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October 20th, 2016:

Market expert: Regulating e-cigarette “a one-way direction”

The Hong Kong government has been urged to reconsider its plan to ban e-cigarettes as they can be a much less harmful alternative to tobacco cigarettes in nicotine delivery – if regulated properly.

Dr Stephen Jenkins, director in regulatory and medical affairs of Nicoventures in the Asia-Pacific region, is in Hong Kong reaching out to lawmakers to garner support for e-cigarette regulation instead of a total ban. Earlier in June, legislator Kwok Wai-keung (郭偉強) of the Federation of Trade Unions revealed that the current administration will propose banning the imports and sale of e-cigarettes in the 2016/2017 LegCo term.

Dr Jenkins stresses that e-cigarette, without tar and the process of combustion, is 95% less harmful than traditional cigarettes and is the most frequently used device to quit smoking, citing much-quoted reports from Public Health England and Royal College of Physicians. He also notes that Canada and New Zealand have recently announced that they will move to regulate e-cigarette, and there is a review undergoing in Australia. The World Health Organisation has also taken a step back by taking out complete ban as a recommended policy option in its latest report on Electronic Nicotine Delivery Systems and Electronic Non-Nicotine Delivery Systems (ENDS/ENNDS) for the seventh session of the COP (COP7). A more concrete stance from the influential health body is expected after COP7 which will be held in November.

“Our view is electronic cigarettes, as they are in Europe, should have dedicated regulation to ensure that they are available to smokers and not sold to under 18s, with quality standards in place to ensure that the devices and liquids are reliable,” Dr Jenkins puts. “The data and the experience globally is clearly in one direction: that they should be available and they should be regulated. […] I am very happy to have an open discussion with the [Hong Kong] government and be challenged on the evidence.”

Other countries in Asia that already have regulation in place, or are looking into introducing one include South Korea, Indonesia and Malaysia.


Nicoventures is a company set up in 2010 by British American Tobacco (BAT) which focuses on the development and commercialisation of non-tobacco nicotine products. The company has made written submissions to the LegCo’s Panel on Health Services back in June last year and to Secretary for Food and Health Dr Ko Wing-man (高永文) in early 2016. It has also requested a meeting between Dr Jenkins and government representatives but the invitation was turned down by the government. In response, the Food and Health Bureau stated that it has received submissions from various groups supporting its legislative proposal and the tobacco trade, and that it is in the process of studying the submissions.

Under the Pharmacy and Poisons Ordinance (Chapter 138), nicotine is a Part I poison in Hong Kong and that e-cigarette containing nicotine is regarded as pharmaceutical product and must be registered with the Pharmacy and Poisons Board before sale or distribution. E-cigarette without nicotine is however unregulated under current laws.

“I hope that the government can present more justifications before presenting its proposal of a total ban in front of the LegCo,” Kwon Wai-keung earlier told Harbour Times. “In the meantime there should be amendments to the Smoking (Public Health) Ordinance to keep e-cigarettes away from the minors.”

As Dr Jenkins adds, studies in the UK and Europe have already dismissed the ‘gateway theory’ as less than 1% of e-cigarette users, or vapers, being non-smokers. One study sampling 27,460 EU citizens shows 1.3% of never smokers used nicotine-containing e-cigarettes, with 0.09% reporting daily nicotine use. The report also notes over one-third of current e-cigarette users polled reported smoking cessation and reduction. He warns that a complete ban will only lead to the emergence of a black market flooded with low quality products.

“Even with a ban in place, e-cigarette devices will remain easily accessible to Hong Kong people as more than 90% of them are produced in Shenzhen,” Dr Jenkins argues. “So what we need to do is to ensure that those products coming into Hong Kong are reliable and traceable.”

“From a health policy perspective, [e-cigarette] is quite unique. The speed of change globally around this area is outstanding. People are making choices and looking for the government to help them. This bottom-up approach is encouraging countries to look at the data and opt for regulation,” Dr Jenkins asserts. “I never think it’s too late. The evidence is so strong that I’m sure as soon as people are aware of it, they will have to consider it.”

Big Tobacco sees its future in cigarettes, not vaping

In 2012, in the early days of the rise of e-cigarettes, Kingsley Wheaton, Director of Corporate and Regulatory Affairs at British American Tobacco, said “Our core business is, and will remain in, tobacco”.

So have the intervening four years made much difference? Apparently not.

This month, senior Philip Morris International executive Werner Barth told shareholders at its investor day presentations the company fully expected its cigarette brands to remain highly profitable. Investment analysts Motley Fool summarised the presentation by saying that Philip Morris planned to have cigarettes “keep bringing in the bulk of its revenue for years to come.”

In 2014, more than one billion smokers spent some $US744 billion on 5.6 trillion cigarettes. By contrast, the global e-cigarette market had estimated sales of $US6.1 billion in 2015 (0.8% of the cigarette market). Bullish forecasts about the future of e-cigarettes are easy to find on the internet. Many of these are undoubtedly efforts to attract investors.

But recent data point to a major slowing in the growth that has been seen in some nations for about five years. In the important US convenience store sector, sales of vapour products fell continuously for seven months (note that this data does not include online or vape shop sales).

A report earlier this year in the industry magazine Tobacco Reporter quoted a Euromonitor tobacco analyst saying:

Western Europe – for the first time in several years – saw positive [tobacco] volume growth as economies recovered and out-switching to illicit and vapour products lessened.

Barth highlighted three high-growth segments for cigarettes: low-tar cigarettes, which Motley Fool noted “have become an important way that some smokers have aimed to address their concerns about potential health impacts of smoking”; slimmer cigarettes (a strategy usually targeted at women); and the capsule market, where smokers can burst a capsule of flavour embedded in the filter.

Low-tar cigarettes have of course been thoroughly discredited as false and misleading harm-reduced products. The Australian Competition and Consumer Commission (ACCC) has banned the light and mild descriptors in Australia. The tobacco industry knew about this deception for decades (see below) but is apparently still happy to benefit from and not actively correct consumer misunderstandings here.

Big Tobacco knew 44 years ago that people did not smoke like tar measuring machines.  Legacy Industry Documents Library

Big Tobacco knew 44 years ago that people did not smoke like tar measuring machines. Legacy Industry Documents Library

In recent years we have seen an incontinence of rebirthing talk from Big Tobacco companies such as Philip Morris, British American Tobacco (BAT), RJ Reynolds and Japan Tobacco International about their commitment to manufacturing non-combustible nicotine delivery devices, particularly e-cigarettes and Philip Morris’ heat not burn products.

The hope for these products, like a conga line of hyped harm-reduction failures of the past, is that they will significantly reduce disease and death from what follows from nicotine addiction.

Tobacco companies of course all wish that two in three of their very best customers didn’t inconveniently die from using their products years earlier than normal life expectancy. They would much rather they could all keep smoking for a normal life span and keep the cash registers turning over.

For decades companies just denied that smoking killed. In the 1990s, these lies were stopped in their tracks when the companies were forced to publicly swallow truth serum in the form of their own newly public internal documents, released via whistleblowers and through litigation. These showed they knew the problems with tobacco all along.

If the industry really cares deeply about the deaths of its customers, this care is not enough to do anything to stop it selling the deadliest forms of nicotine delivery, nor to desist from its major attacks on tobacco-control policies it knows are most effective in reducing smoking. Plain packaging, which started in Australia, continues to attract massively funded attacks and legal challenges, currently in full swing in Canada which is nearing legislation.

Every day British American Tobacco’s twitter feeds around the world are choked with its best efforts to demonise tobacco tax rises, all in the hope that governments will reduce tobacco tax. This would see both smoking and the diseases it causes rise.

The very last thing that Big Tobacco hopes for harm-reduced nicotine products is that they will cannibalise their mainstay cigarette markets. Instead, the business model is dual use (people smoking where and when they can smoke, and vaping when they can’t); luring ex-smokers back as customers with promises of negligible harm from vapoursied nicotine products; and intriguing young people who have never used any nicotine product and who are increasingly never likely to, to start experimenting with vaping and hopefully doing it regularly.

In the United States, the latest National Youth Tobacco Survey shows the historically continuing fall in youth smoking has come to a screaming halt coincident with record use of e-cigarettes. The anxiety in the tobacco industry about this must be all-consuming.

There is now a small group of experts in public health who are now openly or covertly collaborating with the tobacco industry over e-cigarettes. They are being comprehensively played. In mouthing its newfound concern for tobacco’s harms, the industry’s harm-reduction division personnel can now cosy up to a suite of naïve or historically amnesic public heath urgers who lend Big Tobacco a credibility it craves.

Meanwhile, down the Big Tobacco corridor in the cigarette divisions, the harm-reduction staff’s colleagues continue promoting smoking and attempting to thwart effective tobacco control as usual.

This new, embarrassing and appeasing embrace is rather like charity leaders warmly embracing a mafia boss for his generous annual cheque, knowing full well from where the largesse was derived.

Biggest seizure of illicit tobacco in 14 years for Hong Kong, as HK$24 million worth of cargo uncovered

The haul was stashed among pillows in a container allegedly destined for Australia


Hong Kong customs officers seized cargo from Vietnam containing HK$24 million worth of illicit tobacco leaves on Monday, marking the biggest haul of its kind in 14 years.

Officers intercepted a container from Haiphong at the Kwai Chung Customhouse Cargo Examination Compound. Import documents claimed the 40-foot container was carrying pillowcases.

“When officers opened the container for inspection, they found about 5,300kg of suspected illicit tobacco that had not yet been rolled into cigarettes, loaded with 146 cartons of pillows and pillowcases,” Romy Cheuk Yu-sing, the divisional commander of the Ports and Maritime Command overseeing containerised cargo, said. She added the haul had a duty potential of about HK$12 million.

It was unclear if Vietnam was the source port, but authorities believed the syndicate used Hong Kong as a transit point and the illicit tobacco was likely destined for Australia.

“Hand-rolled cigarettes are popular in Australia, and the tobacco tax there is double that of Hong Kong’s,” Parry Wu Yan-kit, deputy head of the Revenue and General Investigation Bureau, said.

“Smugglers can avoid about HK$24 million of tax if the products are successfully trafficked into the country,” he added.

Wu said the syndicate adopted a complicated water route so as to avoid surveillance from law enforcement agencies along the way.

No arrests have been made, and local authorities will contact their counterparts in Australia and Vietnam for further investigation.

The case follows two previous busts of tobacco trafficking – one in 2014 and another in 2015. Both hauls totalled 1,113kg in tobacco leaves.

Three similar cases were also uncovered in 2013, involving 7,553kg of illicit tobacco products.

On September 21, customs officers seized illicit cigarettes with a market value of about HK$54 million and duty potential of about HK$38 million in two containers arriving from Haiphong.

Some 20 million Karelia brand cigarettes from Greece were found hidden in two 40-foot shipping containers, believed to be destined for Europe. It was one of the biggest seizures of illegal cigarettes in the city since 2007.

Under the Import and Export Ordinance, the maximum penalty for smuggling is a fine of HK$2 million and imprisonment of seven years.

Tobacco Plants Found Capable of Producing Malaria Drug

Scientists say they have figured out a way to use tobacco plants to produce artemisinin, a highly effective anti-malaria drug.

Malaria infects an estimated 200 million people each year, resulting in 400,000 deaths. The drug artemisinin is sometimes used to treat the mosquito-borne illness, clearing the parasite from the bloodstream within 48 hours, according to experts. However, it is very expensive.

Artemisinin comes from an herbal plant grown in China called sweet wormwood. It takes 18 months to grow, extract and produce only a small amount of the effective compound, according to bioengineer Shashi Kumar at the U.N. International Center for Genetic Engineering and Biotechnology in New Delhi.

“That increases the cost of this drug, and the people who are suffering most and poor are not able to afford this costly drug,” Kumar said. “That is why we are looking at some source which can be grown everywhere, like the African continent or the Indian continent, easily. Tobacco is that crop.”

Kumar and colleagues have figured out a way to insert wormwood genes into tobacco plants.

Tobacco is a hardy plant and when the gene is inserted, a precursor compound of artemisinin shows up in its broad sturdy leaves.

Scientists at the U.N. Center tested the effectiveness of tobacco-produced artemisinin on rodents infected with Plasmodium berghei, a parasite that causes malaria in rats and is often used as an experimental model for genetic engineered treatments. Kumar said the artemisinin from tobacco leaves was more effective than the currently available drug.

But more tests are needed to see whether the tobacco-derived artemisinin drug is equally effective against P. falciparum, the parasite that causes the most dangerous form of the disease in humans.

Kumar and colleagues are now looking at ways to grow the anti-malaria drug in other, more edible plants.

“What we can do [is] we put this drug into edible plants like lettuce or spinach, where you can just make a powder, put that powder in a capsule and the capsule can be stored like in medical stores or anywhere from where the people can easily buy at a very cheap or very affordable price.”

News about tobacco-grown artemisinin was published in the Cell press journal Molecular Plant.

Kumar says no big tobacco companies have come forward volunteering to produce artemisinin. However, he is hopeful, given that the technology will be made freely available, that there will be some takers.

Researchers to present case report of acute inhalation lung injury related to use of e-cigarettes

Researchers from White River Junction VA Hospital, in Junction, Vermont, will present a case report of acute inhalation lung injury related to the use of e-cigarettes and a flavored e-cigarette liquid containing diacetyl.

The case study presented involves a 60-year-old cigar-smoking male who was admitted with weakness, chills, and cough. No significant radiologic abnormalities were found, but he was treated with ceftriaxone and azithromycin and discharged after three days feeling normal. One month later the patient presented with similar symptoms.

Additionally, he had a fever and was hypoxemic. On examination, he had bilateral upper lung zone crackles and bilateral upper lobe predominant ground-glass opacities on chest CT. After further questioning, the patient reported using strongly flavored e-cigarettes prior to each admission. The patient was diagnosed with inhalation injury and suspected acute hypersensitivity pneumonitis related to electronic cigarette use. The patient did not use e-cigarettes again and had no further symptoms. A follow-up CT scan and pulmonary function test at three months were normal.

E-cigarette liquid contains nicotine, propylene glycol, vegetable glycerin, and flavorings. Recent reports estimate that 69 percent of sweet flavored liquids contain diacetyl.

Diacetyl is used to produce a rich, buttery flavor and has been tied to a 2000 report in which eight former employees of the Gilster-Mary Lee popcorn plant developed bronchiolitis obliterans. The case garnered significant media attention and OSHA subsequently recommended respiratory protection for all workers in microwave popcorn production. Since that time, bronchiolitis obliterans has been referred to as “popcorn lung” or “popcorn worker’s lung.”

“The use of e-cigarettes in the United States is increasing rapidly and the flavorings used, many of which contain diacetyl, may be harmful. This case adds to the growing body of research indicating e-cigarettes pose a health risk,” said Dr. Graham Atkins, of White River Junction VA Hospital, lead researcher.

Further results will be shared during CHEST 2015 on Tuesday, October 27, at 1:30 pm at Palais des congrès de Montréal, Exhibit Hall. The study abstract can be viewed on the CHEST website.

American College of Chest Physicians