In March it was reported in The Sydney Morning Herald that a trial into the efficacy of electronic cigarettes as a quit smoking tool will be conducted by researchers at the University of Queensland later in the year. The research will be funded by a Commonwealth government grant and it is hoped that 1600 participants can be recruited. The head of the research is Dr Carol Gartner, a research fellow at the Centre for Clinical Research at the University of Queensland. In response to questions as to whether she thought that e-cigarettes should be banned, Dr Gartner replied that rather then being banned, they should be regulated, since there are differences in the quality of the various devices on the market. Regarding the potential of electronic cigarettes to help people quit smoking, she said that “If a large enough proportion of the smoking population find them to be an acceptable substitute, it might be possible to encourage smokers to move to e-cigarettes with the longer-term aim of phasing out conventional cigarettes, which are the most harmful nicotine product and kill half of all long-term users” (Asher Moses, “Experts wary of e-cigarettes as test run looms”, The Sydney Morning Herald, 4 March 2013).

We recently received an email from Doug Fraser, who is a research assistant at the University of Queensland Centre for Clinical Research, asking us for help to recruit volunteers for the upcoming study. The email reads:

“The University of Queensland and the Australian National University are currently planning to conduct research looking at the experiences and opinions of people who have used electronic cigarettes. At the moment we are gathering interest from people who would be willing to participate in an online survey later in the year. Researchers at the University of Queensland and Australian National University would like to conduct research with people who use electronic cigarettes or other novel nicotine delivery systems to better understand their experiences with these products. If you have used an electronic cigarette or similar product and are interested in participating in research on this topic, please follow the URL link to a confidential online form to register your interest by providing your contact details (e.g. email address). When a research study on this topic is ready to start, the researchers will then send you an invitation with more details about the study so that you can decide if you would like to participate in the study. Your contact details will not be shared with anyone else and will not be used for any purpose other than to send you invitations to participate in research on this topic.”

We are very happy to hear that research will be conducted into e-cigarettes here in Australia by researchers at such a prestigious institution as the University of Queensland. We strongly urge all of you to sign up to participate in the study, which can be done clicking on the following link:

http://hs-web01.health.uq.edu.au/survey/index.php?sid=34348&lang=en

If you have any questions about the research, you can contact Doug Fraser at d.fraser2@uq.edu.au

The Medicines and Healthcare products Regulatory Agency (MHRA), the government agency responsible for regulating all medicines and medical devices in the United Kingdom to ensure that they work and are acceptably safe, has announced that it will regulate e-cigarettes as medicines from 2016 onwards. This means that electronic cigarettes will have to undergo stringent checks by the medicine regulator before they can be sold on the British market. It also means that physicians will be able to prescribe them to smokers as a quit smoking tool. The new regulations will extend to all nicotine-containing products.

Cigarette smoking is the biggest cause of preventable death in the United Kingdom, killing an estimated 80,000 people annually. Needless to say, this is a major health problem, and reducing the number of smokers is a national health priority.

Jeremy Means from the MHRA said in a press release dated 12 June 2013: “Reducing the harms of smoking to smokers and those around them is a key Government health priority. Our research has shown that existing electronic cigarettes and other nicotine containing products on the market are not good enough to meet this public health priority. Some NCPs are already licensed and the Government’s decision to work towards medicines licensing for all these products is designed to deliver quality products that will support smokers to cut down and to quit. The decision announced today provides a framework that will enable good quality products to be widely available. It’s not about banning products that some people find useful, it’s about making sure that smokers have an effective alternative that they can rely on to meet their needs.”

A number of leading British health figures endorsed the move by the MHRA, including Professor Dame Sally Davies, the United Kingdom Chief Medical Officer, Deborah Arnott, the Chief Officer of the anti-smoking charity ASH, and Dr Clare Gerada, the Chair of the General Council at the Royal College of General Practitioners.

The MHRA advises people to use nicotine-replacement products to quit smoking, and the purpose of the new regulation is to ensure that e-cigarettes meet minimum health and safety standards.

It is estimated that some 1.3 million people use electronic cigarettes in the United Kingdom.

Source: MHRA, “UK moves towards safe and effective electronic cigarettes and other nicotine-containing products”, 12 June 2013, MHRA website.

Recently, Lorillard, one of the biggest manufacturers of tobacco cigarettes in the United States, purchased an e-cigarette company called Blu Ecigs for the sum of $135 million. Blu Ecigs was founded by a young Australian entrepreneur named Jason Healy in 2008, and is based in the town of Charlotte, North Carolina. The young Australian, who hails from the town of Mareeba in north Queensland, founded the company with $50,000 that he managed to raise by convincing investors from Charlotte that he had a great business idea. Despite selling the company he founded, Healy has remained at its helm.

Healy says that he got the idea to start an electronic cigarette company when he was shown one by a Charlotte businessperson. He says: “At the time, I was spending time between Brisbane and Charlotte, North Carolina and while on a trip to Charlotte a local business owner was asking me to take a look at a new product hitting the market, e-cigs.” Healy immediately saw the potential: “Being a smoker and an avid marketer it immediately captured my mind and I was originally looking at purchasing the rights to an existing brand and marketing it in Australia.” The problem, however, was that nobody was actually branding their e-cigarettes, instead preferring the generic names used by the Chinese manufacturers: “Once I started to take a deeper look, I saw so many issues and opportunities that weren’t being addressed and basically came to the opinion that I needed to start a true brand of my own.” Thus, it is probably more accurate to say that Healy just took a good product and marketed it well, thereby making himself a millionaire in the process. He would not be the first person to have done this, and it in no way diminishes his great achievement.

There were, unsurprisingly, many hurdles that needed to be overcome. Questions existed about the safety of electronic cigarettes, which was far more of an issue in 2008 before any research had been undertaken into their safety as a quit smoking device. A number of health groups were, and indeed remain, opposed to e-cigarettes, claiming that they have not been sufficiently tested and that they might encourage children to take up the habit of smoking. These arguments hold much less weight today as more scientific evidence is accumulating that demonstrates that electronic cigarettes are safe, effective and improve the health of people by helping them quit smoking.

Source: Oliver Milman, “Sparking up a smoking hot start-up idea”, StartUpSmart, 12 October 2012.

Although they appeared on the Australian market about six years ago, it is only now that the first Australian clinical trial of electronic cigarettes as a quit-smoking tool has been announced. While they are popular with users, the government and a number of public health experts are cautious about electric cigarettes.

The e-cigarette is a battery-operated device that is used to quit smoking. It simulates the effect of tobacco smoke by heating up a liquid which turns to vapour and is then inhaled by the user. Some models look exactly like a real cigarette, but many are larger and of a different colouration.

Even though electronic cigarettes have not been approved as a therapeutic product, they are legally available in Australia, and are popular with people wishing to quit smoking.

Whereas in the United Kingdom where electric cigarettes are included in official quit smoking guidelines, the Australian federal government does not support their use as a quitting aid because they have not yet been evaluated by the Therapeutic Goods Administration.

Recently the federal Department of Health and Ageing announced that it had “commissioned a regulatory impact statement on options for further regulation of electronic nicotine delivery systems (including electronic cigarettes) and smokeless tobacco products” [1].

Some public health experts have also expressed their concern about e-cigarettes. Dr Steve Hambleton of the Australian Medical Association said that he was concerned about the insufficient evidence of the benefits of electric cigarettes, the lack of regulation, and the possibility that they might serve as an “entry into smoking not necessarily as an exit from smoking” [1].

Similarly, Professor Simon Chapman, a lecturer in public health at the University of Sydney, said that e-cigarettes which mimic the “smoking performance” of cigarettes might reinforce the appeal of smoking [1].

Even so, the scientific research on the effectiveness and safety of electronic cigarettes is promising. In August 2012, the Onassis Cardiac Surgery Centre in Greece reported that it had found that electric cigarettes had no adverse effect on the functioning of the cardiovascular system. One of the researchers, Dr Konstantinos Farsalinos, stated that “substituting tobacco with electronic cigarettes may be beneficial to health” [2]. An article published in the September 2012 issue of the journal Addiction reported that e-cigarettes enhanced quitting motivation, lowered cravings for tobacco cigarettes, and greatly lowered the exposure to toxins in non-smokers [3]. Another study, whose results were published in the BMC Public Health journal in 2011, found that there was a substantial decrease in cigarette consumption in people who used electric cigarettes over a six month period. More than half of the 40 experiment participants either quit smoking altogether or more than halved their cigarette consumption [4].

Now it seems that the Australian government wants the facts about e-cigarettes. Dr Coral Gartner, a research fellow at the Centre for Clinical Research at the University of Queensland, will soon commence a federal government-funded trial with 1600 smokers to test the effectiveness of e-cigarettes as a long-term substitute for tobacco cigarettes.
Dr Gartner rejected calls to ban electronic cigarettes, but argued that they should be regulated with the same restrictions as tobacco cigarettes, because the quality and safety of different devices was highly variable.

“If a large enough proportion of the smoking population find them to be an acceptable substitute, it might be possible to encourage smokers to move to e-cigarettes with the longer-term aim of phasing out conventional cigarettes, which are the most harmful nicotine product and kill half of all long-term users,” she said [1].

References
[1] Asher Moses, “Experts wary of e-cigarettes as test run looms”, The Sydney Morning Herald, 4 March 2013.
[2] Dr Konstantinos Farsalinos, “Electronic cigarettes do not damage the heart: First-hand smoke, second-hand smoke or electronic cigarettes”, 2012 European Society of Cardiology Congress, 25 August 2012.
[3] Wagener T L, Siegel M & Borrelli B (2012) Electronic cigarettes: Achieving a balanced perspective, Addiction, Volume 107, Issue 9, 1545-1548.
[4] Polosa R, Caponnetto P, Morjaria J B, Papale G, Campagna D & Russo C (2011) Effect of an electronic nicotine delivery device (e-cigarette) on smoking reduction and cessation: A prospective 6-month pilot study, BMC Public Health, Volume 11: 786.

In response to falling sales and profits in Europe, Imperial Tobacco, the world’s fourth largest cigarette company by market share, recently announced that it will be establishing a new venture to develop electronic cigarettes. The company’s Chief Executive, Alison Cooper, stated on 26 February 2013 that “We’re looking at opportunities and we’re actively developing in that area at the moment” and that Imperial Tobacco was “open-minded” about purchasing existing electric cigarette companies [1].

Imperial Tobacco is following the lead set by one its main competitors, British American Tobacco, which established a company called Nicoventures in 2011 to research e-cigarettes [2].

Like many tobacco companies, Imperial Tobacco has seen its sales drop in developed countries as people give up smoking and as the black market grows. Instead, it has been focusing on emerging markets in Saudi Arabia and Turkey where anti-smoking legislation and public awareness of the negative health effects of tobacco is far weaker than in most European countries.

Indeed, 2012 and early 2013 have seen a number of big tobacco companies investing in electronic cigarettes, both in the United Kingdom and United States.

In December 2012, for example, British American Tobacco acquired CN Creative, a company that sells electric cigarettes.

A press release published on the company’s website on 19 December 2012 states that “British American Tobacco announced today that it has acquired CN Creative Limited, a UK based start-up company who specialises in the development of e-cigarette technologies intended to offer smokers a less risky alternative to cigarettes” [3].

According to Euromonitor, a market research company, British American Tobacco and CN Creative have plans to launch what they have called an “e-light cigarette” on to the market some time in 2014 [4].

In the United States, big tobacco companies are similarly investing in e-cigarette research or buying up existing electronic cigarette retailers. Market leader Altria is planning to launch an electric cigarette on to the market some time in the middle of 2013 [5]. Its competitor Reynolds American is currently doing market research on its own e-cigarette [6]. All of these companies, however, are following the lead set by Lorillard, the third biggest cigarette manufacturer in the United States, which purchased the largest American electronic cigarette company – BluCigs – in 2012 for a reported $135 million [7]. Lorillard claims to control 40 per cent of the United States electric cigarette market [8].

The big tobacco companies, realising that tobacco cigarettes are a dying business throughout the developed world, have decided to get in to the e-cigarette market in an effort to maintain their earnings in these markets where fewer people are smoking.

References
[1] “Imperial Tobacco to develop e-cigarettes as profits drop”, Reuters, 30 April 2013.
[2] British American Tobacco, “British American Tobacco establishes stand-alone company, Nicoventures Limited”, British American Tobacco website, 5 April 2011.
[3] British American Tobacco, “British American Tobacco buys UK based e-cigarette technology company”, British American Tobacco website, 19 December 2012.
[4] Don Hedley, “What’s happening in tobacco”, Euromonitor International, 29 March 2013.
[5] Mike Esterl & John Kell, “Altria to enter e-cigarette market”, The Wall Street Journal, 25 April 2013.
[6] Reynolds American, Quarterly Report, United States Securities and Exchange Commission, 23 April 2013.
[7] Lorillard, “Lorillard Inc. reports first quarter 2012 results and acquisition of blu ecigs”, Lorillard website, 25 April 2012.
[8] Shane MacGuill, “Mass appeal: Lorillard earnings releases give a unique glimpse of US e-cigarette market”, Euromonitor International, 1 May 2013.