E cigarettes

May 24, 2013

The safety of smoking substitutes remains hazy, as does Big Tobacco’s motives, writes Melissa Davey.

It would be the holy grail for Big Tobacco.

For decades, tobacco companies have been trying to create a “safe” substitute for cigarettes.

Since strong evidence emerged linking smoking to lung cancer in the ’60s – though doctors had suspected the link since much earlier – Big Tobacco has been scrambling to develop a non-toxic substitute as cigarette sales eventually began to drop.

In 1973, the National Newsagent described how “the race to find a suitable substitute that’s not harmful to health has now taken on a fresh drive, with the recent announcement that Imperial Tobacco Ltd and ICI are soon to begin production of NSM – New Smoking Material – a tobacco substitute made from cellulose.” The headline read, “Safe Smoking is on the Way”.

So what happened to these cigarette substitutes, in which a portion of the tobacco was replaced with cellulose derived from eucalyptus and wattle trees? Public health expert Mike Daube, who was interviewed for the National Newsagent article, told Fairfax Media the products were far from safe.

“The massive promotion of these products provided enormous distraction from anti-smoking efforts,” said Daube, a professor of health policy at Curtin University in Western Australia.

“But it turned out that when these products came onto the market, they were much the same as ordinary cigarettes in terms of their tar and nicotine content. In one sense, they were a failure in that they disappeared from the market, but it was also quite a success for tobacco companies, who got massive publicity for the idea that a safe cigarette was just around the corner.”

Electronic cigarettes, known as e-cigarettes, are the latest product on the market being touted as a safe alternative, although health professionals prefer the term “harm reducing”.

Battery-powered cigarette lookalikes, they convert a nicotine liquid into vapour, and they don’t need to be lit by a flame. They provide a hit of the addictive nicotine but don’t contain many of the other harmful substances found in cigarettes, such as carbon dioxide and tar. The amount of nicotine delivered varies depending on the cigarette and the level of nicotine in the liquid.

Unlike nicotine replacements, such as patches and gums, their safety has yet to be proven. No brand of electronic cigarette has been authorised by the Therapeutic Goods Administration in Australia, which states on its website that nicotine is classified by law as a dangerous substance and that the quality, safety and performance of e-cigarettes have yet to be proven.

In Australia, e-cigarettes are classified as therapeutic goods, which are illegal unless they have been approved by the administration. But the device itself is legally available here, as long as it doesn’t contain the nicotine substance. Users usually buy the solution separately from overseas suppliers, which do not have to adhere to Australian standards.

Many of the e-cigarette companies are owned by Big Tobacco. Altria, who owns Marlboro, announced it would be rolling out its own brand of e-cigarettes this year. Tobacco companies are also buying existing e-cigarette companies. Last year, Lorillard paid $135 million to buy blu eCigs.

In February, a New Scientist editorial praised tobacco companies for staking their claim in the e-cigarette industry.
“It may be distasteful to watch a tobacco company spearhead a campaign for cigarette harm reduction,” it said. “But action is sorely needed. If the evidence stacks up, they should be given the benefit of the doubt – for now.”

There has been growing support for e-cigarettes among anti-tobacco groups and health experts, who believe that because they are less harmful, they should be made available alongside other quit aids, such as nicotine patches and gum.

But Professor Daube described the sentiment in the New Scientist editorial as “naive”. “There is little doubt that e-cigarettes are far less dangerous compared with regular cigarettes because you’re essentially inhaling nicotine vapour rather than combusted tobacco smoke that’s full of other cancer-causing chemicals,” Professor Daube says.

“But I’m saying ‘less dangerous’, not that the products are safe. Nicotine is not a benign chemical. And while patches and lozenges have been tested and thousands of studies have been carried out to make sure they are safe in the doses being used, we still don’t have strong enough evidence for the safety of e-cigarettes.”

The buying of e-cigarette firms by Big Tobacco is not a noble attempt to mitigate decades of death caused by cigarettes, Professor Daube says. It is a totally commercial strategy, he says, one that is not motivated by harm reduction.

“They’re not talking about substituting cigarettes for e-cigarettes,” he says. “They’re talking about using these products as well as cigarettes. Through e-cigarettes, they know they can get back into workplaces and restaurants. They’re promoting e-cigarettes as a way to smoke in places that you otherwise can’t.”

And it’s not just smokers being targeted, says Professor Daube, who advocated the plain packaging of tobacco in Australia, implemented last December. Colourful e-cigarettes adorned with decorations could be seen as a way to make cigarettes attractive to younger consumers, targeting people who may never have smoked but may, through attractive marketing, feel compelled to try an e-cigarette.

And with celebrities jumping on board to advertise the products, some e-cigarette commercials are reminiscent of James Dean sucking on a Camel. In a YouTube advertisement by e-cigarette maker NJOY, singer Courtney Love is reprimanded by the hostess at a well-to-do function for smoking rebelliously indoors. “Effing relax,” Love tells her, “it’s an NJOY.” It may be hard for viewers to tell it isn’t an actual cigarette that Love is smoking, however, until the final screen grab, which describes NJOY as the “premium electronic cigarette”.

In a paper recently published in the Journal of Health Economics, Dhaval Dave reported suggestive evidence that the use of smokeless tobacco products had increased for groups traditionally considered at low risk of using them.
“Some of the issues with smokeless tobacco overlap with e-cigarettes,” Dave, an associate professor from the National Bureau of Economic Research in the US, says.

“In most cases, e-cigarettes are not marketed as smoking-cessation aids. Marketing in the US has focused on the advantage of e-cigarettes being able to be consumed where cigarettes are not permitted.

“The question is, are e-cigarettes a potential cessation aid that can help smokers reduce or quit the habit, or are they a substitute for smoking where cigarettes are not permitted, thus making it harder for smokers to quit fully? That is the relevant question for public health.”

As for Professor Daube, his view remains largely unchanged from when he was interviewed four decades ago by National Newsagent.

“The only safe cigarette is the one you don’t smoke,” he says. “Of course, we’ve got to be open to anything that encourages smokers to quit, but those products need to be tested. And we know that the majority of successful quitters are able to do so completely unaided.

“If we have learnt anything over all these years, it’s that Big Tobacco will do anything to keep people smoking.”