every waking hour, unhindered by smokefree areas which stimulate both reduced smoking and cessation [4]. Even better, not harming others, ecigs triumphantly march the smoking performance with its rich semiotic significations back into all the places from which it has been banished for years. For the wide-eyed Bates, there are no collateral benefits to the renormalization of smoking in any of this.
With teenagers being rather fond of electronic gadgetry, and obsessed about products which allow individualized, personality authenticating differences, the industry will have acquired the most stunning set of nicotine training wheels it has ever had. With ecigs and cigarettes made by the same companies and selling from the same outlets, only the utterly naïve could predict with a straight face that the total nicotine load will not increase and dual use will not become a major phenomenon.
Nicotine is being promoted within the ecigarette community as a totally benign drug “as harmless as coffee”. The willful disregard for the large literature on the role of nicotine in angiogenesis, cell proliferation and apoptosis is concerning.
Most tellingly, Big Tobacco continues its virulent, unrelenting global opposition to all potent tobacco control policy, and makes statements to its investors like this November 2012 one from RJReynolds CEO: “We have a little mantra inside of the company . . . which we call the 80-90-90 . . . We spend about 80% of our resources in the combustible space. The combustible space is still 80%, 80+% of our operating income . . . [and] 90% of the organizational focus . . . And despite a lot of these new innovations that you see coming out, 90% of our R&D [research and development] budgets are actually directed at the combustible category . . . “ That is the category that’s still going to deliver a lot of growth into the future.” [6].
The indecent rush to facilitate the growth of ecigarettes may prove to be one of this century’s most myopic and catastrophic public health blunders. I so hope I am wrong.
1. http://www.tobaccoinaustralia.org.au/chapter-1-prevalence/1-6-prevalence...
2. Bullen C, Howe C, Laugesen M, McRobbie H et al . Electtonic cigarettes for smoking cessation: a randomized controlled trial. Lancet September 7, 2013http://dx.doi.org/10.1016/
3. Adkinson SI, O’Connor RJ, Bansal-Travers M, Hyland A et al. Electronic nicotine delivery systems. International Tobacco Control Four Country Study. Am J Prev Med 2013; 44(3) 207-15.
4. Chapman S, Borland R, Brownson R, Scollo M, Dominello A, Woodward S. The impact of workplace smoking bans on declining cigarette consumption in Australia and the USA. Am J Public Health 1999;89:1018-23.
5. Cardinale A, Nastrucci C, Cesario A, Russo P. Nicotine: specific role in angiogenesis, proliferation and apoptosis. Crit Rev Toxicol. 2012 Jan;42(1):68-89. doi: 10.3109/10408444.2011.623150.
6. Moore M Reynolds American's CEO Hosts Investor Day (Transcript)
seekingalpha.com/article/1001691-reynolds-american-s-ceo-hosts-investor-day-transcript 12 Nov 2012. Accessed 13 Jun 2013
Rapid Response:
Re: E-cigarettes and the marketing push that surprised everyone
Clive Bates is mesmerized by potential health gains in the rise of ecigarettes but won’t countenance any of the serious downsides. He counsels calm about teenage uptake because teenagers have always experimented with adult practices. But he fails to mention that successful tobacco control has reduced teenage smoking to its lowest ever levels (just 4.7% of Australian 12-15 years olds smoke) [1]. This is something not lightly traded.
Bates says we should all be assured that “normal controls” on ecig advertising like those that now apply to alcohol will fix any excesses of “truth and fairness”. Meanwhile, a few teenagers have discovered something Bates appears to have forgotten about: the internet where the normal controls are anything goes. He is apparently being serious here.
The best case scenario for ecigs is now well rehearsed but yet to deliver their promise in critical ways: rapid and spectacular migration from incontestably far more dangerous cigarettes, driven by an unprecedented consumer acceptable nicotine delivery system; negligible harm to others from the exhaled vapour; children who would have taken up cigarettes, taking up ecigs instead; few children “currently” adopting ecigs who would have never started smoking; no ex-smokers nostalgically returning to nicotine via ecigs; and horrible tobacco caused diseases eventually declining far more than now.
The two most important studies on whether ecigs in fact do help people quit cigarettes have failed to go anywhere remotely near the self-selecting anecdotal enthusiasms of those users who have successfully stopped smoking. The recent New Zealand trial showed ecigs were as dismal as NRT in getting people off cigarettes [2] and the only cohort study found no differences between smokers and ecig users in cigarette cessation[3].
A worst case scenario plays somewhat differently. Bates’ heroic ecig start-up cottage industry entrepreneurs successively become instant multi-millionaires as the global transnationals buy them out, as they have always done with minnow cigarette producers. The new owners’ business plans see ecigs as an “as well as” addition to, not an “instead of” to cigarettes, so that nicotine dependent people can dose themselves across every waking hour, unhindered by smokefree areas which stimulate both reduced smoking and cessation [4]. Even better, not harming others, ecigs triumphantly march the smoking performance with its rich semiotic significations back into all the places from which it has been banished for years. For the wide-eyed Bates, there are no collateral benefits to the renormalization of smoking in any of this.
With teenagers being rather fond of electronic gadgetry, and obsessed about products which allow individualized, personality authenticating differences, the industry will have acquired the most stunning set of nicotine training wheels it has ever had. With ecigs and cigarettes made by the same companies and selling from the same outlets, only the utterly naïve could predict with a straight face that the total nicotine load will not increase and dual use will not become a major phenomenon.
Nicotine is being promoted within the ecigarette community as a totally benign drug “as harmless as coffee”. The willful disregard for the large literature on the role of nicotine in angiogenesis, cell proliferation and apoptosis is concerning.
Most tellingly, Big Tobacco continues its virulent, unrelenting global opposition to all potent tobacco control policy, and makes statements to its investors like this November 2012 one from RJReynolds CEO: “We have a little mantra inside of the company . . . which we call the 80-90-90 . . . We spend about 80% of our resources in the combustible space. The combustible space is still 80%, 80+% of our operating income . . . [and] 90% of the organizational focus . . . And despite a lot of these new innovations that you see coming out, 90% of our R&D [research and development] budgets are actually directed at the combustible category . . . “ That is the category that’s still going to deliver a lot of growth into the future.” [6].
The indecent rush to facilitate the growth of ecigarettes may prove to be one of this century’s most myopic and catastrophic public health blunders. I so hope I am wrong.
1. http://www.tobaccoinaustralia.org.au/chapter-1-prevalence/1-6-prevalence...
2. Bullen C, Howe C, Laugesen M, McRobbie H et al . Electtonic cigarettes for smoking cessation: a randomized controlled trial. Lancet September 7, 2013http://dx.doi.org/10.1016/
3. Adkinson SI, O’Connor RJ, Bansal-Travers M, Hyland A et al. Electronic nicotine delivery systems. International Tobacco Control Four Country Study. Am J Prev Med 2013; 44(3) 207-15.
4. Chapman S, Borland R, Brownson R, Scollo M, Dominello A, Woodward S. The impact of workplace smoking bans on declining cigarette consumption in Australia and the USA. Am J Public Health 1999;89:1018-23.
5. Cardinale A, Nastrucci C, Cesario A, Russo P. Nicotine: specific role in angiogenesis, proliferation and apoptosis. Crit Rev Toxicol. 2012 Jan;42(1):68-89. doi: 10.3109/10408444.2011.623150.
6. Moore M Reynolds American's CEO Hosts Investor Day (Transcript)
seekingalpha.com/article/1001691-reynolds-american-s-ceo-hosts-investor-day-transcript 12 Nov 2012. Accessed 13 Jun 2013
Competing interests: No competing interests