The industry as a whole has no plans because it is uncoordinated. Lobbying and PR would help, but is expensive. Clinical trials will not deliver full value for money because evidence of safety and efficacy is by and large irrelevant - all those in a position to take such evidence on board are working for the opposition.
In general, the preferred option is to wait and see what the competition comes up with next, and counter it when it arrives. Basic law says that e-cigarettes can't be killed off directly, but there are enough wrinkles that it might be possible to do it the slow way.
Before we start worrying about clinical evidence or anything of that type, we need to appreciate what the problem is: it's nothing to do with whether e-cigs work, or how well they work, or how safe they are. It's entirely about the money and absolutely nothing else has the slightest relevance.
These are the relevant issues:
- NRTs and associated quit-smoking drugs are a billion dollar a year global market.
- Drugs and therapies such as chemotherapy drugs for the treatment of sick and dying smokers are an even bigger money-earner - ten billion a year, fifty billion a year - who knows?
- This income is under direct threat from e-cigarettes. Every smoker who switches to an e-cigarette takes several thousand dollars out of pharma's pocket. Multiply that by a few million and you see the scale of the problem.
- The same goes for Snus of course - but in the US, the tobacco giants punch the same weight as the pharma giants, and no one in their right mind starts a fight they can't win. In any case, some of the tobacco and pharma firms are co-owned: the perfect solution.
- Some States are nearly bankrupt due to inept financial management, and now depend for their solvency on tobacco tax revenue. E-cigarettes are a direct threat to this, and therefore to the power base of the people in charge.
- The tobacco control industry is funded by pharma. In addition to the financial pressure on them to oppose e-cigs, the practical result of a Sweden scenario would mean many losing their jobs; two very good reasons to oppose harm reduction. So the TC crowd make all the noise, and get the legislation needed by pharma.
In Sweden, the number of smokers was reduced by about 40%, due to the widespread uptake of Snus. Now, 20% of the population are Snusers, and about 12% are smokers. This resulted in the smoking deathrate falling through the floor - a reduction of about 40%. Sweden has the lowest smoking-related deathrate in the developed world.
This was a disaster for pharma in Sweden, since all their smoking-related income collapsed. They are desperate to ensure this does not happen elsewhere - and especially in the USA, their biggest market. They have allocated as much money as it takes to fix the problem, and they do have enough: pharma's declared lobbying spend in 2010 was $267m, and they had more lobbyists in Washington than Congressmen.
The FDA works to pharma's agenda since they pay the bills. In addition, there is a revolving-door staff policy between the two, so that the same people work for both. Enough people in the know have stated that the idea that the FDA is an independent body working for public health is simply laughable - even the scientists who work for it will tell you that.
There are only three things that fix a problem like this:
- The application of funds in the right places
- A sudden, strange desire by the party in power to do the right thing, for unexplained reasons
- The crushing weight of overwhelming public & media opinion, and it becomes a voting issue
It is a waste of time even considering the science or evidence in this situation - utterly and completely pointless. First you have to fix the corruption, or out-manouver the suborned. Any other approach is worthless.
The system is completely corrupt and any discussion of normality - evidence-based decisions and the like - is about as relevant as discussing farming on the planet Jupiter. And about as sane. We can continue to accumulate evidence, as available, but ultimately it is not going to fix the crux of the matter: the people with the power are being paid by the opposition.
It needs to be recognized that hundreds of thousands of lives don't count for a nickel here. Well, strictly speaking, that is wrong - they count for millions taken out of pharma's pocket.
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