The popularity of heated tobacco products as a “smoke-free” alternative to cigarettes has skyrocketed in recent years, but a peer-reviewed report suggested that their emissions could be considered smoke, a claim vehemently rejected by the tobacco industry.
Heated tobacco products or HTPs are often confused with e-cigarettes, which heat a liquid that may contain nicotine but does not include the tobacco leaf.
Instead, HTPs use heat to break down tobacco through a process called pyrolysis, which does not ignite or burn it, so no smoke is produced.
Majority popular and the widely available HTP, Philip Morris International’s IQOS, is an electronic device that heats a tobacco-filled, paper-wrapped, cigarette-like stick to temperatures up to 350 degrees Celsius (662 degrees Fahrenheit).
Last month, a review of available research by pyrolysis experts at the University of Nottingham in the UK found “chemical evidence that IQOS emissions meet the definition of both aerosol and smoke.”
An article published in the Omega Journal of the American Chemical Society was funded by the STOP anti-tobacco initiative.
Its lead author, Clement Uguna, said that IQOS emissions contain chemical compounds found “in regular tobacco smoke, bush burning and wood smoke.”
“Therefore, smoke is simply generated by heating organic matter and is not necessarily associated with fire,” he told AFP.
The paper also found that previous IQOS studies, much of which were funded by the tobacco industry, compared the stick to a regular cigarette.
However, IQOS sticks are much smaller and contain about 200 milligrams of tobacco compared to 645 milligrams of a standard cigarette.
Because the Philip Morris International (PMI) study did not use a like-versus-like comparison, it “underreported” levels of harmful and potentially harmful components (HPHC) from IQOS, the review said.
PMI stated that HPHC levels in IQOS emissions – per stick – were “reduced by an average of 90 to 95 percent compared to cigarette smoke.”
However, that level dropped to 68 percent when comparing the tobacco content of the two products, experts at the University of Nottingham said, calling for more research.
– “No smoking”: PMI –
PMI told AFP that the document is “misleading, using parts of a scientific assessment while omitting other critical evidence.”
“Numerous international combustion experts and a number of government agencies have reviewed the same package of evidence and concluded that the IQOS aerosol produced is not smoke,” the report said.
Reto Auer, a physician at the University of Bern in Germany who has previously researched heated tobacco, praised the Omega article, telling AFP that it is “one of the rare reports that dares to go so deep into the issue of ‘smoke’.”
Jamie Hartmann-Boyce of Oxford University’s Center for Evidence-Based Medicine, author of a highly acclaimed review of HTP science published earlier this year, said the “important” paper “made some very good points.”
“I think there are many mechanistic reasons to suspect that HTPs might be more harmful than e-cigarettes and perhaps less harmful than traditional cigarettes, but we really need more data,” she told AFP.
– “A complex balance” –
IQOS is available in more than 60 countries under a wide variety of regulations, and the sticks come in flavors such as menthol, cherry and grape, which critics say helps attract younger users.
Last month, the European Commission proposed a ban on flavored varieties of HTP after stick sales in the EU rose more than 2,000 percent – from 934 million to almost 20 billion – between 2018 and 2020.
PMI told AFP that “the Commission’s proposal is not supported by evidence.”
“For example, it has not been possible to prove that flavorings pose any additional health risks or that they appeal to a significant proportion of non-nicotine users,” the report says.
Hartmann-Beuys said that “there is good reason to be concerned about the extent to which the tobacco industry is manipulating science and reporting on new tobacco products.”
But she warned that reporting the risks of such products was a “tough balance” because of the enormous harm that cigarettes cause. According to the World Health Organization, tobacco kills half of its smokers.
“If we say something is safer than cigarettes, it doesn’t mean it’s safe — it’s like saying this knife is safer than a loaded gun,” Hartmann-Beuys said.