Category: Uncategorized

Fighting for Farmers

Photo: BAT

ITGA’s past and present CEOs, Antonio Abrunhosa and Mercedes Vazquez, reflect on the prospects for tobacco farmers in a rapidly changing business environment.
By Stefanie Rossel
In November 2021, Mercedes Vazquez took over as CEO of the International Growers’ Association (ITGA). She succeeded Antonio Abrunhosa, who announced his retirement after serving in the position since 1998. In a three-way conversation with Tobacco Reporter, the tobacco industry veterans shared their views on the past, present and future of tobacco farming.

Tobacco Reporter: Mr. Abrunhosa, in your 22 years at the helm of the ITGA, how has the leaf growing sector changed?
Antonio Abrunhosa: The main changes I witnessed in my tenure were the moves to decrease production in high-cost countries and move it to developing or underdeveloped countries, with much lower costs of production, especially salaries, which are the main [cost] component in many producing countries. Production went down by almost 1,200 million kg in the USA, Canada and the European Union in 30 years, and it increased by a similar amount in Brazil, Zimbabwe and Malawi, Tanzania and Zambia in the same period. Sales also switched from the auctions system, which prevailed in the U.S., Canada, Zimbabwe and Malawi, to contract growing—the Brazilian system. All this meant a substantial decrease in the [significance] of commercial, large-scale farmers—especially in Zimbabwe after land reform—and a radical loss of bargaining power of millions of growers all over the world [who were] facing seven main buyers with an oligopolistic power seldom seen in other sectors.
Then there was the invasion of tobacco regulation into all aspects of common life, in almost all countries, at different speeds and with different impacts, but [it] translated into the almost total absence of smoking in any public areas anywhere outside of China, and the disappearance of tobacco advertising from almost all media and sponsorship of public events. A visual example of this change can be seen by watching the difference between the Mad Men series and any recent movie of people in offices today.
That regulation got a totally different scale with the creation of the Framework Convention on Tobacco Control (the FCTC) by the United Nations, the first world treaty of the World Health Organization, which turned many dispersed local anti-tobacco initiatives into international law and created an enormous, rich and global anti-tobacco industry with thousands of NGOs [nongovernmental organizations] and companies, funded by public money, covering the whole world.
Furthermore, the technical revolution started by electronic cigarettes, vaporizers and heated-tobacco has deeply changed the consumers’ market and will continue to do so.
In the past years, the world has become much more aware of the dangers of reckless economic development based on the depletion of vital natural resources and the impact of such economic models on the planet’s capacity to sustain a population that has increased more in the past 30 years than it had in all the [previous] centuries. This awareness is impacting all kinds of businesses, especially in agriculture and, thus, in tobacco growing. That attention has pushed tobacco companies to request more and more stringent conditions of production from growers, especially in sensitive areas like labor conditions and child labor, deforestation, use of chemicals and water management.
These four changes have created a completely different tobacco sector compared to the one we had 20 years ago.

Antonio Aburnhosa (Photos: ITGA)

What has the ITGA done to help its members cope with these challenges?
Abrunhosa: Those changes impacted ITGA heavily, as some of its founder members lost thousands of growers and volume of production.
The widespread move to contract growing also meant a much more dependent relationship between growers and buyers, requiring a more intervenient role of ITGA in those relations and in the relations between growers and their governments.
ITGA’s role was also radically modified due to the inclusion into the FCTC of articles conditioning the ways in which growers could produce tobacco in the future or even aimed at ending tobacco production altogether. This required a much stronger presence of ITGA in international fora and a continuous participation in all kinds of members’ initiatives related with national or international issues affecting their businesses.

How much has actual tobacco farming changed during your tenure?
Abrunhosa: The pressure from the public and the published opinion about environmental and business sustainability, especially in a sector as controversial as ours, prompted the main buyers to [implement] radical measures in the management of their supply chains.
As it happens often in corporate praxis, research was done, plans were designed and screaming orders came down the corporate ladder, with little attention given to the opinions of the final and central recipients of those orders—the growers.
The typical case is GAP [good agricultural practices], about which I have said in many meetings that it threatens growers with the big stick of contract suppression in case they disrespect the unending list of mandatory rules for their production but seldom, if ever, shows the carrot of better prices to cover the increased costs that those rules imply.
Child labor is a typical case. Moving production to a country like Malawi requires acknowledging the fact that local infrastructures for childcare are limited or nonexistent. This means that parents have nowhere to leave their children while working—in environments with wild animals. And, in recent years, particularly now, significant increases in the costs of production have not been followed by correspondent increases in tobacco prices. That means additional difficulties for growers to hire workers.
Acknowledging these problems, ITGA, together with IUF, the main worldwide trade union for agriculture workers and almost all the important tobacco companies, except Indian and Chinese ones, created an international foundation, the ECLT, based in Geneva, which, for more than a decade now has been implementing projects in tobacco areas all over the world to address the problem.

What achievements are you most proud of?
Abrunhosa: I am most proud of having established ITGA as the world brand for tobacco growers in spite of the increasingly difficult regulatory, structural and financial conditions of the sector; of our members and of ITGA’s office, which always had between two and four officers. This was particularly relevant when the anti-tobacco lobby, much reinforced by the FCTC, aimed at legally banning tobacco production.
I am also proud of having been able to pass this heritage to the highly capable hands of my successor, Mercedes Vazquez.
Ms. Vazquez, what, in your view, are the most pressing issues for farmers now and in the midterm?
Mercedes Vazquez: Pricing and sustainability, which are intrinsically linked. Sustainability includes all social and environmental challenges but also—and most importantly from farmers’ point[s] of view—the economic survival of their businesses. Without it, other sustainability issues become irrelevant. For years, we have been trying to make this message get through, especially during the prolonged period of stagnation in prices combined with rises in costs of production everywhere.
Now, considering the unprecedented times we are living in, after two years of the pandemic and still comprehending the realities of the war in Ukraine, “long-term” in tobacco production is 12 months. Consequently, in some countries, growers are moving to more profitable crops. If we consider the generational problem in agriculture where youngsters do not feel attracted to follow their family businesses plus this demoralizing scenario, in countries not too dependent on tobacco, companies will face a gap to fulfill their demand for clean, good-quality crop.
For highly dependent countries, there is not a cent that has not been squeezed to the limit. Unless substantial changes are made—mainly in poverty alleviation to grant margins that will allow growers to be in compliance with good agriculture practices—sustainability of the sector will be ever more at stake. Changes will only happen with all main players involved, and ITGA will do its part on behalf of our growers’ associations and tobacco growers in general.

Mercedes Vasquez

What are your plans to help ITGA members to cope with these challenges?
Vazquez: ITGA is at the core of the tobacco conversation. We have been around for almost 40 years. Our experience and global network capacity make us a pivotal player in all discussions related to tobacco around the world. More than ever, we need to work as the vehicle to spread growers’ messages and to promote dialogue among key players in the sector. Outside the sector, ITGA is liaising with agriculture agencies and entities to make sure tobacco growers are taken into account in the global sustainability agenda. With this, we also mean to normalize our sector in the global context, getting rid of the negative connotation we have carried all these years.
Our main concerns are related to those developing countries that are very reliant on tobacco production. There is no transition plan for the near future. To a certain extent, this is due to the lack of collective work done in this regard. After two years of pandemic with limited access or none to our growers’ gatherings, ITGA is committing its time and resources this year to meet them, to bring them together and make their voices be heard. We feel that there is momentum to raise this united collective voice, and growers are responding to this call.
This shouldn’t require a special mention in the 21st century anymore, but you are the first female CEO in the ITGA’s history and one of only a few women at the top of a tobacco-related organization. What is it like?
Vazquez: It seems pretty normal to me because during my more than 10 years of work in ITGA, I have never had reason to think that this could not be possible at some point if I made my work meaningful to our members. I never worked thinking about becoming the CEO, though, and this was important, too, because it did not get me distracted and allowed me to focus on my duties and in making my work worthwhile. The process was very natural, but I think the turning point was my personal investment, going to visit all members’ associations and getting to know their boards and staff. Now I can say—and I think my members would agree—we have built a personal relationship, and I am very close to most of them.
Are we going to see a stronger ITGA focus on gender equality and the issues facing women in the tobacco cultivating sector?
Vazquez: I will do everything in my powers to advance this agenda. Before becoming the CEO, I have always done my best to shed light on women working in the tobacco sector and more specifically those involved in tobacco production. I introduced this item into ITGA’s key priorities with no objection [from others]. The current edition of our flagship publication, The Tobacco Courier, pays tribute to women in tobacco, and we managed to interview many of them from various parts of the globe. I highly recommend the reading of these interviews to learn about their realities. What got my attention was to see that regardless of their specificities, they all agree about the need of education and capacity building. They all want to improve and become more relevant in business decision-making. I have met many of them, and they are all a source of inspiration.

What are the ITGA’s goals for the future?
Vazquez: The future has never been as uncertain as it is now. ITGA must keep advancing the growers’ legitimate and independent agenda. Tobacco production has dramatically changed over the years, diminishing growers’ control over their product. Twenty years ago, the scenario was very different with auctions operating at a higher rate than contracts. ITGA is here to assess the impact of these changes, to help growers make informed decisions through market analysis and [to improve] our tools to provide accurate information. We aim to bring the sector together and expand our network to run efficient advocacy. At this moment, we need to put pressure in the pricing improvement as a paramount issue, and growers are telling us that this is the time to act and to speak out, so we will be up to these expectations.
Provided the challenges for the tobacco growing sector, such as the continuous global decline of cigarette consumption, will persist, where do you see the ITGA and its members 22 years from now?
Vazquez: In 22 years from now, I honestly believe that unfortunately some, not to say many, tobacco farmers and ITGA members will be out of this business. This can happen overnight, as we witnessed with the case of Colombia. Only the ones with the ability to absorb the increasing demands and with a diversified portfolio will remain. Some will be forced to disappear; some others will simply move out.
Tobacco growers’ associations are rare these days. Those remaining are ITGA members. Unless their governments reinforce their role and make sure they are included in every conversation taking place about tobacco, its contribution, its future, its sustainability … at some point, they will be made redundant by companies, taking over their part with the direct contract system.
As for ITGA, we will stick to our commitment even after that. If there is no tobacco production the way we see it now, there will have to be a transition for those vulnerable growers forced to quit. Consumption is declining at a fair pace to permit the changes needed for this sector to adapt. The problem is that farmers are getting ambiguous messages that stimulate productions in some regions while depreciating it in others, and that situation continuously changes. Our partners should be more consistent in that regard because this uncertainty is certainly harming this industry.

Stefanie Rossel is Tobacco Reporter’s editorial contributor. An experienced trade journalist, she combines sharp reporting skills with in-depth knowledge of the tobacco and vapor industries. Prior to joining Tobacco Reporter, Stefanie was editor-in-chief at Tobacco Journal International, where she worked for a decade. Fluent in English, German and French, Stefanie covers tobacco news around the world. She is based in Germany.

June 1, 2022
Study: Vapes Have Higher Health Costs Than Smokes

Photo: Tobacco Reporter Archive

The use of electronic cigarettes costs the United States $15 billion annually in healthcare expenditures—more than $2,000 per person a year—according to a study by researchers at the University of California San Francisco School of Nursing.
The study, published on May 23 in Tobacco Control, is the first to look at the healthcare costs of e-cigarette use among adults 18 and older, according to the release.
“Our finding indicates that healthcare expenditures for a person who uses e-cigarettes are $2,024 more per year than for a person who doesn’t use any tobacco products,” said lead author Yingning Wang of the UCSF Institute for Health and Aging.
According to the U.S. Centers for Disease Control and Prevention, combustible cigarette smoking-related illness in the United States costs more than $300 billion each year, including more than $225 billion for direct medical care for adults.
The researchers based their estimates of healthcare costs and utilization on data from the 2015–2018 National Health Interview Survey. Healthcare utilization included nights in the hospital, emergency room visits, doctor visits and home visits.
“Healthcare costs attributable to e-cigarette use are already greater than our estimates of healthcare costs attributable to cigar and smokeless tobacco use,” said Wang. “This is a concerning finding given that e-cigarettes are a relatively new product whose impact is likely to increase over time.”

May 25, 2022
Innokin Launches Lota Vaporizer

Photo: Oleksandr | Adobe Stock

Innokin Technology has launched Lota, it’s new sub-brand of vaporizers, according to a company press release.
Innokin is partnering with Aquios Labs for the Lota. Aquios Labs is a new technology firm that enables water-based e-liquid.
Lota will initially launch with a portfolio of three water-based devices, each with their own position for specific global markets and consumer needs: the Lota Enviro, F600 and Prefilled Pod Kit, according to a company press release.
“Innokin has always believed in embracing new technology,” said George Xia, Innokin’s co-founder. “When first introduced to Aquios Labs, our product development team was impressed with the unique advantages of water-based vaping. Through this exciting partnership, Innokin is proud to launch the Lota brand, offering high-performance water-based vaping in our continued quest of tobacco harm reduction across the globe.”

May 12, 2022
Zovoo Launches Dragbar 600S with More Balanced Taste

Photo: Tobacco Reporter Archive

Zovoo launched its disposable Dragbar 600S on May 9.
The new device features an upgraded design of five flower-shaped air inlets, which allows for a more evenly distributed airflow. This creates a more comfortable and balanced taste experience, according to Zovoo.
“Without sacrificing user experience or changing external dimensions, it optimizes the internal space structure of the atomizing rod and enlarges the battery capacity to 500 mAh for durability. This new product delivers enormous value in addition to excellent daily experience,” the company wrote in a press release.
Inheriting the high-quality characteristics and positioning of the company’s previous DRAG series products, the Dragbar 600S adopts GENE chip technology that was developed by ICCPP, the parent company of Zovoo.
GENE has an “innovative and upgraded oil lock design structure that allows users to safely operate without oil leakage,” according to the company. “In addition, the more efficient atomization ability ensures that every drop of tobacco oil is safe and fresh, and the taste experience is consistent.”
The first offerings of the Dragbar 600s includes 10 flavors, including strawberry ice, peach ice and “O.M.G.” In addition, 10 new flavors will be available at a future date.
“Quality and taste are the core to impress consumers and the soul of electronic atomizers. Zovoo always adheres to the concept of ‘user focus’ and constantly develops new disposable vapes to meet the ultimate needs of users all over the world,” the company wrote in its release.

May 10, 2022
White Coats, Fuzzy Facts?

Photo: Lisa F. Young

Educating physicians on nicotine and the risk continuum.
By Cheryl K. Olson
In an earlier edition of Tobacco Reporter, I described the globally widespread, misplaced fears about the health risks of nicotine—and the critical need for credible messengers to counter those fears (see “Watch Your Mouth,” Tobacco Reporter, March 2022). People generally trust their doctors for health information. Smokers do too.¹ The limited data available suggest smokers trust their doctors over other sources of information on e-cigarettes² and that most patients using e-cigarettes would appreciate at least a brief discussion or handout.³
Are physicians positioned to take advantage of that trust? Can they effectively guide patients who can’t or won’t quit nicotine toward lifesaving alternatives to smoking? Getting patients to stop smoking is top priority. Cigarettes are still the leading preventable cause of illness and death in the U.S. and many other nations. Smoking rates are stagnant among vulnerable populations, including those who are older, low-income or struggling with chronic physical or mental illness.⁴ Thanks in part to media-driven fears of vaping lung injuries and to e-cigarette flavor bans, cigarette sales are actually on the rise.^{5, 6}
Before doctors can help, they must be armed with accurate information and believe that taking action is necessary.

Physicians are Confused About Nicotine
One huge obstacle is a widespread physician perception that nicotine is dangerous. The first sentence in a 2021 survey report from the Journal of General Internal Medicine states, “Nicotine is responsible for the highly addictive nature of tobacco products, but most tobacco-caused disease is not directly caused by nicotine but rather by other chemicals present in tobacco or tobacco smoke.”⁷ Stunningly, four of five physicians in this U.S. survey strongly agreed (incorrectly!) that nicotine causes cancer, cardiovascular disease and chronic obstructive pulmonary disease. There were only minor variations across medical specialties. Recent surveys across countries have similar findings.
What effects might these beliefs have on physician willingness to recommend nicotine-replacement therapies to patients who smoke? And what about recreational nicotine products?

Physicians Don’t Understand the Continuum of Risk
Another barrier is ignorance about or fear of reduced-harm products that aren’t pharmaceuticals. I couldn’t locate any studies on what, if anything, doctors know about the full range of novel recreational nicotine products. However, a 2020 review from the University of Queensland⁸ found 45 qualitative and quantitative studies internationally that looked at what physicians believe and do regarding electronic nicotine-delivery systems (ENDS). Doctors were aware of ENDS but far from experts in their health effects and use for smoking cessation. Most of what they knew came from media stories or patients. “This lack of knowledge and feeling of being ‘uninformed’ was reported consistently by [healthcare professionals] across and within studies.”
The latest and largest U.S. study of what doctors say to patients about vaping appeared in the April 2022 issue of JAMA Network Open.⁹ The Rutgers University authors surveyed a national cross-section of 2,058 board-certified physicians. The conclusion? “More than half of the physicians believed that all tobacco products are equally harmful, and this belief was associated with lower rates of recommending e-cigarettes.” The authors argue that “it is critical to address physician nicotine misperceptions and to correct misperceptions regarding the relative harm of various tobacco products,” as the “FDA authorization process” introduces more modified-risk products.

What Might Start to Open Minds?
I asked a young physician friend (a third-year resident at Virginia Commonwealth University) what he and his fellow doctors would want to know about reduced-harm nicotine products that their patients might be using. He immediately mentioned wanting to see results from randomized controlled trials (RCTs) on “products that will help patients quit harmful tobacco products but also data regarding health outcomes. For example, what are the rates of lung cancer in a patient who smokes cigarettes for 10 years versus someone who vapes for 10 years?”
This is the sort of response we expect and was consistent with the JAMA Network Open survey findings. But can data alone change beliefs?
An earlier study from the Rutgers researchers involving structured interviews with doctors gives reason for doubt.¹⁰ Most doctors they talked to were at least neutral about attempts to switch to e-cigarettes for patients who had failed with traditional smoking cessation methods. But five of the 35 doctors were adamantly opposed; they would not recommend vaping to patients even if future RCTs found e-cigarettes to be equal or superior to other quit methods. One oncologist said, “Based on what I’ve heard and read about them, I don’t think so. It seems like they’re actually, like I said, kind of dangerous.”
A careful read suggests that physicians who believed e-cigarettes could be effective switching tools—about half of those interviewed—were so persuaded by a combination of stories and data. Patients, friends or family members had cut down or quit cigarettes through vaping. And, perhaps sensitized to the issue by these stories, the doctors recalled seeing one or more studies that backed up their personal observations. Interestingly, 11 of the doctors who doubted e-cigarette effectiveness cited the hand-to-mouth behavior similarities to smoking as a negative rather than a positive for switching. This suggests they don’t know smokers.

Physician Harm Reduction
Sudhanshu Patwardhan
During his postdoctoral training as a primary care physician, Sudhanshu Patwardhan grew increasingly concerned about the ineffectiveness of the advice and treatments given to patients who smoked combustible cigarettes. Since then, he’s focused his clinical and research career on harm reduction for addicted smokers. He’s currently based in Great Britain, where he’s the director of the Centre for Health Research and Education.
Patwardhan has researched physicians and nicotine in the U.K., Sweden, Greece and India. For the past year, he and I have been talking about the clinical and public policy challenges that come with shifting toward a harm reduction approach to smoking cessation.
“Consistently, between 65 [percent and] 80 percent of surveyed physicians across all these countries harbor misperceptions about nicotine,” he said. “It’s no wonder that, universally, ‘Why replace one addiction with another?’ is one of the commonest attitudes [among physicians] for nicotine-replacement therapy for tobacco cessation using a harm reduction approach.
“Doctors forget that in addition to its long-term effects, inhaling the smoke from burning tobacco induces the breakdown of many drugs, thus making those treatments ineffective. Many psychiatrists I interact with admit to simply increasing the dose of the administered medications to compensate for the loss of effectiveness due to smoke-induced breakdown but don’t offer cessation support simultaneously. This, of course, leads to higher side effects and poorer patient outcomes—all because physicians are not sensitized to and empowered about tobacco cessation and harm reduction.
“Most freshly minted doctors would know how to recognize the most esoteric heart murmur but have no practical experience in the basics of behavioral intervention or the role of medications for tobacco cessations. Pharmacology and clinical medicine barely touch on nicotine-replacement therapy and give no clues to trainee doctors on what to prescribe, for how long and how to manage cravings and withdrawal symptoms effectively. Most noncommunicable diseases have tobacco use as a risk factor. Yet doctors simply do not address it along with the presenting complaint.
“Our center’s strategy focuses on the root of the issue: We’re developing and conducting peer-based education of healthcare providers in a safe and nonjudgmental environment. Our approach and materials are country specific. For example, in the U.K., e-cigarettes are a part of the suite of potential harm reduction tools offered by the National Health Service. In India, however, e-cigarettes are currently banned and not licensed for smoking cessation. There, we focus on approved approaches, such as nicotine-replacement therapy, bupropion and varenicline.”
“We need to start overhauling the medical education curriculum in this area. We’re conducting pilot programs at some medical schools with exciting results and will publish those data. Practicing physicians also need training to increase their effectiveness. Finally, scaling up of nicotine education for healthcare providers can be a significant challenge, especially for countries as wide as the U.S. or as populated as India. Digital tech tools, such as cessation apps, short media presentations, including online videos and smart print campaigns designed for social media, can all help.”–C.K.O.

References
¹ Nelms E et al. Trust in physicians among rural Medicaid-enrolled smokers. Journal of Rural Health, 2014: 30(2), 214–220. doi:10.1111/jrh.12046.
² Wackowski OA et al. Smokers’ sources of e-cigarette awareness and risk information. Preventive Medicine Reports, 2015: 906–910, http://dx.doi.org/10.1016/j.pmedr.2015.10.006.
³ Doescher MP et al. Patient perspectives on discussions of electronic cigarettes in primary care. Journal of the American Board of Family Medicine, 2018, doi: 10.3122/jabfm.2018.01.170206.
⁴ Zhu S-H et al. Smoking prevalence in Medicaid has been declining at a negligible rate. PLoS One, 2017, https://doi.org/10.1371/journal.pone.0178279.
⁵ Xu Y et al. The impact of banning electronic nicotine-delivery systems on combustible cigarette sales: Evidence from U.S. state-level policies. Value in Health, 2022, doi: 10.1016/j.jval.2021.12.006.
⁶ Federal Trade Commission. FTC report finds annual cigarette sales increased for the first time in 20 years. October 2021. www.ftc.gov/news-events/news/press-releases/2021/10/ftc-report-finds-annual-cigarette-sales-increased-first-time-20-years.
⁷ Steinberg MB et al. Nicotine risk perceptions among U.S. physicians. Journal of General Internal Medicine, 2020, doi: 10.1007/s11606-020-06172-8.
⁸ Erku DA et al. Beliefs and self-reported practices of healthcare professionals regarding electronic nicotine-delivery systems (ENDS): a mixed-methods systematic review and synthesis. Nicotine & Tobacco Research, 2020 https://doi.org/10.1093/ntr/ntz046.
⁹ Delnevo CD et al. Communication between U.S. physicians and patients regarding electronic cigarette use. JAMA Network Open, 2022, doi:10.1001/jamanetworkopen.2022.6692.
¹⁰ Singh B et al. Knowledge, recommendation and beliefs of e-cigarettes among physicians involved in tobacco cessation: A qualitative study. Preventive Medicine Reports, 2017 http://dx.doi.org/10.1016/j.pmedr.2017.07.012.

Cheryl K. Olson is a California-based public health researcher who specializes in behavioral health issues and consults on tobacco product behaviors via McKinney Regulatory Science Associates. She spent 15 years on the faculty of Harvard Medical School.

May 1, 2022
Bentley: Banning Menthol is a High-Risk Strategy

Guy Bentley
The U.S. Food and Drug Administration’s plan to ban menthol cigarettes may have unintended consequences, such as increased black market sales and more incarceration, while doing little to advance public health, according to Guy Bentley, director of consumer freedom at the Reason Foundation.
Writing on the organization’s website, Bentley says the desired public health gains could also be achieved by applying the harm reduction model to tobacco policy.
In his article, Bentley examines the experiences of Canada, the European Union and Massachusetts, which have already banned menthol cigarettes, and finds the results to be underwhelming.
“In the aggregate, the experience of menthol bans in the real world, as opposed to forecasts about them, is that the bans have minimal effects on tobacco consumption but do engender unintended consequences, even in markets where menthol is relatively unpopular,” he writes.
According to Bentley, banning menthol cigarettes is a radical policy with significant implications for the criminal justice system and personal autonomy. “Rather than resorting to the failed policies of the past, the FDA and the Biden administration should apply the harm reduction model to tobacco policy,” he writes.
“Educating the public and taking a harm reduction approach has been successful in the fields of sexual health and drug addiction, and it would be far more effective in reducing smoking than banning menthols.”

April 18, 2022
In the Pipeline

Photo: Imperial Brands

A glimpse at patent registrations shows what the future of tobacco harm reduction may look like.
By Stefanie Rossel
Since the first filter cigarette was manufactured in 1934, the cigarette has stayed more or less the same. Despite some tweaks to filters, papers and tobacco blends over the decades, innovation was not exactly the word that came to mind in the context of combustible cigarettes. So it’s little wonder that when the World Health Organization Framework Convention on Tobacco Control (FCTC) was drafted in the late 1990s, its authors could not imagine a future product much different from the familiar tobacco column wrapped in paper. As a consequence, the FCTC makes little to no reference to intellectual property or technology.
The past two decades have proven the FCTC creators—and many other observers—wrong. While the WHO was trying to cut down tobacco consumption with classic strategies, such as tax hikes, smoking bans and health warnings, a new generation of reduced-risk products, including e-cigarettes and tobacco-heating devices, entered the market. Many of these products bore little resemblance to the combustible cigarette that the FCTC was designed to tackle.
Developed by independent entrepreneurs, the first vapor products surprised the tobacco industry as much as they did their WHO counterparts. After realizing the potential, however, cigarette manufacturers redirected some of their formidable resources at developing the sector, creating a multitude of new reduced-risk technologies.
In recent years, the leading tobacco companies have pumped billions into research and development to offer their customers smoke-free alternatives. Philip Morris International alone had invested $9 billion in R&D by 2019. Median R&D expenses stood at $495 million for the fiscal years ending December 2017 to December 2021. They peaked in December 2021 at $617 million.
BAT has spent more than $2.6 billion on R&D investment since 2012. In a preliminary statement in February 2022, the company said that it had further increased next-generation products investment by £496 million ($653.44 million) in 2021.
Japan Tobacco International invested $2 billion between 2015 and 2020. The efforts are likely to pay off not just in terms of having less risky products available but also financially. Euromonitor expects the global retail value of the reduced-risk category to exceed $100 billion by 2025, up from $40 million in 2020.

Developed by indpendent entrepreneurs, the first vapor products surprised the tobacco industry as much as they did their WHO counterparts (Illustration: VPR Brands)

A Different Strategy
As technology investments increase, intellectual property is becoming more valuable—and contested, as demonstrated by the recent PMI/Reynolds American Inc. dispute. In September 2021, the U.S. International Trade Commission (ITC) ruled that PMI’s IQOS heated-tobacco product (HTP) infringes on two RAI patents. After the Biden administration failed to intervene, PMI and its U.S. partner, Altria Group, were barred from importing IQOS devices in the U.S.
The case is charged because IQOS is currently the only electronic nicotine product with a modified-risk tobacco product (MRTP) designation from the U.S. Food and Drug Administration, which allows Altria to market the product with reduced exposure information. Among other things, the company may tell consumers that its heating system significantly reduces the production of harmful and potentially harmful chemicals compared to conventional cigarettes. The ITC ruling means that American smokers currently don’t have access to IQOS. PMI is now looking at manufacturing IQOS in the U.S.
Unlike the WHO, the FDA, which was authorized to regulate tobacco products by the 2009 Family Smoking Prevention and Control Act, acknowledges that electronic nicotine-delivery system products are fundamentally different from combustible cigarettes, and the agency has provisions to accommodate reduced-risk products.
To receive MRTP designation, a manufacturer must provide scientific evidence showing that its product is “appropriate to promote the public health” as defined by the FDA. Although criticized as a long-winded and costly pathway—PMI handed in more than a million pages of documentation to support its IQOS application—the process at least offers a prospect for reduced-risk products, which is more promising than the WHO’s “quit-or-die” attitude.

Roya Ghafale at the 2021 GTNF conference in London

Innovation in the Making
Tobacco and vapor companies’ substantial R&D spending is reflected in the number of tobacco harm reduction (THR) patents. Between 2010 and 2020, an estimated 73,758 patents were published globally in the areas of nicotine vapor products, smokeless nicotine products and HTPs, according to the 2021 Patent Landscape Report, a study prepared by Oxfirst Managing Director Roya Ghafele for the Foundation for a Smoke-Free World.
Established tobacco companies, such as PMI, BAT and the China National Tobacco Corp. (CNTC), hold the largest patent portfolios in the THR space, showing that the development of less hazardous nicotine-delivery systems is a priority in their strategies. In terms of patents published, nicotine vapor technology is the fastest-growing THR technology, with a compound annual growth rate of 9.1 percent. It is followed by heated-tobacco technology, which has been growing 4.1 percent per year, and smokeless tobacco technology, which has a 1.1 percent annual growth rate.
Geographically, patent publications are concentrated in high-income or upper-middle-income countries. Companies operating in the tobacco and cannabis sectors dominate patent activity: In tobacco-heating technology, CNTC, PMI and BAT account for 15 percent of patents published in the past 10 years. China leads with an estimated 22,956 patent publications followed by the U.S. with an estimated 14,344 publications. In the Africa and Middle East region, patent activity remains limited to Israel, Morocco and South Africa, according to the report. In nicotine vapor technology, the picture is similar: About 10 percent of all patents granted during the past decade are held by CNTC, PMI and Kimree Hi-Tech, a Chinese e-cigarette manufacturer.

An increasing number of vapor patent applications cover technologies for therapeutic purposes.
(Photo: Respira Technologies)

Toward Therapeutic Uses
The patent filings provide a glimpse into what the future of THR might hold. Interestingly, the number of patents for nicotine vapor technologies that could result in medical smoking cessation devices or be applied to other therapeutic purposes has increased substantially over the studied period. Between 2010 and 2020, 48 percent of patents were filed under classifications related to medical or veterinary science. According to the report, this indicates a shift from recreational technology toward more therapeutically oriented technology. While many patents currently focus on the vaporization of cannabinoids instead of nicotine, there is also mention of other therapeutic drugs, including those targeted at relieving pain, fever, inflammation and disorders of the nervous system.
As far as the hardware is concerned, the number of patents referring to sprayers or atomizers adapted for therapeutic purposes ranks second behind those for inhaling appliances shaped like cigars, cigarettes or pipes.
Patents relating to electrical heating or constructional details, such as the connection of cartridges and battery parts, also represent a large part of publications. BAT’s Pure Tech development is an example of this trend. The ultra-slim, micro-engineered stainless steel distiller plate acts as both the heater and wick, replacing the traditional coil and wick system and thus optimizing the aerosol process so that there is less risk of thermal breakdown in products. In its Science & Innovation Report 2020–21, the company calls Pure Tech a game-changer. Laboratory tests show that the vapor generated by this technology contains around 99 percent fewer and lower levels of certain toxicants compared to cigarette smoke, according to BAT. In biological tests, cells exposed to this vapor exhibited a much lower response or no response at all compared to cigarette smoke, a result that strongly suggested that this technology could contribute to the reduced-risk profile of its vapor products, BAT said.
PMI has filed patents for vaping technology that includes sensors that are designed to monitor the characteristics of their users and provide therapeutic data, according to the Patent Landscape Report. Should these devices make their way into consumer nicotine products, Ghafele concludes, this would shift the purpose of these products from purely recreational to therapeutic, making nicotine businesses potential partners for insurance companies, public health authorities and other related industries. It could also further normalize—and improve access to—reduced-risk product technologies.
While the patent publications by nicotine companies indicate a “pharmaceuticalizaton” of these industries, patent filings by pharmaceutical companies active in nicotine-replacement therapies suggest that these players remained focused on pharmaceutical uses for nicotine and are uninterested in entering the recreational nicotine space.

To make headway in global tobacco harm reduction, critics say tobacco companies should make their innovations more accessible to customers in low- and middle-income countries. (Photo: BAT)

Reserved for High-Income Countries
In heated-tobacco technology, Ghafele found, most patents related to the design and manufacture of devices with an emphasis on the heating element, which tobacco companies seek to improve to increase the efficiency of their technology. BAT’s current Glo HTP range is heated by induction technology, thus avoiding direct contact between the electronics and the heating element. JTI’s Ploom S and Ploom X HTP models, by contrast, work with the company’s proprietary HeatFlow technology, where a ribbed heat chamber heats the tobacco stick from the outside for minimal charring.
Following the blade-heating technology employed in initial generations of IQOS, PMI has added induction to heat the tobacco in its latest generation of HTP devices, IQOS ILUMA, which launched in 2021. The company’s TEEPS HTP platform, meanwhile, uses carbon-heating technology. The device works without electronics. It features a charcoal tip that is lit to produce heat. In the charcoal tip, oxygen reacts with the carbon in a combustion process, producing heat and carbon dioxide. An aluminum disk separates the charcoal from the tobacco, transferring the heat but blocking the airflow, thus preventing the tobacco from reaching the ignition point.
Of the HTP patents analyzed by Ghafele, 38 percent were filed under therapy-related codes. The frequent mention of antineoplastic agents, which are medications used for cancer treatment, could indicate that companies are researching these agents to reduce the health risks of their products, she notes. There was also high patent activity relating to the therapeutic use of nicotine for neurological disorders, such as Parkinson’s disease or Alzheimer’s disease.
While the report suggests that the once-staid tobacco industry has evolved into a highly innovative sector, it also reveals a shortcoming: Few of the patent applications are filed in the developing world, where intellectual property protections tend to be weak. Given that most smokers live in low-income and middle-income countries, this represents a missed opportunity for tobacco harm reduction.
To bridge the gap, says Ghafele, stakeholders should explore ways to better integrate the needs of developing countries and motivate tobacco companies to offer potentially less harmful products outside of the wealthy world.

Stefanie Rossel is Tobacco Reporter’s editorial contributor. An experienced trade journalist, she combines sharp reporting skills with in-depth knowledge of the tobacco and vapor industries. Prior to joining Tobacco Reporter, Stefanie was editor-in-chief at Tobacco Journal International, where she worked for a decade. Fluent in English, German and French, Stefanie covers tobacco news around the world. She is based in Germany.

April 1, 2022
Seeking Synergies

Photo: Feelm

Tobacco companies are applying the expertise gained with reduced-risk products to new business areas.
By Stefanie Rossel
In their journey of transforming their businesses away from combustible cigarettes toward reduced-risk alternatives, tobacco companies have invested billions of dollars into innovation and scientific research over the past two decades. In return, they have obtained a wealth of expertise in adjacent areas—the potential of which they have just started to explore. Today, their goal is no longer limited to merely lowering harm but also to advancing health.
The list of recent initiatives and moves illustrating this shift is impressive. In September 2021, BAT announced the construction of an innovation hub in Trieste, Italy. In addition to hosting a new manufacturing site for the company’s reduced-risk products (RRPs), the facility will house an innovation lab and center of excellence for digital transformation and marketing as well as a digital boutique. On an area of 20,000 square meters, BAT plans to develop multiple production lines for European and global export of its RRPs.
According to BAT Chief Marketing Officer Kingsley Wheaton, the innovation hub, which involves an investment of up to €500 million ($549 million) over the next five years, will play a key role in the company’s transformation toward reducing the health impact of its business. Trieste was chosen as the location for the hub as it is already a globally recognized center of excellence in research and science, BAT said.
Philip Morris International is demonstrating commitment to transformation with a change of location: In November 2021, the company announced it would relocate its headquarters to Stamford, Connecticut, USA, this summer. The new facility is intended to become a center of state-of-the-art innovation and serve PMI’s smoke-free ambitions, which now also include areas such as inhaled therapeutics. Occupying a 6,642-square-meter campus, the Stamford headquarters will house the PMI Americas region and other corporate functions. PMI’s operations center will remain in Lausanne, Switzerland.
The transition of nicotine companies to adjacent business areas is evident in China as well. SmooreTech, the world’s largest vaping device maker in terms of revenue, recently established a fundamental research institute with three centers and hired a chief scientific officer with a deep background in respiratory medicine. Among other activities, the institute will perform physical and toxicology testing, data analysis and develop standards for vaping devices as they seem set to explore related areas in respiratory medicine. In 2020, SmooreTech became the first company in the Chinese vaping sector to get approval for conducting a national research program on vaping harm reduction, which it will conduct jointly with Tongji University.

From Cigarettes to Pharma
Tobacco companies have been aware of the medicinal potential of the tobacco plant for some time now (see “The Virtuous Weed”). In 2008, PMI acquired a stake in Medicago, a Canadian biopharmaceutical company. BAT purchased U.S.-based Kentucky BioProcessing (KBP) in 2014. Medicago and KBP have both been working on tobacco plant-based vaccines. In January, Health Canada approved Medicago’s Covifenz vaccination against Covid-19—the world’s first vaccine approved for human use that utilizes a plant-based protein technology. BAT has been performing clinical trials on its Covid-19 vaccine candidate. In January this year, BAT launched KBio, a new company that will leverage the existing and extensive plant-based technology capabilities of BAT and KBP and focus on delivering treatments for rare and infectious diseases.
These developments are part of the tobacco industry’s desire to move “beyond nicotine.” PMI plans to generate at least $1 billion in revenues from such new business by 2025. Last summer, it acquired the Danish oral drug delivery specialist Fertin Pharma for $820 million and the U.K.-based asthma inhaler manufacturer Vectura for $1.2 billion. In August, the tobacco company took over U.S. respiratory drug company OtiTopic for an undisclosed sum.
Fertin Pharma concentrates on research, creation and manufacturing of gums, pouches and liquefiable tablets as well as various solid oral systems to deliver active ingredients, such as nicotine. The takeover has given PMI access to Fertin Pharma’s technologies, expertise and talent, which includes almost 200 research and development specialists.
While the Danish company can help PMI increase its footprint in the modern oral category, Fertin Pharma’s oral drug delivery platforms also complement PMI’s experience with inhalation technologies and could be used to develop scientifically proven self-care wellness products, such as over-the-counter solutions and supplements for better living.
Commenting on the Fertin Pharma deal, PMI CEO Jacek Olczak said that his company’s future was “centered on health, science, technology and sustainable business practices to deliver innovative products and solutions that aim to improve people’s lives and create a net positive impact on society.”

“PMI’s future is centered on health, science, technology, and sustainable business practices to deliver innovative products and solutions that aim to improve people’s lives and create a net positive impact on society.”

Jacek Olczak, CEO, PMI

Critical Role
Vectura specializes in inhaled drug delivery solutions. At the time of the acquisition, the company had 13 inhaled and 11 noninhaled products in its portfolio. The new subsidiary will provide PMI with another 200 scientists who are knowledgeable about formulation, inhalation, devices, clinical manufacturing and regulatory issues. The company will also provide access to new technology and pharmaceutical development capabilities.
PMI aims to develop a fully owned pipeline of inhaled therapeutics and respiratory drug delivery systems. Vectura, says PMI, will play a critical role in PMI’s beyond nicotine strategy, which the acquisition, together with the Fermin Pharma deal, is expected to accelerate.
OtiTopic, PMI’s third recent acquisition in the pharmaceutical field, has developed an inhalable acetylsalicylic acid treatment for acute myocardial infarction that is currently undergoing clinical trials. The product comprises a novel, proprietary aspirin formulation that, delivered via a dry powder inhaler, enters the bloodstream faster than oral tablets. If approved by the U.S. Food and Drug Administration, the treatment can address the needs of more than 83 million people at risk for myocardial infarction in the U.S. alone, according to PMI.
According to PMI Chief Life Sciences Officer Jorge Insuasty, PMI’s beyond nicotine initiatives will initially focus on respiratory delivery and botanical products addressing areas such as energy, sleep, calm and focus. While currently less developed than established tools, such as pills and syrups, respiratory delivery has advantages over traditional medication delivery methods, Insuasty explained in a recent edition of PMI’s Scientific Update. Medicines delivered via the respiratory tract allow a rapid onset of the drug effect and potentially reduce side effects due to the lower dose that might be needed compared to taking a pill, for example. The same holds true for botanicals, an area in which PMI has gained considerable expertise during its work with plant substrates and aerosolization.
PMI healthcare ambitions are supported by its venture capital unit, PMI Equity Partners. The $150 million Swiss-based fund invests in companies that are involved in respiratory delivery, botanical sciences, health monitoring technologies, computational research methodologies and other innovations that have the potential to benefit health.

Focus on Recreational Products
BAT, meanwhile, has singled out personalized well-being as a starting point for developing opportunities beyond nicotine. In its annual report, the company said it was taking a “disciplined approach” to its beyond nicotine strategy as it expects continuous growth in the emerging market for well-being and “active” products, particularly for CBD. Fortune Business Insights estimates that the global CBD market, which stood at $3.68 billion in 2021, will increase to $55.79 billion in 2028, reflecting a compound annual growth rate of 47.49 percent.
BAT says its strength is its superior understanding of consumers. By combining contextual information with biometric data sets, the company believes it can build a comprehensive model of moods, behaviors and rituals. In January 2021, BAT launched its first vapor CBD product, Vuse CBD Zone, in Manchester, U.K.
The diversification drive is backed by BAT’s March 2021 £126 million ($165 million) acquisition of a 19.9 percent stake in the Canadian cannabis producer Organigram. Organigram grows cannabis and manufactures cannabis-derived products. The investment will provide BAT with access to research and development technologies, product innovation and cannabis expertise. The two companies will establish a center of excellence at Organigram’s New Brunswick site to develop next-generation cannabis products with an initial focus on CBD.
Like PMI, BAT is supported by a corporate venture capital arm in its transformation effort. Established in 2020, Btomorrow Ventures seeks to invest in health and wellness, functional products, science, sustainability and technology sectors.
The nicotine industry’s transformation has just begun. Slowly but surely, several of the companies that most people still identify as creators of health problems are becoming developers of health solutions. They will have to overcome many hurdles on their journey, including public skepticism and resistance from groups such as the World Health Organization, which recently indicated it would reject Medicago’s Covid-19 vaccine because of the biopharmaceutical firm’s link to PMI. If the nicotine companies succeed in their transformation, however, it would arguably represent one of the most remarkable metamorphoses in corporate history.

Stefanie Rossel is Tobacco Reporter’s editorial contributor. An experienced trade journalist, she combines sharp reporting skills with in-depth knowledge of the tobacco and vapor industries. Prior to joining Tobacco Reporter, Stefanie was editor-in-chief at Tobacco Journal International, where she worked for a decade. Fluent in English, German and French, Stefanie covers tobacco news around the world. She is based in Germany.

April 1, 2022
Unlikely Bedfellows

Photo: Dmitry

How free-flowing data streams can help advance public health goals for nicotine products.
By Cheryl K. Olson
How might new technologies engage public health in transforming the tobacco sector? Let’s take a look at three unlikely scientific bedfellows: sewage, Covid-19 and smoking harm reduction.
Of the many innovations born from the Covid-19 pandemic, my favorite is the U.S. Centers for Disease Control and Prevention’s National Wastewater Surveillance System (NWSS). Since September 2020, the NWSS has tapped into underused data streams flowing through our communities to get early warnings of local disease spread. It’s not perfect; you can’t predict how many people are sick, and it misses people not hooked up to municipal collection systems. But the information is there for the taking. It doesn’t depend on persuading people to show up and get tested.
The smoking harm reduction parallel? Technology innovations can also help advance public health goals for nicotine products using the less malodorous but equally free-flowing data streams of search engines and social media. This is information people have already provided, with no need to persuade them to fill out surveys or file a report. We can systematically search those streams to look for evidence of product adverse experiences or youth misuse of tobacco products or to hunt for and counteract nicotine misinformation.
I found a guide to some of these new methods in sociologist Navin Kumar, a postdoctoral associate at the Yale School of Medicine. He uses techniques like social computing, machine learning and natural language analysis to promote health, including tobacco harm reduction.

Countering Misinformation
Kumar’s research group has done several studies looking at how new technologies can identify and potentially counter health misinformation. As an example of how to study web-based narratives in tobacco control, the researchers tackled two controversial areas at once by mapping how misinformation spread about vaping (especially CBD from cannabis) to help treat Covid-19. This included collecting vaping-related text fragments from a wide range of web sources, including health provider forums, news articles and blogs as well as social media. They also generated word clouds (a fun and intuitive way to depict the most-used words) to see how the use of key terms changed before and after Covid-19 was reported to the World Health Organization. The results showed a shift from words related to vaping bans to positive mentions of CBD and CBD oil.
There are many challenges in applying these techniques to counter nicotine misinformation. For a start, we need to understand how people talk about nicotine products in online conversations as opposed to formal news reports. A study by Kumar and colleagues analyzed the framing of vaping in social media and how words used to describe vaping and their meanings shifted over time. In earlier years, “happy” and “wonderful” were among the most frequent words associated with vaping. From 2017 on, these gave way to words like “ban,” “lung” and “teen.” The study vividly illustrates (with those wonderful word clouds) the social media shift from seeing vaping as an alternative to cigarettes to viewing vaping as about harm and regulation like the news media did.
Another problem: It turns out it’s easier to get people to buy into twaddle than to stop them from doing so. Said Kumar, “People tend to believe new misinformation; it’s harder to remove misinformation such as ‘vaccines have microchips.’” One of Kumar’s recent studies was a randomized controlled trial to try to counter tobacco product misinformation. Results were promising, but the challenge is huge. How can a metaphorical cupful of accurate information received in a study counter the buckets of misinformation people get on a daily basis?
That’s why researchers such as Kumar are working on automated ways to detect misinformation on social media using machine learning. If responsible parties can detect the latest mutation in tobacco product misinformation as it emerges, “They could respond before it has a chance to take hold. And go to Facebook and other outlets to counteract it,” said Kumar.

New technologies, such as social computing, machine learning and natural language analysis, may help counter online misinformation about nicotine products. (Photo: Jo Panuwat D)

Adverse Experiences
The goals of reporting are to identify safety risks, to share lessons learned so our mistakes are new instead of repeats of the past and to raise the cost to potential bad actors of disregarding customer safety. The U.S. Food and Drug Administration’s Center for Tobacco Products takes voluntary reports from anyone—including product users, researchers and health professionals—about “adverse experiences.” You can report a tobacco product concern through the FDA’s central safety reporting portal at www.safetyreporting.hhs.gov, which also takes reports about marketed human and animal drugs and biologics, foods and dietary supplements.
Traditional ways of reporting adverse experiences to the FDA leave a lot to be desired. Since the system is primarily voluntary, a busy human must find the time and motivation to report the problem. Under-reporting is assumed, but no one knows by how much or how reporting may differ by product, user or symptom type. Important details may be left out of the report, making it hard to spot patterns (or creating misleading patterns as in the case of e-cigarette or vaping use-associated lung injury (EVALI)). Reporting can also be biased by things like news reports and litigation. The blossoming variety of reduced-harm nicotine products further complicates finding and addressing safety issues when market shares are small and issues are infrequent.
If your company’s tobacco product gets a premarket tobacco product application (PMTA) marketing granted order from the FDA, postmarket reporting of adverse experiences is required as part of the deal. “Serious and unexpected” adverse experiences that companies are told about or discover must be reported through that FDA portal within 15 days. The FDA may also require other postmarket reporting to stay comfortable with keeping a new tobacco product on the market. It’s in your interest to avoid surprises.
This approach is still untested for tobacco products, but publications are proliferating using these methods. I ran across articles that used machine learning and natural language processing to monitor for adverse effects of Covid-19 vaccines on Twitter and for health risks from the mood-altering plant kratom on Reddit and Twitter.
As with our example of using wastewater to predict Covid-19 spread, Kumar notes that multiple data sources better predict outcomes. “So you can use reports on Twitter combined with YouTube and [the] news to predict adverse experiences,” he said. Look to computer science publications for the latest publications on nicotine products; they aren’t caught up in the tobacco harm reduction battles now raging in many public health journals.

How do These Tech Innovations Look to Public Health Authorities?
Are these promising innovations likely to percolate through into accepted practice? Will regulators look upon creative high-tech approaches with favor or scorn? To look for clues, I searched the abstracts (summaries) of studies accepted for the March 2022 meeting of the Society for Research on Nicotine and Tobacco (SRNT). (SRNT is not, at present, an industry-friendly organization and, therefore, is a useful gauge of sentiment among academics and regulators.) Over two dozen studies involved using social media data for research, most simply to gather information and look for patterns. Some involved lifting data from Reddit, Twitter or Instagram about descriptions or perceptions of particular tobacco products then using conventional qualitative methods (coding by human readers) to explore topics and feelings. Others used social network analysis to understand how information about products or policies spread.
Two studies supported the possibility of collecting adverse experiences through social media. One coded mentions of positive and negative health outcomes from vaping found on Twitter and Reddit. Another studied videos posted to the TikTok app (with hashtag #nicsick).
One study combined old and new methods by using an age detection algorithm with Reddit metadata to sort posted comments on vaping and then hand-reviewing the most popular posts by each age group. A nicotine product company could potentially use an age detection algorithm to show regulators that their social media accounts don’t attract youth.
Wearable sensors were used to detect smoking behavior as part of a smartphone-delivered smoking cessation program. Behavior studies documenting the transition from smoking to vaping might benefit from including wearable technologies. We might find, for example, that people who’ve completely transitioned to vaping have better sleep quality.
New technologies bring new potential but also novel problems. For example, social media has been hailed as a new cost-effective, efficient way to recruit subjects for research, especially hard-to-find subgroups. My research team did have some success recently using social media platforms, such as Facebook, to locate a particular “vulnerable population” for PMTA behavioral studies. However, it also attracted responses from scammers, automated survey bots and professional survey takers, which took a lot of time and creativity to block or identify and remove.

Cheryl K. Olson is a California-based public health researcher who specializes in behavioral health issues and consults on tobacco product behaviors via McKinney Regulatory Science Associates. She spent 15 years on the faculty of Harvard Medical School.

Forewarned is Forearmed
Derek Yach
One example of using these advanced techniques to find early signals of both misinformation and potential health concerns is an e-cigarette or vaping use-associated lung injury (EVALI) monitoring and alerting platform developed by Skai (formerly Signals Analytics) for the Foundation for a Smoke-Free World.
As a proof of concept, the platform retrospectively analyzed and compared vaping-related content from social media and news sources. In social media comments about specific symptoms and vape ingredients, Skai’s platform spotted signals of the direct link between seizures and vaping synthetic CBD nearly a year before official reports appeared. This kind of early information, while not definitive, would allow public health authorities and the industry to respond quickly to prevent harm and provide corrective facts in appropriate language.
Disinformation on social media, from naive misunderstandings to deliberate manipulations, will be a fact of life for years to come. Taking advantage of these analytical techniques allows the industry to demonstrate socially responsible leadership in advancing public health. Why be blindsided by EVALI’s inevitable successor when there are tools to detect and respond to it? –Derek Yach
*https://skai.io/reports-and-whitepapers/early-detection-of-pandemics-and-outbreaks/?msclkid=4ac806b7a95011ecb5d22adb0bd2b48e

April 1, 2022
From Coercion to Empowerment
David Sweanor

Tobacco harm reduction advocate David Sweanor describes the shift required to reduce the health toll of smoking.
By Derek Yach
David Sweanor has played a global role in steering the World Health Organization, governments and nongovernmental organizations to use the most powerful interventions they have to end smoking. His focus on policy measures to reduce the carnage from cigarette smoking, including a leading role on excise taxes, marketing restrictions and smoke-free policies, has long included tobacco harm reduction (THR). And in the process, Sweanor has highlighted the need to move from blunt approaches to all tobacco products to a system that regulates products proportionate to their risk. In a recent conversation, Sweanor discussed the origins of innovation in THR.
“Hobbyists” and consumers seeking safer products have long tried to develop products that deliver nicotine without other toxic ingredients common in combustible cigarettes (see “Major Milestones”). Our conversation focused on transformation underway in leading tobacco companies.
Sweanor believes that leading tobacco companies have a clear vision of the endgame for their transformation—addressing health, wellness and consumer needs profitably. This was largely forced upon them by advancements in technology, upstart competitors and consumer demand. In contrast, leaders in tobacco control, he believes, are trapped in a vision set in the 1970s that relies on coercion rather than empathy and empowerment and ignores the role of disruptive technologies.
Sweanor laid out progress reported in the latest round of quarterly earnings by leading tobacco companies. Analysts highlighted the role of reduced-risk products as increasingly driving corporate profitability. Philip Morris International now gets 30 percent of total revenue from reduced-risk products and BAT gets 12 percent, with Altria and Imperial advancing through single digits. And Sweanor stressed the fundamental role that competition and investments in innovative research have played in driving this progress.

The funding, volume, quality and diversity of industry research have accelerated over the past decade, and the nicotine business has attracted new and innovative players. Industry research is more interdisciplinary than most public-funded research and includes cutting-edge insights from toxicology, systems biology, epidemiology and pharmacology enhanced by clinical insights from respiratory medicine, oncology and cardiovascular disease.
Sweanor is concerned that at a time when we need more engagement between industry and public health researchers, more barriers are being created that discourage debate, counterproductively protect the cigarette trade and prolong the epidemic of diseases and deaths caused by cigarette smoking. The Society for Research on Nicotine and Tobacco’s ban on tobacco industry participation in its conferences is only the latest example of industry exclusion.
To demonstrate that they have truly embraced transformation, says Sweanor, tobacco companies and other players in the consumer nicotine market should:
push ahead with investments and the launch of healthier, safer products designed to end combustible use;
be more proactive in challenging misinformation and the laws that protect the cigarette business from competition;
share patents addressing core aspects of health and safety with smaller companies and state monopolies in low-income and middle-income countries—this could be done in many ways within World Trade Organization rules; and
place key data of public health policy relevance in the public domain. This includes, for example, conversion rates from combustibles to reduced-risk products and consumer research on the viability of reduced-risk alternatives to cigarettes. Sweanor stressed that all companies need to do this. Much could be learned from a related effort undertaken by food companies in the United States led by the Healthy Weight Foundation.
Above all, he believes that this is the time for companies to work with governments to more aggressively end the sale of combustibles. “They should not await permission from unyielding anti-tobacco groups before fully engaging in efforts to protect the health of their consumers,” said Sweanor.
Sweanor discussed the emergence of industry initiatives that build on their investments to end combustibles (see “In the Pipeline”). From Covid-19 vaccines derived from tobacco plants (see “The Virtuous Weed”) to deeper insights into medication aerosolization and what this might mean for new classes of pharmaceuticals delivered through 21st century delivery systems, Sweanor stated that it is clear that companies are not stopping their transformation journey. “There are no examples from across other sectors that when such profoundly disruptive change happens, it ever returns to the status quo,” he said. “The arrow of innovation points toward healthier and more environmentally sustainable products and services.”
In time, the recent analyst views that some tobacco companies will become life sciences companies tackling major health issues may well come true!

Derek Yach has been a global health expert and anti-smoking advocate for more than 30 years. Throughout his career, he has supported and led smoking cessation research and policy development and has been a strong proponent of harm reduction policies,

Previously, Yach was the director of the Foundation for a Smoke-Free World, and a World Health Organization cabinet director and executive director for noncommunicable diseases and mental health. He was deeply involved with the development of the Framework Convention on Tobacco Control.
April 1, 2022