August 23rd, 2014

Big Pharma anti-vaping ad complaint

quickmist-lite

I found this annoying and decided to complain

Update: MHRA (predictably) rejected this complaint.  So, medicine regulator defends regulated medicine maker in attack on non-medical but superior alternative to smoking.  To do otherwise would have been to draw attention to the folly of regulating recreational nicotine products as medicines. See letter (PDF). End of update.
It’s perhaps a good sign that Big Pharma feels compelled to apply its boneheaded, plodding, utterly uncreative advertising skills to persuading smokers to use its inferior products rather than take up vaping. For a characteristically entertaining account of the righteous petulance of Big Pharma see Redhead Full of  Steam. Even so, I found this advertisement annoying, especially as e-cig vendors can’t fight back and likely to be counterproductive for health (if enough people followed its advice).  So I decided to see how they can be held to account. As it turns out MHRA is the regulator and it applies a code called the Blue Guide, Advertising and promotion of medicines in the UK.  So here is the complaint:

_____________________ Complaint starts here _____________________
MHRA Advertising Standards Unit
Area 3-M MHRA,
151 Buckingham Palace Road,
LONDON SW1W 9SZ
4 August 2014
Dear sir or madam

1. The Complaint: Nicorette QuickMist ‘Don’t Vape. Quit for Good.’ advertisement

1.0 I would like to complain about the following advertisement for Nicorette Quickmist, a Johnson and Johnson product, with the headline “Don’t Vape. Quit for Good.”.  This was photographed by me on a Northern Line tube train on 16 July 2014 and forms part of a campaign that I saw many times.

quickmist-lite

2. Grounds for complaint

2.0. Breach of the Code

The advertisement breaches several provisions of the MHRA’s Blue Book Section 4.3: Quality Standards:
By regulation 280 of the Regulations, an advertisement must: 
(1) comply with the particulars listed in the summary of product characteristics (SPC); 
(2) encourage the rational use of the product by presenting it objectively and without exaggerating its qualities; and 
(3) not be misleading.

2.1. Fails to comply with product’s Summary of Product Characteristics

The advertiser has no basis for positioning its product as an alternative to vaping or providing messages to consumers that are negative about vaping, especially when vaping may be beneficial to them – and more beneficial than the advertiser’s product (see 2.2 below). The medicine in question is to treat smoking dependence and is only indicated for smoking cessation, reduction and nicotine maintenance. The advertiser should stick to conveying accurately the product’s capabilities in this regard, not disparaging alternative strategies for which it has no supporting evidence on which to base its headline.

2.2. Fails to present the product objectively or without exaggeration

The advertiser has no evidence that its product is superior to vaping as a way of ameliorating the health risks of smoking.  To the extent that there is evidence it points in the opposite direction, for example, a recent study of use of different approaches to unsupported smoking cessation, drew the following conclusion:
Conclusion: Among smokers who have attempted to stop without professional support, those who use e-cigarettes are more likely to report continued abstinence than those who used a licensed NRT product bought over-the-counter or no aid to cessation. This difference persists after adjusting for a range of smoker characteristics such as nicotine dependence.  
Brown J, Beard E, Kotz D, et al. Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study. Addiction Published Online First: 20 May 2014. doi:10.1111/add.12623
The difference is non-trivial: the press release for this article states:
People attempting to quit smoking without professional help are approximately 60% more likely to report succeeding if they use e-cigarettes than if they use willpower alone or over-the-counter nicotine replacement therapies such as patches or gum

However, by asserting ‘Don’t Vape’ the advertiser is implicitly claiming superiority of its product over vaping as a strategy for addressing health risks of smoking, but has not established this and has no basis for claiming it or offering this advice. In making the assertion in the advertisement, the advertiser may be suggesting a course of action to the public that, on the basis of the evidence cited above, is less effective for the user and therefore causes greater harm. While it may be acceptable to convey the attributes of NRT to consumers it is misleading and potentially dangerous to take the further step of criticising an alternative, without a justification.  The burden of proof does not rest with vapour product manufacturers, but with the advertiser advising use of its product rather than vaping. No such evidence exists.

2.3 The advert misleadingly implies users of QuickMist will have a reasonable chance of success in quitting

The vast majority of users of this product will not ‘Quit for Good’ and nowhere does the advertisement convey the very poor probability of success.  Simply adding the disclaimer that it ‘requires willpower’ does not do justice to the difficulty of quitting and to the ineffectiveness of these products – and the reason why vaping is proving attractive.  The Cochrane review for NRT illustrates just how poor the success rates are, merely increasing unaided success rates of 3-5% by just 2-3% – therefore still leaving failures rates of 92-95%. As the Cochrane Review sates:
Studies of people attempting to quit on their own suggest that success rates after six to 12 months are 3-5% (Hughes 2004a). Use of NRT might be expected to increase the rate by 2-3%, giving a number needed to treat (NNT) of 33-50. 
Though often expressed as providing a 50-70% increase in the chance of quitting, the experience for the vast majority of users will be failure and the number of people actually benefitting from following the advice in the advertisement may be as few as 1 in 50 based on the ‘Number Needed to Treat’ figures provided. If the advert conveyed the true likelihood of successfully quitting for good, then it’s advice ‘Don’t Vape’ would not be credible. Consumers are mislead by the appearance of a clear cut choice, but this is provided without the probabilistic context that would make the comparison of these options fair and realistic.

2.4 The advert misleadingly implies a conceptual difference between vaping and NRT which has no basis in reality

The advert implies that vaping is not for quitting but that NRT is for quitting and not long term nicotine maintenance.  In fact both vaping and NRT can be used for exactly the same purposes.  The QuickMist SPC shows it is indicated for quitting, cutting down, long term maintenance and ‘harm reduction’ and it is likely that given the low success for complete quitting using NRT, most of its users would not quit completely they continued with the product – exactly as they would with vaping.
Therapeutic indications
Nicorette QuickMist relieves and/or prevents craving and nicotine withdrawal symptoms associated with tobacco dependence. It is indicated to aid smokers wishing to quit or reduce prior to quitting, to assist smokers who are unwilling or unable to smoke, and as a safer alternative to smoking for smokers and those around them. Nicorette QuickMist is indicated in pregnant and lactating women making a quit attempt. Nicorette QuckMist SPC 4.1 
Vaping can be used in the following ways: to quit smoking and nicotine completely, either by ceasing to vape once craving have subsided or by continuing to vape using non-nicotine e-liquids; as a source of replacement nicotine to assist to cutting down for a continuing smoker; and as an alternative to smoking as a way of self-administering recreational nicotine while avoid the harms of smoking.  By making the comparison “Don’t Vape. Quit for Good“, the advertiser has drawn a misleading distinction between vaping and NRT that has no basis in reality.

3. About this complaint 

3.0 This complaint concerns an implicit attack by a advertiser of a licensed medical product directed towards products that are unlicensed as medicines but are lawful, and now widely used. The argument made above is that the strap line “Don’t Vape. Quit for Good” is inappropriate, misleading, potentially harmful and has no evidential basis as advice to consumers.

3.1 This complaint should not be considered by any of the the self-regulatory bodies as there are potential conflicts given the object of the negative part of the advertising is a non-medicinal product category.

3.2 I am not representing any commercial interest and have no competing interests.  My focus is on tobacco harm reduction as a strategy for public health, and I believe this advertising is counter-productive for health in that respect.

3.3 I have no issue with NRT advertising as long as it does not detract from vaping and conveys meaningful information about its efficacy to consumers.

I hope this complaint is in form that will facilitate your investigation, but please do contact me if you would like further substantiating argument. I look forward to hearing from you.

Yours sincerely

Clive Bates

_____________________ Complaint ends here _____________________

21 comments to Big Pharma anti-vaping ad complaint

  • […] However, we know that the pharmaceutical industry, which sells competing nicotine products, has been advocating heavily against ecigs, both directly and through charities which it funds. (As ex-ASH director Clive Bates points out, big pharma is even taking out paid adverts against vaping.) […]

  • Chris Price

    In the UK, you buy 18 out of the 20 cigarettes in the packet from the government. In effect, it is ‘government tobacco’ in all but name.

    The UK government also receives large revenues from the pharmaceutical industry, who almost certainly make more money from smoking in the UK than the tobacco industry does. (In a year when total UK tobacco retail sales are £14bn including tax, the tobacco industry receives £2bn from those OTC revenues, and the pharmaceutical industry will make more than £2bn: their multiple income channels created by smoking easily add up to more than £2bn.)

    Additionally, pharma has an iron grip on health provision in the UK (and most places, probably); it is the key to profitability. The DoH is a puppet agency, certainly with regard to any area or issue that affects pharma revenues: there is zero possibility of any decision by the MHRA or DoH that will materially harm pharma income, even when massively detrimental to public health.

    The UK government makes at least twice the cost of EU membership from smoking, even after all costs are paid. Smokers are one of the country’s single largest income sources and savings generators (tens of billions in savings on pensions that don’t need to be paid, healthcare costs saved on years of later life care not needed, vast savings in social welfare costs not needed in later life – all due to early death). It costs £5bn a year to treat smokers on the NHS but they generate or save at least five times that, possibly six times (think of all the retail jobs and taxes, transport, company taxes in distribution, and myriad jobs and taxes ultimately dependent on the tobacco trade).

    Don’t expect anyone with power or money to support ecigs. Their money and their power may ultimately derive, in part, from smoking. The smoking economy is worth at least $1 trillion annually and it isn’t going to lay down and die.

    Ecigs aren’t a health issue except for the user community – they are a massive financial problem for anyone else, especially government and established industries. Health issues are irrelevant and just used as a smokescreen. It really wouldn’t matter if ecigs prolong life by 50 years, cure all known ills, and transform your old banger into a Bentley – the opposition would be exactly the same. It’s all about the money, only about the money, and nothing else, and never will be about anything except the money. Don’t get hung up on health as it’s a dead end.

    Advertising was all about money, the last time I looked, and therefore it’s owned by the smoking economy. Sorry :)

  • Bob

    An excellent response Clive, thank you for continuing your intelligent fight for the right to vape. I saw that ad a few days ago and found it difficult to accept it was within advertising standards, apart from getting my back up!

  • Andrew Summerfield

    Thank you very much for this.

    This almost seems like the David and Goliath story.The big Pharma and Tobacco companies are seeing a huge loss in revenue and all of their R & D costs, so what their doing is just sniping.
    Getting the ad banned is one thing , but I think that a few ( or many ) big and small vaping related companies should do a class action against Johnson & Johnson for slander.There is clear evidence that they don’t have any evidence for this advert and should be sued for it.Even if they settle out of court it will be seen as a victory.After all aren’t we all supposed to be innocent until proven guilty ?

    • Phil

      Don’t forget the other “Goliath”: Big Government. They are a huge stakeholder in the Tobacco Industry (+/- 90% in the UK, for example)! (ref. homepage: ecigarette-politics.com)

  • Martin

    Excellent Clive, i saw that advert too and it really did hit a nerve with me.

  • Jerry Hatrick

    Another top effort Clive.Please keep them coming.

  • Of course as always an incisive analysis Clive. But I am now going to try again to make a point about “counter-advertising”: Someone–not necessarily an e-cig/vapor company or association thereof, but perhaps a private citizen with means–should create an ad campaign, to wit: “Smokers: The MHRA- (FDA in my country)-approved methods to help you quit rarely work. Why not consider a better way?” If a trade association placed it, it stops there. But if a non-commercial party place it, it might go on thusly: “E-cigs and vapor products may well help you quit where other methods have failed.” Just a thought.

  • john

    Interesting thing is that the Quick mist product being inhaled, is essentially a PG mist with some nicotine, I.e what is the big difference, that justifies the claims in that ad?

  • Christine May

    OMG Thank you Clive for your intelligent observations. Please can you try to influence this back of beyond (corrupt) system in Western Australia, to save us from being forced back to smoking tobacco PLEASE!!!!

  • Eaton

    Well Professor Robert Wests research showed that you were 60% more likely to quit smoking if you used and EC as compared to using NRT or using nothing – so such advertisements by deduction are misleading re. health information and therefore to public health.

  • This is an excellent and well written response to a cynical piece of marketing. Although frankly I hold out little hope that MHRA will even for one moment consider biting the hand of one of its benefactors, I do hope that this will at least give rise to an awkward moment or two. Thank you Clive, yet again, for your efforts.

  • Dodderer

    It is common knowledge that Nicoventures have submitted a MAA for an ecig – which it is rumoured will be approved in the near future.

    They may argue that a medicine is allowed to ‘knock’ a non-medicine(though false,assumed superiority) but to knock a product that may well soon be approved as a medicine and offers an alternative solution is surely against the code.

  • […] It's perhaps a good sign that Big Pharma feels compelled to apply its boneheaded, plodding, utterly uncreative advertising skills to persuading smokers to use its inferior products rather than take…  […]

  • Excellent!

    What I appreciate about this ad is it’s usefulness for demonstrating the financial motives the pharmaceutical companies have for disparaging vapor products. They might as well have released a statement saying, “The real reason we don’t want people to vape doesn’t have anything to do with safety concerns, it is that we want them to buy our products instead.”

    What is so disgusting about it is the idea that they would discourage anyone from any method of quitting smoking. I have spent time with a lot of vendors of vapor products and I have NEVER heard any of them discourage a smoker from trying a different method of quitting.

  • Donna

    Love your work Clive Bates. Thanks!

  • pedaldo

    or the balance needs enforcing so the NRT are not allowed to use the same arguments of “Better than or Safer than” because evidence, or lack of, works in both directions.

  • Great post! The big problem – as stated – is that e-cigarette retailers can not fight back.

    What features can be safely promoted? What are we allowed to say? Recent cases show you can be a short step away from a call by the Advertising Standards Authority, if adverts contain phrases like; they are ‘better than’, ‘healthier than’ or ‘beneficial’. No matter if true, and especially if there is a slight chance it could be misinterpreted to apply to everybody, and not just smokers.

    This climate restricts advertising the benefits of electronic cigarettes. Often leading to adverts having little or nothing to do with what they offer the long term smoker, and sadly more increasingly with some innuendo-laden suggestion.

    The balance needs readdressing, so that e-cigarettes can promote and defend themselves in equal measure.

  • Thank you – most appreciated.

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