Category: Uncategorized

Bidi Workers Demand Protection Against Cigarettes

Photo: WESTOCK

Bidi workers in Bangladesh formed a human chain on June 21 outside of the Pabna Deputy Commissioner’s office, demanding protection against competition from “foreign” cigarettes, reports The New Nation.
According to the leaders of the group, the biggest competitors to bidis are low-quality cigarettes, which are mostly owned by foreign companies and have not been set to increase in price much in the 2022/2023 budget.
“Bidi industry is a domestic worker-friendly industry,” the group leaders said. “Bidi is a 100 percent indigenous technology-based industry. On the other hand, everything in cigarettes is imported from abroad and depends on technology. Foreign multinational companies are smuggling thousands of crores of rupees by burning the lungs of the people of this country.
“If all kinds of conspiracies against the domestic bidi industry, including the withdrawal of discriminatory advance income tax, are not stopped, we will be forced to wage a fierce agitation.”
After the protest, the leaders of the group presented a memorandum to the prime minister through the deputy commissioner of Pabna.
The group demanded an increase in the price of low-quality cigarettes, withdrawal of a 10 percent tax on bidis, and legislation to protect bidi workers.

June 22, 2022
U.S. Health Groups Call off Menthol Lawsuit

Photo: eccolo

Action on Smoking and Health (ASH), the African American Tobacco Control Leadership Council (AATCLC), the American Medical Association (AMA) and the National Medical Association (NMA) are dismissing their joint lawsuit against the United States Food and Drug Administration. A rulemaking process to ban menthol as a characterizing flavor is in progress, and “we are grateful to be able to declare victory in this case,” the plaintiffs wrote in a joint statement.
The lawsuit followed the 2013 Citizen’s Petition, which called on the FDA to prohibit menthol in cigarettes.
“As African American physicians, we are thrilled with the FDA’s proposed rule to ban menthol in cigarettes and flavored cigars as a remedy to settle our lawsuit,” said Rachel Villanueva, president of the NMA. “This proposed rule will save lives and improve health within Black communities. This would not have been possible without the leadership and assistance of our co-plaintiffs and attorneys, whom we wish to sincerely thank.”
“We are encouraged by the FDA’s recent action to propose a ban on menthol-flavored cigarettes. We look forward to participating in the rulemaking process as we continue our collective push to ensure these harmful products are removed from the market once and for all,” said AMA President Gerald E. Harmon.
“The FDA has finally taken a major step forward to protect the health of Black Americans, but the work is far from done. We will not stop until no more Black lives are lost due to the predatory marketing of menthol cigarettes and flavored little cigars,” promised Phillip Gardiner, co-chair of the AATCLC.
“ASH’s goal is to use litigation as a tool to protect the right to health of all citizens against the harms of the tobacco industry,” said Kelsey Romeo-Stuppy, managing attorney at ASH. “We are proud to have been a co-plaintiff in this extraordinary demonstration of the power of proactive litigation.”

June 3, 2022
Fruitful Cooperation

Photos: Alliance One International

By partnering with Bayer Crop Science, Alliance One International improves farmer livelihoods.
By Stefanie Rossel
Ending poverty is the first of the United Nations’ 17 sustainable development goals, which are supposed to be achieved by 2030. According to the U.N. Food and Agriculture Organization (FAO), the battle to end hunger and poverty must be principally fought in rural areas, which is where almost 80 percent of the world’s hungry and poor live. Success requires investment in “agents of change,” according to the FAO—smallholders, family farmers and other vulnerable groups. To feed more people with less water, farmland and biodiversity, better management and improved techniques in agriculture will be needed.
Agriculture is central to all activities in smallholder communities. In economic terms, most activities in these communities revolve around being able to develop a system that provides food security and improves the health of its members. The work of smallholders is an economic driver, creating prosperity for the community.
Keen to enhance farmers’ incomes, Alliance One International recently embarked on a new project. In June 2021, the company announced that its Alliance One Brazil (AOB) subsidiary was partnering with Bayer Crop Science to provide quality maize seeds and agronomic support to smallholder tobacco farmers in Brazil. AOB’s goal is to help its contracted farmers diversify their income by strengthening the quality and yield of a crop that is cultivated complementary to tobacco in the country.
“For AOI, improving farmer livelihoods is a top priority, and we are committed to maximizing all farmers’ income potential by 2030 through appropriate training in good agricultural practices and the opportunity for crop diversification,” explains AOI President Alex Strohschoen. “Through this partnership, we are making strides to achieve this goal and have already seen positive impacts for growers and their communities.”
During the 2020 growing season, AOB implemented a pilot project in which 2,300 of its contracted Brazilian smallholder tobacco farmers received a high-quality agronomic package for maize. “While many of our contracted growers in Brazil already grow maize in addition to tobacco, they lacked access to high-quality crop inputs such as seed, fertilizer and agronomic support,” says Strohschoen. “This prevented them from scaling up their production and limited their financial return. This agronomic package provides our contracted growers with access to Bayer’s maize seed varieties as well as fertilizer and hands-on guidance from our agronomists and field technicians, helping improve crop quality and yield, in turn, increasing the farmer’s bottom line.”
Globally, AOI employs approximately 1,000 trained agronomists and field technicians that conduct more than 1 million farm visits annually. “These individuals regularly share their expertise to support our contracted growers and are key to this partnership,” says Strohschoen.

Alex Strohschoen

Research Required
Bayer Crop Science offers a range of maize varieties with enhanced features. For instance, a maize variety can be more water efficient, high yielding or resistant to typical maize pests than other varieties.
In the case of AOI’s contracted Brazilian growers, use of Bayer maize varieties, grown using high-quality fertilizer and agronomic support from AOI, made a difference. “Prior to this project’s implementation, our Brazilian tobacco farmers that also cultivate maize produced on average less than 5,500 kg/ha,” says Strohschoen. “The agronomic package that we provide gives growers access to some of the most advanced technology available on the market, potentially increasing yields to over 10,000 kg/ha.”
As part two of the initiative, AOB offered the opportunity to participate in the program across its grower base during the 2021 growing season. Following the season’s completion, Strohschoen said, participating farmers saw a 15 percent increase in maize yield compared to the 2020 growing season, increasing a farmer’s income by $270 per hectare on average. “This additional income supplements the livelihood of our contracted growers and is an important piece of addressing other concerns, such as child labor, deforestation, etc.”
Similar to Africa, where climate change appears to be a big challenge for farmers, extreme weather patterns are impacting crop production in Brazil. Less and less predictable weather patterns make it difficult for growers to determine the right time to plant whereas the worsening precipitation deficit as well as increased frequency and severity of droughts are becoming more prevalent and more concerning. “Food insecurity is a global issue driven by various factors, including increased demand, war and conflict, climate change, and economic slowdowns and downturns exacerbated by Covid-19,” says Strohschoen.

An AOB leaf instructor (left) and a contracted farmer

Expansion Envisaged
Over the next three years, AOB intends to expand the project to include other crops—and other countries. AOI works with nearly 300,000 farmers in 20 countries across five continents, and it is the company’s aim to provide all of its contracted growers with the opportunity to diversify their income and increase their bottom line, says Strohschoen. “To do this, we must evaluate a number of factors to ensure we are implementing projects in the appropriate regions with crops that offer our contracted growers the greatest potential return. For example, we began this project in Brazil because approximately 75 percent of our contracted Brazilian farmers produce maize in addition to tobacco. Since these farmers were already growing maize, many had the infrastructure necessary to produce the crop prior to implementing the project.”
Following the success of the project’s first two phases in Brazil, it makes sense to expand it to a country with a similar climate and where growers have a seminal relationship with maize. “As we enter the 2022 growing season, we plan to introduce the program to our contracted farmers in Argentina, where a significant portion of our grower base could benefit from improving the quality and yield of their maize crops,” says Strohschoen.
In addition to the maize project in Brazil, AOI is also working on other projects around the globe. “For example, in Malawi, we have commercialized new groundnut and soya seed varieties,” says Strohschoen. “We provide interested tobacco growers with inputs, including agronomic expertise, helping them diversify their crop portfolios and produce high-quality crops for domestic, regional and international markets.”
With tobacco accounting for 54 percent of merchandise exports in 2019 and about 15 percent of GDP, the landlocked Southeastern African country is one of the world’s most economically tobacco-dependent nations. Not only in Malawi does food security remain an issue; it’s also a global problem that is being exacerbated by various factors, including increased demand, war and conflict, and economic slowdowns and downturns aggravated by Covid-19. Currently, Russia’s war against Ukraine is severely jeopardizing food security around the world.
“AOI is committed to doing whatever we can to transform people’s lives so that together we can grow a better world,” Strohschoen says. “This starts within our immediate network. To do our part to address global crises, we must first look at what improvements can be made within our supply chain. This begins with providing our contracted farmers with the tools they need to diversify their income and create additional food sources in their communities.”

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
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