Tobacco.org

• Contents: Volume 11, Number 11, November 2009 

• Reynolds' pursuit of a company that promotes smoking cessation raises marketing question 

Trying to buy a company that specializes in products that help people quit smoking may seem like a radical change for Reynolds American Inc.

But analysts said yesterday that it all depends on how Reynolds would potentially use and market cigarette-replacement products in gum, pouch and spray form made by that company, Niconovum AB.

Media reports have said that Reynolds is close to buying Niconovum, of Helsingborg, Sweden, for $44.5 million. The reports are based on comments by David Sweanor, a law professor at the University of Ottawa and a tobacco analyst. Sweanor could not be reached for comment.

Reynolds said it is against its policy to comment on speculation. Niconovum officials could not be reached for comment. . . .

Niconovum was formed in 2000 by Karl Olov Fagerström, who is considered a leading expert on smoking cessation and nicotine dependence. It is managed by many of the individuals who were pivotal in the development of Nicorette, a nicotine-replacement gum.

Although some analysts view Niconovum's products as primarily smoking cessation, the company says on its Web site that it "believes that there is a market for a range of nicotine-replacement therapy products that will deliver nicotine more quickly and effectively than those currently available, thereby giving the consumer a perceived better control of cravings."

The evolution of some health-advocacy groups from anti-smoking to anti-tobacco is ratcheting up the moralistic aspect of buying and consuming a legal product.

Bill Godshall, the executive director of SmokeFree Pennsylvania, said he believes that smokers and public health could benefit if Reynolds buys Niconovum or its patents.

"Its smoke-free nicotine products are 99.9 percent less hazardous alternatives to cigarettes, pose no risks to nonusers, and appear to be more smoker friendly than similar products marketed as smoking cessation aids,'' Godshall said.

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• Will Cigarette Maker Reynolds Try Kicking the Habit?  

It would be either one of the most cynical diversifications ever--or a brilliant stroke of synergy.

If a report in The Wall Street Journal is correct, America's second-largest seller of cigarettes may soon be peddling products that help people quit smoking. The Journal reported on Nov. 9 that Reynolds American (RAI), the distributor of Pall Mall, Camel, and Natural American Spirit cigarette brands as well as smokeless tobacco, is in "advanced talks" with Niconovum, a Swedish manufacturer of nicotine replacement products such as gum and mouth spray. University of Ottawa law professor David Sweanor told the Journal he was briefed by people close to the deal.

The move would mark the first time that a big tobacco company also sold smoking-cessation products, according to industry analysts. But it would be in line with the industry's efforts to diversify as cigarette purchases shrink in the U.S. One analyst referred to a purchase of Niconovum as a "cheap hedge" against the smoking decline. . . .

But as Morningstar's Gorham points out, Reynolds can make far more money convincing people to smoke than helping them quit. The cost per unit to produce cigarettes is extremely low—operating margins average 25%-30% industrywide, he says, which is high for consumer goods. (Pepsi (PEP), by comparison, which enjoys enormous scale and volume operating margins, reaches into the high teens, according to Gorham.)

It's unlikely that returns from smoking-cessation products can compete with that anytime soon. "I think we're talking 20 years-plus at this point before tobacco sales are offset by other sources," says Gorham.

Indeed, some view any talks between Reynolds and Niconovum as more of a publicity stunt, designed to place Reynolds in a better light.

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• Down to the last cigarette - and beyond  

Like a fast-food chain selling diet supplements or a gasoline company building electric cars, a major tobacco company is eyeing a surprising business: Helping the smokers who buy their products kick the habit.

Reynolds American Inc. , which sells the Camel and Pall Mall brands of cigarettes, is in talks to buy a Swedish company that makes nicotine gum and mouth spray designed to help people quit smoking by reducing their cigarette cravings, according to a report in The Wall Street Journal.

Reynolds could buy Niconovum AB for roughly $44.5-million (U.S.), according to University of Ottawa law professor and tobacco expert David Sweanor, who said he had spoken with someone close to the deal. A spokesperson for Reynolds declined to comment.

The deal would also mark a shift for cigarette companies, many of which embraced diversification decades ago but have changed course in recent years. . . .

The acquisition of Niconovum would give Reynolds another cigarette alternative.

In addition to the gum and mouth spray, the Swedish company also makes a Snus-like product called the Zonnic pouch, which has nicotine but no tobacco. Many countries in the European Union as well as Australia and New Zealand, ban oral tobacco, Prof. Sweanor said. The pouch could give Reynolds a way around those regulations.

"I think this may be a very profitable business. They're catering to the same crowd, essentially," said Indiana University's Prof. Beneish, who was a smoker for 30 years. "They have a captive audience. Trust me."

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• Reynolds in Talks to Buy Sweden's Niconovum  

Tobacco giant Reynolds American Inc. is in advanced talks to buy a Swedish maker of products that help people stop smoking, a move that could signal a profound shift in direction in the global tobacco industry.

Reynolds, the second-largest U.S. cigarette maker by sales, is near a deal to buy closely held Niconovum AB, according to David Sweanor, a Canadian law professor and tobacco expert who says he was briefed by people close to the deal.

Niconovum, based in Helsingborg, makes nicotine-replacement therapies such as Zonnic pouch and Zonnic gum. The company, whose products aren't currently sold in the U.S., was formed in 2000 by Karl Olov Fagerstrom, a leading expert in nicotine dependence who has been involved in such products as Nicorette gum.

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• Switching cigarettes may hinder smokers' attempts to quit  

What does this mean for me?

We don't know why people who switched cigarette types were less likely to succeed in quitting. The researchers suggest some possibilities:

* People who switched may have been more addicted to nicotine, so tried to cut down by switching first rather than simply trying to quit

* They may have used up their initial motivation by switching brands, and run out of enthusiasm to quit altogether

* They may have felt that quitting was less important, because they wrongly thought they were doing less damage to their health with the low-tar brand.

Overall, the study suggests that swapping types of cigarette doesn't help you give up smoking. The message seems to be that it's better to concentrate your energies on giving up, rather than worrying about the type of cigarette you smoke.

What should I do now?

If you want to give up smoking, contact your GP surgery. They can help you to quit. Alternatively, call the NHS Smoking Helpline on 0800 022 4332 to find out about stop smoking services in your area.

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• New Study Reveals Quitting Smoking is Good but Switching to Low-risk Nicotine Products is Usually Better 

Prof. Carl V. Phillips, just published in Harm Reduction Journal, shows that for most smokers, immediately switching to a low-risk alternative will lower their risk of dying from their habit more than quitting eventually, even if they use the smoke-free product for the rest of their lives. . . .

Professor Phillips is an epidemiologist and health policy researcher, journal editor, popular educator, and consultant. He and his work group are leading advocates of tobacco harm reduction, and he advises and works with many other organizations who are trying to promote it, some of which are companies that hope to profit from selling low-risk nicotine products. The www.TobaccoHarmReduction.org research group at the University of Alberta School of Public Health is partially supported by an unrestricted (completely hands-off) grant from U.S. Smokeless Tobacco Company. No funder, company, or other organization played any role in initiating, designing, or conducting this research.

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• Switch to lights goes up in smoke  

SMOKERS who switch to low-tar cigarettes have half the chance of successfully quitting the habit.

A study of the smoking history of almost 31,000 US adults found that the odds of smokers managing to leave the habit behind them were 46 per cent lower if they had previously tried to switch to a "lighter" cigarette for any reason.

About 38 per cent of the sample, or 12,000 people, had switched in this way and 43 per cent of those said their reasons had included a wish to quit smoking altogether.

The study, published in the journal Tobacco Control, said although low-tar cigarettes made up about 84 per cent of the US market, the amount of harmful chemicals they delivered into the lungs was comparable to that from regular strength cigarettes. . . .

Simon Chapman, a professor of public health at the University of Sydney and a senior editor with the journal, said the popular belief that "mild" or "light" cigarettes were less harmful than other variants was "a complete myth".

"Smokers adjust the way in which they smoke the cigarette, in order to give them the dose of nicotine that their brain says they want," Professor Chapman said. "The tobacco industry would not put any product on the market that actually contributed towards a cessation of smoking."

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• Nicotine Patch Plus Lozenge Best for Quitting Smoking  

first head-to-head comparison of different quit-smoking products finds that a nicotine patch combined with a nicotine lozenge had the most success.

More than other methods, including antidepressants, this combination best mimics the actual highs and lows of smoking to help smokers kick their habit, experts said.

"The study shows that, yes, one therapy came out on top, the patch and the lozenge [together]," said Dr. Jonathan H. Whiteson, co-director of the Joan and Joel Smilow Cardiopulmonary Rehabilitation and Prevention Center at NYU Langone Medical Center in New York City.

"The reasoning behind it is that the patch supplies a steady supply of nicotine replacement and the lozenges give a boost of nicotine which you can use when you have an extra craving. It gives people control," said Whiteson, who was not involved in the research.

"If you combine these different types of nicotine replacement you're going to get the best bang for your buck," added Megan E. Piper, lead author of the new study and an assistant professor at the Center for Tobacco Research and Intervention at the University of Wisconsin, Madison. "But also remember that in this study people got a lot of counseling. It was that combination that resulted in a 40 percent quit rate [at six months out]."

In fact, coupling the patch with the lozenge was the only intervention that performed better than a placebo, reported the study, which appears in the November issue of the Archives of General Psychiatry.

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• Maternal tobacco, cannabis and alcohol use during pregnancy and risk of adolescent psychotic symptoms in offspring (Full Text) 

Results

Frequency of maternal tobacco use during pregnancy was associated with increased risk of suspected or definite psychotic symptoms (adjusted odds ratio 1.20, 95% CI 1.05–1.37, P = 0.007). Maternal alcohol use showed a non-linear association with psychotic symptoms, with this effect almost exclusively in the offspring of women drinking >21 units weekly. Maternal cannabis use was not associated with psychotic symptoms. Results for paternal smoking during pregnancy and maternal smoking post-pregnancy lend some support for a causal effect of tobacco exposure in utero on development of psychotic experiences.

Conclusions

These findings indicate that risk factors for development of non-clinical psychotic experiences may operate during early development. Future studies of how in utero exposure to tobacco affects cerebral development and function may lead to increased understanding of the pathogenesis of psychotic phenomena. . . .

Possible biological mechanisms

Animal studies indicate that fetal nicotine exposure can result in long-term structural and functional changes,7 including decreased neuronal density and size in the hippocampus and cortex, altered regulation of neuronal apoptosis,7,15 and increased expression of receptors for acetylcholine, which plays a critical role in brain maturation through modulation of axonogenesis and synaptogenesis.15 However, difficulties exist, both conceptually and pragmatically, in the interpretation of results from animal models in relation to effects in humans.

We are not aware of animal studies to date that have examined the effects of nicotine exposure in utero on putative endophenotypes of schizophrenia. Although endophenotypes of schizophrenia that can be modelled in animals are yet to be clearly determined this could potentially become an informative area for future research.

We observed suggestive evidence that maternal smoking during the third trimester was most strongly associated with risk of PLIKS, although results from subgroup comparisons should be interpreted cautiously. This is rather inconsistent with results from studies of famine38,39 and influenza,40,41 where early pregnancy exposure is associated with greatest risk of schizophrenia, but may reflect different sensitive periods of risks in brain development for different types of exposure. Maternal smoking,5,42 particularly during late pregnancy,43 is thought to lead to lower birth weight.7 However, adjusting for birth weight, as well as for gestation and 5-minute Apgar score had no effect on the results, and although these measures are likely to be rather crude markers of pre- and perinatal adversity, it seems unlikely that such adversity mediates or confounds the relationship between maternal smoking and offspring psychotic experiences. . . .

Implications

Observational studies are limited in determining causality due to potential problems of residual confounding. We observed an association between maternal, but not paternal, smoking during pregnancy and risk of psychotic symptoms in the offspring, consistent with accumulating evidence from animal models of adverse effects on brain development from in utero nicotine exposure. These findings suggest that risk factors for development of non-clinical psychotic experiences may operate during early development. Future studies of how in utero exposure to tobacco affects cerebral development and function may lead to increased understanding of the pathogenesis of psychotic phenomena.

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• Pregnant smoking 'psychosis link' 

Mothers who smoke during pregnancy put their children at greater risk of psychotic symptoms such as delusions and hallucinations, a study suggests.

A UK survey of 12-year-olds found those whose mothers had smoked were 20% more likely to suffer such problems.

The link was 84% more pronounced if 20 or more cigarettes a day were smoked.

The researchers suggested tobacco exposure in the womb may affect the child's brain development, but admitted further study of the issue was needed.

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• So you've tried, and tried, and tried, AND TRIED to quit  

Somehow, this time - maybe it was the nicotine-replacement patch, maybe the counseling - Collins resisted the call of the cigarette. But there is no denying: The stranglehold nicotine places on smokers can sometimes prove insurmountable.

Ask Jerry Remy, the Red Sox TV analyst who acknowledged last month that, despite enduring lung cancer, he still falls prey to the occasional impulse to smoke.

Ask Barack Obama . . .

The failure to quit, research has shown, has nothing to do with weakness of will. Nicotine, the primary addictive agent in tobacco, steals into the brain, setting on fire circuitry that regulates our sense of pleasure. At the same time, cigarettes acquire a sort of social permanence in smokers' lives - a way to start the day, to end a meal, to celebrate good times, to muddle through bad times.

So specialists who treat smokers now emphasize a double-barreled approach that combines counseling and medication, including patches, gum, and other nicotine substitutes along with drugs designed to thwart nicotine's addictive effects. There's even a nicotine vaccine being tested that would prevent the substance from reaching the brain.

Still, it's estimated that while roughly 70 percent of smokers want to quit, fewer than 10 percent succeed each year. . . .

Her first major attempt to quit was in 2000, when she went to group counseling at Mass. General. "I'd go there and I'd talk. And I'd leave immediately and have a cigarette.'' She tried again and again to stop smoking for good. Finally, last year, she decided, "This is ridiculous.'' She again sought counseling and wore the most potent nicotine patch available.

Her last drag on a cigarette, she said, was last October.

"No one can tell you to quit smoking. No one can make you feel like a social miscreant to make you quit smoking,'' said Collins, who lives in Belmont. "You have to summon it up from inside. You really, really do.''

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• Child tobacco farmers 'exposed to toxic levels of nicotine' 

* Children can absorb up to 50 cigarettes worth of nicotine on wet days

* Wearing gloves, washing clothes or bathing would all reduce exposure and risk

* Green Tobacco Sickness 'feels like death,' induces headaches, nausea

* Report reveals widespread abuse of child workers, withheld wages, violence . . .

Hundreds of thousands of children worldwide are thought to be working full-time on tobacco farms, suffering from toxic levels of nicotine exposure and abusive labor conditions.

Children as young as five-years-old work on tobacco farms in Malawi, according to Plan International.

In Malawi alone there are an estimated 78,000 boys and girls employed in tobacco harvesting. On average they earn 17 cents for a 12-hour day of back-breaking, bare-handed work, according to a recent report from Plan International.

Handling burley tobacco leaves without gloves, in unwashed clothes and rarely bathing, these children can absorb the same amount of nicotine in one day of harvesting that they would from smoking 50 cigarettes. . . .

Today UNICEF, the ILO, Plan and others all remain active in Malawi, working with the government to develop links between the ministries of labor and agriculture to end child labor on tobacco farms.

Since the report came out in August, Plan International told CNN in an email that "the government has been constructive in their response and are discussing/looking to work with Plan to conduct a national survey to gauge the true scale of the issue and better enforcement of existing child labor laws."

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• Nicotine Tob Res -- Table of Contents (October 2009, 11 [10]) 

• CHAPMAN: Pfizer’s campaign to drug as many smokers as possible  

Pharmaceutical giant Pfizer is in the middle of a major campaign to convince Australian smokers that they should not try to quit without taking anti-smoking medication.

The company sells over-the-counter nicotine replacement therapy (NRT) and prescription drug varenicline (brand name Champix). A Pfizer brochure "what makes you think you can quit this time?" and website stress that "only 3-5% of people who try to outsmart cigarettes without treatment succeed", that "a serious quit attempt needs a plan" and that most smokers "require help from a health-care professional".

Each of these claims is highly contestable. Pfizer and other pharmaceutical companies see cold turkey as the enemy of their efforts to medicate as many smokers as possible. Smoking cessation has become increasingly pathologised to the point that public awareness of its natural history has become heavily distorted.

For years, cold turkey has been denigrated as a hopeless strategy and ignored in public campaigns. But ask 1000 ex-smokers how they stopped and you get a very different answer. As occurs with personal efforts to stop problem drinking, gambling and narcotics use, population studies consistently have shown that a large majority of smokers who permanently succeed in quitting do not use any form of assistance. . . .

Pfizer’s claim that "most require help" is not only nonsense, but contrasts with a reference it cites in its own brochure, which states "about one-third of smokers now use a medication when they try to stop", meaning that two-thirds don’t. Its claim that smokers need a plan is also highly debatable. A recent study (Nicotine Tob Res 2009;11(7):827-32) of unplanned cessation found that unplanned cessation attempts were twice as successful as planned attempts and significantly, that most unplanned quit attempters do not use any assistance.

The emphasis about the futility of people trying to stop smoking unaided acts to exclude popular understanding of what is the most common story of cessation: doing it without professional or therapeutic help. When citizens have common, ordinary and self-limiting ailments, traits and behaviours constantly redefined as needing treatment, avoidable iatrogenic consequences and burgeoning health-care expenditure can follow. But the steady erosion of human agency and self-belief as people lose confidence in their ability to recover or change unhealthy practices is perhaps of greater concern.

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