The US Food and Drug Administration (FDA) authorization for IQOS to be marketed as a modified risk tobacco product is aligned with the claims of a leading tobacco harm reduction expert that the introduction of heated tobacco products (HTPs) as better alternatives to conventional cigarette will see public health gains.

Helen Redmond, adjunct professor at New York University-Silver School of Social Work, said the introduction of HTPs or heat-not-burn (HNB) tobacco products will benefit public health.

She noted that there is a widespread, mistaken notion that nicotine causes cancer and other health problems.

“That is false,” the professor said. “The use of nicotine is no threat, because nicotine is not the problem. Combustible tobacco is … What causes health problems is lighting tobacco on fire. The combustion releases thousands of toxic chemicals.” 

The US FDA, in its recent issuance, concluded that the commercialization of IQOS in the US, a heated tobacco product, developed by Philip Morris International, is “appropriate to promote the public health.”

“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.

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.  

HTPs are smoke-free devices that heat, instead of burn specially-designed tobacco units to release a flavorful nicotine-containing tobacco vapor. The most popular HTP brand today is IQOS—an electronic device that heats tobacco-filled sticks wrapped in paper to generate a nicotine-containing aerosol.  

“Several tobacco companies have developed HNB products like IQOS from Philip Morris and Glo Pro and Glo Nano from British American Tobacco. The technology is constantly evolving and becoming more user-friendly,” Redmond said.

A recent study by Dutch researchers entitled, “A Method for Comparing the Impact on Carcinogenicity of Tobacco Products: A Case Study on Heated Tobacco Versus Cigarettes” assessed eight carcinogens (cancer-causing substances) to understand the likely health impact on individuals who switch to IQOS, compared to those who continue smoking.

The researchers concluded that while not risk-free IQOS is associated with 10 to 25 times lower exposure to these carcinogens, and that this could translate into a substantially improved risk profile. 

The study was published on May 1, 2020 in the monthly peer-reviewed academic journal Risk Analysis.

Smoke-free nicotine products include electronic cigarettes or vapes and Swedish snus.

Public Health England consistently conclude in its annual reviews of all available evidence that E-cigarettes are around 95-percent less harmful than smoking.  

Redmond also noted that e-cigarettes and HNB proved effective in making smokers switch since they offer the same pleasure, rituals and relaxation associated with smoking. 

The UK's National Institute for Health Research (NIHR) concluded in its February 2019 clinical trials that e-cigarette was twice as effective as nicotine replacement treatments such as patches and gum in 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.