Heated tobacco products are intended to heat tobacco without burning it or producing smoke, but are they effective on smoking and health?
In 2016, the popularity of heated tobacco products skyrocketed in Japan after the release of an electronic device called IQOS. Heated tobacco products are all over the world, but scientists often wonder if they actually work.
I found an interesting article that covered data from 11 studies with over 2,600 people. And the result of the studies was that people who switched from cigarettes to heated tobacco had lower levels of exposure to harmful chemicals than those who continued to smoke, but higher levels of these toxins than those who quit smoking completely. .
However, this lower exposure has been observed for a number of harmful substances linked to cancers, heart disease and respiratory problems. In short, this means that switching from cigarettes to heated tobacco could reduce the risk of developing these diseases.
But do we have enough data to be optimistic. Throughout the world, all studies are of relatively short duration. So, to really understand tobacco-related diseases, you have to push long-term studies, because it usually takes a while for people to develop tobacco-related diseases. And until that happens, no one will vouch for these short-term studies.
But one thing is abundantly clear: the evidence shows how particularly dangerous smoking is. Cigarettes kill half of all regular smokers who inhale toxic chemicals made by burning tobacco. Heated tobacco products are designed to avoid burning tobacco, so there is a general impression that these products pose a much lower risk.
Can heated tobacco products benefit public health if they reduce risk and, in turn, help people quit smoking regular cigarettes? And can this happen without attracting people who would otherwise avoid tobacco altogether? Honestly, there are no studies looking at whether giving smokers heated tobacco products helped them quit smoking.
What is interesting is that there are Japanese studies on the evolution of cigarette sales after the penetration of IQOS in the markets. The studies actually found that the drop in cigarette sales accelerated after the launch of IQOS. In short, studies suggest that heated tobacco products may replace rather than complement cigarettes.
At the same time, it is highly likely that cigarette sales fell because most people cut without stopping completely. After all, the greatest health improvements come from completely quitting smoking rather than smoking fewer cigarettes.
And this is where e-cigarettes, or vapes, make a silent entrance. This is a different breed of nicotine products that slowly but steadily became popular, especially among millennials. So let’s compare it with cigarettes. Heated tobacco products heat the tobacco leaf, then e-cigarettes heat a liquid, usually containing nicotine. And then there are big differences in the science and regulation of these products. E-cigarettes have been filling shelves longer than heated tobacco, so there’s more evidence of their pros and cons.
Unlike heated tobacco, e-cigarettes have been shown to help people quit smoking regular cigarettes. Chances are that in the not too distant future, the UK will even offer e-cigarettes to those who want to quit smoking. But then e-cigarettes have to go through the necessary regulatory steps.
Around the world, many countries, including Japan, have imposed restrictions that have essentially banned the sale of nicotine e-cigarettes, while heated tobacco products remain widely available. This may explain why heated tobacco took off in Japan. It is the only potentially less risky alternative to cigarettes available.
The use of heated tobacco remains rare in countries such as the United Kingdom and the United States, where the electronic cigarette market was already well established at the time of the launch of IQOS.
E-cigarettes were the first non-medical nicotine alternative to cigarettes which has gained widespread acceptance among smokers around the world. But e-cigarettes do not contain tobacco, and many manufacturers have no connection with the cigarette manufacturers. Many tobacco companies instead focused on developing heated tobacco devices, a market over which they could maintain greater control because they owned the patents.
Global sales grew rapidly in Japan and South Korea in 2014 with the introduction of IQOS in test markets by Philip Morris International. Subsequently, other tobacco companies introduced their own electronic heated tobacco devices. Some of the most popular today are Glo from British American Tobacco and Ploom from Japan Tobacco International.
Interestingly, most of the research on the safety of heated tobacco – ironically – comes from Philip Morris International, which requested that IQOS be sold as a “reduced exposure” and “reduced risk” tobacco product to United States.
A few years ago, probably in 2019, the United States allowed IQOS to be marketed as a reduced exposure product. Their review concluded that “switching completely from conventional cigarettes to the IQOS system significantly reduces your body’s exposure to harmful or potentially harmful chemicals”.
Now the risk reduction claim did not hold water, it failed miserably because “there is not sufficient evidence to demonstrate substantiation of either reduced risk of disease claim or tobacco-related harm”.
I think the world needs more evidence to be sure how the use of heated tobacco affects people’s health.
It is therefore clear that the heated tobacco market is dominated by products from the cigarette industry, which has historically acted to distort the science about the harms of cigarettes. And then, many e-cigarette manufacturers are not affiliated with cigarette manufacturers.
Tobacco giants have searched for decades for a less harmful cigarette. They failed. Worse still, their attempts to add ventilation holes to cigarette filters added to the mess.
The tobacco giants are still trying, very hard.