17 July 2017

Africa: Global Forum on Nicotine, Warsaw, 15-17 June

interview

The 4th edition of the Global Forum on Nicotine took place in Warsaw, from 15 to 17 June.

The meeting discussed the various alternatives to cigarette, the less harmful alternatives to consume nicotine for those who wish to continue smoking. What are these alternatives, how do they work? Are they really less harmful?

Interview with Professor Manuel C. Peitsch, Chief Scientific Officer for Philip Morris International (PMI)

During this Forum on Nicotine, there have been many presentations on heated tobacco products and electronic cigarettes, what is the difference between all these products, what are the benefits and disadvantages, on what products Philip Morris focuses the most?

There are different techniques, different technologies:  In one of them, the nicotine is extracted and blended with tobacco or blended with a liquid that is then converted into aerosol in an electronic device by means of a wick, with a metal coil that heats and by that way creates the aerosol.

In the case of the heated tobacco products, the nicotine is contained in the tobacco rod and the user gets his/her dose of nicotine through a process of distillation. The tobacco is not burned, heat is created. With a conventional cigarette, heat is created when the cigarette is lit. In the case of heated tobacco, it is another technology that is used to heat the tobacco to a temperature that allows the distillation of the nicotine from the natural mould of the tobacco, without reaching temperatures that cause combustion.

What is the advantage of this technology, as we particularly know electronic cigarette, with liquid nicotine, were you able to determine what the best choice is?

I can explain to you through two things that are the two challenges in the equation of harm reduction: The first challenge is biological or biomedical, here we have to reduce the risk of the product used by the consumer. The product with a maximum risk is the conventional cigarette.  The minimum risk is smoking cessation, the best choice.

The second is an acceptance challenge. The product must be sufficiently accepted by an adult smoker so that he/she will want to quit smoking and adopt this new product.  But unfortunately, the product that is most accepted by an adult smoker is what he/she is smoking currently: the combustible cigarette. The most difficult thing for an adult smoker is to quit smoking overnight. In fact, you have these two challenges that are almost opposed.

At the same time, the experience must be similar from the point of view of the taste, ritual and resemblance to cigarette. If you are a cigarette smoker you will be seeking something that resemble to cigarette in terms of taste and perception to senses, a good percentage of the individuals would rather turn to a product such as IQOS, which contains heated tobacco.

Whether it is an electronic cigarette or a heated tobacco product, it is a question of preference. And you must have a variety of products to offer these various preferences.

A question for a person who has no idea of these new products: what allows you to say that the heated tobacco products are potentially less harmful than the traditional cigarettes?

Basically, the main toxicity of cigarette smoke is due to substances resulting from combustion. When you burn a biological material, whether it is wood or tobacco, when you pyrolyse at the utmost, you create all sorts of substances. The objective of the heated tobacco is to get rid of combustion. That allows us to say that there is less risk.

The second thing is that we have tested these products on the basis of thorough analytical chemistry practices with extremely high accuracy devices to measure the quantities of toxic substances they contain in comparison with traditional cigarettes.

With IQOS, our first heated tobacco product, we have an average reduction of 90 to 95% for the levels of these toxic substances.

Then, we conduct clinical tests on humans to check if we have effectively a reduction of the consumers exposure to these toxic substances, by comparing these smokers with persons who have turned to the potentially reduced-risk product for the duration of the study and those who have stopped smoking in order to prove and demonstrate at what extend the persons who have switched to a potentially reduced-risk product are close to those who have stopped smoking.

Do public health professionals agree with your arguments, your ambitions, are they convinced?

I would say that all of them are not, but are increasingly becoming convinced. We are on the right track. Everybody recognizes that smoking cessation is the best way to reduce risks.  But, if there is no cessation, if the persons don't want to stop smoking? Now, more and more public health specialists agree on the fact that there is actually a role in this equation for potentially reduced-risk products.

As for now, the non-combustion flagship product is really the electronic cigarette, as in some countries as Sweden, we have the snus that is forbidden in many parts of the world. We also have heated tobacco, which is to some extends the 3rd entrant, not historically, but in terms of success rate.

The heated tobacco products date from the last century. There were experiments, but that have ended in failure. That's not something new or surprising.  What is new are the technologies: in the 21st century we can do things that could not be done in the 20th century thanks to the technologic development of batteries, electronic micro-sensors, etc.

I come from Senegal and electronic cigarettes are not very widespread there, does Philip Morris consider to market these products in Africa where the purchasing power is low and the knowledge of these products are minimal?

The idea is finally that one day we could make smoke-free products available to all smokers, including in Africa because we really consider all smokers.

We will have many platforms with different prices to be sure that all consumers could have access to them. We have already begun because IQOS is already available in South Africa.  In South Africa, the sticks are sold at prices comparable to those of traditional cigarettes. We have to be mindful that we have 4 different products with basic different prices and the initial cost of the electronic will decrease over time and with the economies of scale.

Are there information programmes on these products elsewhere, are there already attempts to inform people in the rest of Africa or are there reluctances from the governments of these regions?

We talk about this wherever we are, our colleagues talk about this wherever they go. Our presence at this conference proves that we are open to discussion in order to talk about our products and that our commitment for a smoke-free world is real. For instance, just recently we were in Bamako to present to the media of the francophone region our new vision for a smoke-free world.

In this connection, there still is the suspicion against the industry, many people feel that there is too much money in cigarette and that the tobacco industry wants to replace cigarette by something different in order to continue to make big profits. After having done so many harms, why the tobacco industry want to do good now? 

Like any other company, we want to make profits, it is obvious.  But at the same time we are also aware of the fact that there are concerns with regard to issues related to health, tobacco products and cigarette. For a company, addressing these concerns is an advantage and is the best thing to do. And today, technology and science allow us to do that.

Before, it was not the case. IQOS has had a predecessor - the Heatbar - which has been tested in 2006 but was unsuccessful.  The battery was huge, only eight puffs was possible, it was not heated centrally.  The taste of the product was really not up to that of the cigarette.

Biology has also advanced, today's biology is different from that of the last century because the human genome was not known. Unfortunately, there couldn't have been systems biology.

All these things that happened with the 21st century make this offer possible and feasible and that is why we are working very hard to progress in this direction as quickly as possible.

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