9. Tobacco industry – pariahs, predators or player?
- 9.1 Are e-cigarettes a tobacco industry ploy to keep people smoking?
- 9.2 Should tobacco control authorities collaborate with tobacco-related industries in pursuit of public health objectives?
- 9.3 If tobacco companies want to reduce the harm caused by cigarettes, why don’t they just stop selling cigarettes?
9.1 Are e-cigarettes a tobacco industry ploy to keep people smoking?
No. Modern e-cigarettes were not invented by the tobacco industry and there are thousands of suppliers who are not part of the tobacco industry. The tobacco industry has realised that its customers want to switch to these products and has entered the market. The industry deserves to be treated with great scepticism and should always be handled with caution. However, it is positive that the industry is marketing low-risk alternatives to its core product, the cigarette – there is no reason to want the industry to remain exclusively focussed on selling cigarettes. A long-term transition of the industry from selling combustible products to non-combustible is in the interests of public health and is the most likely and rapid way to end the worldwide epidemic of smoking-related disease.
9.2 Should tobacco control authorities collaborate with tobacco-related industries in pursuit of public health objectives?
Yes, of course – if the companies have something to offer that would benefit health. Imagine a situation where a deal could be done between a government and a tobacco company to include an insert and/or voucher for e-cigarettes in each pack of cigarettes it sells. Suppose they want to run this as area controlled trial to see if this works to reduce smoking and increase switching. What would be the consequences of not collaborating? It could mean health opportunities are lost and more harm is caused. That cannot be justified. The marketplace is changing radically and I think everyone in public health has a ‘duty of curiosity‘ to find ways to exploit these opportunities to the greatest possible extent, even if that means ‘talking to the enemy’. Dogmatic inflexible positions that are oblivious to changes in the real world positions are the enemy of progress and liable to cause more harm than good.
9.3 If tobacco companies want to reduce the harm caused by cigarettes, why don’t they just stop selling cigarettes?
This is more of an empty campaigning posture than a plausible way to make progress. No public company could do this unilaterally. The management has a legal duty to its shareholders not to destroy the value of their equity (shares). If a management team tried it they would be fired and replaced by the board or shareholders. If somehow they succeeded, the company would be taken over or its profitable assets and brands sold to another company. Somebody would end up selling the cigarettes. There are two other ways in which it could happen: (1) a government-led legal ban on cigarettes or its equivalent (reducing nicotine levels to near-zero). (2) a technology transition, reinforced by risk-proportionate regulation, in which cigarettes become an obsolete niche product. I doubt the first will work and no-one has so far tried it. The second is already underway but obstructed by tobacco control activism. The most pragmatic way to get rid of smoking is to have a much better alternative.