Just down the road from the fairytale Swiss city of Neuchatel, which boasts a castle and cathedral, is a state-of-the-art glass and steel structure known as the Cube. The building is a factory for Philip Morris International (PMI) and in both form and function it represents Big Tobacco’s attempt to rebrand as champions of a smoke-free future. Inside and out, the see-through walls and tech campus’s open plan starkly contrast with the traditional cigarette factory next to it, built in 1983, which looks more like a secretive, concrete Soviet prison.
The products researched and developed in the Cube use a new technology that offers smokers an experience like a traditional cigarette, but with drastically less harmful toxins introduced to their bodies. Known as “Heat Not Burn” (HNB), these products use heat to release nicotine from actual tobacco, without the combustion of setting a cigarette on fire, which drastically reduces harm—or so PMI claims.
One can be forgiven for looking askance at safety claims from Big Tobacco. Perhaps no industry has a worse track record of lies and disregard for human life than these purveyors of poison pleasure, so badly exposed in 1980s and 1990s. PMI understands and accepts that reputation, and it is no accident that their new facility is visually transparent. For the industry believes heralding transparency will restore its good name and close the door on its terrible past.
A Billion People Are Just Not Going to Quit
A billion people around the globe smoke traditional cigarettes. I happen to be one of them. Most of us understand the serious risks, but as a result of addiction and enjoyment choose to smoke notwithstanding. It is estimated that by 2025 there will still be a billion smokers, a smaller percentage of the world’s population but still a huge number of people putting themselves in harm’s way.
It is these people, the unrepentant smokers, if you will, that PMI is targeting and reaching with HNB products. There are already myriad non-smoking nicotine delivery systems. The patch, gum, prescription medications, e-cigarettes, dip, and snus are a few. Each has had success for some smokers. But for a significant segment of the smoking population, these cessation methods have not proved effective.
HNB products offer a few advantages over other products. They create an inhalable aerosol hit of nicotine using real tobacco, unlike e-cigs, and closely mimic the physical act of smoking, unlike patches and gum. PMI’s signature product, IQOS, has been on the market in Japan and parts of Europe for more than a year, and the results thus far are very promising.
At the Cube, where my visit was sponsored by the public relations company FP1 Strategies, I had a chance to try IQOS. It is a small, hand-held electronic machine into which one places “heat sticks” (which look like tiny cigarettes) and pushes a button that heats them to a level that produces a hit of nicotine without smoke. After embarrassing myself by putting the heat stick in the wrong way, I started to get the hang of it. While not exactly the same as smoking a cigarette—nothing is—it was the closest thing to it I’ve ever experienced. In both flavor and consistency the mimicry was impressive. I even managed to blow a few rings.
Thus far, sales for IQOS have been impressive, especially in the Japanese market, where it has spent longest time on shelves. The IQOS heat sticks now account for 7.6 percent of the Japanese tobacco market, a remarkably high number for a year-old product.
Do These Alternatives Reduce Harms to Smokers?
Perhaps more important than overall sales are the percentages of smokers who switch entirely from combustible cigarettes to the IQOS device. In Japan 72 percent of those who tried to switch to IQOS have done so completely, with another 8 percent using both traditional cigarettes and this new smokeless technology.
But, as impressive as these results are, one key question remains: is the IQOS device really significantly less harmful than traditional cigarettes, or is Big Tobacco once more pulling the wool over the eyes of a vulnerable and addicted customer base?
To answer that question during this trip I also visited Warsaw, Poland for the annual Global Forum on Nicotine. The event is a strange corporate convention, a kind of nerd prom for vapers and scientists. On the balcony behind the Warsaw Marriot, e-cigs and vape devices of every shape and size sat in the hands of a diverse, international group of manufacturers and enthusiasts.
This year it seemed that Heat Not Burn, especially IQOS, was the belle of the ball, and the product most in the crosshairs of independent scientists questioning the results of PMI’s testing on harm reduction. The most persuasive testimony came from Dr. Konstantinos Farsalinos, a Greek cardiologist much respected in the nicotine community, who sought to replicate PMI’s science in his own lab. He says his independent analysis confirms the manufacturer’s claims. In fact, every toxin he tested for was dramatically reduced in the smoke-free IQOS product. For most of the toxins, the reduction was 90 percent or more.
I spoke to Farsalinos about his findings and responsible ways to regulate products like IQOS. He argued that we need to move the most smokers away from combustible products to as many alternative options as possible. This is because for some smokers, simply replacing nicotine, as with a patch or gum, is sufficient, but for others, the ritual is a key component. The hand-to-mouth aspect, for example, can be vital.
Opening to Alternatives Will Improve Public Health
He had three goals for regulations: that they be “reasonable, proportionate and realistic.” While stressing quality assurances, he argued that the perfect must not be made the enemy of the good in addressing the public health crisis smoking represents. Among other things, he advocates reducing or even eliminating taxes on non-combustible nicotine products to make their adoption as attractive as possible.
By almost any measure the conference was a great success for PMI and other advocates and manufacturers of HNB technology. But questions and hurdles still linger. The U.S. Food and Drug Administration is currently considering two applications from PMI for its sister company Altria to sell these products in the United States. One is a Pre Market Tobacco Application (PMTA) to introduce the IQOS product to the American market. Another is to allow Altria to label the product as a Modified Risk Tobacco Product (MRTP). The applications, which come in at over 2 million pages, will be decided on later this year.
The PMTA should be a slam-dunk. The independent science makes it clear that IQOS does not carry risks more severe than e-cigarette products already in the American market. The MRTP, on the other hand, is a different story. This is only the second time a tobacco company has ever applied for this modified risk status. The first application, from Swedish Match, a producer of the oral product snus, was rejected, notwithstanding tremendous evidence that the product is less harmful than traditional cigarettes.
Much of the reason the FDA resists granting modified risk status seems to be that it does not wish to normalize tobacco use. Indeed, the stigma surrounding smoking, especially in the sometimes puritanical United States, has helped reduce smoking rates in the years since Big Tobacco’s disgrace. Tobacco use is often viewed, rightly or wrongly, as a moral failing. People will make faces or nasty comments to a smoker on the street in a way that they won’t to a fat person walking out of McDonalds.
Harm Reduction Is a Realistic Goal
But in some ways this attitude is reminiscent of abstinence-only programs directed at teenagers having sex. Condom use reduces risks of AIDS and pregnancy, but other diseases can still be transmitted. Clearly abstinence is the safest option, just as quitting nicotine entirely is. But just as teenagers are going to have sex, people are going to use nicotine. So the FDA should seriously consider endorsing products that reduce harm and in the process save lives.
Almost every person from Big Tobacco I spoke with prefaced their comments by saying something along of the lines of, “Look, we know we deserve our terrible reputation.” Even though most of the executives who lied for decades about the deadly nature of smoking are long gone, tobacco companies do not expect to be trusted, and they aren’t asking to be.
What they are asking for is fair, independent analysis of their scientific claims. Hundreds of scientists in Neuchatel and around the world are developing smoke-free nicotine alternatives. Many are so young that they weren’t even born yet in the bad old days. According to Dr. Matt Melvin, a senior research scientist at Altria, it is still a challenge to attract bright young talent to an industry so scarred by past disgrace.
For the 40 million smokers in the United States and the billion around the world, time is not on their side. Every day that new alternatives are delayed, more harm is caused and more of us die.
The past sins of Big Tobacco are grave, and should give us pause. We need to verify more than trust. But we must not let the past keep us from embracing the future. Big Tobacco has invested heavily these new technologies, and if it is sincere in its desire to create a smoke-free future, and in so doing mitigate the harm they have done, we would be foolish not to let them try.
Correction: PMI applied to the FDA for U.S. approval of these products on behalf of Altria, Altria did not itself apply directly.