The introduction of heat-not-burn tobacco products as better alternatives to combustible tobacco will translate into public health gains, according to a public health expert.
Helen Redmond, adjunct professor at New York University-Silver School of Social Work, was referring to HNB or heated tobacco products which are smoke-free devices that heat, instead of burn specially-designed tobacco units to release flavorful nicotine-containing tobacco vapor. As the tobacco is not burned, the levels of harmful chemicals produced by HNB products are significantly lower compared to combustible cigarette smoke.
She made the statement before the U.S. Food and Drug Administration authorized the marketing of IQOS, the tobacco heating system of Philip Morris International, as a modified risk tobacco product on July 7, 2020.
The FDA’s action authorizes the marketing of IQOS in the US with the following information: the IQOS system heats tobacco but does not burn it; and scientific studies have shown that switching completely from conventional cigarettes to the IQOS system significantly reduces the body’s exposure to harmful or potentially harmful chemicals.
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 most popular HNB brand today is IQOS—an electronic device that heats tobacco-filled sticks wrapped in paper to generate a nicotine-containing aerosol. Other popular smoke-free nicotine products are electronic cigarettes or vapes and Swedish snus. Public Health England’s annual reviews of all available evidence have consistently concluded that e-cigarettes are around 95-percent less harmful than smoking.
“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 said.
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 U.K., Germany and the Netherlands, which have found that the product emits lower levels of harmful toxicants.
“The availability of IQOS is an incredibly important development for the millions of Americans who continue to smoke and who suffer almost half a million preventable deaths each year,” Redmond said, even before the FDA issued the latest authorization for IQOS.
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.
“E-cigarettes and HNB products make nicotine consumption much safer. In that, they are similar to patches or gums. The crucial difference is they look and feel like cigarettes, replicating the rituals and the enjoyment of smoking for people who switch from combustible tobacco—and therefore reducing the risk of relapse,” said Redmond.
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.