Category: GTNF

  • Panel: Innovating Products for the Future

    Panel: Innovating Products for the Future

    Discussing the future of innovation in nicotine products is complicated. The industry is innovating at lightning speed, especially in batteries and atomization. However, manufacturers don’t often want to discuss innovations in progress because competition in the next-generation nicotine-delivery segment is fierce. It’s not uncommon for a company to launch a new innovative design only to see its IP stolen and used in counterfeit products.

    During the panel “Innovating Products for the Future,” moderator Eve Wang, executive director of Smoore International and vice president of Shenzhen Smoore Technology Co., questioned five industry experts about how they imagine the future of the vaping industry. The participants agreed that innovation would continue boosting the harm reduction potential of next-generation nicotine-delivery products. Surprisingly, they all willingly shared interesting insights into new product innovation.

    Tao Cui, director of innovation, strategy and compliance at Innokin Technology, said that future vaping products will likely be more individualized, more efficient and more intelligent. He also said that products will continue to become less harmful. He said the heating element is especially an area that will see more innovation.

    “In a perfect scenario, you can control the temperature as low as possible and also precisely control it. And, if you have a much, much less harmful substance, we combine both together, then we have a less harmful product,” he said. “In the future, I would say the products will be more individualized because no one product fits 1 billion people. In the future, your product may adapt to your habits. The product may know if you need more [puffs] in the morning, in the afternoon, today or tomorrow.”

    Cui outlined some potential solutions for sustainability-related issues, including the use of research and development. He proposed that countries that have successfully controlled youth usage could offer insight; they could accomplish this by better regulating flavor names and packaging.

    James Kuang, chief scientist and head of the Life Science Institute at ICCPP, parent to Voopoo vaping products, stated that the innovation of products is needed to balance user experience, harm reduction and environmental protection. “Yes, we should develop some [better batteries] and [e-liquid bases] for that. “We talk about the effective battery …. Can we do something for our environment by developing different [e-liquids]? I say if we can develop some new type of [e-liquid base] … for example, can we use some nature-sourced alcohol? …. Another solution, I think, is a water-based solution. In my opinion, a water-based [solution] may be the best product for the future.”

    Fadi Maayta, president and co-founder of Alternative Nicotine Delivery Solutions (ANDS), stated that the next stage of innovation should be aimed at protecting consumers—especially nonsmokers and ex-smokers—and youth. He noted that it was the responsibility of the industry to ensure it was on the right path to responsible growth. He said that artificial intelligence (AI) could play for both the industry and regulators by helping to better analyze data concerning consumers and product use.

    “I know many companies that invested in applications to link [AI] to the device to tell the consumer how many puffs they took, what’s the health risk. All these apps failed. I don’t see consumers really using it, to be realistic,” said Maayta. “It will help consumers to get more data. It will help companies and factories [know where] to locate and know how to get the right product for the consumers through using that engine but also externally for the regulators and policymakers to get data about these products. It might help in tracking as well, track and trace for the product.”

    When it comes to eco-friendly products, Maayta claimed that a rational vision of environmental sustainability involves four distinct pillars. The first pillar is the product. Manufacturers should use the right elements … cardboard, biodegradable silicon and biodegradable plastics. The second pillar is showing that your claims of eco-friendliness are provable—that they can be substantiated.

    “If you want to claim that your product is recoverable and recyclable, and your product can be recycled to 99 percent, whatever—you [had] better be careful. You are in a very controversial industry, and every word will be tracked,” he said. “You better [be able] to substantiate every word, every percentage, everything you say about the recyclability and the probability of the product.”

    The third pillar is that if you market an eco-friendly product, you need to have a program to support recycling. The collection of these products is important. “Make it simple … because consumers need simplicity,” he said. “You used to have a cigarette and a lighter. That’s it. You are giving them an electronic device. They don’t want to have a headache there.”

    The fourth element is regulation. Maayta said regulators should be involved in investing in approving sustainable products and possibly incentivizing recycling programs. He criticized manufacturers that aggressively market products that appeal to youth. He criticized regulators for not doing more to remove the “bad players” from the market because it’s leading to good manufacturers being replaced by the black market.

    Cherry Pan, managing director of consumer and marketplace insights at Altria, said that as the industry moves toward more “eco-friendly” products, the term needs to be better defined. Pan said that the environment should be a concern for all manufacturers. She also suggested that manufacturers could play a more innovative role in the design of eco-friendly products.

    “First, how to define eco-friendly … that means you’re 100 percent recycled or 50 percent recycled or 30 percent? …. Or does it mean that we use vaping products that are less harmful than cigarettes? This also means it’s eco-friendly,” Pan explained. “We will make about 150 to 200 new products every year [not necessarily that make it to market] with our army engineers. We have about 150 engineers. So we also must make products which we [consider] eco-friendly because we can recycle it, maybe 70 [percent] to 80 percent. We use some degradable materials. The percentage we use is higher [than many other products]. We want to make removable batteries.”

    Ryan Selby, CEO of Generative AI Solutions and executive chairman at The Modern Nicotine Co., said that innovation will not bring about a one-size-fits-all solution for consumers. It’s going to take a comprehensive approach to create choices for consumers through innovation. However, he doesn’t know what the next best thing is.

    “I do think we need to keep our eyes on the future and look at there’s some big changes coming down in terms of the virtual and augmented reality experiences,” Selby said. “In the oral space, looking at opportunities for creating more personal nicotine experiences that have a lower [third-party] impact as well as lower the impact on the environment.”

    Selby also said that AI could be beneficial in providing consumer insight and in helping find innovative ways to restrict youth access. He said AI can aid the nicotine industry by helping to reduce harm by analyzing data. Regulators may even be better able to understand the consumer experience.

    “I think this is a tremendous opportunity for AI in this space to help feed in massive amounts of data set and tease out some of these interactions between devices … looking at opportunities for combining substances and devices in a way that can reduce the harms associated with [use],” said Selby. “I think there is tremendous promise with large data sets and the ability of AI to tease out some hidden secrets in there that can help us to continue moving in the right direction.”

  • GTNF 2023 Sessions

    GTNF 2023 Sessions

    Panel: Youth Use

    Preventing underage use while guiding adult smokers down the continuum of risk.

    GTNF 2023 Sessions

    Stakeholders meet in Seoul to discuss the challenges and opportunities for the nicotine business.

  • Bonus Content: Rob Burton

    Bonus Content: Rob Burton

    In a video recording posted as part of the Bonus Content of the September Global Tobacco and Nicotine Forum in Seoul, South Korea, Robert Burton, group scientific and regulatory director of the Plxsur Group, made the case for the vaping industry to comply with the highest standards of integrity—even going beyond the requirements of regulations where necessary.

    “As the world’s largest group of independent vaping companies, we at Plxsur take our responsibilities very seriously and to that end we have developed a set of standards that we feel are appropriate, not just for ourselves, but for the industry as a whole,” Burton said.

    “Our first standard is in relation to compliance. We believe that all products should be manufactured to the highest possible standards. This includes the ingredients that go into them, the packaging, and the final product in terms of how it is merchandised, distributed and consumed.

    “Our second standard is youth access prevention. Nobody under the age of 18 should get access to these products. We should only be targeting adult smokers and adult vapers. To that end, online age verification systems should be standard. In-store education of shopkeepers, people selling these products, should also be standard, and systems in place in those stores to prevent access … [by] youth, such as age verification, facial recognition systems, which are now standard in many of our stores.

    “Our third standard is recycling, and obviously this is a very hot topic at the moment, particularly relating to disposables, the single use of plastics and the battery-use regulations that are coming into many countries. We believe it is the responsibility of not just the manufacturers but of the retailers of these products to encourage consumers to recycle and to proactively encourage facilitation of that recycling with collection sites and partnerships with recycling companies.

    “Our fourth standard is responsible marketing. We believe, as with our child-protection standards, that these products should not be marketed to youth. They should be marketed to adult smokers and vapers, and that includes the way that these are packaged—so no cartoon characters, no descriptors that imply these are sweets, confectionery. And also, that should be encouraged through the retailers as well to make sure these products are not in obvious areas where youth can have access to … [them] visually; or even access to them from a purchasing point of view.

    “The final standard, standard five, relates to child protection. And this relates to protecting children from access to these products; so accidental vaping or swallowing ingredients that could potentially cause harm. Specifically, we believe that all manufacturers should look at methods to protect their devices from access … [by] children. That includes pod activation systems, child locks on the devices themselves, and also various types of packaging that prevent access .. [by] children. There is no justifiable reason why any vape system should find its way into a child’s hands.

    “One thing that we need to remember is that this industry is still new, it’s still emerging, it’s still disruptive. Regulation is still playing catch-up. And just because that regulation either doesn’t exist or is being abused doesn’t mean that we as an industry should not set the highest possible standards. We at Plxsur are doing that not just for ourselves, we believe that this is a benchmark for the whole of the industry to follow.”

  • Bonus Content: Christopher Russell

    Bonus Content: Christopher Russell

    In a 45-minute video recording posted as part of the bonus content of the September Global Tobacco and Nicotine Forum in Seoul, South Korea, Christopher Russell, director of Russell Burnett Research and Consultancy of Glasgow, U.K., described a type of study that manufacturers of new tobacco products can conduct to demonstrate the cigarette-switching and smoking reduction potential of their products.

    Russell started by outlining the risks associated with smoking and the importance of reducing smoking prevalence and smoking-related harms.

    Then, in a presentation largely looking at the U.S. and the Health Risk Investigations section of the Food and Drug Administration’s system of premarket tobacco product applications (PMTAs), which require the submission of substantive amounts of data and information, he focused on the requirement to demonstrate the impact of a new tobacco product on tobacco use behavior among current tobacco users.

    The FDA, he said, had recommended that an applicant manufacturer conduct an Actual Use Study (AUS) but had not provided any formal guidance on how to design and conduct such a study in respect of a new tobacco product. Russell therefore spent some time describing how pharmaceutical manufacturers carried out AUSes in support of applications to change the marketing status of a drug from prescription to nonprescription and followed that up by describing how a PMTA applicant might take some of the key principles and design elements from such a drug-switch AUS and apply it to an AUS for a new tobacco product aimed at assisting adult smokers completely to switch or substantially to reduce their cigarette smoking when using a new product in everyday settings. He described four core principles that underpin how an AUS should be designed and conducted and on the objectives that new tobacco product AUSes had focused to date.

    Russell referenced a number of studies conducted primarily by the major tobacco manufacturers, Philip Morris International, Altria and Reynolds American. And he briefly described the design and key results of two of these studies, one involving a heated-tobacco product and another involving a nicotine pouch.

    In summary, Russell said the AUSes that had been completed to date showed they could provide near to real-world evidence that new tobacco products can serve as complete or substantial substitutes for combustible cigarettes for many adult smokers, so demonstrating the utility of this behavioral study design for providing the FDA with reliable and robust real-world information about the likelihood that if a new tobacco product were to be authorized for marketing, it would be used by adult smokers and that those adult smokers using the product in question would ultimately, in the short term to medium term, completely switch to using the product or, if not completely switch, substantially reduce the number of cigarettes they smoke while continuing to use the product, hopefully on a path to complete abstinence from cigarettes.

    Finally, Russell outlined a number of factors that manufacturers should have in mind when considering undertaking AUSes, including the company’s internal and external expertise capacity; the time required to design and conduct a study; the timing relative to the proposed PMTA; scientific engagement with the FDA’s Center for Tobacco Products; the possible availability of a robust, reliable alternative; the cost of the study and the cost of a lost opportunity.

  • Panel: Pathways to Sustainability

    Panel: Pathways to Sustainability

    The panel discussion “Pathways to Sustainability” explored how different companies approach the topic and navigate the path to a sustainable future.

    Christopher Fleury, senior vice president of regulatory affairs research at Ipsos, who moderated the panel, started off with a simple statement: “Promoting sustainability is a priority for businesses, but it is not easy.” This idea of sustainability being a complex goal remained a theme throughout the discussion.

    Each panelist brought a different perspective to the conversation. Ana Krasojevic, sustainability strategy and reporting director at Japan Tobacco International, offered corporate sustainability insight, noting that to achieve sustainability in any aspect requires full commitment.

    Sudhanshu Patwardhan, HealthTech entrepreneur and director of the Center for Health Research and Education, brought in the consumer perspective, having worked with many consumers in a medical capacity. He noted that sustainability brings with it a broader discussion of society at large and the environment.

    Diane Raverdy-Lambert, chief scientist and director of regulatory affairs at SWM, discussed the papers side of sustainability and how SWM looks at the entire life cycle of papers when creating their products. She also reiterated that “data is data” and “science should be irrefutable.”

    Michiel Reerink, international affairs director at Alliance One International (AOI) and managing director at AOI GmbH, addressed the agricultural side of sustainability, discussing how AOI works with farmers in Malawi to ensure they are using sustainable wood sources and are able to generate additional sources of income by growing crops like groundnuts. Sustainability is about the farmer relationship, he said, noting that it is not an isolated action but requires the whole supply chain to be involved.

    As the conversation progressed, Krasojevic noted three key aspects in thinking about sustainability and how to implement sustainable practices: taking decisions in a balanced way; taking a multi-stakeholder view; and looking at how the company impacts the external world and how the external world impacts the company. In her view, sustainability is embedded in “each and every business function” and is “circular.”

    The panel also discussed how sustainability has changed, noting that younger talent has strong expectations regarding sustainable practices and that it’s important to have standardized frameworks, like those of the United Nations’ Sustainable Development Goals (SDGs), that allow everyone to “speak the same language.” Standardization allows for something concrete rather than an “abstract story.”

    Much was said about the SDGs, with an emphasis on industry and consumers taking part in discussions and engagement. Patwardhan expressed that more of the SDGs should be discussed and engaged with by industry. The question was also posed as to whether the voices of the customer, the citizen and the smoker are saying the same thing. Ultimately, the panel seemed to agree that communication is important in achieving sustainability. Reerink noted that in many countries, companies are not allowed to communicate the sustainability of their products to consumers. Communication with consumers is extremely important, however, and misinformation regarding nicotine and tobacco products needs to be addressed, he noted.

    Sustainability is the new norm, according to the panel, and it drives innovation and a sense of purpose for companies. The ongoing question is how does the industry transform itself to be more responsible to the consumers and broader society? “Let’s not be reactive to everything that’s thrown at us,” Patwardhan said, referring to the industry at large. “If we are reactive, only we are to blame for the eventual outcomes. If we are proactive, there are benefits to be for the broader society.”

  • Keynote: Eve Wang

    Keynote: Eve Wang

    Eve Wang, executive director of Smoore International and vice president of Smoore Technology, gave a keynote speech on balancing innovation and social responsibility.

    Wang began by discussing the vapor industry as a whole, noting that the industry is young at only 20 years old. Smoore, she said, has been an industry player for 17 years.

    “We are at a very critical path for the vapor industry,” she said. The vapor industry has grown rapidly over the past 20 years. The first decade saw rapid growth while the following 10 years were characterized by diversification and sophistication along with greater regulation. Products became more compact and portable, usability improved, and open systems evolved into pod mods.

    Wang cited Frost and Sullivan data from March of this year, which showed that as of last year, the vapor industry was worth $52 billion, nearly double what it was in 2018. “There is no doubt the market is fast growing with huge potential,” said Wang. 

    With growth comes media attention, as Wang noted, highlighting headlines that called for bans and restrictions, overwhelmingly regarding disposables. Smoore, Wang explained, is tackling the issue by improving atomization efficiency and power efficiency. Atomization efficiency involves improving the utilization of e-liquid while power efficiency means increasing energy density and reducing battery size.

    “Do we have answers to all the challenges?” she asked. “I’m afraid it’s too early to tell.” She urged the industry to keep innovating and for every player to take their responsibility seriously.

    “As long as the conversation goes on, we are confident that together we can make the best outcome.”

  • Bonus Content: Stefan Bomhard

    Bonus Content: Stefan Bomhard

    Stefan Bomhard, CEO of Imperial Brands, highlighted how the industry has changed in the past couple years and how companies have dealt with these changes.

    “We’ve seen huge innovations and the growing diversity of products,” he said. “These have given adult consumers exciting, new and potentially healthier alternative choices.”

    Bomhard focused on the idea of challengers. He recalled his presentation at the 2021 GTNF, when he described Imperial, the smallest of the tobacco and nicotine companies, as the industry challenger. “Challengers drive increased consumer choice. They stimulate stronger competition, and they spur on innovation,” he said.

    The way to success for challengers, according to Bomhard, is by doing things differently—getting closer to consumers, being more agile and collaborating better with partners as well as recognizing limitations.

    Following his statement two years ago that Imperial could be the challenger in the industry, the company has made changes. “We haven’t always gotten it right,” he said. “That is the nature of business, of innovation, of trying new things.” Imperial has since created new capabilities in consumer insights, marketing and sales. The company has also invested in data and unifying dozens of legacy systems into a single solution. The company’s changes and investments have paid off, according to Bomhard. Imperial has stabilized its core combustible business and has credible offerings in all three of its next-generation product (NGP) categories. The company is starting to make meaningful contributions to reduce harm, he said.

    Circling back to his 2021 talk again, Bomhard reiterated that every consumer is different. Since then, Imperial has conducted the largest piece of consumer research in the category’s history, focusing on what is called “demand spaces.”

    The research breaks down the lives of consumers to individual moments when they enjoy tobacco and nicotine products, giving the industry a more nuanced understanding of how consumers are moving toward potentially healthier choices. The data showed that next-generation products are used more often when consumers are outside of the home and with other people while more traditional combustible products are more often used at home during periods of alone time.

    The research shows that “NGPs are no longer a niche category,” Bomhard said.

    “We still need to be humble,” he said. “The fact that there are large spaces in people’s lives where our new products have yet to find a firm footing means together, we still have much more work to do. We need to work harder together to create even better alternatives to the traditional cigarette.

    “Innovation, partnership and deepening the industry’s ecosystem are now more important than ever. And we need to provide reassurance to those consumers who are reluctant to consider alternatives to smoking. That means finding new ways of communicating the potential harm reduction benefits of NGPs.

    “Sadly, too many people still believe that vaping or heated tobacco is just as risky as smoking. And it means we need to use our collective experience to help policymakers build more orderly regulatory environments that inspire greater trust among adult consumers.

    “It is becoming clearer that in our industry, there will be no silver bullet, no single winner who takes it all. Consumers are not converging around a single product or category. Instead, they’re choosing different products for different occasions in their lives.”

    He went on to discuss how different countries are developing and cultivating their own distinctive nicotine cultures and how this makes it clear that there is “room for many players in this industry.”

    “The journey to the future typically never runs in a straight line,” he said, noting that the industry must continue navigating emerging challenges. “I am an optimist, and I believe that if, collectively, we continue to stay close to our consumers and continue to work openly and collaboratively, there’s a bright and healthier future ahead.”

  • Keynote: Kingsley Wheaton (given by Jonathan Atwood)

    Keynote: Kingsley Wheaton (given by Jonathan Atwood)

    During GTNF 2023, BAT’s global head of business communications, Jonathan Atwood, told attendees how BAT’s five-step plan for regulation could support achieving the right balance between harm reduction and the unintended consequences of access, including underage use.

    “As an industry, we stand at an important crossroads. There is much confusion as to the way forward. Consumers are slightly confused. Doctors are slightly confused. Regulators are slightly confused and are struggling to enforce the laws they have written,” said Atwood. “What’s too often missed is the opportunity that tobacco harm reduction presents. The opportunity for a more progressive environment where both tobacco harm reduction and the role of [vaping products] is far better understood.”

    Speaking on behalf of Kingsley Wheaton, BAT’s chief strategy and growth officer, Atwood said that reckless players in the market need to be penalized when they do not abide by the rules. He said the five suggestions are the areas that regulators should explore and then establish “smart regulation” that is right for their market.

    “When I talk about smarter regulation, I mean regulation that is evidence-based, concentrated by nature, and achieving its policy aims while also avoiding unintended consequences. Greater partnership is required to achieve this,” Atwood said. “We must join forces externally with regulators and policymakers to try and create catalysts for positive change if smoke-free ambitions are to be met. Sustained and lasting changes to consumer behavior are difficult. However, it is consumer choice that offers the greatest hope for making a cigarette obsolete.”

    Atwood said that the five areas were where smarter regulation could be applied to the vapor category to build a “more progressive environment” for tobacco harm reduction. He said the recommendations would need to be applied to the entire market and combined with greater enforcement. The five steps Atwood outlined included:

    • On-device technology and functionality: Vapor products should be accessible only to adults. Both underage prevention and restriction is crucial. On-device technology, when applied and enforced across entire markets, could help in this regard.
    • Flavors: More recognition is needed that flavors are an important driver of adoption for smokers seeking alternatives. However, flavors in vapor products should not particularly appeal to anyone underage.
    • Manufacturing and import level: ensuring that noncompliant products cannot reach the market in the first place.
    • Right to sell: Where no restrictions exist already, regulators may want to look at who should be able to sell vapor products and where. Reasonable safeguards at the point of sale would help ensure these products are sold only to adult consumers. Solutions such as retail licensing and facial recognition technologies should be seriously considered.
    • Enforcement and penalties: Governments must wield their power and ensure consumers are purchasing legitimate products. Such measures should be rigorously enforced, and those who fail to comply should face meaningful sanctions.

    Atwood said BAT was calling upon governments, regulators and industry peers to rally toward a sustainable and progressive environment in which vaping products are sold and marketed responsibly.

    “The time for boldness is now. The time to change the conversation is now. The time to change the outcome is now. The opportunity for change is here. It is not about relaxing regulations. It’s about recalibrating them to align with the evidence and aspirations of millions seeking a better alternative to smoking,” said Atwood. “We have the opportunity to redefine the future of public health, and it begins with smarter regulation that reflects the reality of smoking alternatives and provides smokers the freedom to choose less risky products.”

  • Panel: Talking Nicotine: Perception vs. Reality

    Panel: Talking Nicotine: Perception vs. Reality

    From a public health perspective, the misperceptions and misunderstandings surrounding nicotine are incredibly frustrating, according to David Sweanor, adjunct professor of law at the University of Ottawa, who moderated the GTNF panel on the public perception of nicotine. Science has proven that it is the delivery system [combustible cigarettes], not the nicotine itself, that causes the deadly diseases suffered by cigarette smokers.

    Sweanor said Sweden was an excellent example of a country where the use of different delivery systems, such as snus, led to massive decreases in the number of combustible cigarette smokers. Sweanor said it would be a major benefit to public health if the industry would or even could do more to educate consumers, public health groups and legislators about the facts. He emphasized that people can only make as good a decision as the information available to them allows.

    “We already knew from the work of Michael Russell that people smoked to get nicotine, but they died from the smoke. Nicotine wasn’t the problem. It was the delivery system that was the problem,” Sweanor explained. “We’ve known that for 50 years. And we’ve seen examples from places like Sweden where people can move to an alternative product and have disease rates that are massively lower than what you see elsewhere. In fact, looking at the long-term users of a product called snus, it is very hard to find anything to distinguish their disease risks from those people who don’t use any tobacco or nicotine product at all.”

    The first speaker on Sweanor’s panel was Carolyn Beaumont, a general practitioner, educator and founder of SmokerHealth Telehealth and Medical Nicotine Scripts who for the last three years has been prescribing vaping products to cigarette smokers in Australia. She said that there is an outpouring of need and frustration and even fear from the smokers that she works with. Australia’s vaping rules permit vaping products only through prescription and severely restrict the products that can be prescribed. Beaumont presented several quotes from former smokers showing how vaping had changed their lives for the better.

    “They really want their stories to be heard …. Smokers want to be heard—not judged—supported and advocated for. They’re also very fearful that if they can’t get their vape, they will return to smoking, and that seems true as well,” said Beaumont. “For those of you who are not sure how successful vaping is in [supporting] smoking cessation—it’s very effective.”

    The next speaker, Delon Human, president of Health Diplomats, said that misperceptions surrounding nicotine were causing people to die. “At the heart of nicotine misperception lies an issue that we are wasting unnecessary lives,” Human told attendees. “We are allowing the misperception of nicotine to lead to disease. And that is a time that we absolutely have to take hold of the stakeholders, who can change those perceptions.”

    He stated that the World Health Organization’s failure to differentiate between tobacco and nicotine, and between combustibles and noncombustibles, has caused the spread of misinformation among the government and nongovernment organizations it influences. “If you read WHO documentation … on the one hand, nicotine is part of the WHO list of essential medicines. Nicotine as part of nicotine-replacement therapy as prescribed by physicians and health professionals for smoking cessation,” said Human. “And on the other hand, there’s an all-out war on nicotine. What has happened over the years, over the last 50 years, is that the so-called war on tobacco has changed into the war on nicotine.”

    Human also noted that there is a serious amount of misperception surrounding nicotine among physicians and consumers. He mentioned a recent study from the Foundation for a Smoke-Free World that found that on average, nearly 77 percent of doctors mistakenly believe nicotine causes lung cancer, and 78 percent believe it causes atherosclerosis. While on average 87 percent of doctors at least moderately agree that helping patients quit smoking is a priority, lack of training and nicotine knowledge adversely impacts quitting and harm reduction advice, according to the study.

    “It found that 58 percent of those respondents thought that [nicotine] caused cardiovascular or heart disease, which again shows you that the level of misconception is not only dangerous—it’s sick …. It’s 2023 and so simple of a situation, but suddenly physicians have a complete misconception of what nicotine is,” he said. “In our own study in five countries, we [found that among] GPs [general practitioners], there was a persistent belief that nicotine is the most awful aspect of smoking. Nicotine causes cancer, and nicotine causes heart and lung disease.”

    Human pointed out the positive outcomes of correcting misconceptions about nicotine, including improved health for smokers and lower smoking rates. He proposed that medical professionals should receive new training on the effects of nicotine and the advantages of tobacco harm reduction. Human said that companies should also refrain from marketing to youth and keep up with the research and development of new reduced-harm products.

    “In terms of physicians, what can they do for misperceptions to be corrected? No. 1, training needs to be updated to the 21st century. Doctors need to know that nicotine does not cause cancer. It’s a crime for doctors to think that nicotine causes cancer or heart disease or lung disease in a way that they perceive it now, so correct the training,” he said. “No. 2, make sure that doctors understand what harm reduction is. Harm reduction is really part of everyday medical life. That’s what we do in medical practice. You’re trying to reduce the harm.”

    Hiroya Kumamaru, a cardiovascular surgeon and vice director of AOI International Hospital in Japan, said that in his country, there is also a wide misperception among physicians that nicotine is harmful. He argued that the industry needs to think about how best to educate regulators on understanding the effects of nicotine and the risks of different delivery systems. “Many, many … GPs are thinking that nicotine is quite harmful itself [in Japan], and we have to educate them somehow. Thinking about how we can [address] this issue, I tried to have a small meeting in the Swedish embassy about four years ago to educate not only physicians but also media and governmental officers to understand the concept of harm reduction in tobacco, in smoking,” explained Kumamaru. “But it was still difficult because some of the physicians, even [ones that] were working in a university hospital or working in the Ministry of Health, were saying that smoking is a sin …. They didn’t care about the difference [between] vapor and cigarette smoking. Because they say nicotine drug dependency is a very bad agent. We have to think once more to educate these people to understand.”

    Kumamaru said Japan has seen a historic decline in the number of combustible smokers because of the rise of heated-tobacco products. He said more than half of the combustible market has disappeared in just a few years. He also agreed that the industry could accomplish more if more were done to battle misinformation.

    “We’re still stuck with this problem of it. People and regulators can only make as good a decision as the information available to them allows us. And people believe that using nicotine is about sin rather than about health. If people don’t understand that [combustible cigarettes, not] nicotine causes cancer, what can you do? …. Millions of Americans who are able to move between the [various harm reduction] products never had the information that one product is very likely to kill you and [that] the alternative product is massively less hazardous.”

    Mohamadi Sarkar, a fellow of scientific strategy and analysis and regulatory affairs at Altria Client Services, told attendees that the science on nicotine is not new. He said that even though many mistakenly believe that vaping is just as dangerous or even more so than smoking combustible cigarettes, there is a plethora of evidence to show that vaping contains fewer harmful chemicals than cigarette smoke.

    “We often hear that ‘Well, these products have not been on the market long enough, so there is no long-term epidemiology.’ We don’t need it. What we do know is that cigarettes have 70,000 chemicals. Seventy of them are carcinogens and linear, cardiovascular and respiratory toxins,” he explained. “On the other hand, smoke-free products like e-vapor or [heated-tobacco products] are nicotine-positive and have far fewer chemicals.”

    In the end, all the speakers agreed that the industry could do more to battle the misinformation surrounding reduced-risk products. The vaping industry needs a unified voice. “We need unified goals for all the stakeholders to communicate …. We know that education works. Education has changed perceptions,” said Sarkar. “We need immediate action.”

  • Keynote: Hiroya Kumamaru,

    Keynote: Hiroya Kumamaru,

    Hiroya Kumamaru, vice director at Japan’s AOI Universal Hospital, gave a 15-minute overview of the current status of harm reduction in Japan.

    Quoting 2019 figures, Kumamaru said that, as in many other countries, smoking is the biggest cause of death in Japan, though high blood pressure is not far behind and is catching up, probably because of the aging of Japanese society.

    On top of this, he put forward the economic argument for reducing smoking, which, he said, while having a positive annual impact on the economy of ¥2.8 trillion ($18.76 billion), mainly through taxation, had a negative impact of ¥4.3 trillion mainly due to loss of labor because of smoking-related diseases, the medical costs associated with smokers and passive smokers, cleanups and fire-related expenses.

    Kumamaru told how, about 15 years ago, he had started working in a small clinic in the center of Tokyo, where he became involved in a national smoking cessation program that was based on a three-month-long series of five visits by smokers to doctors. Although a lot of effort was put into the program, and nearly 60 percent of the participants at his clinic went on to complete the five outpatient visits, nine months after the end of the program, nearly half of those who had appeared to have quit started smoking again, a result he described as “disappointing.”

    He then compared this with what had happened after the start of sales of heated-tobacco products (HTPs) from 2016. By 2019, almost one-third of male and one quarter of female tobacco consumers were using HTPs, a result that he described as “amazing.” As a result, total cigarette and HTP consumption was heading down while HTP consumption was increasing.

    In part, his amazement sprang from the fact that while this was happening in Japan, it appeared not to be happening at the same level elsewhere, and he didn’t know why this was the case. For example, Japan’s smoking rate was decreasing at a faster rate than that of Australia, which had introduced very strict smoking restrictions but banned the sales of HTPs.

    Notwithstanding Japan’s success with lowering smoking rates, many people in Japan remained skeptical about HTPs and raised issues about the unintended use of these products: dual usage, initiation, relapse and what is called in Japan the gateway effect of youth initiation. But these turned out not to be significant issues. Kumamaru said about 20 percent of smokers use HTPs and cigarettes, which is not that many. And initiation or re-initiation has been at a very low level, with two years of surveys recording a 2 percent factor in the first year and 1.3 percent in the second. In particular, youth initiation is low, and there has been no increase in initiation among younger people due to the launch of HTPs.

    Kumamaru said that interesting data from Italy, Korea and Japan pointed to the fact that consumers of HTPs have better outcomes than smokers in respect of chronic obstructive pulmonary disease and cardiovascular disease while the exposure to carcinogens associated with HTP use is just 3 percent of that of smoking.

    He ended his presentation by saying that Japan could look forward to a better future because of HTPs, though it is necessary to keep carrying out surveys and probably starting a long-term clinical study.