Professor J.F. Etter presentation E-Cigarette Summit 2014

1. Prof Jean Francois Etter
Professor of Public Health
University of Geneva

2. 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

3. 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

4. 3 broad types of e-cigarettes, but no distinction is made in many sales statistics, user surveys
Cig-alike:
Tanks, vaporizers:
Mods:

5. 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

6. 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

7. 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)

8. England: prevalence of electronic cigarette use: smokers and recent ex-smokers
8
0
5
10
15
20
25
30
35
40
45
50
Percent of smokers and recent ex- smokers
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

9. = cig-alike

10. USA: dollar share by company: convenience stores
and XAOC = expanded all outlets combined
(Nielsen bar code data)
Lorillard
Reynolds
Logic
NJoy
Altria

11. 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

12. 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

14. 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)

15. iQos = Philip Morris
heated tobacco product

16. Pharmacokinetics: Philip Morris iQos
Same speed as tobacco cigarette
= iQos

17. Voke = Nicoventures (BAT)

18. Voke: pharmacokinetics
Delivery twice as quick as for Nicorette inhalator

19. Ploom: tobacco vaporizer commercialized by Japan Tobacco

20. 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 ?

21. 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’

22. Science + regulation are part of the tobacco industry’s business model

23. Regulation: part of the tobacco
industry business model

24. 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

25. 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 ?

26. 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

27. 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.)

28. 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