Getting the vapours

Electronic cigarettes are everywhere. The market for them has increased 340 per cent over the last year alone, according to market research commissioned by pharmaceutical companies, who are worried at a slowdown in their own smoking cessation products.

“I was speaking to a smoking cessation coordinator the other day and she said their numbers are way down. They would expect maybe 3,000 quit attempts, and they’re 800 down on that this year. The advisors are attributing that to e-cigarettes,” says Sheila Duffy, chief executive of Action on Smoking and Health (Scotland).
The burgeoning market is diverse, and with many different products. Initially resembling real cigarettes, e-cigarettes now more closely resemble Doctor Who’s sonic screwdriver. ‘Pop-up’ independent shops have sprung up all over the country, and ‘vaping’ is emerging as its own sub-culture.
The vials used in e-cigarettes contain nicotine in its purest form extracted from tobacco, with traces of flavouring, colour and assorted chemicals. The liquid is a neurotoxin which is dangerous if spilled, but inhaled as a vapour it contains none of the tar of a cigarette. The vapour emitted is similar to that used in theatrical fog.
Although there are only five years of safety data available and therefore no long-term health statistics, it is thought the devices are much less harmful than tobacco.
“Tobacco is the most lethal consumer product out there. When used as manufacturers intend it kills one in two consumers, and behind each death there are about 30 people with chronic disease. So if existing smokers can use e-cigarettes as an acceptable and palatable form of nicotine replacement and cut down and quit that’s a win,” says Duffy.
However, the market is not standardised and currently unregulated. Cancer Research UK commissioned a report in November into e-cigarettes, which found the pace of change frenetic. The report says: “The result is akin to a gold rush: anarchic, unpredictable and with potentially vast profits to be made. There is a massive incentive for the new e-cigarette companies to get established, develop brand share and so attract a buy-out by one of the big tobacco companies. In the longer term, a whole new sector for ‘lower risk’ products may emerge.”
Public Health Minister Michael Matheson has expressed suspicion at the motives of tobacco companies, who are investing heavily in a market before EU legislation comes into effect in 2016 which will see stronger e-cigarettes classified as medicines. This will result in their availability on prescription for the first time, which may hamper the market, and will see advertising and promotion restricted for weaker non-medical products.
Tobacco giant Lorillard, the third largest cigarette manufacturer in the USA which owns half the American e-cigarette market, purchased Edinburgh e-cigarette company SKYCIG in October for £30m. The company stated on their website that the purchase had “additional contingent consideration of up to an additional £30m to be paid in 2016 based on the achievement of certain financial performance benchmarks”. In other words, Lorillard want to corner the UK market before the restrictions come in. Murray Kessler, Lorillard Chairman, President and CEO, said: “We firmly believe that e-cigarettes may present the most significant harm reduction option ever made available to smokers in the US and abroad and we look forward to working with regulators around the world to confirm this conclusion.”
Duffy believes Michael Matheson is right to be suspicious. “Harm reduction isn’t really on the tobacco industry’s agenda, because if you look at what they’re doing in other countries, they are subverting every regulation that they abide by here because they can, and they’re not pushing e-cigs in developing markets, they’re pushing tobacco,” she says.
Duffy argues that the tobacco companies should be judged by their history. “There’s a long track record, and we’ve had two previous forays into harm reduction by tobacco companies. One was when they put filters on cigarettes and people went, ‘great, that makes the smoke safer’. We know now it doesn’t make the smoke safer, it makes it more palatable. Then there was low tar and light cigarettes with vents in, but the way that machines smoked them wasn’t the way that people smoked them, and so they ended up being actually more harmful because people held the smoke in their lungs longer and breathed it in deeper, and ended up getting harder to treat cancers deeper in their lungs.”
In 1994 seven CEOs of major tobacco companies told an American courtroom that nicotine was not addictive, yet some research has suggested it may be more addictive than heroin.
Sheila Duffy believes the 2006 ban on smoking in places of work and public spaces has resulted in real improvements in health, but the cultural shift is under threat by e-cigarettes. Marketing has centred on how the products are suitable for situations where the smoke-free legislation applies. “Now that to me indicates that they’re interested in dual use, not harm reduction, and it’s an easy way for keeping people on,” she says. Companies including ScotRail, Starbucks and the Wetherspoons pub chain have already announced a ban on e-cigarettes.
Marketing for e-cigarettes is not restricted to existing smokers, however. SKYCIG has now hired PR agencies W and Cake, with expertise in music, fashion and sport, to provide the marketing push to meet their new targets. The advertising strategy is telling, says Duffy: “The fact that Lorillard is engaging PR companies that specialise in music, sport and fashion doesn’t suggest to me that they’re aiming for existing heavily addicted majority smokers in Scotland. It suggests to me they’ve got their eye on the next generation.”
Lorillard’s American product, Blu, has seen advertising reminiscent of an older era of tobacco advertising. “I was sent some photo adverts recently which they used for Blu, and it’s basically got a very shapely female form with a bikini bottom and the logo on it. And we’ve seen ads like Audrey Hepburn with the very elegant cigarette holder, and it’s an e-cig photoshopped in. So we’re seeing the return of images that we haven’t seen for decades, because we had to close them down because tobacco is lethal,” says Duffy.
Most companies have introduced several flavours. SKYCIG stocks cinnamon, vanilla and cherry, for example.
Rangers and Celtic football clubs have branded e-cigarettes by E-lites which light up in club colours, which has made policing smoking in stadia difficult. Dutch company Supersmoker has launched a Bluetooth e-cigarette that allows you to receive calls and stream music from your mobile phone.
The Royal Pharmaceutical Society, the membership body for pharmacy, updated its policy in February to include advertising. “E-cigarettes are currently unlicensed products with no standardisation of safety, quality or efficacy. As such, the RPS believes e-cigarettes should not currently be sold or advertised from pharmacies,” it says. Despite this, Boots the Chemist has recently signed an exclusive deal with a subsidiary of Imperial Tobacco to stock the Puritane e-cigarette, and Lloyds Pharmacy has struck a deal to sell British American Tobacco’s product Vype e-cigarettes. These deals followed unsuccessful attempts by independently-owned e-cigarette companies to have their products stocked at the pharmacy chains.
From advertising to retail tie-ins, clearly the tobacco industry is investing heavily in e-cigarettes. “Achieving legitimacy and aligning both public and private interests through the harm reduction debate are core aims,” according to Cancer Research UK’s report, which likens the environment to the surge in ‘Alco-pops’ in the early 90s which saw a new youth market for alcohol established. “When there was a weak regulatory response, the multinationals moved in to take over what has now become a global and highly profitable new sector. All the indications are that e-cigarettes will follow a similar trajectory,” it says.
Although there are currently no age restrictions on e-cigarettes, Michael Matheson remains bullish. “We believe that electronic cigarettes need appropriate regulation. While I accept that the devices may potentially help people smoke fewer cigarettes, or even stop altogether, there is concern that the devices could also re-normalise smoking. I have said before that the case for restricting the sale of e-cigarettes to young people makes sense, but we need to work through the practicalities before bringing forward specific plans. Not enough research exists to prove that e-cigarettes are safe, yet the evidence that does exist suggests they are almost certainly less harmful than tobacco. However, I am clear that electronic cigarettes should not be marketed or promoted in a way that makes them attractive to young people and we will do all we can to bring forward measures that keep children protected from behaviours that may make smoking seem normal,” he says.
Harm reduction in the illicit drugs field and in sexual health has been a success story in Scotland, but Duffy argues the agenda has since been widened.
“Harm reduction is doing what you can with what you have, but you’re aiming for people to be free. My aim for my kids, who are 14 and 10, is not that they end up using recreational nicotine, addicted to nicotine and therefore open to the predatory activities of tobacco companies who want to get them onto the ‘real thing’. My ambition for my kids is that they are free of addiction and can make their own choices. I don’t think that’s where the tobacco companies are aiming,” she says.