Category Archives: Tobacco

Juul: Does new e-cigarette save or cost lives?

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The rapid growth of a new brand of e-cigarette known as Juul has attracted media and public health advocates’ attention.  According to The New York Times, school officials, struggling to control an explosion of vaping among high school and middle school students across the country, fear that the devices are creating a new generation of nicotine addicts.

Since launching about two years ago, reports BuzzFeed News, Juul has become one of the hottest e-cigarettes on the market. It’s been called “the iPhone of e-cigs” and it has gained somewhat of a cult following among young adults. Shaped like a USB device and easy to conceal, Juul is made by a San Francisco-based company that has received venture capital money.

Following the playbook of cigarette and alcohol manufacturers, who long ago learned that the best way to market their products to children and young people was to claim they were only for adults, Ashley Gould, the chief administrative officer of Juul, told the Times that the company’s products are intended solely for adults who want to quit smoking. Among the flavors Juul markets are fruit medley and crème brulee.

A new study published in PLOS One assesses the net gains and losses from the spread of  vaping.  The authors calculated the expected years of life gained or lost from the impact of e-cigarette use on smoking cessation among current smokers and transition to long-term cigarette smoking among never smokers for the 2014 US population cohort.  Their conclusion: “e-cigarette use currently represents more population-level harm than benefit. Effective national, state, and local efforts are needed to reduce e-cigarette use among youth and young adults if e-cigarettes are to confer a net population-level benefit in the future.”

To counteract the rapid spread of e-cigarettes, seven public health and medical groups, and several individual pediatricians, filed suit in federal court in Maryland challenging a U.S. Food and Drug Administration (FDA) decision that allows electronic cigarettes and cigars – including candy-flavored products that appeal to kids – to stay on the market for years without being reviewed by the agency. According to Industrial Safety and Hygiene News,  The lawsuit was filed by the American Academy of Pediatrics and its Maryland chapter, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, Campaign for Tobacco-Free Kids, Truth Initiative and five individual pediatricians.

Although the groups strongly support the FDA’s new efforts to reduce nicotine levels in cigarettes to minimally or non-addictive levels, they also believe that the FDA’s August 2017 decision to exempt e-cigarettes and cigars from agency review for years to come is unlawful and harms public health.

PMI’s Foundation for a Smoke-Free World and the Future of Public Health Research

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Dr. Derek Yach at the launch of the Foundation for a Tobacco Free World credit

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Last September, Phillip Morris International , which calls itself the “world’s most successful cigarette company”, announced that beginning in 2018, it would contribute about US$80 million annually over the next 12 years to create the Foundation for a Smoke-Free World with the goal of accelerating “progress in reducing harm and deaths from smoking worldwide.”  Derek Yach, whose credits include serving as a key architect of the WHO’s Framework Convention on Tobacco Control and a stint as Senior Vice President for Global Health and Agriculture Policy at PepsiCo, was hired to serve as President of the new foundation.

Within the public health and tobacco control community reaction to the new foundation has been divided—mostly negative.

Writing in The Wire, an independent news platform based in India, Anoo Bhuyan summarized some of the reactions:

Philip Morris International is attempting to distribute nearly $1 billion for research on reducing smoking. But the grant is being called a “billion dollar bribe” of “blood money,” a “wolf in sheep’s clothing,” a “smokescreen,” a “public relations stunt” and the “height of hypocrisy.” The American Cancer Society  has even called it a “new twist out of the tobacco industry’s deadly playbook”, while the World Heart Federation says it is  a “vehicle for the tobacco industry.” One anti-smoking group said “the tobacco epidemic will never be ended by its perpetrators.” Another found it so unbelievable they said it “truly sounds like fake news.”

A number of top universities in the US and UK have said they will not be accepting this research funding as it clashes with their ethics policies. Columbia University remained non-committal on the issue. However, one scholar at Harvard’s prestigious T.H. Chan School of Public Health told The Wire that they are “discussing” if it violates their 15-year-old policy of rejecting funding from the tobacco industry. He added, however, that the university’s ban on tobacco industry funds remained firmly in place.

In a blog for the British Medical Journal, Richard Smith, who served as editor of that journal until 2004, offered a different opinion:

There is a logic to Yach’s move. It will probably never be possible to achieve a nicotine-free world, not least because people with severe mental health problems find benefit from nicotine…. But with the arrival of e-cigarettes it may be possible to achieve a tobacco-free world. E-cigarettes might be harmful, but even the most ardent anti-tobacco campaigner would agree that it’s the smoke not the nicotine that kills. The appearance of e-cigarettes is changing the world of tobacco as railways changed canals and digital images changed film. How should tobacco companies react? …Philip Morris International seems to have bet that e-cigarettes will be the future, and so there is business logic to funding a Foundation for a Smoke-Free world. Unfortunately, there is also a business logic to continuing to block attempts to reduce cigarette consumption in markets where e-cigarettes have yet to make inroads.

This two-faced attitude will seem unacceptable to many, but if the foundation can achieve real independence from the company then much can be achieved with $1 billion. Many foundations have little or no independence from their companies, but I believe that it is possible to achieve true independence with the right governance—at least if the money is committed for 12 years.

The debate about BMI’s billion dollar investment mirrors a larger dispute about e-cigarettes and the future of the tobacco/nicotine industry and of tobacco/nicotine control.  A few recent reports illustrate the scope of the conflict.

In a special report on Philip Morris research on e-cigarettes, Reuters questioned the quality of the research PMI has sponsored to justify its new smoking devices to the US Food and Drug Administration and other regulatory agencies.

Tamara Koval, who worked at the company from 2012 to 2014 and helped coordinate clinical trials for the device, questioned the quality of some of the researchers and sites contracted to carry out those experiments. Koval was a co-author of the company’s protocol used to run the studies globally. When she highlighted an irregularity in one of the studies, Koval said, Philip Morris excluded her from meetings.

Reuters also found irregularities during interviews with some of the principal investigators contracted to conduct the trials for the company. One principal investigator said he knew nothing about tobacco. Philip Morris had to jettison the experiment that investigator performed after it emerged he hadn’t followed a basic procedure for obtaining informed consent from participants during clinical trials.

The allegations raise questions as to whether despite its new foundation, PMI is following its old strategy of distorting science to achieve its business goals.  David Kessler, a former FDA commissioner told Reuters, “taken as a whole, it’s clear they do not have the sophistication to carry out adequate and well-controlled clinical trials.”

The conflicts about PMI and e-cigarettes also raise larger questions for the public health community:

  1. What might be the consequences of creating corporate sponsored research foundations at the same time as the federal government is cutting public health regulations and the agencies that support them?
  2. How will private corporate-sponsored philanthropy influence government decisions about public research funding?
  3. What effect will corporate -sponsored research foundations—however rigorous and independent their research—have on public trust of science and scientists?

As tobacco control activists debate the specific questions of how to respond to PMI’s new Foundation for a Smoke-Free World, it is important to also pay attention to the longer-term consequences of corporate funding for  public health research.

 

Nicholas Freudenberg

Corporations and Health Watch

 

 

 

 

 

Breaking News: Tobacco kills 1,200 Americans a day

Eleven years ago, writes historian Robert Proctor in The New York Times, a Federal District Court judge in Washington concluded after a nine-month trial that cigarette makers had committed fraud and violated racketeering statutes in a decades-long conspiracy to deceive the public about the dangers of smoking.  Judge Gladys Kessler didn’t mince words, ruling that Philip Morris and other tobacco companies had “marketed and sold their lethal product with zeal, with deception, with a single-minded focus on their financial success, and without regard for the human tragedy or social costs that success exacted.”  This week, newspapers and television networks will begin carrying five “corrective statements” ordered by the court, shown above as printed in The Times. Altria, R. J. Reynolds, Lorillard and Philip Morris will be required to run statements five times a week on weekdays for one year on CBS, NBC and ABC; the statements will also appear in full-page ads on five Sundays between now and March in more than 50 leading newspapers.

Despite the corrective statements, tobacco companies still spend far more money persuading people to smoke than warning of the dangers.  And, as Wall Street Journal columnist Jo Craven McGinty noted, “the nation’s 92 million millennials and teenagers may not get the message because the ads will run primarily  on network television and newspapers.  ‘That’s not where young people’s eyeballs are’, said Robin Koval, CEO and President of Truth Initiative, a nonprofit organization that campaigns against youth smoking.”

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Taking the Overseas Blinders Off Corporate Governance

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In its annual Good Governance report, writes Fair Observer, the Institute of Directors  assesses the United Kingdom’s largest listed companies against indicators that include board effectiveness, audit and risk accountability, remuneration, shareholder relations and stakeholder relations. Ironically, the IoD index’s top performers often come from the alcohol and tobacco industries. This year’s report gave pride of place to the distiller Diageo and the 2016 winner was British American Tobacco (BAT). The IoD’s standards may be appropriate for how these companies behave in London. In Kinshasa, Kampala and Juba, though, the praise of BAT surely raises eyebrows. As the rest of the world has learned over the intervening months, above-board corporate behavior in the UK does not guarantee ethical conduct elsewhere. Over the summer, The Guardian revealed in a series of explosive investigative pieces that BAT (as well as other multinational tobacco firms) has been ruthless in staking out market share and seeing off health regulations in African markets. BAT and its allies have threatened governments in some eight African countries to counteract policies that have underpinned public health initiatives in Western markets.

Countermarketing Unhealthy Food: An Effective Strategy for Preventing Noncommunicable Diseases? Lessons from Tobacco

Image from Youth Food Educators of East Harlem

Countermarketing campaigns use health communications to reduce the demand for unhealthy products by exposing motives and undermining marketing practices of producers. These campaigns can contribute to the prevention of noncommunicable diseases by denormalizing the marketing of tobacco, alcohol, and unhealthy food. By portraying these activities as outside the boundaries of civilized corporate behavior, countermarketing can reduce the demand for unhealthy products and lead to changes in industry marketing practices. Countermarketing blends consumer protection, media advocacy, and health education with the demand for corporate accountability. Countermarketing campaigns have been demonstrated to be an effective component of comprehensive tobacco control. This review describes common elements of tobacco countermarketing such as describing adverse health consequences, appealing to negative emotions, highlighting industry manipulation of consumers, and engaging users in the design or implementation of campaigns. It then assesses the potential for using these elements to reduce consumption of alcohol and unhealthy foods.

Full citation: Palmedo PC, Dorfman L, Garza S, Murphy E, Freudenberg N. Countermarketing Alcohol and Unhealthy Food: An Effective Strategy for Preventing Noncommunicable Diseases? Lessons from Tobacco. Annu Rev Public Health. 2017;38:119-144.

New York City Is Oversaturated with Licensed Tobacco Retail Outlets

For more than a decade New York City has led a historic and successful effort to reduce smoking, driving down smoking rates to historic lows. Despite these efforts, about 950,000 people still smoke and significant disparities persist by education, household income and mental health.  One reason why tobacco use is still the number one cause of preventable disease and death in New York City is the overwhelming number of places where tobacco can be legally purchased in the five boroughs.  In a new report, the American Cancer Society Cancer Actions Network recommends that New York City should:

• Establish a cap on retail tobacco licenses

• Restrict access near youth-service entities

• Restrict retail outlet proximity to each other

• Restrict all tobacco sales in pharmacies

• Add restrictions on other tobacco products

Why Many Tobacco-Friendly Business Groups Are Now Switching Sides

The local chamber of commerce is usually a reliable ally in battles against regulation. But when it comes to smoking rules, many business groups have decided they would rather switch than fight, reports Reuters. Even in states where tobacco has played an important role in the economy—including North Carolina, Kentucky and Missouri—chambers have endorsed cigarette tax hikes, raising the smoking age and other efforts to curb tobacco habits. The shift has accelerated since 2016, driven by a growing awareness that smoking drives up healthcare costs for employers, business groups said. Smoking restrictions often are part of broader wellness initiatives, such as promoting exercise and nutrition, aimed at improving health—and business. “Smoking isn’t just killing us, it’s bankrupting us,” said Ashli Watts, a spokeswoman with the Chamber of Commerce for Kentucky, where one in four adults uses tobacco, the lung cancer rate is the nation’s highest and related healthcare and lost productivity costs nearly $5 billion a year. “Companies do look at the health of a workforce,” Watts said. An unhealthy workforce “is a deterrent.”