Combustible Tobacco – Will it Burn Out or Fade Away?

According to the World Health Organization (WHO), tobacco kills over seven million people each year, including almost one million who don’t even smoke. Moving away from combustible cigarettes in favor of modern alternatives – such as e-cigarettes and “heat not burn” devices (HNBs) – is a transition that ostensibly threatens the tobacco industry. However, rather than oppose it, the big guns of the sector appear to have thrown their weight behind it.

This unexpected turn of events has resulted in the “tobacco paradox”, a phrase coined by the Economist, which refers to an industry scenting the profits to be made from aiding public health via its own competition. Regardless of their motives, the switch could theoretically save the equivalent of a small country’s entire population every annum, but achieving approval from the appropriate regulatory bodies is proving to be a tricky fly in the ointment.

Big changes from Big Tobacco

Since the emergence of e-cigarettes a few years ago, and the more recent advent of HNBs, it is reasonable to surmise that the traditional tycoons of the tobacco industry could feel threatened. But rather than resisting the winds of change, major players in the sector appear to be running with it; Phillip Morris International (PMI) have reportedly invested $3 billion into non-combustible alternatives since 2008 and its CEO André Calantzopolous has indicated he wishes to earn over a thrid of overall profits from smoke-free alternatives by 2025. The firm’s biggest rival, British American Tobacco (BAT), have made similar noises about their own intentions.

In order to speed up the acceptance of these new products, PMI have pledged almost $1 billion to the cause – though the announcement earned a swift slap-down from the WHO. This rebuttal was brought on by the obvious conflict of interests that a tobacco company funding research would engender, but also highlights how PMI are still actively fighting progress on anti-smoking measures across the board. Not only are Big Tobacco resistant to taxation hikes wherever they are suggested (one of the few measures which could put a serious dent in smoking numbers), as recently as November 26th last year they were still resisting legislation which came into force in 2006. Clearly, a ringing endorsement from the industry is more of a cigarette burn than a seal of approval.

What the science says

A more solid basis for policy creation should perhaps be the opinions of academics and independent observers. The signs here seem to be largely good; a review from the British Committee on Toxicology found that HNBs were responsible for between 50% and 90% less exposure to contaminants than traditional cigarettes, while Public Health England (PHE) concluded e-cigarettes were 95% less harmful than combustible tobacco. Outside of academia, a New Zealand judge recently ruled in favor of IQOS (the PMI brand of HNBs), adding the antipodean country to a list of over 30 nations across the world where they are legally available.

However, not everyone is convinced. The Food and Drug Administration (FDA) has not yet given the green light for PMI to market the IQOS brand in America as “less risky” than smoking, with 10 prominent US senators making a stand against the application. Other observers fear that both alternatives may not provide enough impetus for regular smokers to quit – and may actually serve as a gateway product for younger customers who didn’t smoke at all beforehand. Still more argue that the data supporting e-cigarettes and HNBs is insufficient to throw substantial support behind them, and claim that regulating the concentration of nicotine in existing cigarettes is the best way to curtail the global smoking habit.

Which way will policy makers jump?

With Big Tobacco already owning four-fifths of the alternative smoking market, it appears to matter little to them which way regulatory bodies act in the long run. For a population who are dying in their millions because of this debilitating addiction, it’s far more meaningful. One thing’s for sure: something’s got to give with regards to the tobacco paradox and the ramifications for which way policy makers ultimately fall could be immense. Should they bet on the probable but as yet inconclusive health improvements offered by alternative products, or focus all of their energy on weening the global population off tobacco cold turkey? With lives in the balance, it’s the most burning issue health legislators have faced in years. Let’s hope they make the right decision.