Last year, an increase in heat-not-burn (HNB) electronic tobacco product sales in South Korea coincided with a decrease in cigarette sales, causing people who care about public health to pore over the potential significance.
South Korea’s consumer trend could indicate the harm reduction potential of HNB products—which heat tobacco sticks enough to produce nicotine-containing vapor, but not enough to produce smoke—to move smokers off of cigarettes. US federal regulators, meanwhile, say that not enough evidence shows that HNB products reduce harms relative to smoking.
New 2018 data show that South Korean combustible cigarette sales are down by 8.9 percent from 2017. Third-quarter 2018 cigarette sales from the nation’s leading tobacco company, KT&G, dropped 15 percent from its 2017 third-quarter sales.
The latest figures represent a continuation of a downward trajectory in cigarette sales that began back in 2014, the year before the government hiked up the price of a pack from around $2 to $4 (in USD). According to the Korean Herald, lower cigarette sales have also been influenced by increased HNB sales, which rose from 79 million packs in 2017 to 332 million packs in 2018.
A similar phenomenon—though much more advanced, due to HNB products having been on the market there for longer—has occurred in Japan, a country that constitutes 90 percent of the $5 billion global HNB market.
“Cigarette sales [in South Korea] have fallen rapidly since heated tobacco products became available,” David Sweanor, an industry expert and chair of the Advisory Board for Centre for Health Law, Policy and Ethics at the University of Ottawa, tells Filter. “Just as we have seen in Japan, where the introduction of this technology has led to declines in cigarette sales of over 12 percent in each of the past two years. This is also what we have seen with the availability of substitutes like snus and vaping products in many other countries.”
HNB products aren’t harmless, and most experts agree that more research would be beneficial. However, the evidence that is so far available suggests that they reduce risks compared with smoking. “HNB exposed users and bystanders to toxicants, although at substantially lower levels than cigarettes,” found a literature review in the peer-reviewed journal, Tobacco Control.
Another study found that heating tobacco, instead of “lighting [it] on fire,” reduces the quantity of some harmful chemicals associated with smoking, while also “increas[ing] the levels of other chemicals.”
“Heating tobacco at lower temperatures than combustible cigarettes allows nicotine to be delivered in ways that retain much of the ritual and experience of smoking,” writes Dr. Edward Anselm, a senior fellow of the R Street Institute and author of a report on HNB technology. “Comprehensive scientific programs have demonstrated these products present significantly reduced risk when compared to traditional cigarettes. Collectively, they represent a new set of tools to reduce the harm of combustible tobacco.”
For Sweanor, HNB shares the common-sense logic undergirding “a tremendous range of products and behaviors”—from seat belts to condoms—that are accepted harm reduction tools. “Substitution of safer alternatives works very well, and clearly does better than seeking abstinence via coercion,” he says.
The attendant harms of HNB products, however, continue to dissuade regulatory bodies, like the US Food and Drug Administration, from allowing companies to market them as “modified risk.”
“In the case of alternatives to cigarettes in general, and in South Korea specifically, the dramatic moves away from smoking are happening with many health bodies seeking to oppose rather than facilitate the transition,” says Sweanor. “All of which gives some idea of the magnitude of the public health gains achievable if the transition away from lethal cigarettes were to be actively encouraged.”
Image: “Streets of Seoul” via Unsplash
This article was edited on January 29 to clarify South Korea’s 2018 combustible cigarette percentage decrease.