Research paperNicorette reborn? E-cigarettes in light of the history of nicotine replacement technology
Introduction
Much discussion currently centres on the question of whether or not e-cigarettes are responsible for re-normalizing smoking and making nicotine addiction publicly acceptable once more (Chapman, 2013, Fairchild et al., 2014). In this paper, I wish to shift the focus of attention by viewing the e-cigarette controversy in light of longstanding disagreements about the meaning and significance of nicotine replacement technologies. I argue that it is more apposite to draw attention to how e-cigarettes are making apparent the historically contingent association of nicotine replacement technology with pharmaceutical innovation and medical product development.
Designed and developed as safe and pleasurable to consume, e-cigarettes deserve recognition as reopening and restaging the controversy that engulfed the development of Nicorette chewing gum, the first commercial nicotine replacement technology launched during the 1970s. Just as the nature and identity of e-cigarettes as medical goods, tobacco-related products or general consumer goods is hotly contested today (Farsalinos and Stimson, 2014, Hajek et al., 2013), the nature and identity of nicotine-containing chewing gum remained a matter of chronic uncertainty and regulatory indecision for more than a decade after its invention at the end of the 1960s.
Section snippets
Alternative scripts of nicotine replacement
In the sociology and philosophy of technology it has become common to talk of the success or failure of innovations as hingeing upon the ‘scripts’ that are connected to and inscribed into them under their development (Akrich, 1992, Akrich and Latour, 1992, Latour, 2005, p. 79; Verbeek, 2006, p. 362; Verbeek, 2011, p. 10). Due to their novelty, innovations are obliged to prefigure the contexts of use into which they are to be inserted. Innovators must author original roles and identities for
Drug replacement as a cure for smoking: the birth of the smokers’ clinic in Stockholm 1955–1960
As already mentioned, prefiguring the rise of nicotine replacement therapies, Sweden was also the birthplace of the smoking cessation clinic. The pioneering figure behind the establishment of four polyclinics in Stockholm during the late 1950s offering a drug replacement ‘cure’ for smoking was a cardiologist called Börje Ejrup (Elam, 2014a). Initially limiting treatment to patients on a cardiac ward whose medical condition was clearly aggravated by their smoking, Ejrup was enabled by
Nicorette as a replacement for cigarettes
The Nicorette script originates from a letter sent by two doctors, Stefan Lichtneckert and Claes Lundgren, at the Department of Clinical Physiology, Lund University, to Ove Fernö, the research director at the LEO Pharmaceutical Company in nearby Helsingborg, on 8 December 1967 (Ahlin & Lundgren, 2002, p. 269; Fernö, 1994, p. 1216; Lichtneckert & Lundgren, 1967). The letter offered support for the view that the hazards of tobacco use derive firstly from the inhalation of cigarette smoke.
Early controlled and ‘open’ clinical trials of Nicorette gum
By envisioning nicotine chewing gum as a substitute for cigarettes and oral tobacco alike, Fernö and his colleagues were intent on delivering a new therapeutic tool capable of re-galvanizing the development of the Ejrupian smokers’ clinic. The Lund clinic which had closed down in 1967 due to the lack of a viable treatment technology was re-opened at the beginning of 1970 precisely to carry out preliminary trials of Nicorette gum (Ahlin & Lundgren, 2002, p. 272; Ohlin & Westling, 1972). Fifty
The parallel emergence of Nicorette gum and the first ‘Portionssnus’
Writing together with Lichtneckert and Lundgren in the early 1970s, Öve Fernö described the cigarette substitute he was engaged in developing as follows:
“It should reduce the medical risks compared to smoking
It should provide a pharmacological reward comparable to smoking
It should preferably imply the possibility of habit formation and conditioning to substitute for the habits and conditioned reflexes related to smoking
The time required to teach or apply the method should be minimal”
(Fernö,
Nicorette as an object of parliamentary controversy
By the summer of 1975, Swedish Tobacco had taken the initiative of drawing up a draft agreement for the joint commercialization of Nicorette gum with LEO. A two-stage market launch was planned with initial sale through pharmacies directed towards the flourishing informal network of smoking cessation clinics which had emerged as lead-users of the gum. Thereafter, Swedish Tobacco would take charge of the more general distribution of the product through the channels already established for oral
Nicorette gum becomes a therapeutic tool with global reach 1977–1983
Neither a medicine nor a foodstuff, Nicorette gum was outlawed in Sweden in the middle of 1977. The supplies of gum that LEO had distributed free of charge to a growing informal network of smoking cessation clinics for more than seven years had to be stopped (Fernö, 1994, p. 1223). Simultaneously, and much to the relief of LEO, the product was successfully registered as a prescription-free medicine in Switzerland, with a market launch in summer 1978 (Ahlin & Lundgren, 2002, p. 274).
After LEO
Michael Russell's vision of post-therapeutic nicotine replacement
Within four years of the first NRT becoming available as a prescription medicine in the United States, the 20th report of the US Surgeon General on the health consequences of smoking was able to officially confirm that “cigarettes and other forms of tobacco are addicting” and that in treating the tobacco user “health professionals must address the tenacious hold that nicotine has on the body” (US Department of Health and Human Services, 1988, pp. iii–vii). Thus, 20 years after Lichtneckert and
Conclusion
If Michael Russell's future for nicotine replacement failed to materialize during the 1990s, it has come several steps closer to reality with the controversial rise of e-cigarettes after 2003. Without question, the global diffusion of e-cigarettes represents a turning point in the history of nicotine replacement technology. E-cigarettes have resurrected the script of nicotine replacement as the righting of nicotine consumption as opposed to the treatment of nicotine addiction. Corresponding
Acknowledgement
This work arises out of research supported by the Swedish Research Council (contract number 90197701).
Conflict of interest statement: None declared.
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