Professor Jean-François Etter discusses the evolving e-cigarette and vaporizer market. He notes that major tobacco companies like Philip Morris and British American Tobacco are now major players in the e-cigarette industry through brands like iQos and Voke. Independent research on these new products is needed, as the tobacco industry's past shows a history of deception. Frameworks for managing conflicts of interest are crucial to preserve the integrity of research and public trust. Academia must thoughtfully rethink interactions with industries producing nicotine and tobacco vaporizers.

1. Prof Jean Francois Etter
Professor of Public Health
University of Geneva

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. 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. 3 broad types of e-cigarettes, but no distinction is made in many sales statistics, user surveys
Cig-alike:
Tanks, vaporizers:
Mods:

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. 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. 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. 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. = cig-alike

10. USA: dollar share by company: convenience stores
and XAOC = expanded all outlets combined
(Nielsen bar code data)
Lorillard
Reynolds
Logic
NJoy
Altria

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. 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

14. 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)

15. iQos = Philip Morris
heated tobacco product

16. Pharmacokinetics: Philip Morris iQos
Same speed as tobacco cigarette
= iQos

17. Voke = Nicoventures (BAT)

18. Voke: pharmacokinetics
Delivery twice as quick as for Nicorette inhalator

19. Ploom: tobacco vaporizer commercialized by Japan Tobacco

20. 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 ?

21. 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’

22. Science + regulation are part of the tobacco industry’s business model

23. Regulation: part of the tobacco
industry business model

24. 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

25. 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 ?

26. 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

27. 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.)

28. 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