Heat-not-burn tobacco product

A heat-not-burn tobacco product (HNB), or heated tobacco product,[1] heats tobacco to a lower temperature than a conventional cigarette.[2] The resulting aerosol contains nicotine and other chemicals.[1] These products may match some of the behavioral aspects of smoking.[3] Some tobacco companies claim these products are less harmful to consumers than other types of cigarettes, but there is no reliable evidence to support these claims.[2][4]

Heat-not-burn products first came to market in 1988, however they were not a commercial success.[2] The ubiquitousness of electronic cigarettes and growing dissatisfaction that e-cigarettes do not provide the "throat-hit" that smokers are used to may present an opportunity for heat-not-burn tobacco products.[2] These products are currently being introduced by large tobacco companies.[5]

Health effects

Claims of lowered risk or health benefits for heat-not-burn tobacco products are based on industry-funded research, and reliable independent research is not available to support these claims.[4] No compelling evidence has been presented for the claims of lowered risk and health benefits for these products.[4] There is not enough research to evaluate their level of harm.[6] Some scientists believe that heat-not-burn tobacco products to be as dangerous as traditional cigarettes.[4]

Carlos Jiménez, director of research on smoking at the Spanish Society of Pneumonology and Thoracic Surgery stated in 2017 that these products are still harmful.[7] Action on Smoking and Health stated in 2016 that due to "the tobacco industry's long record of deceit" regarding the health risks involving smoking, it is important to conduct independent studies into the health effects of these products.[8] Marketing slogans like "heat-not-burn" cannot be a substitute for science.[9]

The effects of second-hand exposure are unknown.[1]

History

Steam Hot One, a Japanese variant of the Eclipse made by Japan Tobacco.
Philip Morris' Heatbar pictured without a specifically designed cigarette.

The first commercial heat-not-burn product was the R.J. Reynolds Premier,[10] a smokeless cigarette launched in 1988 and described as difficult to use.[11] Many smokers disliked the taste.[12] It was shaped like a traditional cigarette, and when heated the smoldered charcoal moved past processed tobacco containing more than 50 percent glycerin to create an aerosol of nicotine.[13] It did require some combustion.[14] In 1989,[15] after spending $325 million,[16] R.J. Reynolds pulled it from the market months later after organisations recommended to the US Food and Drug Administration (FDA) to restrict it or classify it as a drug.[17]

The Premier product concept went on to be further developed and re-launched as Eclipse[15] in the mid-1990s,[18] and was available in limited distribution as of 2015.[19] Reynolds American stated that the Revo was a "repositioning" of its Eclipse.[20] R.J. Reynolds' Revo was withdrawn in 2015.[19]

Philip Morris International (PMI) launched a cigarette in 1998 that was placed into an electronic heating device as Accord.[21] The battery-powered product was the size of a pager.[22] In 2007 PMI launched Heatbar.[23] The Heatbar was around the size of a mobile phone and heated specifically designed cigarettes, rather than burning them.[24] The only benefit was to lower second-hand smoke, which lead to Heatbar being discontinued.[25] Heatbar did not obtain any significant user reception.[26] Accord and Heatbar are predecessors of PMI's heat-not-burn tobacco products.[27]

The ubiquitousness of electronic cigarettes and growing dissatisfaction with not providing a throat-hit may present an opportunity for heat-not-burn tobacco products.[2] These products are currently being introduced by large tobacco companies.[5] PMI anticipates a future without traditional cigarettes, but campaigners and industry analysts call into question the probability of traditional cigarettes being dissolved, by either e-cigarettes or other products like iQOS.[28]

Products

The products use systems where tobacco is not burning, but rather tobacco constituents are heated and aerosolized.[3] They are designed to be similar their combustible counterparts.[20] A tobacco stick along with a heating element will provide the user a choice across the different heat-not-burn tobacco products available.[20] Another type of heat-not-burn tobacco product is the loose-leaf tobacco vaporizer that entails putting loose-leaf tobacco into a chamber, which is electrically heated using an element.[29]

3T

3T Organic red, gold and menthol bubble-packs containing stick-like products.
3T Organic red, gold and menthol products.

The 3T from Vapor Tobacco Manufacturing was launched in December 2014.[30] The product employs a patented, aqueous system whereby desired components are extracted into water.[31] The liquid is mixed with glycerin and aerosolized by an electronic heating system.[31] Their organic liquids are made from organic tobacco, organic glycerin, and water.[30]

Glo

In 2016 British American Tobacco (BAT) launched a heat-not-burn product called glo in Japan.[32] glo is battery-powered.[32] It uses a heating element with a tobacco stick.[20] In May 2017 they released i-glo in Canada.[33] The glo iFuse debuted in Romania by BAT in 2015.[20] It uses a cartridge with a tobacco stick and a flavored nicotine liquid.[20] Bonnie Herzog, a senior analyst at Wells Fargo Securities stated that the proposed acquisition of R. J. Reynolds by BAT in 2016 would let them catch up in the technology competition.[34]

IQOS

IQOS, consisting of charger, holder, and tobacco stick.
iQOS, consisting of charger, holder, and tobacco stick.

The introduction of IQOS was announced on 26 June 2014.[35] The product is marketed by Philip Morris International (PMI) under the Marlboro and Parliament brands.[36] Initially launched in 2014 in Nagoya, Japan and Milan, Italy, IQOS is being gradually rolled out to other countries.[37] By end of 2016 it was available in over 20 countries, with expansion plans into several more in 2017 as manufacturing capacity increases.[38] PMI has stated it will likely launch its iQOS heat-not-burn product in the US market in 2017.[39] PMI has projected that when 30 billions units are sold, iQOS would increase profits by $700 million.[40] To date, the company claims that total investments made in the development and assessment of these products have exceeded $3 billion.[41] Phillip Morris spent €500 million on iQOS in 2016 alone.[42]

iQOS consists of a charger around the size of a mobile phone and a holder that looks like a pen.[43] The disposable tobacco stick, which looks somewhat like a short cigarette, has been dipped in propylene glycol,[9] is inserted into the holder which then heats it to temperatures up to 350 °C.[21] The smoke released contains nicotine and other chemicals.[3] The amount of nicotine provided may be a little strong for light cigarette smokers.[44] Users have reported less smell and odour on clothing.[14] The smoke generated by iQOS contains substances from pyrolysis and thermogenic degradation that are identical to the constituents found in traditional tobacco cigarette smoke.[9] A 2017 review found "little research on what substances are released after the device heats the tobacco-based paste. The physical effects on users are also not yet known."[45]

One independent study of the iQOS criticized Phillip Morris, saying "Dancing around the definition of smoke to avoid indoor-smoking bans is unethical" and called for more independent research, saying "Smokers and non-smokers need accurate information about toxic compounds released in IQOS smoke. This information should come from sources independent of the tobacco industry".[9] After the study was published, the heads of the three Swiss universities where the authors worked received unusual letters from Phillip Morris, accusing the authors of faulty methodology, and subsequently the researchers were not willing to talk to a journalist.[46] Phillip Morris also published an online academic counter-argument.[46]

In December 2016, PMI submitted an multi-million page application[42] to the US FDA for iQOS to be authorized as a modified risk tobacco product.[47] The FDA reviewed Phillip Morris's data, some independent studies, including the May 2017 Swiss paper about toxic compounds in iQOS smoke mentioned above, a December 2017 amendment to the application by Phillip Morris on the same topic, and the FDA's own laboratory testing data.[48]

In January 2018, the FDA advisory panel ruled that Phillip Morris had not shown that their product cut health risks;[49][50] the panel also "expressed concerns about the lack of data" on risk relative to cigarettes.[51] An official from the Campaign for Tobacco-Free Kids have stated that "It is high-tech. It is sleek. It is designed in exactly the way that would appeal to young people."[52]

PMI intends to convert its customers in Japan to using heat-not-burn products.[53] iQOS is sold as an alternative to cigarettes.[54] PMI states that they understand that its iQOS product will be as addictive as tobacco smoking.[8] iQOS is sold with a warning that the best option is to avoid tobacco use altogether.[55]

iSmoke OneHitter

iSmoke OneHitter by iSmoke was launched in 2015.[56] It can be used as a loose-leaf tobacco vaporizer.[57] It has a chamber that can be filled with up to 800-milligrams of tobacco.[57]

Korea Tobacco & Ginseng Corporation

Korea Tobacco & Ginseng Corporation announced on 8 June 2017 that they will launching a heat-not-burn tobacco product in September 2017.[58]

Pax 2

PAX Labs, formerly known as Ploom,[59] sells PAX vaporizers.[60] In 2010 they launched Ploom, a butane-powered product used for the heating tobacco or botanical products.[61] Later models replaced butane heating with an electric system.[62] After its initial partnership with Japan Tobacco was abandoned, the company became known as Pax Labs.[63] The Pax 2 uses loose-leaf tobacco.[20] The surface of the Pax 2 remains cool, while the oven heats to temperatures up to 455 °F.[64] It has four temperature options.[64]

Ploom Tech

In January 2016 Japan Tobacco (JT) released Ploom TECH.[65] JT's Ploom has been withdrawn from the US.[20] The Ploom brand, however, remained with JT and the product itself has been replaced with a different product called Ploom Tech, in which an aerosol passes through a capsule of granulated tobacco leaves.[66] Sales are being expanded throughout Japan in 2017.[67] They intend to spend $500 million to increase their heated tobacco manufacturing capacity by late 2018.[68]

V2 Pro

V2 originally released their vaporizer line named V2 Pro in July 2014.[69] The initial product was named Series 3.[69] Series 3 comes with 3 cartridges including a loose-leaf cartridge, which heats the material by conduction.[70] It comes with a battery and USB changer, among other things.[70] Pro Series 3X also by V2 can be used with dry material.[71] It has three different air flow options that can be adjusted with a slight turn of the mouthpiece.[71] Series 7 comes with a loose-leaf cartridge, among other things.[72] Series 7 lets the user change the temperature by using a single button.[69]

Regulations

In the United States, these products fall under the jurisdiction of the Food and Drug Administration.[29] As of 2016, 19 countries have permitted the sale of iQOS.[9] Advertisement for the iQOS, but not iQOS' tobacco stick, is not regulated under the European Union Tobacco Products Directive.[20] Heat-not-burn tobacco products are not restricted for sale in Israel by the Ministry of Health.[73] Ploom and iQOS are governed by the Tobacco Industries Act regulations as tobacco products in Japan.[74] The Liberal Democratic Party will deliberate over increasing the tax rate for heat-not-burn tobacco products in April 2018.[75] iQOS's refill sticks are not legal for sale in New Zealand by the Ministry of Health.[76] Emerging tobacco products are banned in Singapore by the Ministry of Health.[77] Electronic tobacco products using dry material are regulated as e-cigarettes in South Korea by the Ministry of Health and Welfare.[78] Korea regulates e-cigarettes differently than traditional cigarettes for tax reasons.[79] As a result, iQOS are taxed at a decreased rate, compared to the 75% incurred on normal cigarettes.[79]

Action on Smoking and Health stated in 2016 that "unless and until independent evidence shows that IQOS and similar products are substantially less harmful than smoking then these products should be regulated in the same way as other tobacco products."[8] Tobacco control activist Stanton Glantz stated that the US FDA should halt new tobacco products until tobacco companies stop selling traditional cigarettes.[80] "There is concern that heat-not-burn tobacco will skirt local ordinances that prevent smoking in public areas," Mitchell H. Katz, director of the Los Angeles County Health Agency, wrote in 2017.[81]

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