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Pharmaceuticalization of tobacco industry jeopardizes public health

The transformation of the tobacco industry into a pharmaceutical-like manufacturer and seller of “safer” noncombustible tobacco and nicotine products for smoking cessation poses a new threat to public health, according to a commentary published in Annals of Internal Medicine.

“Cigarettes constitute more than 90% of the [tobacco] industry's profits, and the number of smokers is increasing worldwide with population growth,” Yogi Hale Hendlin, PhD, from the University of California, San Francisco, and colleagues wrote. “Smoking prevalence is simultaneously declining, threatening cigarettes' long-term profitability. Transnational tobacco companies aggressively promote smoking in low- and middle-income countries but have also diversified their product lines to include more socially acceptable alternative nicotine products, marking an industry-wide shift.”

Hendlin and colleagues warn that this opportunistic pursuit of standardized, designer nicotine products that have the potential to be government-certified may fundamentally alter how the tobacco industry and its products are perceived by policymakers and the public.

This process, known as pharmaceuticalization, is facilitated by two false assumptions, according to Hendlin and colleagues: First, the belief that a substantial proportion of chronic smokers cannot quit because the habit is too ingrained and second, the theory that a majority of smokers require pharmacotherapy to quit, the authors wrote. These assumptions support prolonged use of safer nicotine products by allowing policy to move away from prevention or complete cessation, according to the authors.

Furthermore, pharmaceuticalization presents three essential health implications, Hendlin and colleagues noted. First, the transition dilutes and obscures the process and trust associated with the approval of legal prescription pharmaceuticals. In addition, it complicates the regulatory process by not subjecting new tobacco drugs and devices to the same regulation and scrutiny as prescription drugs. Lastly, pharmaceuticalization empowers the tobacco industry and legitimizes it as a partner and supplier of nicotine products while dismissing ethics associated with producing and profiting from addiction and its treatment, according to the authors.

“By transitioning the cigarette business to the nicotine business, [transnational tobacco companies] stand to profit from smokers, new nicotine users and would-be quitters,” Hendlin and colleagues concluded. “They seek to rehabilitate their image by seeming responsive to public health concerns and exonerate themselves from the responsibility of having addicted smokers by offering long-term modified-risk nicotine maintenance. And they ensure profitability amid increasingly strict regulations while renormalizing the tobacco industry and nicotine use. Pharmaceuticalization represents the next phase of the tobacco industry and a new threat to public health.” – by Alaina Tedesco

Disclosure: Hendlin and colleagues report receiving grants from the National Cancer Institute at the NIH.