A new tobacco product that’s already popular overseas could overtake e-cigarettes in the United States.
The authors warn that policymakers, anti-tobacco advocates, and the healthcare community need to be prepared for action when the products arrive.
Heat-not-burn tobacco products are the latest iteration of electronic smoking.
Unlike e-cigarettes and vaporizers, they don’t rely on a nicotine-infused liquid (“e-juice”).
Instead, they use actual tobacco that’s heated to roughly 570°F (299°C) using a battery-powered heating element.
The tobacco is kept below the temperature of combustion, creating an inhalable aerosol.
Heat-not-burn products are currently unavailable in the United States.
They are for sale in a series of test markets in Europe and Asia. The most robust market is in Japan, where they’ve been available since 2014.
Product under study in the U.S.
An evaluation of Philip Morris International’s IQOS, a heat-not-burn technology, is currently under way by the U.S. Food and Drug Administration (FDA) in the United States.
However, the product must undergo rigorous review because it’s being brought to market as a “
Modified risk tobacco product (MRTP) is a designation given by the FDA that 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.
Whether or not the IQOS and other heat-not-burn products can meet this designation remains to be seen.
The FDA will make their ruling on the product within the next two months.
If approved, the IQOS would be the first device to carry an MRTP designation.
Searching for answers
Currently, there’s a lack of information on heat-not-burn tobacco products.
The study authors note that there are less than 30 studies in the medical literature on these devices.
On account of this, they turned to nontraditional data, including Google search information to analyze growing interest in the product.
“[Google searches] are probably a stronger indicator of interest than if you just asked on a survey,” John Ayers, a lead study author and a research professor at San Diego State, told Healthline. “Here we’re observing people seeking out information on the product, potentially trying to buy the product.”
Ayers said looking at this kind of data before has previously been able to predict the rise of e-cigarettes, as well as other things such as movie and album sales.
What they’ve seen so far of heat-not-burn tobacco products gives every indication that they could be a phenomenon, dwarfing even e-cigarettes.
According to the study, there are now about 6 to 7 million “heat-not-burn” Google searches in Japan each month. Two years ago, almost no one was searching for them online.
“That growth rate eclipses anything else we’ve ever seen for any other tobacco product, including electronic cigarettes,” said Ayers.
Researchers said that given these trends, the potential for massive growth both in the United States and around the globe is likely.
Why the product is popular
The appeal of the product is manifold.
It offers a novel new form of nicotine consumption that could be of interest to e-cigarette smokers.
It also offers a distinct “throat-hit,” a physical sensation of smoking cigarettes, that’s sometimes lacking in other vaporizers or e-cigarette models.
However, the health implications of heat-not-burn products are still not well understood.
“There are all these public health questions like ‘Can it be a cessation device?’ We don’t know,” said Ayers. “What are the harms of it? What are the harms of being exposed to the vapor? We don’t know that.”
E-cigarettes, which have already been on the market for years, are still problematic.
Researchers have yet to reach a conclusion on their overall effects on public health.
While recent studies indicate that e-cigarettes are most likely a healthier option than traditional smoking, not all experts agree.
The role of e-cigarettes as potential cessation devices is still debated.
The allure of e-cigarettes for teens, especially on account of sweet, fruit, and candy flavored vaping liquids also remains particularly contentious.
A ‘call to action’
Instead of trying to answer the myriad of health questions surrounding heat-not-burn tobacco, Ayers instead says his study is “a call to action.”
“Let's start studying it now and creating infrastructure to respond now,” said Ayers. “If we don’t, then Phillip Morris is going to be setting the agenda when it comes to this product.”
Advocacy groups in the United States do seem to be aware of the potentially imminent arrival of heat-not-burn tobacco.
Erika Sward, a spokesperson for the American Lung Association, told Healthline that they’ve been following the development of these products since they came on the market in Japan.
“We assumed it was a matter of time before Philip Morris International would want to introduce the product into the U.S.,” she said.
While Sward wouldn’t give a direct comment on the potential of the device (for harm or good), owing to a lack of research thus far, she says that they’re following the FDA review closely.
“We look forward to a very thorough review of the data that we have, that the public has, as well as FDA doing a very careful review of how this product may impact the public health and whether or not ultimately it is appropriate to allow the product to be sold here in the states,” said Sward.