He started smoking at the age of 13—and continued for 30 years. During that time, he repeatedly tried to quit, using nicotine patches, gum and vapes.

“They didn’t really do anything for me,” he told Filter. “I didn’t care for vaping at all.”

Luckily, there was another option available. And this one helped him to stay off cigarettes long-term.

“As heated tobacco products can somewhat replicate the smoking experience, I found it much more suitable,” Sweeney said. “HTP is much closer to smoking, and I found it much more satisfying than the other products.”

Sweeney isn’t alone in that preference, or that experience. Although only 1.2 percent of Ireland’s adult population currently use HTP (compared to 11.2 percent using vapes), that still equates to almost 50,000 people who could otherwise be smoking.

“They felt closer to my usual habits, so for me, the switch was easier and more natural.”

Felisia Porcaro, who lives in Italy, quit smoking the same way. “I had looked at other alternatives, but HTPs worked best for me,” she told Filter. Just like Sweeney, she cited the products’ ability to mimic smoking as the key factor.

“They felt closer to my usual habits, so for me, the switch was easier and more natural,” she said.

Unlike vapes or nicotine pouches, heated tobacco products actually involve tobacco. You insert a stick of tobacco into an electronic device, which heats it up. Critically, the tobacco is not burned—the devices have also been known as “heat not burn” products—just heated enough to emit an aerosol containing nicotine, which is then inhaled. The absence of combustion is why HTP use is harm reduction.

Other consumers find further advantages. “For me, it wasn’t so much the familiarity of a tobacco stick,” Lindsay Reese, who lives in Switzerland and quit cigarettes with HTP, told Filter. “It was the finite experience.”

“Vapes keep going and going,” she explained, “but when the consumable is a stick it is more like… Ok, I’m going to take these five minutes to relax, as opposed to hitting a vape every 10 minutes.”

Despite their obvious appeal to some and their availability in an estimated 69 countries, it can feel to people in the Western world that HTP have not matched the popularity of vapes and pouches. In truth, there is a clear global divide: HTP have taken off in parts of East Asia, but much less so in Europe and North America.

“This creates an information gap. Adults should have access to clear, balanced and evidence-based information on all alternatives to combustible cigarettes.”

Francesco Luongo is the president of Heated Community Hub, a consumer advocacy group. He thinks one big reason for the global mismatch is a question of public consciousness in the West.

Vapes “have been more visible in the media, in public policy debates and in broader consumer awareness,” he told Filter. “Heated tobacco products, by contrast, have often remained in the background, even though they are part of the wider tobacco harm reduction discussion.”

Another factor, Luongo continued, is that the products tend to be viewed through an industry lens. The high costs and logistics of production, including the required research, mean that the HTP market is completely dominated by tobacco companies with deep enough pockets. While that doesn’t reduce the inherent validity of HTP as a harm reduction option, it does mean bad PR.

“From our perspective, this creates an information gap,” Luongo explained. “Adults should have access to clear, balanced and evidence-based information on all alternatives to combustible cigarettes, including HTPs.”

Another drawback of the current HTP landscape is that each brand has its own tobacco sticks, which aren’t compatible with other brands’ devices. This helps keep costs for consumers higher.

Though Sweeney is continuing to use the product that enabled him to quit cigarettes, he does consider this a major negative. “The main problem I have with them is the cost of replacement sticks,” he said. “More people would probably use them as a replacement for smoking if the cost was lower.”

“Many people still do not know the difference between cigarettes and heated tobacco products, and this creates confusion and prejudice.”

In Italy, 4.5 percent of the adult population use HTP—making it a rare European country where they’ve achieved that kind of popularity. But even there, Porcaro said, public information about the products “is still quite limited.”

She credited the internet, retailers and the tobacco harm reduction community for giving her the knowledge to try replacing cigarettes with HTP. But too many remain unaware of this method of reducing their exposure to health risks.

“I think many people still do not know the difference between cigarettes and heated tobacco products, and this creates confusion and prejudice,” Porcaro said.

On top of the general climate of misinformation around tobacco harm reduction, the fact that many studies on the efficacy of HTP are industry-led may add to public skepticism. However, since 2024, over 400 independent studies that “support their use as a safer alternative to smoking” have been published, according to a briefing paper by the Global State of Tobacco Harm Reduction.

Such assessments are complex, and experts are often reluctant to put a simple figure on relative risk, given toxic politics and many unknowns. But there is a consensus that HTP use is substantially safer than smoking. One widely cited 2022 study indicates that it’s about 20 times less risky.

Among those calling for more independent research is Dr. Harry Tattan-Birch, a researcher at University College London’s Department of Behavioural Science and Health. He has been involved in studies looking at the effects of HTP use.

“Heated tobacco products are likely to be a lot less harmful than cigarettes, but probably more harmful than vaping.”

“Based on a selection of randomized controlled trials, we found moderate-certainty evidence that people using heated tobacco products had lower exposure to many toxicants and carcinogens than cigarette smokers,” he told Filter.

Tattan-Birch added that this was “unsurprising,” since the products don’t burn tobacco. “Combustion is the main source of many harmful chemicals in cigarette smoke.”

Burning at 800 degrees Celsius, cigarettes produce over 4,000 chemicals in the smoke, including at least 70 known carcinogens. HTP devices heat tobacco to around 350 °C, producing fewer harmful chemicals—though not none.

Tattan-Birch said exposure from HTP use was higher than when people stop using tobacco altogether, and generally higher than levels seen with vaping.

“Taken together,” he said, the evidence “suggests heated tobacco products are likely to be a lot less harmful than cigarettes, but probably more harmful than vaping, and of course more harmful than not using nicotine or tobacco at all.”

People deserve to know all that as they weigh their choices. But as well as the relative risks of use, another factor is how effectively a tobacco harm reduction product can shift people away from the most dangerous option—cigarettes—at a population level.

Researchers found that from 2016-2019, immediately after HTP were first marketed in Japan, the decline in cigarette sales was five times faster.

One country above all is the leading example to show that HTP can be very effective indeed.

Japan, where the smoking rate among men aged 20-29 once stood at 79 percent in groups of men aged between 20-29, has halved its smoking rate in just a decade—a globally unprecedented achievement.

This has largely been attributed to the soaring popularity of HTP. While Japan’s smoking rate was already falling, researchers found that from 2016-2019, immediately after HTP were first marketed in the country, the decline in cigarette sales was five times faster than in the previous few years.

Other countries have also recognized the potential. Even the United States Food and Drug Administration, not known as a tobacco harm reduction champion, first authorized some HTP to be marketed as “modified risk” back in 2020. In 2023, the FDA authorized three new HTP, reasoning that, “the net population-level benefits to adult smokers outweigh the risks to youth.” 

In 2024, New Zealand decided to halve its tax on HTP in a bid to encourage more people to quit smoking. The country had already accelerated smoking cessation by embracing vaping as harm reduction, and now has one of the world’s lowest smoking rates. But as a health minister said at the time, “Vaping does not work for everyone,” so they also wanted to make alternatives more accessible.

“If they help some smokers move away from combustible cigarettes, they deserve to be part of the conversation.”

There’s always a backlash somewhere, and the United Kingdom is currently looking to limit HTP use by banning it from various public spaces. Outside hospitals, vaping will be permitted but HTP use will not—indicating a dismissal of the latter’s harm reduction role.

Dr. Riccardo Polosa, a professor of internal medicine at the University of Catania, Italy, said the proposed ban “muddled the message” that HTP are smoking cessation tools, not cigarettes.

“Quite frankly, I don’t see the urgency here as heated tobacco use in the UK is well under 1 percent of adults,” he told Filter. “Use is largely concentrated among people who already smoke or smoked in the recent past, so the ban looks like a solution in search of a problem.”

“It is also worth mentioning that, although not risk-free, HTPs expose users and bystanders to much lower levels of harmful compounds than cigarette smoke,” Polosa continued. “So banning them in open-air spaces around hospitals is unlikely to deliver any meaningful health gain.”

Helping people quit smoking, however, is about the most meaningful health gain imaginable. And when HTP work for many and are much safer than cigarettes, they fully merit being on a menu varied enough to save as many lives as possible.

“The key point is adult smokers should have access to different alternatives and to correct information, so they can find the option that works best for them,” Luongo said. “If HTPs help some smokers move away from combustible cigarettes, they deserve to be part of the conversation.”

Correction, March 25: The original version of this article misspelled Felisia Porcaro’s name.

Photograph by the Global State of Tobacco Harm Reduction, via Flickr/Creative Commons 2.0

The Influence Foundation, which operates Filter, has received grants and donations from Knowledge-Action-Change, which publishes the Global State of Tobacco Harm Reduction. Both The Influence Foundation and the Center of Excellence for the Acceleration of Harm Reduction at the University of Catania, founded by Dr. Polosa, received grants from Global Action to End Smoking. Filter’s Editorial Independence Policy applies.

The post Heated Tobacco Products Shouldn’t Be a Harm Reduction Afterthought appeared first on Filter.

The study, published in the Scientific Reports journal and titled “Improved aerobic capacity in a randomized controlled trial of noncombustible nicotine and tobacco products,” was conducted by researchers at the Center of Excellence for the acceleration of Harm Reduction (CoEHAR) of the University of Catania, Italy. It looked at a measure known as V̇O₂ max—the top rate of oxygen consumption a person can achieve during physical exercise, which the paper described as “the gold standard measure of cardiorespiratory fitness.”

This was the first time research had examined the specific impact on V̇O₂ max of using e-cigarettes (EC) or heated tobacco products (HTP) versus smoking. The study was a secondary analysis of CoEHAR’s CEASEFIRE trial, which followed a group of 220 people who didn’t intend to quit smoking, and used the Chester Step Test to measure aerobic performance after four and 12 weeks.

Smoking reduces aerobic capacity. But the study found that people who quit smoking, or even just reduced it, showed significant increases in V̇O₂ max, with the researchers noting that “these gains were observed equally in users of ECs and HTPs.”

“These gains in aerobic performance can be viewed as a collateral benefit of switching, reinforcing the potential of smoke-free alternatives as effective harm reduction tools.”

One of the authors was Riccardo Polosa, professor of internal medicine at the University of Catania and founder of CoEHAR. “In our trial, participants who completely switched to combustion-free nicotine products exhibited meaningful increases in V̇O₂ max,” he told Filter. “These improvements were comparable to those reported in prior studies involving individuals who achieved complete smoking abstinence—defined as quitting all tobacco use without substituting with alternative nicotine products.”

According to Dr. Polosa, participants who used safer nicotine products to reduce their cigarette use achieved V̇O₂ max improvements of about 3 percent and 4.5 percent at four and 12 weeks, respectively. Those who switched entirely saw improvements of about 5.5 percent and 6 percent at those points.

“These gains in aerobic performance can be viewed as a collateral benefit of switching, reinforcing the potential of smoke-free alternatives as effective harm reduction tools,” he said. 

Polosa didn’t find the broad results surprising, as they aligned with what he has previously witnessed. But he did find the speed and consistency of V̇O₂ max gains after just four weeks “remarkable.”  

“These improvements exceeded the minimum clinically important difference, indicating that the changes were not only statistically significant but also clinically meaningful,” he said. “This reinforces the idea that removing combustion-related toxicants, particularly carbon monoxide, can rapidly enhance oxygen transport and cardiovascular efficiency.”  

HTP have proved popular alternatives to cigarettes in a number of countries, including Japan, where cigarette sales have halved following their introduction. But the benefits of switching to these devices, which heat tobacco sticks to produce vapor without combustion, are probably less well documented than the benefits of switching to vapes, so it’s a particularly valuable addition to that evidence base.

“Indeed, in our study, we found no significant difference in V̇O₂ max gains between users of ECs and HTPs,” Polosa said. “Both groups demonstrated clinically meaningful improvements.”  

To younger people who smoke, “the prospect of improved fitness and better athletic performance speaks directly to their lifestyle and aspirations.”

This, too, broadly matched his expectations when the two options are conceptually similar in eliminating combustion from nicotine use; it would, he said, have been surprising to observe major differences.

The researchers anticipate that the biggest practical impact from communicating their findings may be among younger people. To young people who smoke, cancer or heart disease may feel like distant threats, “but the prospect of improved fitness and better athletic performance speaks directly to their lifestyle and aspirations,” Polosa said.

“More research, particularly long-term studies, is needed, but our findings suggest that both ECs and HTPs can be effective tools for enhancing cardiovascular fitness when switching from smoking is complete,” he concluded.

Photograph by Magda Ehlers via Pexels

Both CoEHAR and The Influence Foundation, which operates Filter, have received grants from Global Action to End Smoking. Filter‘s Editorial Independence Policy applies.

The post Swapping Cigarettes for Vapes or HTP Rapidly Boosts Fitness, Study Finds appeared first on Filter.

Shapiro is a British author and journalist whose extensive resume includes biographies of music figures like Jimi Hendrix, and books about drug culture and policy, such as Fierce Chemistry: A History of UK Drug Wars (2021). He’s worked for drug-related charities, too, and is the director of DrugWise.

But I wanted to speak with Shapiro in the context of another of his roles, as lead author of the invaluable series of biennial Global State of Tobacco Harm Reduction reports, published by Knowledge-Action-Change. As Filter has reported, these have included “No Fire, No Smoke” (2018), “Burning Issues” (2020) and “The Right Side of History” 2022.

The report estimates that global sales of safer alternatives to combustible tobacco have grown six-fold since 2015.

Earlier in November, I attended the London launch event for the latest edition, “The Global State of Tobacco Harm Reduction 2024: A Situation Report.” Its 200-plus pages give many insights into how, and how much, use of safer nicotine products (SNP) is replacing smoking in people’s lives.

It’s happening more and more. The report estimates that global sales of safer alternatives to combustible tobacco have grown six-fold since 2015.

“This growth indicates that SNP have moved beyond their niche status,” it states. “In 2015, SNP accounted for only 1.4% of the total tobacco and nicotine market. By 2024, this figure had increased to 8.8%, with [heated tobacco products] at 4.2%, nicotine vaping products at 3.2%, nicotine pouches at 1.1%, and snus at 0.3%.” 

Excluding China’s vast tobacco market from the total makes the impact elsewhere even clearer, the report notes. China accounts for over one third of the world’s combustible tobacco sales; despite the country being the world’s biggest manufacturer of vapes, few are sold domestically. Without China, 12.3 percent of the world’s tobacco and nicotine sales are now of safer products—up from practically zero in 2004.

Shapiro and his coauthors draw on various evidence to show how these sales are associated with declines in smoking, at rates far faster than traditional tobacco control measures have achieved.

But this global transition is often happening despite, not because of, countries’ governments—and going slower than it would if governments were supportive.

Close to one third of the world’s population still cannot legally buy any safer nicotine alternatives.

Sweden is a standout success story. It just became the world’s first country to reach “smoke free” status, with a smoking rate below 5 percent. But even there, Shapiro doesn’t give the authorities much credit.

“To be honest, I’m not sure the government did much to encourage this,” he said. “It has basically been the result of Swedish smokers acknowledging the dangers of smoking—allied to an available, accessible, affordable and acceptable product in the form of snus.”

Meanwhile, close to one third of the world’s population still cannot legally buy any safer nicotine alternatives like vapes, pouches or heated tobacco products. And though residents of nearly 130 countries can access at least one of those options, very few can access all of them in a way that would best position different people to quit smoking.

Combustible tobacco is available everywhere, and claims 8.9 million lives each year, according to the report.

“Those against tobacco harm reduction don’t want people to use safer nicotine products,” Shapiro said, describing what amounts to support for cigarette sales.

“WHO targets for reducing the toll from non-communicable diseases could be approached with little or no cost to governments.”

His latest report is split into two sections: “A Global Perspective” and “Regional and National Insights.” The latter includes in-depth assessments of two regions with very challenging situations—Latin America and Eastern Europe/Central Asia—plus detailed updates on four countries which have made big progress: the United Kingdom, Japan, Norway and New Zealand.

Shapiro said that overall, the report “demonstrates the potential for SNP to make a significant contribution to reducing death and disease from smoking and the use of dangerous oral [tobacco] products.”

Part of the attraction for lawmakers, he suggested, should be that “World Health Organization targets for reducing the toll from non-communicable diseases could be approached with little or no cost to governments.”

That’s because simply allowing people to access SNP requires little expenditure; governments just “need to create an environment which encourages adult smokers to switch away from smoking,” Shapiro said.

Among the levers governments should use to encourage safer choices is taxation, he continued. Imposing no tax on SNP can go a long way to making them a more attractive option than heavily-taxed cigarettes.

Regarding flavors—a big part of the attraction for adults, but so often a target for opponents of SNP, due to their perceived role in youth use—Shapiro suggested that New Zealand has a reasonable way to ward off such attacks. The country rules out “unnecessary flavor labels that might be seen to encourage youth vaping, but still allows many flavors and flavor descriptors,” he said—retaining the substance of flavors’ ability to aid switching.

“It’s like your local Sunday football team taking on Real Madrid!”

Another thing Shapiro wants to see from governments is also free, yet often in short supply: courage.

“Those countries which have taken a more pragmatic approach, like the UK, should be more willing to openly endorse SNP,” he said, “and not let the teen-vaping narrative dominate the story, which it does.”

Speaking of the UK, both there and in neighboring Ireland, flavor bans and other restrictive measures have recently gained political traction.

“It is often the case of two steps forward and one step back when it comes to making progress towards acceptance of tobacco harm reduction,” Shapiro commented. “So this kind of non-evidence-based policy clearly blocks progress. This is all part of the teen vaping epidemic narrative, which does not hold up to much scrutiny. Teen vaping in the States, for example, has been falling for the past six years.”

The report also discusses grassroots SNP consumer advocacy groups, and I asked Shapiro about their importance, as well as the barriers they face.

“Despite all the hurdles, safer nicotine products are here to stay.”

“It is very hard for the voices of consumer groups to be heard when faced with a global network of well organized, well funded NGOs—medical and public health organizations right up to the WHO,” he replied. “It’s like your local Sunday football team taking on Real Madrid!”

“But they keep on keeping on, and they are doing something pretty unique in the history of consumer activism,” he continued. “Normally, these groups are campaigning against multinational companies for one reason or another—the impact of fast food on health, polluting energy and water companies, unsafe products, and so on. Here, you have consumer activists campaigning for access to a consumer product for the benefit of their health.”

It is in consumers, and the way more and more people are managing to make safer choices even when they’ve been deluged with misinformation, that tobacco harm reduction advocates can readily find hope.

Asked for the biggest takeaway from his new report, Shapiro’s reply reflected this: “Despite all the hurdles, safer nicotine products are here to stay.”

Image via Picryl/Public Domain

The Influence Foundation, which operates Filter, has received restricted grants and donations from Knowledge-Action-Change. Both The Influence Foundation and KAC have received grants from Global Action to End Smoking. Filter’s Editorial Independence Policy applies.

The post Despite Everything, More People Than Ever Choose Safer Nicotine Options appeared first on Filter.

Heated tobacco products (HTP)—devices that heat tobacco sticks enough to produce nicotine-containing vapor, but without the combustion that produces deadly smoke—are substantially safer than cigarettes.

As well as making HTP more affordable, the 50 percent tax cut sends a potentially powerful public message. Associate Health Minister Casey Costello, who ordered the change in July, has said she did so to incentivize people who smoke to switch. 

New Zealand knows plenty about switching already. In recent years, the country has embraced nicotine vapes as harm reduction tools, and the government recommends them for this purpose. As vaping has gained popularity, the decline in New Zealand’s smoking rate has accelerated—down to 6.8 percent by 2023.

Costello, who is also customs minister, is looking to speed things up further, however, in pursuit of the national target of being “smoke-free”—a rate below 5 percent—by 2025.

“Vaping does not work for everyone and some attempting to quit have tried several times,” she told RNZ. “HTPs have a similar risk profile to vapes and they are currently legally available, so we are testing what impact halving excise on those products makes.”

She and her government colleagues will be aware that in Japan, mass adoption of HTP by people who smoke—aided by widespread availability, with no restrictions on advertising them as safer than cigarettes—has seen a decline in past-decade cigarette sales that’s unequaled anywhere else in the world.

The minister is reportedly also considering allowing the sale of snus and nicotine pouches—currently banned in New Zealand—to add to the smoking cessation effort. These oral products have similarly demonstrated real-world harm reduction efficacy.

“Risk-proportionate taxation to make lower-risk alternatives to cigarettes more affordable for people who smoke is sensible.”

Such a multi-pronged approach would place New Zealand in a unique position, as the world continues to grapple with 8 million annual smoking-related deaths. Everyone seeking to quit smoking has their own needs, and what helps one person might not suit another.

Dr. Marewa Glover, a behavioral scientist and tobacco harm reduction advocate in New Zealand, applauded the recent tax move. “The adoption of risk-proportionate taxation intended to make lower-risk alternatives to cigarettes more affordable for people who smoke is sensible,” she told Filter.

“People who do not want to try vaping or who haven’t been able to quit via vaping need access to affordable and acceptable lower-risk substitutes for cigarettes,” Glover continued. “Heated tobacco products have been proven to be one of these substitutes.”

Relevant past research has found that increasing taxes on safer nicotine alternatives leads to more cigarette sales.

However, Glover added that New Zealand’s ban on advertising tobacco products has meant few participants in her research are aware of HTP and their harm reduction potential, so reducing tax on HTP might not be as effective as it could be.

Costello’s tax cut has also not been without its critics, many of whom frame the decision as playing into the interests of the Big Tobacco manufacturers of HTP.

“Certainly that is something that tobacco companies would have been keen to see happen,” Dr. Janet Hoek, a professor of public health at the University of Otago, told RNZ. “This is not advice that is coming from the Ministry [of Health]. It certainly seems to be advice that is suiting tobacco industry interests.”

Ben Youdan, the director of ASH New Zealand, doesn’t see that as the main takeaway, however. “There is absolutely a case to regulate and tax products according to harm,” he told Filter. “Any regulatory regime that allows vaping, or heated tobacco, oral nicotine or even pharmacological nicotine must accept that there are commercial interests.”

“The crusade against Big Tobacco is clouding judgment about the reduction in harm from all safer nicotine products.”

And the key goal of public health policy and advocacy, according to Nancy Loucas, director of the Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA), should not be to destroy Big Tobacco or demonize nicotine, but to “reduce harm and save lives.”

“The crusade against Big Tobacco is clouding judgment about the reduction in harm from all [safer nicotine] products,” she told Filter, echoing the observations of other experts.

Halving the tax on HTP makes them “more accessible to those who would benefit from them,” Loucas said. Increased affordability is likely to matter most for low-income populations with the highest smoking rates.

“But if that tax cut is used by PMI [Philip Morris International, the manufacturer of the leading HTP brand] to increase unit price of devices and heat sticks, that is bad business,” Loucas warned.

New Zealand’s success in reducing smoking rates, she continued, is down to recent governments’ respect for the evidence, combined with a willingness to engage on policy with various stakeholders—including, importantly, people who use nicotine.

In 2021, the previous government held a six-week open consultation where New Zealanders were encouraged to voice their ideas on the Smokefree Aotearoa 2025 Action Plan. Citizens and organizations shared thoughts on “supporting more New Zealanders to stay smoke-free, quit smoking tobacco or help them move to less harmful alternatives.”

The previous government also passed controversial legislation to incrementally ban cigarette sales, by raising the purchase age each year—a plan the current government controversially scrapped in November 2023. Advocates now hope that a range of accessible harm reduction products will help end smoking in New Zealand without the risks of cigarette prohibition.

Youdan said if current trends continue, it’s possible that the country could meet its 2025 “smoke-free” target.

New Zealand’s closest neighbor, Australia, has meanwhile effectively prohibited vapes by making them prescription-only and very expensive, though some pharmacy access will be permitted from October.

Public health outcomes in the two countries have since trended in opposite directions. And it’s no surprise to anyone familiar with the drug war that Australia has experienced numerous problems related to a booming illicit market for vapes (and for tobacco, which is very heavily taxed there).

In contrast, “New Zealand seems to understand that harm reduction benefits everyone, and that prohibition is not the solution when it comes to what is best for the health of the public,” Loucas said.

Youdan agreed that “New Zealand has done much better in regulating vaping as a consumer product,” but added that “we are certainly not perfect.”

“We only finally legislated on vaping in 2021,” he noted. “Whilst this legislation was intentional about harm reduction, it was also trying to catch up with a vape industry that grew almost unregulated until then.”

Youdan said if current trends continue, it’s possible that the country could meet its 2025 “smoke-free” target.

“I think NZ has shown leadership on tobacco harm reduction,” he told Filter, though “not always intentionally.” 

Photograph by HS You via Flickr/Creative Commons 2.0

Both The Influence Foundation, which operates Filter, and the Centre of Research Excellence: Indigenous Sovereignty & Smoking, founded by Dr. Glover, have received grants from Global Action to End Smoking (formerly the Foundation for a Smoke-Free World). The Influence Foundation has also received unrestricted grants from PMI. Filter‘s Editorial Independence Policy applies.

The post New Zealand Boosts Heated Tobacco Products for Harm Reduction appeared first on Filter.

A new Global State of Tobacco Harm Reduction (GSTHR) briefing paper reviews this success story. It cites a number of contributing factors to the dramatic fall in cigarette sales, some held in common with other wealthy countries. But it makes clear that what sets Japan apart, in achieving a world-leading 52 percent decline during this period, is the widespread popularity of heated tobacco products (HTP).

HTP are electronic devices that heat tobacco sticks—enough to produce vapor, but not enough to burn them. The inhaled vapor provides nicotine with fewer toxins than are found in smoke from combustion, making HTP substantially safer than cigarettes. Many people have used HTP to switch entirely, or to reduce the amount they smoke. 

“Japan provides a unique example of what happens when people are given the opportunity to switch from an inherently dangerous nicotine delivery system, cigarettes, to one with significantly lower risk,” David MacKintosh, a director of Knowledge Action Change (KAC), which runs the GSTHR project, told Filter.

Hitoshi Tanaka is part of this trend. He used to smoke exclusively, but now often replaces the cigarettes he would have smoked. 

Currently, the majority of Japanese people who use HTP are “dual users” of both HTP and cigarettes, the briefing paper notes. Dual use is sometimes seized upon by opponents of tobacco harm reduction as evidence of products’ ineffectiveness. But this ignores how it is often part of a journey toward smoking cessation—and how smoking fewer cigarettes, while not optimal, reduces harms compared to smoking more. Japan is smoking much less.

Japanese resident Hitoshi Tanaka is part of this trend. He used to smoke exclusively, but now often replaces the cigarettes he would have smoked with his HTP device. He didn’t necessarily intend to make this transition, but has done so principally because of regulatory factors.

“The government has raised the tax on paper cigarettes and narrowed the range of environments in which cigarettes can be smoked,” Tanaka told Filter. 

“In such an environment, people have no choice but to switch to heated tobacco products,” he said, adding that the decreasing number of spaces where he’s permitted to smoke is the main reason “I now carry both.”

Still, Tanaka acknowledged that “health concerns” and the “safety” of HTP are also among major possible reasons why “Japanese people have switched.”

HTP were first introduced in Japan in 2014. A single brand—IQOS, made by Philip Morris International (PMI)—was initially on the market. By 2016, more brands had launched and the products were available nationwide. And by 2018, one in four tobacco users was using HTP.

In 2015, the GSTHR briefing states, cigarette sales stood at “around 182.34 billion units.” By 2023, this figure had fallen to 88.1 billion; sales of the tobacco sticks used with HTP, meanwhile, had risen to 72 billion units, strongly indicating substitution. Based on industry data, GSTHR projects that in 2024, HTP sales will very nearly match cigarette sales.

Other safer nicotine options, like vapes and nicotine pouches, are regulated as medicinal products in Japan, and unavailable in practice. It makes sense that HTP sales would thrive without competition from harm reduction alternatives.

“The retail environment create a ‘safe place’ for smokers to have a discussion with knowledgeable, nonjudgemental and empathetic salespeople.”

But Derek Yach, formerly the founding director of the Foundation for a Smoke-Free World and executive director for noncommunicable diseases at the World Health Organization, thinks the reasons run deeper.

“The retail environment in IQOS stores create a ‘safe place’ for adult smokers seeking to end smoking to have a discussion with knowledgeable, nonjudgemental and empathetic salespeople,” he told Filter. “It allows smokers to feel valued, breaking the stigma and shunning many people feel.”

Yach, who has visited stores in Japan, said the retailers’ success is notable. “It would be valuable for PMI to share the behavioral research that underpinned store design,” he continued. “I feel that researchers focused on tobacco harm reduction should visit IQOS stores. They will learn a lot about determinants of success from salespeople and consumers that rarely make it into publications.”  

Unlike countries such as the United Kingdom, where government policies have actively promoted smoking cessation through harm reduction, Japan has seen a more laissez-faire approach. Product migration has happened with relatively little government involvement.

Importantly, there are no restrictions on advertising HTP as being less harmful than cigarettes (though the industry self-imposes a rule of marketing to adults only). And in 2021, the GSTHR paper also notes, taxation on cigarettes “was more than double that of HTP,” even if that financial incentive has often not been passed on to HTP consumers.

“The Japanese people are likely protected by language and culture from the inundation of misinformation on nicotine.”

“It should be no surprise that consumers will move to products that give them better value,” David Sweanor, an industry expert who chairs the advisory board of the Centre for Health Law, Policy and Ethics at the University of Ottawa, told Filter.

“The Japanese people are likely protected by language and culture from the inundation of misinformation on nicotine, and by having a less developed anti-tobacco infrastructure,” he added.

In the absence of these obstacles, and with a government that neither opposes nor endorses tobacco harm reduction, Japan is a clear example of how consumer preferences can drive public health wins, Sweanor believes.

The GSTHR briefing references a poll conducted by the Foundation for a Smoke-Free World in 2019, when Yach was its director (the organization recently rebranded as Global Action to End Smoking). This found that “concern about the health risks to others associated with second-hand smoke from cigarettes” was a key factor in Japanese people switching.  

“Based on talking to Japanese smokers seeking to switch, it was my impression that many cited concerns they had about the health of family members exposed to smoke and a dislike for odor left by smoke as a reason to stop smoking,” Yach said. “Their own health being a lower priority.”  

The GSTHR briefing cites this concern for others’ wellbeing, as well as an openness to embracing new technology, as characteristics of Japanese culture that have sped the rise of HTP.

“We should all be interested in learning from those countries seeing dramatic drops in cigarette sales.”

Whatever the reasons, Japan has established an eye-opening position in the global tobacco harm reduction landscape—alongside other countries that have taken quite different paths to increased smoking cessation, such as Sweden (with snus) and the UK (with vapes).

“In situations where there is a broader range of safer nicotine products available, the potential for massive public health gains is clear,” MacKintosh said.

“Every country faces their own challenges and context, but all have the opportunity to help reduce premature deaths from smoking by enabling people to make better, healthier choices,” he concluded. “We should all be interested in learning from those countries seeing dramatic drops in cigarette sales, and those who are on track to achieve smoke-free status.”

Photograph (cropped) of IQOS store in Japan by Tokumeigakarinoaoshima via Wikimedia Commons/Creative Commons 4.0

The Influence Foundation, which operates Filter, has received grants from Global Action to End Smoking (formerly the Foundation for a Smoke-Free World), from KAC and from PMI. Filter’s Editorial Independence Policy applies.

The post Japan’s Leading Position in the Tobacco Harm Reduction World appeared first on Filter.

That’s crucial, when individuals who switch from smoking have a variety of different needs. Some won’t find vaping helpful until they hit upon the right flavor, for example. To some, hand-to-mouth action and inhalation are essential elements for harm reduction products to replace; for others, it’s more about the nicotine, and oral products are more convenient.

But others still may prefer the smell and taste of tobacco, delivered over shorter periods—the harm reduction option that perhaps most closely replicates the cigarettes they’re trying to quit, only without the deadly smoke. And that’s why heated tobacco products have a vital role to play.

Heated tobacco products have a real-world track record of being linked with large-scale reductions in smoking.

Modern heated tobacco products (HTP) are devices that heat (but don’t burn) sticks of tobacco to produce vapor. The fact that they don’t produce smoke makes them much less harmful than cigarettes.

HTP also have a real-world track record of being linked with large-scale reductions in smoking—notably in Japan, where HTP were introduced a decade ago.

So what about the States? Regulatory requirements and court cases concerning copyright have greatly hindered HTP access here. But federal decisions over the next few years will be critical in determining how soon the country can make smoking obsolete. The evidence suggests it is time for the Food and Drug Administration (FDA) to lower barriers and allow more HTP to market.

While modern HTP are relatively new, the science behind heating tobacco is not. Researchers have understood since at least the 1970s that it is smoke (not nicotine) which causes most harms related to tobacco use. And ever since, manufacturers have sought to develop technologies that provide satisfying nicotine delivery for people who smoked, without those smoke-related harms.

HTP, in a very different form from later models, first entered the US market in the 1980s. First came Premier, which utilized a “small piece of charcoal-like carbon” to heat  the tobacco. In 1994 the Eclipse HTP was introduced, later rebranded as “Revo.” Various factors severely limited any impact of these early models, whose harm reduction potential is disputed, on US smoking, although Eclipse is still authorized by the federal government to be offered for retail sale.

In 2009, the FDA was granted regulatory authority over tobacco products, and with that came a slew of strict restrictions and requirements to introduce new products to market. To date, the FDA has still authorized only two HTP for sale: Eclipse and IQOS.

Eclipse resembles traditional cigarettes, with each tobacco stick having a charcoal tip at the end to heat it, to be discarded after each use. But IQOS—which was the first HTP to be introduced in Japan—is an electronic device to which you attach a tobacco stick, with only the stick being discarded after use.

The products are also treated quite differently under federal regulations. The Eclipse was granted a “substantial equivalence” marketing order by the FDA in 2018, largely because the product was on the market prior to February 15, 2007.

But because IQOS was unlike any previously available product, it was subject to the FDA’s onerous premarket tobacco product application (PMTA) pathway to be authorized for sale.

The FDA granting a modified risk order was a significant step in acknowledging potential benefits of HTP—and of tobacco harm reduction more broadly.

In 2019, the FDA authorized the marketing of an earlier version of IQOS, deeming it “appropriate for the protection of public health” for producing “fewer or lower levels of some toxins than combustible cigarettes.” In 2020, the agency also granted a supplemental marketing authorization for the IQOS 3 model.

These PMTA applications, requiring reams of scientific evidence, cost more than any but the biggest manufacturers can afford. Newer products may also be subject to entirely new applications, depending on FDA decisions.

In 2020, IQOS additionally became the only HTP to date authorized under a different FDA pathway, as a modified risk tobacco product (MRTP). MRTP orders are issued to a “single specific product,” rather than the entire class (i.e, all HTP). To be granted an MRTP, a manufacturer must demonstrate to the FDA that “the product will or is expected to benefit the health of the population as a whole.”

That decision was a significant step in the FDA acknowledging the potential benefits of HTP—and of tobacco harm reduction more broadly.

But other parts of the world are moving much faster. In 2014, an estimated 100,000 HTP devices and 15 million heated tobacco sticks were sold worldwide. By 2021, nearly 30 million HTP devices and over 125 billion heated tobacco sticks were sold.

Increased HTP use has correlated with declines in smoking. In Japan, one report estimates that within five years of the introduction of HTP in 2014, cigarette consumption there decreased by an incredible 44 percent—the biggest decline the country had ever seen.

Even researchers at the American Cancer Society—no champion of tobacco harm reduction—have noted that, “The introduction of IQOS likely reduced cigarette sales in Japan.”

We need all the tools we can get, and inaction costs lives.

Now, three major HTP brands are available in the country. A 2023 study found dramatic increases in HTP use from 2015-18 among Japanese people who formerly smoked and those currently smoking (whether or not they intended to quit)—but not among people who had never smoked.

As of 2022, more than 30 million US adults were currently smoking. All of them deserve access to a wide range of harm reduction options, and the chance to find out what helps them to quit cigarettes and live a healthier life. For many, the best answer might be a heated tobacco product, but when only one recent HTP has been authorized, their chances are limited.

It’s down to the FDA to improve their chances. If the agency knows that one HTP can “benefit the health of the population as a whole,” this must surely apply to other, comparable products. We need all the tools we can get, and inaction costs lives.

Photograph of heated tobacco product and vapes by Vaping360 via Flickr/Creative Commons 2.0

The Influence Foundation, which operates Filter, has received unrestricted grants from Reynolds American, Inc. and Philip Morris International, which manufacture products mentioned in this article. The author’s employer, the Taxpayers Protection Alliance, previously made a one-off donation to The Influence Foundation to support travel to a harm reduction event. Filter’s Editorial Independence Policy applies.

The post Heated Tobacco Products Can Help the US Make Smoking Obsolete appeared first on Filter.

That’s because appearance can be an important motivation for people to quit smoking, as past research has shown. Other work has indicated that tooth discoloration is a major source of dissatisfaction among people who smoke.

The new study is the first to investigate changes in oral health and dental aesthetics among people who’ve switched from cigarettes to harm reduction alternatives such as vapes.  

Part of the SMILE project at the Center of Excellence for the Acceleration of Harm Reduction (CoEHAR) at the University of Catania, Italy, the study involved a large group of international researchers. Over 400 participants in Italy, Poland, Moldova and Indonesia were offered tobacco harm reduction products of their choice.

The ongoing research aims to help lower smoking rates by presenting compelling evidence that using harm reduction alternatives is better for oral health.

Dr. Riccardo Polosa, professor of internal medicine at the University of Catania and founder of CoEHAR, is one of the authors, and Filter spoke with him to find out more. Our interview has been lightly edited for length and clarity.

Kiran Sidhu: Why is this study important?

Dr. Riccardo Polosa: This study is significant as it marks the first investigation into how e-cigarettes and heated tobacco products affect dental aesthetics. Utilizing a new methodology that allows precise measurement of dental color, findings revealed that cigarette smokers had about 35 percent more dental discoloration than non-smokers, former smokers, and those exclusively using e-cigarettes or heated tobacco products, who showed notably whiter teeth in comparison. 

How can your findings be used to help people? 

These insights are relevant both for research—enriching our understanding of the aesthetic impacts of non-combustible products—and for consumers. Given the concern many, particularly young people, have regarding the appearance of their smile, this evidence could encourage smokers who struggle to quit to consider switching to these less harmful alternatives, not only to improve their teeth appearance, but also potentially to lower their health risks.

“For these individuals, a narrative emphasizing the benefits of a healthier and brighter smile could be a more persuasive incentive than the fear of future lung cancer.”

The negative impact of cigarette smoking on oral health and teeth discoloration is  well-known, yet convincing smokers to quit remains a challenging and often fruitless struggle. I believe that highlighting [our] findings … could provide compelling new information for dentists and dental hygienists, and may carry significant implications for smokers who are particularly concerned about bad breath and/or the aesthetic appearance of their teeth.

For these individuals, an oral health-focused narrative, emphasizing the benefits of a healthier and brighter smile, could be a more persuasive incentive to stop smoking than the fear of future lung cancer or cardiopulmonary diseases.

I’ve read about dentists who are very anti-vape. Do you think this study will help change their minds?

While it’s true that many dentists are skeptical about vaping, this perspective isn’t universal. I’ve encountered numerous dentists, dental hygienists and implantologists who are keen on encouraging patients to transition away from tobacco smoke by switching to combustion-free nicotine products.

This variation in viewpoints highlights the complexity of the issue, which is often compounded by a lack of thorough understanding and the influence of low-quality research. A critical examination of existing studies is essential to navigate these opinions and foster a more informed stance on vaping within the dental and health care communities.

The hope is to heighten awareness among dentists and dental hygienists about their pivotal role in smoking cessation and tobacco harm reduction. Dentists, perhaps more than other health care professionals, are in a unique position to monitor patients longitudinally and build trustful relationships. This positions them well to engage with patients who find it difficult or are unwilling to stop smoking, by introducing them to alternative options that can positively impact oral health and dental aesthetics.

Dental discoloration, often a source of discomfort and embarrassment, particularly for younger individuals, is a sensitive issue. By focusing on the potential for aesthetic improvement, dentists can use the appeal of a brighter smile as a powerful motivator, thereby contributing significantly to the reduction of smoking-related harm.

“The belief that the damage done by smoking is permanent, and that changing habits is pointless, is wrong, and our study proves it.”

Some people who’ve smoked long-term may think it’s too late to repair the staining caused by smoking cigarettes. What would you say to them?

To long-term smokers, I would say that it is never too late to make a healthy choice. The belief that the damage done by smoking is permanent, and that changing habits is pointless, is wrong, and our study proves it.

The evidence shows that former smokers have whiter teeth than current smokers, and that using combustion-free products can lead to whiter teeth compared to conventional cigarette use.

Success in reducing smoking-related harm hinges on patient awareness and engagement. Without genuine commitment and motivation from patients, no smoking cessation strategy can succeed. As mentioned earlier, this scientific evidence may serve as a powerful motivator.

Photograph (cropped) by William Fortunato via Pexels

Both The Influence Foundation, which operates Filter, and CoEHAR have received grants from the Foundation for a Smoke-Free World.

The post Why It Matters That Tobacco Harm Reduction Brightens Smiles appeared first on Filter.

In July I wrote for Filter about COP10 threats to products that have helped millions quit smoking. These threats could, in Panama City this November, become formal WHO policies with worldwide impacts. COP10’s provisional agenda and other preparatory reports had previously been published, though were short on detail.

But a recent flurry of documents has revealed more of the WHO’s hostile strategy.

With no substantive justification, the WHO pronounces that “there is a need to regulate novel and emerging tobacco products by applying traditional tobacco control measures.”

Particularly egregious is a WHO report on regulation and disclosure of contents of alternative nicotine products. This document dismisses vaping for smoking cessation, stating that evidence in favor is “low” or “insufficient”—ignoring the November Cochrane Review finding of “high certainty evidence that nicotine e-cigarettes are more effective than traditional nicotine-replacement therapy (NRT) in helping people quit smoking.”

The WHO’s 9th “report on the tobacco epidemic” has also just been published. It’s funded by Bloomberg Philanthropies, which bankrolls global tobacco control efforts to restrict or ban alternative nicotine products. 

It claims that “aerosols commonly emitted by [heated tobacco products] do fall under the definition of tobacco smoke.”  The citation for this claim is not a scientific document, but an opinion given by one of the WHO’s handpicked reviewers in a previous report, who mused, “… aerosols generated by chemical reactions involving heat are termed ‘smoke’ … Can the aerosols of novel and emerging tobacco products qualify as ‘tobacco smoke’ ? Yes. … strictly speaking, visible aerosols deriving in whole or in part from thermally driven chemical reactions qualify as ‘smoke,’ even when combustion is not involved.”

The WHO’s tobacco epidemic report further insists that “[s]moke-free legislation should encompass new and emerging nicotine and tobacco products and specific products, like [vapes], should never be excluded from its provisions”—despite scant research on the effects of second hand vapor for bystanders, let alone any solid evidence of harm. Claiming that vaping is “undoubtedly harmful” and that vapes are “specifically targeted at children,” it calls for taxation at the same level as cigarettes, imposition of health warnings, and a ban on all non-tobacco flavors.

The WHO has also just published a report on heated tobacco products (HTP), which have led to a dramatic collapse of cigarette sales in countries such as Japan, South Korea, Italy and Lithuania. HTP are significantly less harmful than smoking, and one brand has been authorized by the United States Food and Drug Administration to be marketed as “modified risk.”

The WHO has also moved aggressively to cut the chances of COP10 parties being swayed by evidence-based opposition to a crackdown on harm reduction.

The WHO concedes that levels of Harmful and Potentially Harmful Constituents (HPHC) in heated tobacco aerosol are “typically lower than those found in the smoke from [combustible cigarettes].” But it still recommends that policymakers tax HTP as heavily as cigarettes, ban public use and mandate “large graphic health warnings and plain packaging … as for any other smoked tobacco product.” Here, the significance of the WHO’s “smoke” definition kicks in.

But perhaps the bluntest signal of the WHO’s intent came from a report made public on July 17, four months after the relevant meeting of the WHO Eastern Mediterranean region. With no substantive justification, the WHO pronounces that “there is a need to regulate novel and emerging tobacco products by applying traditional tobacco control measures.” The report recommends that governments “strengthen tobacco product legislation by regularly updating laws to include novel and emerging products.”

The WHO has also moved aggressively to cut the chances of COP10 parties being swayed by evidence-based opposition to a crackdown on harm reduction. It has now belatedly made public a report on how evidence on alternative nicotine products will be gathered to inform COP debates.

A working group, open to all signatories to the FCTC, used to compile up-to-date science on testing and reporting of product content and emissions. It was suspended in 2018. Administrators surveyed WHO members in 2020 and found that “60% of the Parties that responded indicated that they would like the Working Group to continue its work.” A second survey in 2021 also found that a majority of respondents favored reactivation of the working group—rather than replacing it with “an advisory group of experts and relevant partners … invited by the [FCTC] Secretariat” (read: carefully handpicked by the WHO).

Yet the WHO considers that these majorities “suggest little support at present for the reactivation of the mandate of the Working Group.” Siding with the minority, its report recommends that “an expert group be established to consider and make recommendations to the COP.”

It is vital that COP10 parties recognize these tactics for what they are, and make decisions based on robust evidence, rather than a steady stream of propaganda.

There appears to be no room for objective evaluation of the science in advance of COP10. Instead, the WHO is dishonestly railroading delegates toward a preordained outcome of heavy restrictions and prohibition when they gather in Panama.

In reviewing these concerted and gratuitous attacks on safer substitutes, you could be forgiven for concluding that the WHO wished to protect the incumbent cigarette trade.

For the good of global public health, it is vital that COP10 parties recognize these tactics for what they are. It is vital that they make their decisions based on robust evidence, rather than a steady stream of propaganda.

Photograph via Pxfuel

The post The WHO’s COP10 Takedown of Tobacco Harm Reduction Takes Shape appeared first on Filter.

The first-of-its kind study, known as CEASEFIRE, enrolled 220 participants. On average, they were 41 years old and smoked about a pack a day. They averaged two previous attempts to quit smoking.

The participants were randomized into two groups: one given a refillable vape, and one given a heated tobacco product—a device that heats sticks of tobacco to produce vapor, without the combustion that produces smoke. Researchers sought to compare effectiveness and tolerability between the two harm reduction options.

High rates of quitting and staying off of cigarettes were observed in both groups, described as “remarkable” by one of the researchers.

Understanding the critical role of flavors in making the switch, they also gave participants a choice of three different flavors. In addition, motivational counseling was offered throughout the 12-week study.

High rates of quitting and staying off of cigarettes were observed in both groups, at 39.1 percent for those using the heated tobacco product (IQOS 2.4 Plus) and 30.8 percent for the vape (JustFog Q16). These rates were described as “remarkable” by one of the researchers.

The results are encouraging for both combustion-free devices—the difference between the two rates was not deemed significant—and it’s notable that more than 95 percent of participants completed the study.

“Data confirm the effectiveness and tolerability of e-cigarettes and the health potential of heated tobacco products for smokers not intending to quit,” said principal investigator Maria Signorelli.

Both vapes and heated tobacco products are safer than combustible cigarettes, which cause over 7 million deaths worldwide each year.

Some participants became healthier even during the short study period. “We observed an improvement in exercise tolerance in participants compared to the initial levels,” said Pasquale Caponnetto, another of the researchers. “Many patients from the first month declared that they have more breath and feel less fatigue in small but important daily activities such as climbing stairs or doing household chores.”

In Italy, where the research was conducted, heated tobacco products have been available for years at tabaccheria (tobacco shops), and are sold alongside cigarettes in vending machines. Japan, where the products are also widely available, has seen an unprecedented decline in cigarette sales in just a few years. This is tobacco harm reduction in action.

In 2020, the Food and Drug Administration authorized IQOS to be marketed as having “reduced exposure” to harmful chemicals compared with cigarettes. But a patent dispute has delayed rollout in the United States.

Different things work for different people, and both vapes and heated tobacco products are essential tools to bring down smoking rates.

“Comparing the Effectiveness, Tolerability, and Acceptability of Heated Tobacco Products and Refillable Electronic Cigarettes for Cigarette Substitution (CEASEFIRE): Randomized Controlled Trial” was conducted by researchers in the Department of Clinical and Experimental Medicine at the University of Catania and the Center of Excellence for the Acceleration of Harm Reduction (CoEHAR).

Unfortunately, people with mental health diagnoses or histories of problematic drug use other than tobacco were excluded from this study. These are two groups with some of the highest rates of smoking, smoking-related illnesses and premature deaths. It’s crucial to include them in safer nicotine product research.

The researchers cautioned that longer follow-up studies are needed “to confirm significant and prolonged abstinence from smoking,” and whether the results can be generalized to settings that don’t offer high levels of support.

But the CEASEFIRE study suggests that giving people who smoke and don’t even intend to quit the option of heated tobacco products or vapes is highly effective. Different things work for different people, and both of these are essential tools to bring down smoking rates.

Photograph of vending machine carrying both cigarettes and heated tobacco products in Catania, Italy, by Helen Redmond

The Influence Foundation, which operates Filter, has received grants from Philip Morris International, which manufactures IQOS. Both The Influence Foundation and CoEHAR have received grants from the Foundation for a Smoke-Free World. Filter’s Editorial Independence Policy applies.

The post Heated Tobacco Products Help People Quit Smoking, Even Unintentionally appeared first on Filter.

In 2019, the FDA had authorized IQOS and handful of other Marlboro HeatSticks through its premarket tobacco product application process (PMTA), in which PMI had to demonstrate that these products would be “appropriate for the protection of public health”—meaning, in short, that they’d be more likely to help adults who smoke switch to the safer alternative than to introduce a new generation to nicotine. The agency also granted the company the ability to make some modified risk claims in 2020.

Heated tobacco products (HTPs) heat tobacco sticks without burning them, to produce vapor that is inhaled. Research has suggested that the vapor contains far fewer harmful compounds than cigarette smoke, but probably more than are present in the vapor from e-cigarettes.

It will add to the small availability of FDA-authorized safer nicotine alternatives, but is also a reminder that the PMTA process favors well-financed manufacturers, mainly with ties to the tobacco industry.

HTPs have already taken off in other parts of the world, showing eye-catching potential as a harm reduction option. Most notably, Japan has seen an almost 43 percent decline in cigarette sales over the past decade, right after HTPs were introduced and soared in popularity. And that’s despite the fact that the Japanese government has been, for the most part, rather hostile toward tobacco harm reduction (THR); nicotine vapes, for instance, are effectively outlawed. Critics of mainstream tobacco control—which usually favors prohibition-focused measures—have pointed to Japan as a potential, if limited, model. South Korea has already followed suit, and though Taiwan has just banned even the use of vapes, it has left HTPs alone.

Although the additional IQOS MGOs will add to the small availability of FDA-authorized safer nicotine alternatives in the United States, they are also a reminder that the PMTA process favors well-financed manufacturers, mainly with ties to the tobacco industry.

Still, no flavored vaping products made by anyone have received MGOs. Just days before the IQOS announcement, the FDA rejected two menthol e-cigarettes from Vuse, the R.J. Reynolds-owned vapor company. It left THR advocates and industry observers wondering—again—if the agency will ever authorize any flavored e-cigarettes.

At the moment, IQOS is unavailable in the United States: Altria had begun limited sales of the device in 2019, but a patent dispute with R.J. Reynolds halted any sustained rollout. Then, last October, PMI paid $2.7 billion to regain the US commercialization rights for IQOS from Altria and announced plans to start manufacturing the product in the country.

A new rollout is now set for mid-2024, as the tobacco giant continues to eye the market for safer nicotine alternatives, especially in the US. In November, PMI also took over a majority of Swedish Match—the producer of Zyn, the popular oral nicotine pouch—for $16 billion, inching ever closer toward sole ownership.

Meanwhile, smaller and medium-sized vapor manufacturers—most of which have already had their PMTAs denied—continue to have to fight in court for, perhaps, any hope of an MGO.

Photograph by Vaping360 via Flickr/Creative Commons 2.0

The Influence Foundation, which operates Filter, has received grants from both PMI and Reynolds American, Inc. Filter’s Editorial Independence Policy applies.

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