Next generation tobacco products like heat-not-burn (HNB) offer a less risky alternative to combustible cigarettes. Making these products more available to smokers would translate into public health gains, according to Helen Redmond, adjunct professor at New York University-Silver School of Social Work.
Because the tobacco is not burned, the levels of harmful chemicals produced by HNB products are significantly lower compared to combustible cigarette smoke, according to Redmond. She made the statement before the U.S. Food and Drug Administration (FDA) authorized the marketing of IQOS, the tobacco heating system produced by Philip Morris International, as a modified risk tobacco product (MRTP).
It has been known for decades that tar and carcinogens found in tobacco smoke, causes the death and disease associated with smoking and not nicotine. “The use of nicotine is no threat, because nicotine is not the problem. Combustible tobacco is,” Redmond said. “There is a widespread, mistaken notion that nicotine causes cancer and other health problems. That is false. What causes health problems is lighting tobacco on fire. The combustion releases thousands of toxic chemicals.”
The FDA’s MRTP authorization shows that IQOS is a fundamentally different product than combustible cigarettes, and must be regulated differently. The FDA’s decision is consistent with earlier conclusions of other leading regulatory and scientific bodies, including in the United Kingdom, Germany and the Netherlands, which have found that the product emits lower levels of harmful toxicants.
“If HNB products appeal to smokers who, for whatever reason, find that vaping — estimated by Public Health England to be 95 percent safer than smoking — isn’t for them, it’s a huge win for public health,” she added.
She said e-cigarettes and HNB devices proved effective in making smokers switch because they offer the same pleasure, rituals and relaxation associated with smoking. A February 2019 clinical trial by UK’s National Institute for Health Research found that e-cigarette was twice as effective as nicotine replacement treatments such as patches and gum at helping smokers quit.
Redmond cited the case of Japan where nearly a third of smokers have already switched to HNBs. “HNB products have been available in Japan since 2014. The result— cigarette sales in the country have plummeted, outstripping anything abstinence-only messages have achieved” she said.
PMI has conducted extensive research on IQOS, including 18 non-clinical and 10 clinical studies. Based on PMI evidence to date, switching completely to IQOS — while not risk-free — is a better alternative for those who would otherwise continue to smoke.
Another study by Canadian and American researchers looked at how trends in the sale of cigarettes in Japan between 2011 and 2019 correspond to the sales of HTPs that were introduced into the Japanese market in late 2015.
The researchers concluded that the accelerated five-fold decline in cigarette sales in Japan since 2016 was due to the introduction of HTPs.