This week, the electronic cigarette maker NJOY received a $70 million capital injection from a group of investors including Brookside Capital and Morgan Stanley Investment Management, in the latest vote of confidence for a fast-growing industry.
The company, based in Scottsdale, Ariz., boasts several entrepreneurial investors including Sean Parker, the co-founder of the now-defunct Napster, and Peter Thiel, one of the founders of PayPal.
We believe that only an independent company can have as its corporate mission the extraordinary technological and important objective to make cigarettes obsolete,” said Craig Weiss, chief executive of NJOY. Mr. Weiss, who is a patent lawyer and former hedge fund manager, compared the initiative and its ambition to putting a man on the moon. His brother Mark, also a lawyer, founded NJOY in 2006 after a trip to China inspired him to enter the electronic cigarette market. During his trip, he visited a trade show where e-cigs, so large they looked like cigars, were being showcased. “It seemed to him that this was the future of smoking,” said Mr. Weiss, who took over as president of NJOY in 2010.
But as e-cigarettes become more popular, major tobacco companies are taking note. Lorillard, the maker of cigarette brands like Newport and Kent, acquired Blu eCigs for $135 million in 2012, and RJ Reynolds, Japan Tobacco International and British American Tobacco have also scooped up stakes in emerging e-cigarette companies.
The presence of such big tobacco firms has caused some critics to question whether e-cigarettes are just a new way to get people hooked on nicotine, an addiction that could lead them to turn to tobacco cigarettes.
To counter that impression, NJOY points to its unusual team of executives that include veterans of the old tobacco industry, as well as scientists and well-respected doctors to help with this image. It recently added former Surgeon General Dr. Richard H. Carmona, who served in the George W. Bush administration, to its board
Young children’s perceptions of health warning labels on cigarette packages: a study in six countries
Health warning labels on cigarette packages are one way to reach youth thinking about initiating tobacco use. The purpose of this study was to examine awareness and understanding of current health warning labels among 5 and 6 year old children.
SUBJECTS AND METHODS:
Researchers conducted one-on-one interviews with urban and rural 5 and 6 year olds from Brazil, China, India, Nigeria, Pakistan, and Russia.
Among the 2,423 participating children, 62 % were unaware of the health warnings currently featured on cigarette packages, with the lowest levels of awareness in India and the highest levels in Brazil. When shown the messages, the same percentage of participating children (62 %) showed no level of message understanding.
While youth are receiving social and informational messages promoting tobacco use, health warning labels featured on cigarette packages are not effectively reaching young children with anti-smoking messages.
For those of us who have been impacted by the death of loved ones due to the negative health consequences of smoking, the recent announcement by Larry Merlo, the CEO of the U.S. pharmacy chain CVS, to stop selling tobacco products in the chain’s 7,600 stores, was a ray of hope and a step toward a future when public health concerns trump short-term profit motives.
CVS’s decision should be applauded and emulated as a good corporate example of the adoption of “shared value” principles,which combine social and economic concerns. Indeed, this was not only a courageous decision to help prevent more societal harm caused by tobacco addiction, but also a business-savvy decision for a man who lost his father to lung cancer.
While the company stands to lose about US$2 billion in annual revenues (1.6% of its total sales of US$123 billion), he is positioning CVS for the long term as an important health care provider, not just for selling prescription drugs but also for offering basic health services such as flu vaccination and preventive care for chronic conditions in its fast-expanding “MinuteClinics” network.
Governments, private and non-governmental stakeholders, and international donors will do well to fully understand the business rationale of CVS and rethink their development strategies and assistance programs to make tobacco control a national and international priority. As Mr. Merlo noted in a recent interview with the Financial Times, selling tobacco in CVS stores “had become a contradiction to the health outcomes that we were trying to achieve.”
So, if governments, private and civil society actors, and international donors are committed to maximize the well-being of the population, they must redouble multisectoral efforts towards tobacco control to avoid falling into the same contradiction that CVS faced.
Let’s be clear. As World Health Organization (WHO) experts pointed out years ago, tobacco is the only consumer product that eventually kills half of its regular users if they follow its manufacturers’ recommendations. So how to stop this “legalized” carnage across the world?
Besides corporate actions such as CVS’s decision,which will contribute to further reduce the social acceptability of smoking, the 2003 WHO Framework Convention on Tobacco Control (FCTC)—ratified by the majority of the world’s countries—offers a number of anti-tobacco measures, including high taxes on tobacco products and regulations to protect people from exposure to tobacco smoke in public places.
The good news is that the effective application of the FCTC measures is both good for public health and for the economy at large. On one hand, these measures could yield cost-effective prevention for up to one-third of the world’s cancer cases— a positive step since cancer treatment is already unaffordable in many countries. On the other hand, as suggested in a 2012 analysis conducted for the U.S. government by the Congressional Budget Office, an increase of 50 cents per pack in the U.S. excise tax on cigarettes and small cigars (adjusted each year to keep pace with inflation and, in the long term, with the growth of people’s income), and the resulting impact on people’s behavior and health, would increase U.S. federal revenues by about US$41 billion and reduce spending by US$1 billion through 2021.
Almost US$38 billion of the additional revenues would come from the higher excise tax, and another US$3 billion in revenues would stem from improvements in health, primarily from additional earnings as better health allows people to work more and be more productive. Spending on the U.S. government’s largest health care programs, Medicare and Medicaid, would also decline slightly during that period as people’s health improved, while spending on Social Security would increase slightly as more people lived longer.
CVS CEO Merlo’s decision comes on the heels of another courageous position taken by Lt. General Ian Khama, President of Botswana. In spite of strong opposition from the tobacco industry, President Khama announced in his State of the Nation speech on November 4, 2013, a 30% increase in the tobacco levy on top of the 48% excise tax on tobacco adopted by the five Southern Africa Customs Union (SACU) countries, of which Botswana is a member.
Taking into account public health and economic evidence, and building upon these examples of bold leadership, we need to continue to keep pushing tobacco control across the world as a moral and development imperative. And only then we will truly honor the legacy of our loved ones who suffered and were lost because of lung cancer and other tobacco-related diseases.
Personal tobacco pack display before and after the introduction of plain packaging with larger pictorial health warnings in Australia: an observational study of outdoor café strips
We tested whether prevalence of cigarette pack display and smoking at outdoor venues and pack orientation changed following the introduction of plain packaging and larger pictorial health warnings in Australia.
Between October and April 2011-12 (pre-plain packaging, pre-PP) and 2012-13 (post-plain packaging, post-PP), we counted patrons, smokers and tobacco packs at cafés, restaurants and bars with outdoor seating. Pack type (fully branded, plain or unknown) and orientation were noted. Rates of pack display, smoking and pack orientation were analysed using multi-level Poisson regression.
Pack display declined by 15% [adjusted incident rate ratio (IRR) = 0.85, 95% confidence interval (CI) = 0.79-0.91, P < 0.001], driven by a 23% decline in active smoking (IRR = 0.77, 95% CI = 0.71-0.84, P < 0.001) between phases. The decline in pack display coincided with the full implementation of plain packaging from December 2012, was stronger in venues with children present and was limited to mid and high socio-economic status (SES) areas. The proportion of packs orientated face-up declined from 85.4% of fully branded packs pre-PP to 73.6% of plain packs post-PP (IRR = 0.87, 95% CI = 0.79-0.95, P = 0.002). Alternatively, the proportions concealed by telephones, wallets or other items (4.4% of fully branded packs pre-PP and 9.5% of plain packs post-PP; IRR = 2.33, 95% CI = 1.72-3.17, P < 0.001) and in an external case (1.5-3.5% of all packs; IRR = 2.79, 95% CI = 1.77-4.40, P < 0.001) increased. Low SES areas evidenced the greatest increase in pack concealment and the greatest decline in face-up pack orientation.
Following Australia’s 2012 policy of plain packaging and larger pictorial health warnings on cigarette and tobacco packs, smoking in outdoor areas of cafés, restaurants and bars and personal pack display (packs clearly visible on tables) declined. Further, a small proportion of smokers took steps to conceal packs that would otherwise be visible. Both are promising outcomes to minimize exposure to tobacco promotion.
Do they or don’t they help tobacco smokers quit?
A California man named Eric McGovern is attempting to bring a class action suit against e-cig maker Njoy, on the grounds that e-cigs are allegedly not as harmless as they claim to be, and also that it is inconsistent regarding whether it does or does not help smokers give up the habit.
Courthouse News Service reports that McGovern’s suit claims that e-cig vapor contains the “same impurities and the same cancer-causing agents as traditional cigarettes” (though the levels of such substances in tobacco smoke vs. e-cig vapor are not specified).
E-cigs are marketed as the less-harmful alternative to cigarette smoking, though this has not prevented criticism from those opposed to any use of nicotine, regardless of form. For example: last November, researchers at UC San Francisco released a report criticizing e-cigs for being “the new phase of the nicotine epidemic” and claiming that, instead of reducing the number of nicotine addicts (read: smokers of tobacco) in the world, e-cigs actually increase the number of nicotine addicts (read: inhalers of e-cig vapor).
However, traditional opposition to tobacco smoking was based not on opposition to nicotine use per se, but to the very real health risks that come from regularly inhaling pure tobacco smoke into your lungs. So the debate on whether e-cigs are good, bad or neutral could also be reframed as a debate over what, exactly, is bad about traditional cigarette smoking: is it bad only because of the harmfulness of the smoke? Or should we assume any use of nicotine is bad, even if smoke damage is removed from the equation?
The Courthouse News article about McGovern’s lawsuit also reports this apparent non-sequitur:
Njoy touts e-cigarettes as a safe alternative by implying that its product is as safe as vegetables and plants that contain nicotine, McGovern says.
“In reality, a typical consumer would need to ingest, as an example, 244 grams of tomatoes to equal the amount of nicotine a passive smoker would absorb in about three hours in a room with a minimal amount of tobacco smoke,” the 25-page lawsuit states.
Assuming this is accurate, it still conflates two different things: the question of whether nicotine-containing plants can safely be ingested is entirely different from the question of how many plants one must ingest specifically to get a certain dose of nicotine. (If cigarette addicts jonesing for a nicotine fix are in the habit of eating tomatoes instead, this trend has not yet received mainstream media coverage.)
And, of course, neither question addresses how much nicotine one might expect from a typical e-cig dose, let alone how much if any nicotine passive non-e-cig users could expect if they sat in a room with an e-cig user.
McGovern is being represented by Brian Chase, a personal injury lawyer out of Newport Beach.
A proposed ordinance would treat them like traditional tobacco cigarettes
There doesn’t seem to be much middle ground on electronic cigarettes; people either love them or hate them. And those who hate them tend to be in positions of power.
The Los Angeles city council is the latest to consider outlawing the gadgets. A pending ordinance would basically treat e-cigs as though they were traditional, tobacco-burning cigarettes, outlawing them in public places.
The proposed ordinance made it through a committee on Monday and is now headed to the full city council. The committee acted after hearing from Los Angeles County’s public health director, Jonathan Fielding, who said the e-cigs tend to make smoking socially acceptable, encouraging young people to take up smoking.
“We don’t want to risk e-cigarettes undermining a half century of successful tobacco control,” he said, according to the Los Angeles Times.
Opponents of the measure say it would simply drive smokers back to tobacco.
Promoters of e-cigs argue that they are much safer than traditional cigarettes, which release nicotine as a byproduct of burning tobacco, a process that releases deadly tars into the lungs of smokers and those nearby.
E-cigarettes electrically heat nicotine, releasing it as vapor, giving users their nicotine fix without the dangerous tars and minus the fire hazards of traditional cigarettes.
But a study released late last year disputed the contention that e-cigs are an effective way to keep teens from taking up the smoking habit.
UC San Francisco researchers said last November that the youths they studied using e-cigarettes were more likely to be trying to quit, but also were less likely to have stopped smoking and were smoking more, not less.
“We are witnessing the beginning of a new phase of the nicotine epidemic and a new route to nicotine addiction for kids,” according to senior author Stanton A. Glantz, PhD, UCSF professor of medicine and director of the Center for Tobacco Control Research and Education at UCSF.
The Centers for Disease Control and Prevention recently reported that the majority of adolescent e-cigarette users also smoke regular cigarettes, and that the percentage of middle and high school students who use e-cigarettes more than doubled from 2011 to 2012. An estimated 1.78 million U.S. students had used the devices as of 2012, said the CDC.
Mr. Fashola signed the smoke-free public places bill barely one month after the Lagos State House of Assembly passed it into law.
Some civil society organizations have commended Babatunde Fashola, the Lagos State Governor, for signing into law the bill regulating smoking in public places.
The Environmental Rights Action/Friends of the Earth Nigeria, ERA/FoEN, and Civil Society Legislative Advocacy Center, CISLAC, in a statement in Lagos, Wednesday, described the law as a “timely vote for public health” which should be emulated by the National Assembly that is yet to pass the National Tobacco Control Bill into law.
Mr. Fashola signed the smoke-free public places bill on Monday; barely one month after the Lagos State House of Assembly passed it into law and forwarded it to his office for his signature.
Under the law, places designated as no smoking areas are libraries, archives, museums, galleries, public toilets, hospitals and other health facilities, nurseries, day care centres and any facility used for the care of infants and children or adults.
During the signing ceremony which had top government functionaries and members of the Lagos State House of Assembly in attendance, the governor said the smoke-free public places law will help government discharge its responsibility to the citizenry more efficiently.
In their joint statement, ERA/FoEN and CISLAC said the development is welcome. They urged lawmakers at the National Assembly to put aside party differences and personal ambitions.
“We salute the courage of Governor Fashola for shunning the rapprochement of British American Tobacco Nigeria (BATN) which was clearly targeted at thwarting this life-saving bill when the company’s top echelon visited his office last year.
“The governor has through the signing of this bill sided with the people over and above deadly investments,” said Akinbode Oluwafemi, ERA/FoEN Director Corporate Accountability and Administration.
“The Lagos state government must not go to bed now. It must be alert and refuse to be hoodwinked by BATN media hoax about supporting the bill. The tobacco industry is known to double speak on matters if regulation and quick to set in motion groups that counter sound logic behind regulation of its deadly products,” Mr. Oluwafemi added.
Other places designated as non-smoking areas include kindergartens, nursery, primary, secondary schools, public telephone kiosks or call centres, and public transportation vehicles, among others.
The law criminalizes smoking before minors and compels management of public places to conspicuously display “No Smoking” signs at appropriate positions within their premises.
Auwal Rafsanjani, Executive Director of CISLAC, commended the expedited action on the bill by the governor, saying that Lagos has again shown it blazes the trail in delivering good governance without prevarication.
“Of particular note is the fact that it took the governor less than a month to sign this pro-people bill into law. It is disheartening that we cannot say same for the tobacco control bill at the National Assembly which has suffered bureaucratic setbacks instigated by tobacco industry misinformation which puts profits before health,” Mr. Rafsanjani said.
Mr. Rafsanjani urged the National Assembly to follow the example of Lagos by accelerating work on the National Tobacco Control Bill, NTCB, which he said, would save Nigerians from further trauma inflicted on health and the national economy by products marketed by BATN and other tobacco companies.
The Revere City Council is in the process of reviewing a motion to raise the legal sales age of tobacco in Revere gradually from 18 to 21. Tobacco companies know that youth are more vulnerable to addiction when they are younger, and that is why they market to kids with products that look like candy.
Should we just stand by and let our youth pay with their health, while the tobacco companies fill their pockets? The burden of death, disease, and disability by the use of tobacco products doesn’t just lie with the smoker, but society as well. In the US $193 billion are spent in tobacco-related health cost and productivity loss.
Let’s stand together and send a message that as a community we will advocate for our kids! Please support this motion by testifying before the legislative subcommittee:
Monday, March 10 at 5 PM in the City Council Chamber
If you can’t attend please write a letter or email to the City Council Members:
REASON WHY YOU SHOULD SUPPORT THIS MOTION:
20% of Revere high school students have smoked cigarettes in the past 30 days. That is about 300 kids. If those kids turn into daily smokers, 1/3 of them will eventually die from tobacco health related problems. (2011 Revere Youth Risk Behavior Survey)
Most Adult Smokers Start Smoking Before Age 21
“If a man has never smoked by age 18, the odds are three-to-one he never will. By age 21, the odds are twenty-to-one.”
— RJ Reynolds, September 10, 1982
• National data show that 95 percent of adult smokers begin smoking before they turn 21. The ages of 18 to 21 are also a critical period when many smokers move from experimental smoking to regular, daily use. While nearly half of adult smokers become daily smokers before age 18, more than 75 percent do so before they turn 21.
• Nicotine is incredibly addictive, and adolescents and young adults are more susceptible to its effects because their brains are still developing. Delaying the age when young people first experiment with or begin using tobacco can reduce the risk that they will become addicted smokers.
Tobacco Companies Target Kids and Young Adults
• Tobacco companies intentionally market to kids and young adults in order to recruit “replacement smokers” and protect company profits. They know nearly all users become addicted before age 21. Increasing the tobacco sale age to 21 will help counter the efforts of the tobacco companies to target young people at a critical time when many move from experimenting with tobacco to regular smoking.
Raising the Sale Age Will Help Keep Tobacco Out of High Schools
• Research shows that kids often turn to older friends and classmates as sources of cigarettes. With more high school students turning 18 before graduation, younger kids have regular contact with older students who can legally purchase tobacco for them.
• Raising the tobacco sale age to 21 would reduce the likelihood that a high school student will be able to legally purchase tobacco products for other students and underage friends.
• About 700 kids under the age of 18 become regular smokers each day – one in three will eventually die as result. We should do everything we can to prevent young people from smoking and save lives. Increasing the minimum legal age of sale for tobacco products to 21 will help achieve these goals.
• A similar strategy was highly successful in addressing alcohol sales. A national age 21 law for alcohol sales resulted in dramatic reductions in drunk driving fatalities. At the time, some critics of the policy argued that because 18 year-olds can vote and enlist in the military, they should be allowed to be sold alcohol. Despite these arguments, the increase in the minimum sales age for alcoholic beverages has saved tens of thousands of lives of young drivers, their passengers, and others on the road.
•The burden of death, disease, and disability by the use of tobacco products doesn’t just lie with the smoker, but society as well. In the US $193 billion are spend in tobacco-related health cost and productive loss.
• Research has shown that when minimal legal sales age of tobacco are adequately enforced, they are effective in reducing or delaying smoking initiation among youth. This leads to lower smoking prevalence rates, saving millions of dollars in health care costs as well as significantly increasing not just the length, but also the quality of life, across populations.
• Delaying the onset of tobacco use is associated with several long-term health benefits. Not only does it reduce the number of life-years available for tobacco use (and of course, the longer a person uses tobacco, the higher the risk of developing severe health consequences), but delays in onset are also associated with a higher probability of successful cessation efforts later.
SOURCE: Tobacco Control Legal Consortium, “Raising the Minimal Legal Sale Age for Tobacco and Related Products”
THE MILITARY ARGUMENT
(“ If I am fighting for my country, I have a right to smoke”)
1. Smoking soldiers are less combat ready and have slower wound healing as compared to their counterparts. Smoking also has been “implicated in higher dropout rates in basic training, poorer visual acuity, higher rates of leaving the service during the first year and higher absenteeism in the active-duty military personnel. In 1995 1/6th of deaths in the DoD population ( including military retirees) were attributed to smoking…”
2. Lung cancer rates are twice as high among soldiers than in the civilian population and response to chemotherapy and 5 year survival rates are poorer.
3. Cost to the tax payers due to tobacco related diseases in the military and VA system
a. In active servicemen/women 1/2 billion dollar per year in medical costs
b. Loss in work productivity of active-duty military personnel due to smoking was over $345 million.
c. The cost of treating emphysema in the VA system per year is $5 billions of which 80% of this disease can be attributed to smoking.
4. The 67% non-smoking military personnel are experiencing the consequences of 2nd hand smoke exposure. 53,000 Americans die per year due to second hand smoke.
Source: Above info is taken from the 2009 Institute of Medicine report for the Department of Defense
SMOKING RATES IN REVERE
• The adult smoking rate is 73% higher in Revere than statewide (25.9% in Revere compared to 15% statewide).
• Revere has the highest lung cancer mortality rate compared to the 6 boarding towns.
• Mortality from lung cancer is 34% higher in Revere compared to Massachusetts.
• Lung cancer incidence is 75% higher among females in Revere compared to the state of Massachusetts. The age-adjusted lung cancer incidence (per 100,000) for females is 114.2 in Revere compared to 65.2 in Massachusetts.
Source: Massachusetts Department of Public Health
Tobacco Cessation and Prevention Program
(617) 624-5900 www.mass.gov/dph/mtcp
OTHER COMMUNITIES IN MASSACHUSETTS THAT HAVE RAISED THE LEGAL SALES AGE OF TOBACCO
Ashland, Dedham, Canton, Sharon, Dover, Wellesley, Arlington, Needham (2005), Scituate.