Tobacco companies have introduced new products (e-cigarettes and heat-not-burn tobacco), in a bid to transform tobacco and ‘unsmoke’ the world. While the unsubstantiated ‘95% safer’ claim for e-cigarettes has been invalidated by many scientists, the same claim cannot be directly transposed to heat-not-burn products. Both heat-not-burn and e-cigarettes are electronic devices and produce an inhalable aerosol but they are very different.
E-cigarettes heat a flavored liquid which can contain nicotine to produce an aerosol. Growing evidence disproves claims that these products are less harmful. Showing that use of e-cigarettes carries high risk of strokes, cancers, respiratory and cardiovascular diseases. They do not help smokers to stop smoking, instead many end up using both cigarettes and e-cigarettes (dual use) which is even more concerning. Because of the flavors such as blueberry cheesecake many of the e-cigarette users are also people who have never smoked, as such the product acts as an entry products to tobacco products. This justifies extreme caution by any government concerned with the health of its youth and the health of its people, that is why the proposed Control of Tobacco Products and Electronic Delivery Systems Devices Control Bill will strictly regulate e-cigarettes.
Whilst great attention has been directed at e-cigarettes, heat-not-burn tobacco products have not drawn equal attention. Heat-not-burn tobacco products should not be confused with electronic cigarettes. Similarly, the evidence and arguments made about e-cigarettes do not directly apply to heat-not-burn tobacco products. Since they do not burn but heat the tobacco and produce an aerosol, heat-not-burn products are often confused and bundled up together with e-cigarettes. It is important for the public to make clear differentiation.
The latest generation of heat-not-burn tobacco products have only been launched in many countries over the past 4 years including brands like IQOS, GLO and Ploom Tech. A main difference between heat-not burn products and e-cigarettes is that the former is a tobacco product. They are hybrids between electronic and normal cigarettes: they are equipped with a battery-operated device - but the aerosol is produced by heating "real" tobacco and not flavoured liquid. The aersol from the heated tobacco contains nicotine and other chemicals such as tar, gases and solid particles.
The World Health Organisation has cautioned that the health effects of these devices are still unproven, emphasising that all tobacco even in its natural form is carcinogenic and highly toxic. Evidence shows that using heat-not-burn products does not avoid the adverse cardiovascular effects of smoking cigarettes, as the products have the same negative impact on blood vessel function. Tobacco companies argue that when tobacco is heated and not burned it emits lower levels of the thousands of chemicals in tobacco. The WHO warns that there is no evidence that suggests that reduced exposure to some chemicals translates to reduced risk in humans. Exposure to lower levels of chemicals does not equal reduced health risks.
Even without burning tobacco, the heating of tobacco still produces thousands of toxicants that are present in all forms of tobacco. Heat-not-burn tobacco products also expose users to new risks, some chemicals in tobacco which are completely destroyed when burned, are now still present in these products. While some toxicants are found in lower levels in heat-not-burn products, some are actually found in higher levels. In addition to the tobacco chemicals, HNBs also contain substantial amounts of propylene glycol a problematic chemical found in e-cigarettes which has been associated to lung damage. The reality is that the products have a ‘distinct toxicity profile’ and the public should not be misled into believing that they are better off using heated tobacco products.
Producers of heat-not-burn products have also admitted that these are just as addictive as all other forms of tobacco. They contain the same range of nicotine, so people will be equally addicted and dependant on heat-not-burn products, prolonging and not solving the problem. The aerosol emitted by heat-not-burn also contains cancer containing chemicals, so people using heat-not-burn must not expose their families and everyone else to the aerosol. Second hand exposure is also harmful to the health of bystanders.
The products are relatively new and it does take long to have a clear standing on the long-term health effects of using them. The WHO maintains that the risk reduction claims of heat-not-burn products, are not backed by reliable science and that these new products are not appropriate for the protection of public health. It is important to emphasise the risk that use of any tobacco products including heat-not-products, snuff, hookah pipes and cigarettes carry, all should be subjected to equal and strict regulation. The WHO is an organisation committed to promoting and protecting human health and is not motivated by profits. When it concerns public health such organisations are where directions should be sought and not from companies driven by profit.