Wednesday, April 23, 2014

eCigarette advertising: past is prologue

Smithsonian National Museum of American History

Dr. Robert Jackler, “Freedom to Vape”: Unregulated Exuberance in Electronic Cigarette Advertising (Dr. Jackler is talking to FDA and to Congress about the same issues on his trip to the East Coast)

Note: I’m just going to stuff Dr. Jackler’s images into this post until Blogger rebels, because they are amazing.

Study of advertising looked at outrageous ads (doctors recommending) as well as tobacco ads targeting women and African-Americans; Ebony has 3-4 tobacco ads/month and no antismoking/ “talk to your kids” content.

Vape ads faithfully reproduce all the excesses of the past century—seem to have been using historical ads to inform their own claims.  Stanford Research into the Impact of Tobacco Advertising: many high-resolution scans online.  Themes and subthemes, all annotated with metadata and theme descriptors; fully searchable. Stanford’s collection, shared with Smithsonian’s collection, is over 20,000 original ads. Also an antismoking ad compendium, largely far less sophisticated—someone in a county is given a budget with no idea what to do.  Also have comparisons: then and now.  Many videos, including many from 40s-60s that were broadcast.  Also videos done in 2014 for electronic cigarettes. 

E-cigarettes becoming very prominent: 2x on front page of NYT in last few weeks. (Also a new store just opened near my home, so I’m quite interested.)  Almost all e-cigarette ads are online. Invented in 2004 in China; entered American market in 2007.  Varieties: look like cigarettes, Vape PENS (often used for marijuana), and e-hookahs; e-cigars and ePipes. Even inhalers (look like asthma inhalers) have been repurposed—for social acceptability?

Two forms: emulate cigarettes and distinctive design in some way. Some disposable w/fixed battery, and some rechargeable. They come as systems; can even get a USB charger to charge one from your smartphone.  Battery; atomizer; cartridge filled with vapor.  Suck on it = lights up and produces a mist.  E-liquid/e-juice.  Unlike tobacco, the vapor is much more extensive.  In Mad Men, when they smoke, it’s not tobacco but clove—but that big plume is part of the glamor of smoking of that time.  Ads tout the thickness of the vapor.

How bad is this stuff?  Much less cancer causing bad stuff than combustible tobacco. 

Marketplace is a gold rush. Over 250 brands, many startups, in US alone. Lorillard just bought a couple.  Altria/Philip Morris is buying them up; RJ Reynolds too.  Selling both ends of the market: owning both the problem and the solution.

Where made? China. Handful of Chinese mfgrs.  Look at boxes: different brands, same boxes with different printing.  You can have your own e-cigarette company by buying off the shelf.

¾ of adults who use are committed tobacco smokers who aspire to quit. Unlike patches and gums, e-cigarettes have advantage of recapitulating social glamor of smoking; sucking, primordial human urge.  Smoking is also a social identity, given the ostracization.  E-cigarettes allow you to participate in that social identity.

Teens are very different. Teens aren’t motivated by desire to quit.  Many haven’t chosen to smoke conventional tobacco at all. Expressing individuality by conforming to “coolness.”  Percentage of teens smoking doubled in a year. Many are “tobacco naïve.”  Smoking is only started by young people, not by adults.  If you get them started with nicotine addiction at an early age, you have them.

Museum ads: themes of freedom.  E-cigarette ads use freedom to show: freedom to break the rules, to smoke anywhere, freedom from stigma, etc. Ad shows woman giving smoking ban the finger.  “Inhale the freedom.”  “Liberty Vapor.” “Smoke Revolt.” “Take back your freedom.” Compare classic Philip Morris ad: “Freedom from throat irritation.”

“Welcome Back.”  Shows diner: welcome back to being allowed to be in a restaurant; welcome back to the glamor of the 60s; welcome back to the Greensboro diner, where the sit-ins were—an image that appears in every history textbook.  Discontinuity of nicotine in bloodstream from bans on airplanes and restaurants and work—that helps people quit.  Risk with e-cigarettes: people dual-use and keep nicotine levels high.

“Rewrite the Rules.”  Woman fueling up at gas station (with retro car). Though e-cigarettes do explode; they have lithium ion batteries in them.

Now we are seeing more explicit health claims—lots of images of doctors; image of caduceus to connote health. “eHealth Cigarette.”  (Also claim “Marlboro flavor.)  Label says “Smoking is bad for your health. e-cigarette is good for your health.”) Safer is likely true; safe is likely untrue.  “I plan to be a grandfather; therefore I smoke e-cigarettes.”  Compare historical claims for specific tobacco brands promoting health.  Claims that esmoking is the smart/logical choice.  “Pure”—compare purity claims in historical ads.  “True Cigarettes” were supposedly safer; now you have “Tru e-cigarettes.”  “Lung Buddy.” “Breathe Freely.”

What’s changed is that online you don’t only have ads; you have blogs, forums, Twitter.  Website: “Women and COPD: Reducing the Risk”—looks scientific.  “No smokers cough”—like old tobacco promises. 6 different e-cigarette companies put out breast cancer-themed e-cigarettes.   ProSmoke uses American Cancer Society logo and donation promise to advertise.  (Hmm…wonder what TM counsel thinks about that.)

Health claims: “Vitamin Smokes.”  “iSlim,” “NutriCigs” to make you slim.  “Inhale Flavors. Curb Cravings. Lose Weight.”  This is “Reach for a Lucky instead of a sweet” revisited.

Energy claims: similar to energy drinks.  “Energy Surge.”

Targeting teens: They claim not to target teens.  They have sham age certifications—you click and go in.  The ads have 20-something models doing things that 15 year olds could do. Very youth-oriented. Cartoons are forbidden to tobacco under master agreement, but e-cigarettes use them.  Then they blog about parents secretly buying teens e-cigarettes.  Sampling is illegal for tobacco, but they’re doing it.  Online games that result in coupons for e-cigarettes.

Cheapness as lure: youth are notably price sensitive.  “Student discount” for cigarettes.

Sex sells: XXX e-cigarettes.  Sex Stimulant, Tiger E cigarette.  Party with Playmates at Playboy’s Top Party Schools—2 Playmates hand out e-cigarettes; Playboy even has its own brand. Subliminal sex signals too.

Teen flavors: primary way of attracting teens is sweetness, which was also true in tobacco; 2009 FDA banned tobacco flavors, but flavored mini-cigars escaped the FDA ban.  Vapor companies produce flavors like bubble gum, gummi bears, candy corn, cotton candy, peppermint patty, honey, chocolate, caramel, banana split, Fruit Loops, Lucky’s Charms; Trix (again, TM counsel pay attention); cakes, colas, coffees; alcohol flavors—beer, champagne, amaretto, gin & tonic; pepperoni pizza; popcorn; kosher; bacon.  If you want to create your own, you can buy an e-liquid kit online and mix your own.  Dangerous! 

Teens crave social acceptability, and one of the ways they advertise is the avoidance of trash, yellowed teeth, stinky hair/clothes. You can vape around your loved ones. “Save humanity. Start vaping.”

Second hand vapor does contain nicotine, but not combustion products of leaf. Probably considerably safer than secondhand smoke.  Many ads show people in love smoking. Touted as good Mother’s Day gifts (as tobacco historically was).  Ads show smoking in groups; organized meetups for people who smoke the same brand; sponsor festivals.  Social media: Your Blu cigarette pack can be turned on so that it identifies nearby Blu smokers, stores, or other relevant locations. “Friends don’t let friends smoke.”  Indeed, if he knew a smoker he’d want them to switch; he’s not saying that vaping is bad but that the combination of nicotine, flavor (and marketing) is bad.  Bringing back the era of glamorous smoking.

Even mking them as luxury items—Louis Vuitton e-cigarettes (query whether authorized); one Russian oligarch ordered one covered in diamonds. Women’s brands; started to segment women, though not African Americans yet—recapitulation of history of tobacco. Dozens of pink e-cigarettes. 

Celebrity endorsements—Courtney Love. (Wow, that’s quite an ad.) Jenny McCarthy (hates vaccines, loves e-cigarettes).  Steven Dorff (actor who has emphysema).   E-cigarettes are at Oscars in the grab bags, and advertise heavily around that. Golden Globes—Julia Louis-Dreyfuss smoked on camera. Websites show celebrity vapers like Jack Nicholson (and they photoshop John Lennon and Marilyn Monroe in).  (Intermediate conclusion: these small players don’t actually care about any advertising rules.)

Nicotine fix: advertised as giving big dose. Deaths in children from toxic liquid. Doses even in small bottle will kill a kid. Industry is trying to normalize nicotine addiction, as with caffeine.  Some brands even have “no nicotine” e-cigs.

What of the argument that it helps you quit? That’s not a good business model.  Look at data: most-cited study is that an adult smoker with counseling has 5.8% chance of quitting on patches, 7.3% chance on e-cigarettes. Another recent study showed no assistance of e-cigarettes.  If marketed as cessation aid, FDA can regulate as drug—so they say something like “smoking alternative,” or “kiss tobacco goodbye” or “it works” (without saying works for what).  Deniability.  FDA needs consumer perception studies because tobacco industry has cleverest people money can buy; banning some words aren’t enough.  “Why quit? Switch to Blu” as reverse psychology: consumers perceive as “quit” message.

Consumer testimonials include disallowed claims, and companies post those on their websites and try to disclaim responsibility. (Again, these people just don’t care to conform their conduct to the law.)

Additive free, organic, and natural in tobacco—same gimmick in e-cigarettes.  Young people also like tech, and they emphasize the technological aspects. Apps track your vape consumption and plot your “life expectancy increase” v. tobacco.

Also of course used heavily for cannabis. You can get cannabis flavored e-cigarettes.

Sponsorships: forbidden to tobacco, now coming to e-cigarettes. Big investment in car racing; showed an Olympic ad that I can’t imagine was authorized.

NJOY ran a Super Bowl ad; but most ads are on websites and elsewhere online.  Blogs, wikis, chats—claims that FDA would regulate as drug claims made on social media.  Many “independent” sites are highly laudatory of particular brands—he suspects that they are actually marketing arms.  There are road shows with free samples; discounts; contasts with iPad giveaways; stores all over America.  Sophisticated point of sale displays, not required to be behind the counter like tobacco.  Vapor bars: you can fill your cigarette at the bar.  Estimated 250,000 retail outlets like 7-11s are markets for e-cigarettes, and the business trajectory is sharply upward. Prediction that they may overtake tobacco cigarettes in 10 years.

Business model is like printer cartridges: they want you to buy the liquid, and they want to stop you from buying from other makers. 

Right now FDA is in a process called “deeming.”  Land rush for market share. But when they deem it to be a tobacco product, e-cigarettes will have the same regulation, which will take away flavoring, health claims, cessation claims, medicinal roles, celebrity endorsements, and sponsorships; will leave channels intact (except TV & radio that they don’t use anyway).  Backdoor online channels are a challenge.  (Is the FTC talking to the FDA about this? The endorsement guidelines would seem very relevant.)

Jurisdictional issues: nicotine free e-cigarettes; nicotine can be extracted from tomatoes, though that’s not economical now—if becomes possible, then it will escape FDA authority. Local ordinances are everywhere.

Unless youth adoption can be stemmed, public health gain will be offset by youth initiation and dual-use smoking where vaping is used to support tobacco.

His end game strategy: replace combustible tobacco with vapor.  He supports e-cigarettes, but not the Wild West.  E-cigarettes could be used to provide glamor/social benefits.  If they have no nicotine: low tax, flavors allowed; youth drawn to it. Nicotine: high tax, flavors forbidden, for experienced smokers.

Q (from RT): is FDA talking to FTC?  FTC has useful guidelines for the online advertising with which you are so justly concerned, especially the undisclosed advertising.

A: there’s inertia there.  Big players want regulation—that will put all the riffraff out of business; want expensive burdens for testing/purity to get rid of the competition.  That’s their endgame.  His hope is they’ll have deeming, but what we’ve learned from history of ad regulation is that they figure a way around any regulation.  In Europe etc. they can be much more effective, but the First Amendment restrictions (that killed graphic warnings on packs) is a barrier here.

Q: what of the impact on throat and mouth cancer?

A: seems unlikely to be as bad as combustible tobacco, given the carcinogens in the partially burnt hydrocarbons in combustible tobacco. We’re seeing a big explosion in cancer from HPV, but we hope vaccinations of young women—and men—will produce herd immunity.

Q: what are the materials—plastic?  Leaching?

A: Some of the stuff, they’ve detected cadmium/nickel in; not much known about the polymers. Stuff is being deeply inhaled in the lungs that you wouldn’t normally inhale, and especially extended use is an unknown.  A few reports of pneumonia, reactive airway disease. The additives are also an issue. Not meant to be in the lungs! Your nose is usually a filter.  We should see what’s growing in these liquids—the compounders are not necessarily trustworthy.  But it’s here to stay, and probably will replace combustible tobacco.

Q: what is the vapor?

A: People are starting to study. Mostly water/propylene glycol, which is well known.  Really key thing: right now, smoking is declasse; it’s a deprecated social signal and was growing over time. That’s changing—reglamorizes/renormalizes smoking. He is a realist about this.  Genie won’t go back in bottle.

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