F E AT U R E
Assessing the
reduced-risk
possibilities of
e-cigarettes and
other novel tobacco
and nicotine products
by Dr Marina Murphy, Head of Scientific Media Relations,
Research & Development at British American Tobacco
The ‘billion-people’ issue this century,
according to the World Health
Organisation (WHO), is undoubtedly
the public health impact of smoking1.
The WHO says that around one billion
people will die from smoking-related
disease, but many others believe that
e-cigarettes, as well as other products,
are substantially reduced risk compared
to cigarettes and have the potential
to have a significant positive public
health impact.
But how can you be sure? How do
you ‘measure’ that? This requires a
framework of tests that seek to first
understand the products and the
aerosols they produce and then assess
the biological impact of the aerosols
compared with cigarette smoke and
finally the likely impact on the consumer.
Several companies are actively involved
in e-cigarettes and next generation
products. The key to demonstrating the
reduced-risk potential of these products
will therefore be agreeing on testing
approaches. This means that there is
now a great opportunity for the industry,
regulators and academia to come
together and agree on standards and
testing protocols.
The Public Health Impact of Smoking
The WHO has said that in this century,
about one billion people will die from
smoking-related disease, compared to
one hundred million in the last century1.
This is because although the percentage
of the population that smokes every day
has decreased, the number of cigarette
smokers worldwide has increased due to
population growth.
A 2014 study2 by the Institute of Health
Metrics and Evaluation, at the University
of Washington examined smoking
prevalence and cigarette consumption in
187 countries between 1980 and 2012.
The results, published in JAMA, showed
that although overall smoking prevalence
decreased by 42% for women and
25% for men between 1980 and 2012,
substantial population growth contributed
to a 41% increase in the number of
male daily smokers and a 7% increase
for females. But the WHO has failed to
support e-cigarettes and some regulators
have responded by banning them.
Many others, however, believe that
the popularity of e-cigarettes and the
fact that they are substantially reduced
risk compared to cigarettes could be
the answer to this public health crisis.
Public Health England3, an executive
body of the UK Department of Health,
recently published a report saying that
e-cigarettes are 95% safer
than cigarettes.
Professor Julian Kinderlerer, President
of the European Group on Ethics in
Science and New Technologies (EGE),
told a delegation at the Annual Meeting
of the American Association for the
Advancement of Science in February
2015 that: “In the case of cigarettes
and e-cigarettes, history will judge us
harshly as to how we answer this billionperson question. It may also look back
in anger at policy-making amounting to
institutionalized manslaughter.”
(http://www.science20.com/news_
articles/ban_them_or_embrace_them_
ecigarettes_face_a_fork_in_the_road153217)
The use of products like e-cigarettes,
therefore, holds great potential for
reducing the harm associated with
tobacco use. But this reduction in harm
needs to be scientifically proven. To this
end, we and others in the industry are
developing frameworks of tests to help
us understand our products and their
biological impact.
Testing, testing…
The renaissance in product innovation
away from traditional combustible
cigarettes has certainly seen the
emergence of some very high-tech
gadgetry and technology. These require
fresh eyes and new tests to help ensure
that products based on these new
technologies are as safe as they can be.
We at British American Tobacco have
proposed a new scientific framework4
that could be used to assess the
reduced-risk promise of the myriad of
innovative nicotine and tobacco products
currently being developed.
This framework employs a four-stage
process that uses lab-based and clinical
tests along with real-world observations
of individual and population perception
and use (Fig 1).
The first step is understanding how
consumers use the products and using
this information to then understand the
products. This is followed by clinical
testing to determine that these products
produce and deliver less toxicants
than conventional cigarettes. Then the
testing moves into the real-world use
to determine what impact, if any, this
reduction in toxicants will have on a
person’s individual risk and also on the
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