On  February 21, 2019 I published a blog where I asked Dr Moira Gilchrist, Vice President Scientific & Public Communications at Philip Morris International, 10 sceptical questions about her company’s much trumpeted “smokefree vision” after she tweeted that she would like questions submitted.

A month later, she’s handed in her homework on my questions, publishing them on Philip Morris International’s website.  I’d urge readers to first read my questions and then her answers at the above links.

Here is my response to her efforts.

Gilchrist first corrects me for suggesting that Philip Morris International may be somehow related to Philip Morris USA (which describes cigarettes as its “core” product). She writes “Philip Morris USA is owned by Altria and is neither an affiliate of PMI nor part of the same corporate organization.”

Below are the corporate logos for the two entirely unaffiliated companies. How very odd that one company has not taken legal action against the other for using an almost wholly identical trademark!

PM Logos

The drift of Moira Gilchrist’s responses is that PMI is working as hard as it can to accelerate the transition of its cigarette smokers to its IQOS smokeless product. While 86% of its business today still comes from cigarettes, the IQOS share is rising, with a forecast of 38% net revenue by 2025. But by any assessment, cigarettes are and will remain PMI’s leading revenue earner for the foreseeable future.

While PMI’s IQOS division is pulling out all stops to urge its smoking customers to switch, down the corridor in its cigarette division and in its over-arching corporate and regulatory affairs divisions, it’s business as usual. Cigarettes are being advertised and promoted anywhere in the world where they can still legally do this. And as we will see later, tobacco control policies are being opposed whenever these threaten to accelerate the inexorable fall in smoking.

The bottom line for the company is that wherever they see lips, they fantasise about one of their products being between them. As often as possible. Notably, Gilchrist failed to answer one of my questions: “What are the KPIs (key performance indicators) for the sales, marketing and public affairs staff in your cigarette division today? Are they being asked to try and sell less cigarettes or to keep on trying to sell more? Could we all see copies of some of those please?” Why do we hear so little from PMI on its twitter feed about its army of staff bringing home the bacon for its cigarette business?

Gilchrist states “We agree that regulations should continue to dissuade people from starting to smoke or use nicotine-containing products, and also encourage people to quit.” Let me spell that out in case anyone read it too quickly. PMI says it supports regulations that dissuade people from taking up smoking “or us[ing] nicotine-containing products”.

Now consider for a moment if a parallel statement was being made by a senior official of any other industry. For example, imagine the CEO of Toyota, hand-on-heart, saying Toyota supported government efforts to do all they could to dissuade people from starting to drive and encouraging drivers to give up driving. Would such a person be still in the job that afternoon? Yet apparently, this is what we are to take as a serious, trustworthy public statement from Philip Morris.

PMI wrote in their preamble to Gilchrist’s responses “We understand the continuing distrust of cigarette companies, and we know the tobacco industry faces a trust deficit. But we are not asking for trust.” I can’t imagine why.

The problem of their loyal, addicted cigarette customers abandoning smoking without substituting another form of nicotine delivery would loom as large for PMI. This is in fact (by far) the way that most ex-smokers quit, causing there to be many more ex-smokers than current smokers in nations that have taken tobacco control seriously.

It is perfectly clear that the “smoke-free vision” blather is very much not about the company encouraging smokers to quit using cigarettes and any form of nicotine delivery device. It is about encouraging them to switch to IQOS and to use it as much as possible. That’s understandable. They are in the nicotine addiction business, something Big Tobacco has always understood as the sine qua non of its survival.

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Teens should not smoke or vape

As all tobacco companies have always done, PMI unctuously hand-wrings over its concerns about youth smoking. It doesn’t want youth to use any nicotine products:  “Our marketing code is strong and enforced globally. Our post-market research shows that initiation of IQOS use by non-smokers is very low. We remain continually vigilant and welcome constructive feedback.”

In Canada, data will soon be published showing that for the first time in 30 years, youth smoking has risen, in concert with an 80% upswing in vaping. PMI will doubtless megaphone its vigilant efforts to put this genie back in its bottle. But the history of the tobacco industry’s intense interest in young smokers speaks for itself.

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While it would never say this publicly, the company would surely be ecstatic if children and teens who were nicotine naïve were to also experiment with IQOS and e-cigarettes, become nicotine dependent and live their lives spending money to satisfy their addiction. No business in its right mind would ever seriously propose that it would do all it could to dissuade non- and ex- users of its products or services to ever become customers. Yet for decades this has been the bizarre posturing we have seen continuously about smoking from the tobacco industry. PMI has recently given youth-focussed Vice Media £5m to promote its smokeless product. Perhaps the company has developed a magic way of preventing its pro-vaping messages from ever being seen by non-smoking youth, while being very effective with those which smoke.

Gilchrist also says “We do not encourage dual use”. Encourage, no. But jump for joy? Almost certainly. We know from recent research that smokers who also vape  “leads to a reduction in the number of combustible cigarettes, but total nicotine use and dependence increases …the increase in total nicotine use and dependence could affect the ability to quit either or both products.”  I’m sure this entirely unplanned collateral benefit would have never occurred to every company in the tobacco industry that has now climbed quickly aboard the good ship Harm Reduction.

Flogging the dead hardening hypothesis horse

Dr Gilchrist anchors IQOS as being for people who would otherwise continue smoking” and  people who cannot quit smoking”. This language borrows from the core assumption of the hardening hypothesis: the idea that today’s smokers are hard-core — mainly those who “can’t” quit smoking. They are people who are intransigent, helpless nicotine addicts, impervious to all that tobacco control policy and programs can throw at them. We all need to accept that these people will never quit and must instead dose themselves with nicotine, perhaps forever, runs the pitch.

Unfortunately for this argument, John Hughes, one of the world’s most respected and prolific researchers on smoking cessation, recently let all the air out of the hardening hypothesis tyres in a paper in Nicotine and Tobacco Research. He reviewed 26 studies on hardening and found:

“None of the 26 studies found that conversion from current to former smoking, number of quit attempts, or success on a given quit attempt decreased over time and several found these increased over time.” He concluded “Some have argued that a greater emphasis on harm reduction or intensive treatment approaches is needed because remaining smokers are those who are less likely to stop with current methods. The current review finds no or little evidence for this rationale.”

Moira Gilchrist pleads for understanding that the transformation of all their smokers to IQOS users will take time. Probably lots of time. She writes that “PMI does not control the speed at which this happens on our own: governments, regulators, scientists and tobacco control activists all play a role. We encourage everyone to engage in a debate on how to bring solutions to men and women who don’t quit smoking in as short a time frame as possible.” This is code for PMI wanting  governments, regulators, scientists and tobacco control activists to inhabit the same self-serving narrow definition of “smoke-free” that PMI is promoting, and become quasi promoters of IQOS.

We are presumably supposed to cosy down at the table with them on IQOS and then watch politely while the next day the same company does all it can to defeat, dilute and delay effective tobacco control like tobacco tax, plain packaging, graphic health warnings, retail display bans and advertising bans.

What it’s up to in low income nations

Gilchrist confirmed that PM had supported the Philippine Tobacco Institute’s challenges to two Balanga City (Philippines) local tobacco control ordinances, saying that they “would deny adult smokers the opportunity to switch to smoke-free products”.

Balanga is a tiny city – by Philippine standards – of just 80,000 people. Its local government was trying to introduce a smokefree ordinance in the vicinity of a local campus. The tobacco industry has known for decades that smoking restrictions reduce smoking (and so its profits – see below) dramatically. So PMI used the courts to stomp on proposed initiative that would have also not allowed vaping in the smokefree area. This was by any assessment using a sledgehammer to crack a walnut, and obviously intended to serve as a warning to other minnow jurisdictions in impoverished nations trying to introduce what is commonplace in wealthier nations where smoking and vaping is often outlawed in public spaces.

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Another recent example comes from Indonesia. PMI, through Gaprindo,  the ‘white cigarette manufacturers association’ as recently as November 2018, fought advertising bans and opposed tax increases. The head of Gaprindo said that said that the cigarette industry had in the past  few years had experienced declining selling volume decline of 1-2%. In 2015  he saidIncreasing excise tax on cigarettes twice a year will just harm the [tobacco] industry growth.”

Gilchrist says “In the past” PMI has opposed policies it considers “to be extreme and not backed by evidence of effectiveness.” Across my 40 year experience this has included almost every single platform of comprehensive tobacco control policy, with the exception of manifestly ineffective mush like signs in shops saying “we don’t sell to children”, guidelines for parents on how to have a chat with their kids about the dangers of smoking, and nicotine replacement therapy (which we know now has rock-bottom utility in helping smokers quit for good under real-world use). From this, we can take it that “extreme” means anything with any prospect of reducing smoking.

So, my verdict? No matter how many times a snake changes its skin … it is still a snake.

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