E-cigarettes are not the silver bullet to solving the smoking epidemic as many hoped.
There are multiple truths facing the millions of smokers in America who want to quit smoking; however, the noise is getting in the way. It is true that electronic cigarettes are a tool that can help addicted smokers get nicotine while reducing the harm associated with smoking. However, it is also true that bad behavior by some and unintended consequences, including youth usage and importation of illegal products, continue to take the opportunity out at the knees. It is also true that we have medicines available to help smokers quit, but they were developed decades ago. Lastly, and most importantly, millions of people define quitting as the desire to not only never use a cigarette again but also to end their addiction to nicotine.
The human toll and financial impact of smoking in our society continues to be staggering, with almost 500,000 lives lost each year and hundreds of billions of dollars in cost to the health care system. Today, more than half of smokers will attempt to quit, so why in 2024 is the most used method of quitting still the age-old and least effective method: cold turkey?
Yes, there are medicines available to help smokers quit, as well as consumer products like e-cigarettes that at least can help move a smoker away from combustible cigarettes. But the landscape of solutions available today continues to be unable to turn the tide. Here are some facts that can guide how we finally solve this problem and end the death and disease caused by smoking once and for all.
First, so much money is at stake that companies will break or bend the law and risk reputational harm to make a buck on the backs of smokers. That is why we had a youth usage crisis with e-cigarettes, and today it is why we have illegal products being shipped into the country. Yes, e-cigarettes can reduce exposure and are a tool to reduce harm. But when people decide to break the laws and ship illegal products into the country to make a buck, they aren’t doing it to help smokers. They are doing it to get rich.
Second, we need to remember there are for-profit companies making business decisions that shape the playing field. On one side, every major tobacco company is now focused on ending smoking as part of their mission. But this is more of a required business pivot than an awakening of some kind. Cigarettes are and will continue to be increasingly taxed and regulated, which results in sustained annual declines in volume. These tobacco companies know the cash cow is sick and eventually will die. The only way for them to achieve their goals for shareholders is to find a business solution that will not disappear into the ether but will provide a sustainable stream of cashflow for years to come: selling nicotine products that won’t kill you. That is why they need reduced-risk products.
Third, patients and practitioners are left dealing with a 2024 health crisis using medicines from decades ago. Physicians, other clinicians and patients see the truth every day. We just don’t have all the tools we need to solve the problem. We need innovation in medicine. We need innovation in treatment, and we need industry to remember there are tens of millions of people who are being left behind without any change.
Today there is a lot of focus on illegal and illicit products; however, they aren’t the problem. The real problem is smokers aren’t stopping smoking and using e-cigarettes instead. If smokers thought e-cigarettes alone were the ultimate solution to ending the death and disease caused by combustible cigarette smoking, then after eight years of availability where any adult smoker can go to any gas station to buy a legal e-cigarette product for less than a pack of cigarettes, why are people still smoking? Yes, it is working for some, but e-cigarettes are not the silver bullet to solving the problem.
On the other side, we have pharma driving huge innovations in medicine and treatment. But smoking cessation and its tens of millions of prospective patients just doesn’t cut it when it comes to prioritizing development of new medicines. I think it comes down to the fact that nicotine as a drug is scary to some, developing cessation therapies is hard, and pharma sees the tobacco industry for what it was: a smaller segment with generally not super-effective medicines. That backward-looking view prevents companies from seeing what the industry can be with meaningful innovation: the single largest opportunity to improve public health in front of us today – and one that can generate significant financial return on investment.
By focusing on the patient and their needs, it is possible to drive innovation in cessation medicines that can achieve patient-centered outcomes. We have the technology and science to develop new pharmacotherapies to help millions of Americans achieve their goal of never smoking again. It’s a solvable problem, and the need is there. We just need to remember the truth.
Brian Quigley is CEO of Qnovia, a pharma company whose proprietary inhalation device is a category-maker nicotine replacement therapy that utilizes no heat and combustion.