A new e-cig uses solid tobacco. Getty Images
“Heat-not-burn” tobacco products are already incredibly popular in some overseas markets, but they haven’t made inroads into the United States yet.
Promoted in a similar fashion to e-cigarettes as a safer alternative to traditional smoking, public health experts worry that “heat-not-burn” products could be the next big phase for the tobacco industry.
Because of their novelty, there is little scientific research on these devices about their safety and usefulness for smoking cessation.
But in a damning new study, researchers say they aren’t any better for you than either traditional cigarettes or e-cigarettes.
What the study found
The paper, published this week in the journal ERJ Open Research, looked at the in vitro effects of vapor produced by IQOS devices (IQOS is the brand name of a “heat-not-burn” tobacco product by Philip Morris International, an American tobacco company) on human cells found in the lungs and airways.
Researchers exposed bronchial epithelial cells and primary human airway smooth muscle cells to IQOS vapor and directly compared what they saw to the effects of cigarette smoke and e-cigarette vapor.
All three were found to be toxic to lung cells, with the IQOS device’s vapor having a comparable toxicity to traditional smoking.
“We observed different levels of cellular toxicity with all forms of exposures in human lung cells. What came out clearly was that the newer products were in no way less toxic to cells than conventional cigarettes or e-cigarette vaping,” said Sukhwinder Sohal, PhD, one of the authors of the study and a health sciences researcher at University of Tasmania’s Respiratory Translational Research Group.
The study concludes that IQOS devices, like cigarettes and e-cigarettes, have the potential to lead to inflammation, oxidative stress, and other deleterious effects on the lungs and airways. Over the long term, this can lead to serious health problems typically seen in smokers, including chronic obstructive pulmonary disease (COPD) and lung cancer.
The authors say that their study is an important first step in understanding the potential harm of “heat-not-burn” tobacco products.
New name, same old tobacco
Heat-not-burn tobacco products are the most novel iteration of electronic smoking. But unlike e-cigarettes and vaporizers, they don’t use nicotine-infused liquid (“e-juice”).
They use real tobacco. Inside the device is a carefully calibrated heating mechanism that heats the tobacco to roughly 570°F (299°C), below the temperature of combustion, creating an inhalable aerosol.
Part of the appeal of such devices is that they are able to offer a distinct “throat-hit,” part of the physical sensation of smoking cigarettes, that’s sometimes lacking in other vaporizers or e-cigarette models.
“Heat-not-burn” products are not yet available in the United States, but in test markets in Europe and Asia, where they have been available in some cases since 2014, they have proved to be incredibly popular.
John Ayers, PhD, vice-chief of innovation at UC San Diego Division of Infectious Disease and Global Public Health, has been tracking the popularity of “heat-not-burn” through practical methods like Google searches.
“It seems like the tobacco control community gets thrown into confusion when tobacco products get renamed or revised. That’s what I’m afraid is going to happen with IQOS, like what happened with e-cigs,” he told Healthline.
In the US, IQOS devices are currently under review by the Food and Drug Administration as “Modified Risk Tobacco Products” (MRTP). The MRTP designation refers to “tobacco products that are sold or distributed for use to reduce harm or the risk of tobacco-related disease associated with commercially marketed tobacco products.”
To achieve this designation, an applicant must demonstrate that the product has the ability to “significantly reduce harm” and disease related to tobacco. It must also benefit overall health on a population level, accounting for individuals who don’t use tobacco products.
According to Sohal, based on their research, IQOS does not meet this definition.
“The burden is on the tobacco industry to generate evidence that their newest products, like IQOS, are potentially less harmful than cigarettes,” said Ayers. “Until then, the regulatory environment assumes they are yet another tobacco product.”
Helping or hurting
An ongoing debate continues even today at the federal level about whether e-cigarettes and vaporizers actually help smokers quit or if they lure in new, especially young, smokers.
In fact, it is likely both.
Recent statistics from the Centers for Disease Control and Prevention show a dramatic increase of 1.5 million teen tobacco users between 2017 and 2018. And it’s because of the popularity of e-cigarettes among the youth.
While the role of e-cigarettes in tobacco initiation is clear, their role in tobacco cessation is much less so.
Public health experts say that “heat-not-burn” is just another attempt to get more people smoking.
“The American Lung Association fears for both the health of individuals who use IQOS, and the overall public health if IQOS is given a green light by [the] FDA,” Erika Sward, assistant vice president of National Advocacy for the American Lung Association, told Healthline.
“There are also a lot of unanswered questions about the true impact on health — and this latest study continues to raise real doubts about Philip Morris International’s assertions about the real impact on health. Lungs are often the canary in the coal mine when it comes to the health impact of tobacco products, and we are gravely concerned about what may occur as the result of IQOS,” she said.