Tobacco companies diversify into ‘pharmaceuticals’

(Reuters Health) - Tobacco companies claim to be developing and selling merchandise to help cigarette smokers quit, but health researchers accuse the industry of trying to hook consumers on different – still dangerous – nicotine products.

Writing in Annals of Internal Medicine, researchers at the University of California, San Francisco (UCSF) call the industry’s push into the smoking-cessation market “the pharmaceuticalization of the tobacco industry.”

“The same hand that’s creating the problem is attempting to create the solution,” lead author Yogi Hendlin said in a phone interview. “But their solution is long-term nicotine maintenance, rather than total tobacco cessation.”

Marketing tobacco-industry merchandise as pharmaceutical products and devices threatens to endanger public health and to derail decades of progress in educating the public about the risks of smoking, his team’s opinion piece says.

“Tobacco companies see their future as pharmaceutical companies. They’ve already begun to acquire pharmaceutical subsidiaries, and they’re producing tobacco products that look and feel like medicines,” senior author Dr. Pamela Ling, a professor of medicine at UCSF, said in a phone interview.

The authors define “pharmaceuticalization” as the tobacco industry’s “actual and perceived transition into a pharmaceutical-like industry through the manufacture and sale of noncombustible tobacco and nicotine products for smoking cessation or long-term nicotine maintenance without the testing and oversight required of traditional pharmaceutical products.”

The effort confuses consumers, complicates the regulatory process and legitimizes the tobacco industry as a healthcare partner, they say.

In response, Philip Morris International told Reuters Health in a statement that it understood that some might question its motives.

“At the same time we are very encouraged by the growing number of experts and health authorities who believe that tobacco companies like us have a key role to play in reducing the harm caused by smoking,” the statement said.

“We are making significant efforts so that all those who would otherwise continue smoking switch to scientifically substantiated smoke-free alternatives as soon as possible,” it said. “We do not ask to be trusted but to be judged based on facts.”

Ling, Hendlin and their coauthor Jesse Elias say the pharmaceuticalization of tobacco relies on two false assumptions: substantial numbers of smokers cannot quit, and the only way most smokers could quit would be with the help of pharmacotherapy.

As many as 90 percent of smokers who stop smoking do so cold turkey, without cessation aids, said Hendlin, a postdoctoral fellow at UCSF’s Center for Tobacco Control Research and Education.

But quitting cold turkey is easier said than done for a substantial group of smokers, particularly smokers coping with substance abuse and other mental health issues, said Donna Vallone, chief research officer at Truth Initiative’s Schroeder Institute, a Washington, D.C. nonprofit dedicated to ending youth smoking.

“Believe me, it’s right to worry about the industry’s objectives here,” she said by phone.

“On the other hand, we do believe that harm reduction is a legitimate public-health strategy. When you’re a lifetime committed smoker and you’re trying to quit, these products can be helpful to you,” said Vallone, who was not involved in the commentary.

All the major transnational tobacco companies have invested in so-called pharmaceuticalized tobacco products, according to the commentary authors.

In December, Philip Morris submitted a multimillion-page application to the U.S. Food and Drug Administration (FDA) seeking to certify a new product – I Quit Ordinary Smoking, or IQOS – as having “modified risk” compared to cigarettes.

IQOS includes short, disposable tobacco sticks soaked in propylene glycol and inserted in a heat-not-burn cigarette, which, like e-cigarettes, exempts it from smoking laws in many countries. A recent study in JAMA Internal Medicine found that the product releases chemicals linked to cancer, sometimes in higher concentrations than conventional cigarettes.

If approved by the FDA, IQOS would become the country’s first modified-risk, or reduced-harm, tobacco product.

Smoke from IQOS cigarettes releases 84 percent of the nicotine found in traditional cigarettes, the JAMA Internal Medicine study found.

“While the tobacco industry seeks to glamorize, normalize and rationalize nicotine addiction, don’t be fooled: nicotine is a potently addictive and harmful drug,” said Mark Travers, a researcher at the Roswell Park Cancer Institute in Buffalo, New York.

“Our ultimate goal will always be to end tobacco use AND nicotine addiction,” said Travers, who was not involved with the commentary, in an email. “Yes, pharmaceutical nicotine, as approved by the FDA, is an effective way to assist in stopping smoking, but complete abstinence of tobacco and nicotine use is the best outcome.”

SOURCE: Annals of Internal Medicine, online July 17, 2017.