Claims by the tobacco industry that heated tobacco products (HTPs) are safer than conventional cigarettes are not supported by the industry’s own data and are likely to be misunderstood by consumers, according to research published in a special issue of Tobacco Control.
The issue was assembled by Stanton A. Glantz, PhD, director of the UCSF Center for Tobacco Control Research and Education.
HTPs are aggressively promoted by the tobacco industry as less harmful than cigarettes because they heat tobacco rather than burn it to generate the aerosol that delivers nicotine to users’ lungs. The industry argument is that because HTPs do not set the tobacco on fire, they release lower levels of harmful chemicals and so cause less disease than conventional cigarettes.
The papers, published October 23, 2018, represent the first comprehensive collection of industry-independent peer-reviewed analyses of HTPs.
Many of the papers focus on IQOS, an HTP sold by Philip Morris International (PMI) in 30 countries including Canada, Israel, Italy and Japan. The U.S. Food and Drug Administration (FDA) has not yet approved IQOS for sale in the United States. In the issue’s introductory overview, Glantz noted that eight papers use data provided by PMI in its pending application to the FDA, while 12 provide independent assessments of IQOS and other HTPs, including their political and policy implications.
Stanton Glantz, PhD, assembled the recent issue of Tobacco Control. “Until now, most of the published research on HTPs had been done by tobacco companies,” said Glantz. “We’ve seen this charade from Big Tobacco before, going back to the 1960s, and the goal is always the same: to convince governments and the public that a new tobacco product is ‘safer,’ ‘cleaner’ or ‘less harmful’ than existing tobacco products. But in paper after paper, the scientists writing in this issue demonstrate that the health and other claims made for IQOS and other HTPs are false and misleading.”
Overall, said Glantz, the issue’s contributors demonstrate that PMI’s safety claims for HTPs are not supported by the company’s own data, which further show that consumers are likely to misunderstand those claims. “While some impacts of IQOS may be lower than that of cigarettes, others may be as bad or worse,” he said. “The evidence does not support PMI’s broad claims of reduced harm.” He noted that researchers also found that HTPs are not as new as the industry would have consumers believe, with precursor devices going back decades. In addition, HTPs may appeal to young people. A final set of papers describes how HTPs fit into the tobacco industry’s global strategy to deal with increasing regulation worldwide; after a legal analysis, the authors conclude that the FDA should not allow IQOS to be sold in the U.S.
UCSF scientists contributed to 14 of the 22 papers. Among them are:
Stella Bialous, RN, DrPH, FAAN, UCSF associate professor of social behavioral sciences, and Glantz identified the introduction of HTPs as the latest in a line of similar past efforts by the tobacco industry to undermine government regulation of tobacco by marketing a new product as “safer” or representing “harm reduction.” They called on governments to regulate HTPs as tobacco products or drugs, noting that tobacco companies are the “vector” for the tobacco epidemic and cannot be part of the global tobacco control solution.
Glantz analyzed PMI’s publicly available data on biomarkers of potential harm and determined that there was no statistically detectable difference between IQOS and conventional cigarettes for 23 of 24 biomarkers of potential harm among American adult smokers, and no significant difference in 10 of 13 such biomarkers among Japanese adult smokers.
A team led by Jeffrey Gotts, MD, UCSF assistant professor of medicine, found that that HTPs could possibly cause some diseases not caused by conventional cigarettes. They identified animal and human studies in PMI’s FDA application suggesting that IQOS may cause liver toxicity not observed in cigarette users.