Philip Morris International, the company responsible for Marlboro and over fifty other cigarette brands, has entered the e-cigarette market with the IQOS -- “I Quit Ordinary Smoking” -- a device for smokers who are looking for something between conventional tobacco cigarettes and newer e-cigarette alternatives. Instead of the fluid-filled cartridges found in most e-cigarettes, the IQOS uses “heatsticks” containing cast-leaf sheet tobacco – a processed combination of tobacco, glycerine, and other chemicals. The IQOS delivers a “flavourful nicotine-containing vapour” when the device's electronic core heats the tobacco sheet [5].
The IQOS is a “heat-not-burn” device that is marketed as a harm-reduction product and allegedly delivers fewer toxic chemicals than cigarettes. In theory, it is the burning of tobacco that is to blame for the health risks associated with smoking cigarettes. Phillip Morris International suggests that the IQOS, which allegedly generates no combustion and no smoke, poses a much lower threat to human health than conventional cigarettes because of its low heat [3]. The central flange of the IQOS has a silver, gold, platinum and ceramic coating which heats up the rolled cast-leaf sheet of tobacco and glycerine inside the heatstick. Rather than directly burning the tobacco, the heat creates a smokeless combustion which, in theory, reduces the amount of harmful chemicals released as compared to burning cigarettes. Recent studies have suggested that this may not be entirely realistic [2][6]. Sure, the IQOS operates at temperatures under 350°C, but harmful constituents of tobacco smoke can form at temperatures as low as 70°C – 300°C [1]. In fact, the Philip Morris company’s own application for FDA approval presented data that demonstrates that the IQOS is no different from conventional cigarettes when it comes to the biomedical effects of smoking [7].
A 2018 study investigated the legitimacy of the fundamental claim that the IQOS is a “heat-not-burn” device. Researchers found that the tobacco in the IQOS actually did char (i.e. burn), particularly when the device was cleaned irregularly or even as per the manufacturer's instructions. More alarmingly, the polymer-film filters that are designed to keep the tobacco cool did not hold up against the heat produced by the IQOS and, in fact, they melted [2]. The scorched polymer released toxic vapours including formaldehyde cyanohydrin – a highly toxic chemical that is metabolised in the human liver into formaldehyde and cyanide. This occurred at only 90°C – a much lower temperature than the 350°C that the IQOS can reach.
The Philip Morris International company stands by its own study results that suggest that the IQOS aerosol “has significantly lower levels of harmful and potentially harmful constituents… and is much less toxic than cigarette smoke.” [5] Of the Philip Morris funded studies, their Chief Scientific Officer states, “Results to date give us confidence that we are on course with our plans to demonstrate that [the IQOS] is a less harmful alternative for smokers who switch.” [5] However, critics and even company insiders are unimpressed with the rigour of their in-house research. In 2017, documents and testimonies of former Philip Morris employees were released by the press, detailing irregularities in the clinical trials of the IQOS [4]. David Kessler, the FDA Commissioner from 1990 – 1997, has stated that, “Taken as a whole, it’s clear [Philip Morris International] do not have the sophistication to carry out adequate and well-controlled clinical trials.” [4]
Aside from the potential of toxic-laden vapours, independent researchers agree that the IQOS is particularly well-manufactured compared to many e-cigarette devices on the market, but they have highlighted key issues with the design that may increase the severity of nicotine addiction. For example, each heatstick delivers a maximum of 14 puffs but the iQOS shuts off after 6 minutes and needs to be recharged before being used again. Heatsticks that haven't been fully exhausted cannot be re-used. With those numbers, users would need to take a puff about every 25 seconds to get the most out of each heatstick. This isn't going to work for all users, especially those who take a puff less frequently – they'll end up with a stack of half-full heatsticks that can't be reused and can only be disposed of. Alternatively, this time crunch and threat of wastefulness may encourage users to puff more frequently, leading to a larger consumption of nicotine and also toxic vapours.
It’s not just smokers who suffer from cigarette use -- passive smoking causes 600,000 deaths worldwide each year which is over 1,600 deaths every day [8]. Philip Morris International suggests that the IQOS may help to solve this health risk for passive smokers, claiming that the device releases no smoke because the tobacco is only heated instead of burned or combusted. The definition of “smoke” is of some contention here. A 2017 study showed that the harmful constituents found in the vapour of the IQOS were near-identical to those found in cigarette smoke. The authors suggested that the “heat-not-burn” label of the IQOS was an unethical attempt to dance around the definition of smoke to avoid indoor-smoking bans [6].
First launched in Japan and Italy in 2014, the IQOS is now available in over a dozen countries worldwide.The US market is notably missing at time of writing, but Philip Morris International recently submitted an extensive application for FDA approval for the device. This global spread of the IQOS is part of Philip Morris International’s 10-year plan for the “normalization” of tobacco products after the cigarette industry has suffered from decades from call-outs for producing, promoting and lying about products that harm and kill people [4]. While the IQOS may present on face-value as a “smokeless” harm-reduction tobacco device, independent evidence suggests that it delivers just as much toxic burden to smokers and passive smokers alike and may even increase the severity of nicotine addiction. Those who are thinking of quitting “Ordinary Smoking” may be better off choosing a nicotine replacement therapy, such as gum, that has been proven to help break the addiction [9].
References:
[1] Baker, R. R. & Bishop, L. J. (2004) The pyrolysis of tobacco ingredients. J Anal Appl Pyrolysis, 71, 223 – 311. https://www.sciencedirect.com/science/article/pii/S0165237003000901
[2] Davis, B., et al. (2018) iQOS: evidence of pyrolysis and release of a toxicant from plastic. Tob Control., https://www.ncbi.nlm.nih.gov/pubmed/29535257
[3] Farsalinos, K. E., et al. (2018) Nicotine Delivery to the Aerosol of a Heat-Not-Burn Tobacco Product: Comparison With a Tobacco Cigarette and E-Cigarettes. Nicotine Tob Res., 20:8, 1004 – 1009. https://www.ncbi.nlm.nih.gov/pubmed/28637344
[4] Lasseter, T., et al. (2017) Scientists describe problems in Philip Morris e-cigarette experiments. Reuters Investigates. https://www.reuters.com/investigates/special-report/tobacco-iqos-science/ Last accessed 31st August 2018
[5] Philip Morris International (n.d.) Science and Innovation – Our Findings to Date. https://www.pmi.com/science-and-innovation/our-findings-to-date Last accessed 31st August 2018
[6] Auer, R., et al. (2017) Heat-Not-Burn Tobacco Cigarettes – Smoke by Any Other Name. JAMA Internal Medicine., 177:7, 1050 – 1052. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2628970
[7] Glanz, S. A. (2017) PMI’s Own Data on Biomarkers of Potential Harm in Americans Show that IQOS is Not Detectably Different from Conventional Cigs. UCFS. https://tobacco.ucsf.edu/pmi%E2%80%99s-own-data-biomarkers-potential-harm-americans-show-iqos-not-detectably-different-conventional-cigs
[8] World Health Organization (n.d.) Second-hand smoke. http://www.who.int/gho/phe/secondhand_smoke/en/
[9] Silagy, C., et al. (2005) Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews., 3.https://www.ncbi.nlm.nih.gov/pubmed/15266423