Relevant to COP10: Pharmaceuticalisation as the tobacco industry’s endgame

Yogi Hendlin, Eileen Han and Pam Ling’s new paper Pharmaceuticalisation as the tobacco industry’s endgame provides a detailed analysis of how the multinational tobacco companies have developed and used the companies efforts to reposition themselves a source for “clean” nicotine while simultaneously maintaining and expanding their sales of cigarettes and other “traditional” tobacco products where they can do so: “the transition to continuing the tobacco epidemic in declining mature markets using pharmaceutical-style
nicotine products to sustain nicotine addiction, sanctioning partnership with scientists and regulators and distracting from ongoing cigarette sales in developing markets.”

In particular, they highlight how the industry’s pharmaceuticalisation strategy has had the effect of engaging public health authorities in promoting policies that broadly assist the industry:

BAT and PMI initiatives embracing pharmaceuticalisation have been facilitated by public health professionals’ calls. Longstanding supporters of the Public Health England position, Britton and McNeill, for example, wrote in 2001 that ‘we also need legislation that explicitly encourages the development of alternative products that can deliver uncontaminated nicotine at a dose and rate comparable with cigarettes and in a way that is commercially and socially acceptable’. Public Health England’s more recent guidelines to distinguish between smoking and vaping for differential application of smoke-free policies highlighted the fundamental differences between smoking and vaping, and insufficient evidence suggesting vaping harms bystanders, emphasizing potential to help cessation and denormalise smoking. Such regulatory considerations could pave the way to revoke the smoke-free norms public health long fought to achieve. Granting exceptions to e-cigarettes under smoke-free policies is also framed as an equity issue, as Public Health England’s recent report on e-cigarettes argues that disadvantaged groups with higher smoking prevalence need access to e-cigarettes as cessation tools. It is one thing to claim that e-cigarettes can be one tool among many in helping people quit. It is quite another to reframe quitting conventional cigarettes as dependent on lifting the policy restrictions surrounding e-cigarette manufacture, advertising and use. Public health advocacy to reintroduce pharmaceuticalised tobacco product use into denormalised spaces may not help public health, but it definitely benefits the tobacco industry. [emphasis added, citations eliminated]

These are important lessons for delegates at COP10 as they consider how to respond to the current arguments that the companies are making that they should be exempted from FCTC Article 5.3, at least for their “new” products.

Here is the abstract:

Context: Declining smoking prevalence and denormalisation of tobacco in developed countries reduced transnational tobacco company (TTC) profit during 1990s and 2000s. As these companies faced increasingly restrictive policies and lawsuits, they planned to shift their business to socially acceptable reduced-harm products. We describe the internal motivations and strategies to achieve this goal.

Methods: We analysed previously secret tobacco industry documents available through the Truth Tobacco Documents Library. These documents were triangulated with TTCs’ investor and other professional reports, websites and public statements.

Findings: Mimicking pharmaceutical business models, tobacco companies sought to refurbish their image and ensure long-term profitability by creating and selling pharmaceutical-like products as smoking declined. These products included snus, heated tobacco products, e-cigarettes, nicotine gums and inhalers. Tobacco companies created separate divisions to develop and roll out these products, and the majority developed medical research programmes to steer these products through regulatory agencies, seeking certification as reduced-harm or pharmaceutical products. These products were regarded as key to the survival of the tobacco industry in an unfriendly political and social climate.

Conclusions: Pharmaceuticalisation was pursued to perpetuate the profitability of tobacco and nicotine for tobacco companies, not as a sincere search to mitigate the harms of smoking in society. Promotion of new pharmaceuticalised products has split the tobacco control community, with some public health professionals and institutions advocating for the use of ‘clean’ reduced-harm nicotine and tobacco products, essentially carrying out tobacco industry objectives.

The full citation is: Hendlin YH, Han EL, Ling PM. Pharmaceuticalisation as the tobacco industry’s endgame. BMJ Glob Health. 2024 Feb 5;9(2):e013866. doi: 10.1136/bmjgh-2023-013866. PMID: 38316465. It is available here.