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Professor J.F. Etter - E-Cigarette Summit 2014

Professor J.F. Etter presentation E-Cigarette Summit 2014

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Professor J.F. Etter - E-Cigarette Summit 2014

  1. 1. Prof Jean Francois Etter Professor of Public Health University of Geneva
  2. 2. Prof. Jean-François ETTER, PhD Faculty of Medicine University of Geneva, Switzerland E-cigarette Summit, London November 13, 2014 Product diversity, user behavior, players in the e-cig market
  3. 3. Conflicts of Interest Tobacco industry: - never received any funding, no CoI Pharmaceutical industry - no funding in past 8 years, no CoI E-cigarette industry - plane ticket + hotel (London + China, 2013) - no honorarium
  4. 4. 3 broad types of e-cigarettes, but no distinction is made in many sales statistics, user surveys Cig-alike: Tanks, vaporizers: Mods:
  5. 5. Speed of nicotine delivery to the blood: 1st generation e-cig, 2nd generation e-cig, tobacco cigarettes Source: Farsalinos et al Sci Rep. 2014; 4: 4133
  6. 6. Machine tests: depending on puff conditions and product features, ECIG can provide far less or far more nicotine than a tobacco cigarette (50-fold variation). Talih et al. Nicotine & Tobacco Research, Sept 2014
  7. 7. E-cig global sales, $ million 2014: probably $5 billion <1% of tobacco cigarette market 190 350 700 1200 240 160 150 100 480 770 950 1200 0 500 1000 1500 2000 2500 2010 2011 2012 2013 USA China International (source: Philip Morris)
  8. 8. England: prevalence of electronic cigarette use: smokers and recent ex-smokers 8 0 5 10 15 20 25 30 35 40 45 50 Percent of smokers and recent ex- smokers Any Daily Growth in prevalence of e-cigarette use has not increased since Q3 2013 N=14490 adults who smoke or who stopped in the past year; increase p<0.001 Source: STS - Smoking Toolkit Study
  9. 9. = cig-alike
  10. 10. USA: dollar share by company: convenience stores and XAOC = expanded all outlets combined (Nielsen bar code data) Lorillard Reynolds Logic NJoy Altria
  11. 11. UK e-cigarette retail market share (%) Total U.K. retail market, including U.K. Major Multiples, Household, Impulse and Chemist Channels, 52 weeks ending Sept 2014. Source: Wells Fargo 33.6 32.8 11 6.7 3.3 2.1 1.9 1.4 1.4 1 0.9 0.9 3 UK 2014 Ecig Group (FIN, VIP, Ten Motives) Nicocig - PMI E-Lites - Japan Tob Halco blu - Lorillard Gamucci BAT Vapouriz Dekang NJOY Vapourlites Supreme Imports Other
  12. 12. Tobacco company Brands of e-cigarette / vaporizers Altria MarkTen Green Smoke Reynolds + Lorillard, merged July 2014 Vuse SkyCigs Imperial Tobacco Blu (sold by Lorillard) Puritane + intellectual rights on Dragonite Japan Tobacco Ploom (tobacco vaporizer) E-Lites Philip Morris Nicolite iQos (heat not burn) + partners with Altria / MarkTen British American Tobacco Vype Intellicig (CNCreative) Voke (Nicoventures) ITC (Imperial Tobacco Company of India) Eon NTC (National Tobacco Company, distributor of Zig-Zag cig. paper) V2 Cig
  13. 13. New nicotine + tobacco vaporizers: no combustion of tobacco Nicotine vaporizers, without tobacco: 1.E-cigarettes (3 broad categories: cig-alike, tank, mod) 2.Nicotine vaporizer using the technology of asthma vaporizers VOKE (Nicoventures = BAT: British American Tobacco): 3.Nicotine pyruvate (chemical reaction that vaporizes nicotine, Jed Rose) (PMI: Philip Morris, under development) Tobacco vaporizers: 1.Heated tobacco products, «heat not burn»: - electric heating (e.g. iQos by PMI, Chinese models) - charcoal heating (ember) 2.Hot air flow - Nespresso-like cartridge (Ploom: distributed by Japan Tobacco) - loose tobacco (various brands of vaporizers)
  14. 14. iQos = Philip Morris heated tobacco product
  15. 15. Pharmacokinetics: Philip Morris iQos Same speed as tobacco cigarette = iQos
  16. 16. Voke = Nicoventures (BAT)
  17. 17. Voke: pharmacokinetics Delivery twice as quick as for Nicorette inhalator
  18. 18. Ploom: tobacco vaporizer commercialized by Japan Tobacco
  19. 19. Snus: first FDA application as reduced risk product (Swedish Match) For FDA registration as reduced risk product, applicant must show that: - the product is less harmful to the individual user - the total effect on the population is beneficial Very costly process, very long Will e-cig / vaporizers follow ?
  20. 20. Philip Morris: 4 new reduced risk products See presentation on PM Investor’s day 2014: https://www.media-server.com/m/instances/8hjnb6wm/items/29n825fv/assets/75ngrwuk/0/file.pdf iQos Coal ember Nicotine pyruvate E-cig ‘cig-alike’
  21. 21. Science + regulation are part of the tobacco industry’s business model
  22. 22. Regulation: part of the tobacco industry business model
  23. 23. Tobacco industry involvement New situation: tobacco industry sells reduced risk vaporizers Science Huge investments in R&D on vaporizers ($2bn for PMI only) Regulation Intense lobbying (EU, US, nationally) Large numbers of experienced, professional lobbyists Long tradition, historically strong influence on tobacco laws Suspicion that aim of tobacco industry involvement in regulation is to: . avoid “unfriendly” rules . raise technical + legal barriers at entry in this market . eliminate (Chinese) competitors + small players
  24. 24. Tobacco industry: history Denied - that nicotine is addictive - risks of smoking - risks of passive smoking Produced bogus science Artificially created controversy, confusion Deception campaign to block smoking bans Will e-cig / vaporizers enable the tobacco industry to re-emerge as a legitimate stakeholder ?
  25. 25. How to react to tobacco industry involvement ? Science: Need for independent research, not just research conducted by tobacco industry + its subsidiaries If collaborations emerge between academy + industry, there is a need to define conditions / limits Transparency is crucial Follow example of guidelines for academic collaboration with pharma industry A framework is needed to manage conflicts of interest
  26. 26. Management of conflicts of interest Goals = protect the integrity of research, = preserve public trust Core principle = transparency Declaration of conflict of interest + registration of studies = insufficient Define policies, rules and restrictions, code of practice Rely on organizations / institutions that define + enforce + monitor these policies (national academy of sciences, ethics committees, etc.)
  27. 27. Perspectives New situation: are we prepared ? We have no choice but to rethink academic + political interactions with the industries that produce nicotine + tobacco vaporizers Need for transparency Need to develop rules, policies Need for a debate involving all stakeholders

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