Prof Jean Francois Etter

Professor of Public Health

University of Geneva

Prof. Jean-François ETTER, PhD

Faculty of Medicine

University of Geneva, Switzerland

E-cigarette Summit, London

November 13, 2014

Product diversity, user behavior,

players in the e-cig market

Conflicts of Interest

Tobacco industry:

- never received any funding, no CoI

Pharmaceutical industry

- no funding in past 8 years, no CoI

E-cigarette industry

- plane ticket + hotel (London + China, 2013)

- no honorarium

3 broad types of e-cigarettes, but no distinction is

made in many sales statistics, user surveys

Cig-alike:

Tanks, vaporizers:

Mods:

Speed of nicotine delivery to the blood:

1st generation e-cig, 2nd generation e-cig, tobacco cigarettes

Source: Farsalinos et al Sci Rep. 2014; 4: 4133

Machine tests: depending on puff conditions and product features,

ECIG can provide far less or far more nicotine than a tobacco

cigarette (50-fold variation). Talih et al. Nicotine & Tobacco Research, Sept 2014

E-cig global sales, $ million 2014: probably $5 billion

<1% of tobacco cigarette market

190 350 700

1200

240 160

150

100

480

770

950

1200

0

500

1000

1500

2000

2500

2010 2011 2012 2013

USA China International

(source: Philip Morris)

England: prevalence of electronic cigarette

use: smokers and recent ex-smokers

8

0

5

10

15

20

25

30

35

40

45

50

Perc

ent

of sm

okers

and

recent

ex-

sm

okers

Any

Daily

Growth in prevalence of e-cigarette use has not

increased since Q3 2013

N=14490 adults who smoke or who stopped in the past year; increase p<0.001

Source: STS - Smoking Toolkit Study

= cig-alike

USA: dollar share by company: convenience stores

and XAOC = expanded all outlets combined

(Nielsen bar code data)

Lorillard

Reynolds

Logic

NJoy

Altria

UK e-cigarette retail market share (%) Total U.K. retail market, including U.K. Major Multiples, Household, Impulse and Chemist

Channels, 52 weeks ending Sept 2014. Source: Wells Fargo

33.6

32.8

11

6.7

3.3

2.1 1.9

1.4 1.4

1

0.9 0.9

3

UK 2014

Ecig Group (FIN, VIP, Ten Motives)

Nicocig - PMI

E-Lites - Japan Tob

Halco

blu - Lorillard

Gamucci

BAT

Vapouriz

Dekang

NJOY

Vapourlites

Supreme Imports

Other

Tobacco company Brands of e-cigarette / vaporizers

Altria MarkTen

Green Smoke

Reynolds + Lorillard, merged July 2014 Vuse

SkyCigs

Imperial Tobacco Blu (sold by Lorillard)

Puritane

+ intellectual rights on Dragonite

Japan Tobacco Ploom (tobacco vaporizer)

E-Lites

Philip Morris Nicolite

iQos (heat not burn)

+ partners with Altria / MarkTen

British American Tobacco Vype

Intellicig (CNCreative)

Voke (Nicoventures)

ITC (Imperial Tobacco Company of

India) Eon

NTC (National Tobacco Company,

distributor of Zig-Zag cig. paper) V2 Cig

New nicotine + tobacco vaporizers:

no combustion of tobacco

Nicotine vaporizers, without tobacco:

1. E-cigarettes (3 broad categories: cig-alike, tank, mod)

2. Nicotine vaporizer using the technology of asthma vaporizers

VOKE (Nicoventures = BAT: British American Tobacco):

3. Nicotine pyruvate (chemical reaction that vaporizes nicotine, Jed Rose)

(PMI: Philip Morris, under development)

Tobacco vaporizers:

1. Heated tobacco products, «heat not burn»:

- electric heating (e.g. iQos by PMI, Chinese models)

- charcoal heating (ember)

2. Hot air flow

- Nespresso-like cartridge (Ploom: distributed by Japan Tobacco)

- loose tobacco (various brands of vaporizers)

iQos = Philip Morris

heated tobacco product

Pharmacokinetics: Philip Morris iQos

Same speed as tobacco cigarette

= iQos

Voke = Nicoventures (BAT)

Voke: pharmacokinetics Delivery twice as quick as for Nicorette inhalator

Ploom: tobacco vaporizer

commercialized by Japan Tobacco

Snus: first FDA application as reduced

risk product (Swedish Match)

For FDA registration as reduced risk product, applicant must show that:

- the product is less harmful to the individual user

- the total effect on the population is beneficial

Very costly process, very long

Will e-cig / vaporizers follow ?

Philip Morris:

4 new reduced risk products

See presentation on PM Investor’s day 2014: https://www.media-server.com/m/instances/8hjnb6wm/items/29n825fv/assets/75ngrwuk/0/file.pdf

iQos Coal ember Nicotine pyruvate E-cig ‘cig-alike’

Science + regulation are part of the

tobacco industry’s business model

Regulation: part of the tobacco

industry business model

Tobacco industry involvement

New situation: tobacco industry sells reduced risk vaporizers

Science

Huge investments in R&D on vaporizers ($2bn for PMI only)

Regulation

Intense lobbying (EU, US, nationally)

Large numbers of experienced, professional lobbyists

Long tradition, historically strong influence on tobacco laws

Suspicion that aim of tobacco industry involvement in regulation is to:

. avoid “unfriendly” rules

. raise technical + legal barriers at entry in this market

. eliminate (Chinese) competitors + small players

Tobacco industry: history

Denied

- that nicotine is addictive

- risks of smoking

- risks of passive smoking

Produced bogus science

Artificially created controversy, confusion

Deception campaign to block smoking bans

Will e-cig / vaporizers enable the tobacco industry to re-emerge as a

legitimate stakeholder ?

How to react to tobacco industry

involvement ?

Science:

Need for independent research, not just research conducted by tobacco

industry + its subsidiaries

If collaborations emerge between academy + industry, there is a need to

define conditions / limits

Transparency is crucial

Follow example of guidelines for academic collaboration with pharma

industry

A framework is needed to manage conflicts of interest

Management of conflicts of interest

Goals

= protect the integrity of research,

= preserve public trust

Core principle = transparency

Declaration of conflict of interest + registration of studies = insufficient

Define policies, rules and restrictions, code of practice

Rely on organizations / institutions that define + enforce + monitor these

policies (national academy of sciences, ethics committees, etc.)

Perspectives

New situation: are we prepared ?

We have no choice but to rethink academic + political interactions with the

industries that produce nicotine + tobacco vaporizers

Need for transparency

Need to develop rules, policies

Need for a debate involving all stakeholders