Special report: With the influence of the tobacco and pharmaceutical industries on public health policy on the agenda in the wake of European Commissioner John Dalli's resignation, the president of the Electronic Cigarette Industry Trade Association explains how the emerging electronic cigarette sector can operate with a true ethical underpinning
"For the love of money is the root of all evil: which while some coveted after, they have erred from the faith, and pierced themselves through with many sorrows." – 1 Timothy 6:10, King James Version. What a turbulent year this has been. It seems that every day there is another tale of bad behaviour, public inquiries, internal investigations, inglorious resignations, spectacular sackings, and apparently no area of society remains unaffected. Politicians' expense scandals, banking institutions crumbling under the weight of their own greed – and appearing to do their best to bring the rest of the world down with them – police forces facing inquiries, the media under special scrutiny, teachers falling in love with pupils, care homes abusing the elderly, child abuse in the church and the list goes on. It is a sad but true reflection of a world that seems intent on destroying itself.
Is there a ray of hope anywhere, amid all this doom and gloom? Is it possible to trust anyone anymore? Or is King Greed in charge now, with his consorts, Intrigue and Corruption. These consorts are beautiful and seductive. Can we resist them? It is hard. Salacious stories sell. The internet has been a powerful force for good, but the resulting transparency and access to incomprehensible quantities of information has, I believe, eroded our trust in all those institutions on which we used to rely. And what is the impact on public health? And more particularly, what is the impact on the development of public health policy? For this is, surely, the starting point if there is any hope for improvement, even if mistakes are made along the way.
Owing to the publicised past court cases involving the tobacco industry – or Big Death, if you prefer – we now know much of the full extent of the lies, the cover-ups, the backhanders, etc. It is not a pretty picture. But then, few people outside that industry were surprised to learn that they were not the mighty force for good they once touted themselves to be. In March this year, the New Tobacco Atlas
estimated that the tobacco industry profits were up to US$35bn. On the surface, to many, that would look like success. Until you consider that, by this measure, the cost of this 'success' was almost six million annual deaths.
The pharmaceutical industry came to the fore, offering products to help people quit smoking, in the form of nicotine replacement therapies, and tablets designed to 'muddle' the brain and make it block out the craving for a smoke. This market has been very successful too, if you measure success by market share and profits. But how successful has it been in more important terms, such as in contributing towards saving some of those six million annual deaths? Well, with a long-term successful quit rate of 7 per cent at best, not very. According to a recent Harvard study
, one of the authors reported: "No difference in quitting success with use of nicotine replacement therapies was found for either heavy or light smokers."
Indeed, this market has actually contributed a few thousand more deaths – in almost equally awful and distressing ways, with the suicides and other neuropsychiatric events
reported – and now warned against – caused by varenicline, marketed as Chantix and Champix. And this, unfortunately, is where we must begin to examine some of the insidious goings on behind the scenes in these large corporate industries. October 16 saw the resignation of the European Commissioner for Health, John Dalli. I blogged about it – rather harshly, I admit, although with no apology – for the kind of behaviour indicated by the reported events leading up to the pronouncement by the European Union's anti-fraud office OLAF is utterly reprehensible and repugnant.
It seems, if the allegations are true, that what should have been a shining example of good behaviour coming from Big Death – in the form of smokeless tobacco products, with an undoubtedly far better public health profile – was involved up to its elbows in seeking to 'buy' favourable policy from the then commissioner Dalli. That, of course, is if we can believe the email from the secretary general of the European Smokeless Tobacco Council, Inge Delfosse, published
by Malta Today
, asking how much Silvio Zammit would charge in return for arranging an informal meeting to discuss the "bad rumours flying around Brussels". However, if we are to get to the facts of the case, we must remember that this email should be set in context, not plucked out in isolation for scrutiny. We do not know what the rest of this correspondence may have contained. Nor do we know to what extent, if any at all, Dalli was aware of such correspondences. Indeed, as was pointed out in one of the comments on the Malta Today
article: "The subject of this email is 'Re: proposal'. So where is the email with the subject 'proposal' and who sent that? Just would like the full story, not trying to jump at any conclusions."
Jumping to conclusions will not help us get to the bottom of this, or any of these machinations of the seductive intrigue; we must seek out the full facts. I first met Delfosse in April 2010, at a conference in Liverpool. She seemed nice enough, and the smokeless advocates clearly had an important message: rely on the science to inform decisions. And certainly, the evidence is well and truly in for snus – it works, and is far, far safer than smoking. Sweden's results are astonishing, so clearly it seemed a bad idea for these products to be restricted. And yet, I begin to see why policy-makers and public health advocates have been so reluctant to trust that the tobacco industry might have done something good. While in Liverpool, I had the opportunity to spend some time with a truly wonderful gentleman by the name of Dr Adrian Payne. The Electronic Cigarette Industry Trade Association was in its infancy at that stage. He said the reason that the final doors in Brussels had remained closed to snus was simply because it came from the tobacco industry. He also recognised – as I always have – that the United States electronic cigarette industry has done itself, and public health, a significant disservice in pushing for classification as a tobacco product, rather than a medicinal product.
Its proper classification, of course, is where it currently sits – as a consumer product, properly safeguarded by the wealth of regulatory legislation that covers every product ever conceived, and any product awaiting development in the future, which does not naturally fall into any other specific classification. This is the best fit, and the best way to ensure the widest possible dissemination of this harm reduction opportunity, in the safest and most accessible way. More on this in future reports. Dr Payne had already recognised the enormous promise for harm reduction offered by electronic cigarettes, and he advised me to ensure that we remain entirely separate from the tobacco industry. I have never forgotten that advice. Indeed, the electronic cigarette industry has come from outside both the tobacco and the pharmaceutical industries, and has grown in its own right. But now that we have done so, of course, these large enterprises – whose market shares are equally adversely affected – are buying in. I cannot begin to express my disappointment at this.
Inge Delfosse contacted me before the commission's stakeholders' meeting in March this year, suggesting I might like to join her and her colleagues for a "pre-meeting to clarify approach, etc". She suggested that she could see "some advantages" were I to attend. Frankly, I could see no such advantages, and indeed, at the meeting, I made it very clear where the dividing lines were and are. My report on this meeting is publicly available here
. Very persuasive attempts were made to draw me into supporting the Smokeless Lobby's position in the stakeholders' meeting, but I reiterated my position that we remain absolutely separate from any part of the tobacco industry, with the only common ground being our wish to see a reliance on genuine scientific evidence.
I concluded in my blog
on Dalli's resignation: "The undeniable reality of this whole sordid mess is that the commission's revisions to the Tobacco Products Directive have been utterly derailed. Indeed, the damage may even go far wider than just this, but surely at the very least, the commission ought to scrap the existing consultation as entirely besmirched by these events, and start again, with the focus properly on public health and scientific evidence? One wonders how else they can possibly proceed, if they are to regain any of the credibility they have so publicly lost." Regrettably, it begins to look increasingly as if this is precisely what the tobacco industry set out to achieve, when Inge Delfosse sent that email, and then Swedish Match reported these events to the commission. It is difficult to see how the current revisions to the Tobacco Products Directive could be concluded without parties from both extremes likely to cry foul about the end result. Indeed, up to this point, we ourselves had grave concerns that there was undue influence coming from the pharma lobbies into Dalli's deliberations. Oh, what a tangled web.
We at ECITA must do whatever we can to ensure that access to electronic cigarette products is as unrestricted as possible – always with the proviso that the appropriate regulations must be rigorously enforced – but, despite our having no desire to be tarred with the same brush as Big Death, we almost seem to end up on the same side. But is the pharmaceutical industry any less morally reprehensible? In WhyQuit News
, John Polito suggests that pharma bias is deliberately interfering in scientific research – and unfortunately, this is not news. In Science-Based Medicine
, Steven Novella reported the US$3bn fine paid by GSK recently, and described it as: "The most recent evidence that industry cannot be left to their own devices without proper monitoring and regulation." Many of the comments left in response also make very interesting reading.
And of course, we cannot complete this examination of these issues without mentioning Pfizer's current challenges
over its 'brain-muddling' drug Chantix. Perhaps the most regrettable aspect of this is that these are but two among the many examples of morally repugnant behaviour by Big Pharma. Many and varied are the accusations
against even the tobacco control lobby itself, so how can we know where to turn? Dr Carl Phillips makes some interesting observations on his blog
. Is it possible to find a small part of the human consciousness that is not corrupted by greed and selfishness? At the start of this somewhat dark and depressing journey, I asked the question: Is there a ray of hope? Surely, the light at the end of the tunnel must be, simply the truth.
The electronic cigarette industry has not yet achieved the Big Industry status to which it will surely grow. However, in its earliest beginnings, I have personally seen that, alongside an entirely healthy wish to succeed, and build a profitable business – which can contribute to the economic growth of the country, offer employment, and yes, make money – it is possible to have a true ethical underpinning. The members of ECITA, together with many others in this industry, are proud to be able to offer for sale a product that can really make a difference in the lives of their customers. I hope that they will never lose sight of this, as their businesses grow, and they achieve ever greater successes.
For the sake of transparency and honesty, and for the avoidance of doubt – if that is possible, in this world of noise and confusion – full information on my background and conflicts of interest can be found here
. Whether it be corrupt politicians, corrupt corporations, or both intertwined, public health advocates have a moral obligation to root out the truth and expose it, with the specific intention of ensuring that better public health policy decisions can be made. "And ye shall know the truth, and the truth shall make you free." – John 8:32, King James Version
Katherine Devlin is president of the Electronic Cigarette Industry Trade Association