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Beneficence or maleficence—big tobacco and smokeless products

2009; Wiley; Volume: 104; Issue: 2 Linguagem: Inglês

10.1111/j.1360-0443.2008.02483.x

1360-0443

Ann McNeill, David Sweanor,

Smoking Behavior and Cessation

Smokeless tobacco products have been marketed and consumed for many centuries, surpassed in popularity in the last century only by the cigarette. More recently, there has been renewed activity in the smokeless tobacco (ST) market, with manufacturers either broadening their marketing base or following a strategy of bringing reduced risk products to the market, depending on one's perspective on the industry's motivation and calculations. Debate over the availability and use of ST products for harm reduction and cessation is animated and ongoing (e.g. 1, 2). ST covers a range of products with large differences in toxin concentrations. We believe that all credible scientists accept that, at the individual level. The least harmful ST is less harmful than smoked tobacco by one or two orders of magnitude 3. The difference in opinion occurs over the virtue of increasing availability and accessibility of ST products. Will this cause societal harm by giving tacit endorsement to tobacco manufacturers and encouraging non-users to take up tobacco products and ultimately become cigarette smokers; or will support for ST use save lives by giving nicotine addicts a less harmful option, one which causes no secondary harm to non-users? We outline here recent developments by tobacco transnationals which merit attention but are either going unnoticed or occurring without any regulatory oversight. We cover two main issues: industry mergers and takeovers; and new ST products, either launched in the past year or two or recently granted a revitalized marketing push. Most tobacco industry activity has occurred in the United States and Sweden, the two most established ST markets outside the Asian subcontinent, where there has been little new product development. Among the company developments, Altria Group, Inc. (the owner of Philip Morris USA) recently launched a takeover of UST (the parent company of US Smokeless Tobacco Company). This is an interesting move, in that UST dominates the US ST market but does not manufacture or distribute smoked tobacco products, whereas Philip Morris USA dominates the cigarette market and had only recently and minimally entered the ST market. This follows the Reynolds American (RAI) purchase of Conwood in 2006, leaving only Swedish Match as a major ST manufacturer neither involved in the cigarette business nor owned by a cigarette company. The purchase of ST firms by cigarette companies creates both challenges and opportunities for public health. Given the significant purchase prices, it is hard to imagine that the cigarette companies are simply trying to prevent ST from making further inroads into the cigarette market. In addition, competitive pressure, combined with cigarette companies' limited acknowledgement of their products' risks, could allow the marketing power of the big cigarette companies to facilitate consumer movement away from the most toxic forms of nicotine delivery. However, having ST companies bought by entities that are still principally dependent upon cigarettes for sales and profits raises the risk that such purchases will reduce health-based inter-product competition and be used more to protect the cigarette business than to transform the market. The existence of stand-alone ST companies might allow for a far more aggressive attack on the cigarette market. Three of the four main transnationals are now marketing smokeless tobacco products. Before its purchase of UST, Philip Morris USA was test-marketing Marlboro Snus and Marlboro Moist Smokeless Tobacco. Although no independent research has been carried out on this set of products, Foulds & Furberg have questioned whether Marlboro snus really is snus, because it appears to deliver very low levels of nicotine compared to the snus products sold in Sweden 4. British American Tobacco (BAT), second to Philip Morris International in its global share of the tobacco market, entered the ST tobacco field only recently. It acquired a Danish-based tobacco firm, Skandinavisk Tobakskompagni, which enabled BAT to manufacture ST products in-house. Test marketing began in May 2005 in South Africa and Sweden, with the company extending the Lucky Strike brand for its 'sachet variety' ST products in both countries, with the Peter Stuyvesant brand also offered in South Africa. BAT is now second only to market leader Swedish Match in ST sales in Sweden. The firm continues to add new products and extend its existing brand lines. Japan Tobacco International (JTI) also markets a snus type product in Sweden. The status quo is to ignore these developments or criticize them and hope they will go away. Small companies that innovate may wither. An example of this is Star Scientific, which introduced two ST potentially reduced exposure products in the United States, Ariva and Stonewall, in 2001 and 2003, respectively. Tobacco control campaigners advocated that these products be regulated by the Food and Drug Administration (FDA) and taken off the market. Sales of both are minimal. The leading transnational tobacco companies will continue to make forays into the smokeless market but possibly, as noted above, for all the wrong reasons: to gain legitimacy and credibility, promote brand names and increase cigarette sales. What about the consumer? Research in the United States, United Kingdom and Sweden has shown that some smokers would be interested in using non-combustible nicotine products rather than continue smoking, and although more chose nicotine replacement-type products, a significant minority chose ST (e.g. 5, 6). However, this option is not currently available to many smokers. In the European Union, for example, the least harmful types of smokeless tobacco are banned with no immediate prospect of that changing 7, whereas unregulated chewing tobacco products will continue to be freely available. In our opinion, the only viable way forward is to set out a regulatory framework for all tobacco and nicotine products which also sets limits for contents and extends controls on packaging and marketing. There have been calls for such a new regulatory framework over the last decade (e.g. 3), but there appears to be very little happening on this front currently. With such a regulatory framework in place, we believe that companies could be encouraged to favour ST products over smoked ones. The goal will always be complete cessation of nicotine products, but through differential taxation and marketing regulations (including clear evidence-based statements of differential risk), consumers who cannot stop smoking could be encouraged to shift along a continuum of nicotine products with clean nicotine (such as current nicotine replacement products) favoured over the least harmful ST products and the latter favoured over cigarettes. We believe that only when this happens can smoked tobacco products, noxious to users and non-users alike, go the way of leaded petrol, bathtub gin and snake oil medicines, within a foreseeable future. Ann McNeill has no declarations of interest. David Sweanor has ongoing contacts and discussions with current and former tobacco industry employees, stock analysts and other sources of information on the industry. He does not receive direct payments from industry sources but does receive payments for work conducted for attorneys who have been involved in litigation against tobacco companies. David Sweanor has carried out consulting work for pharmaceutical companies on issues concerning tobacco control and also has ongoing contacts with pharmaceutical company employees and consultants. Other than a nominal shareholding in one tobacco company, he has no direct investments in tobacco, alcohol, pharmaceutical or gaming companies, but does have investments in a wide range of companies that will, in the normal course of business, interact with these industries and in pooled investments that may involve these industries. We are very grateful to Stan Shatenstein for researching and contributing background information. This work developed out of a grant by the Foundation Open Society Institute.