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Invisible smoke: Third-party endorsement and the resurrection of heat-not-burn tobacco products
Abstract
Background
Tobacco companies are introducing new ‘heat-not-burn’ cigarettes in dozens of countries. Historically, these products failed commercially, and independent researchers contested their health claims. The most prominent early heat-not-burn cigarette was RJ Reynolds’s (RJR’s) Premier, introduced in the USA in 1988. Curiously, The Lancet endorsed Premier as a ‘near-perfect low tar cigarette’ in a 1991 editorial, 2 years after Premier had been removed from the market. We examined the context of this endorsement.
Methods
To ascertain what RJR knew about this endorsement, we systematically searched and analysed previously secret RJR documents in public archives and triangulated the industry document data with other published work.
Results
RJR had a long-standing interest in collaborating with outside scientists to endorse potentially reduced harm cigarettes. The author of The Lancet editorial had previously corresponded with RJR regarding Premier’s health effects and market potential. Internally, RJR regarded The Lancet’s editorial, its stance on novel tobacco products, and its endorsement of Premier as major successes. While the editorial came too late to save Premier, RJR saw future business opportunities for novel products if endorsed by health authorities.
Conclusions
Endorsement by high-impact medical journals and health authorities may be critical in helping heat-not-burn’ products succeed where previous attempts have failed. Conflicts of interest influenced these endorsements in the past. Health leaders and academic journals should consider both conflicts of interest and the ethics of endorsing tobacco product substitution, as tobacco companies simultaneously work to promote cigarette smoking and undermine tobacco control globally.
... With the increasing awareness of the health risks associated with smoking, new tobacco products are being marketed as less toxic alternatives to traditional cigarettes in order to lower emissions of toxicants and reduce harm [1,2]. Among them, the electrically heated tobacco product is a new type of tobacco product emerging rapidly in the tobacco industry in recent years [3], accounting for 42.7% of the global market share of new tobacco products in 2021. An electric heating sheet or heating needle is typically used to heat the tobacco substrate to temperatures sufcient to release water and volatile organic compounds such as nicotine, without initiating a self-sustaining smoldering combustion process [4]. ...
Electrically heated tobacco products (EHTPs) could release effective aerosol components from tobacco materials at relatively low temperatures without a burning phenomenon. It is essential to grasp the temperature distribution and release mechanism of key components in heated tobacco materials. The existing experimental studies have provided initial insights into the thermodynamic behavior of tobacco materials under various conditions. However, current numerical models are still in their early stages of development, with the majority failing to correlate heat transfer with component release. Based on this, a coupled numerical model of gas flow, heat transfer, and the release of key components in the electrically heated tobacco product is established in this study, which exhibits improvements in revealing the internal heat and mass transfer characteristics in the porous media of tobacco and is capable of evaluating the influence of component contents and product design parameters. The release rates of water, glycerol, and nicotine components are quantitatively described by the first-order Arrhenius formula, and the transport of heat and gas flow is simulated using the Navier-Stokes equation. The accuracy of the model is validated through experiments, including temperature monitoring at multiple measurement points and determination of residual contents in the tobacco substrate after each puff. The simulation results suggest that an appropriate component ratio and tobacco filler mass can enhance both the release amount and release efficiency of key components, and reducing either the diameter or length of the tobacco section can help to improve the heat transfer performance. A slower heating rate matched with longer preheating times enables the complementary release of water and glycerol components, which helps to regulate the uniformity of component content in the aerosol to some extent. This study helps to provide suggestions for the design and optimization of electrically heated tobacco products.
... 43 This sentiment was later repeated by influential British psychiatrist Michael Russell (who had a history of tobacco industry research funding). 44 After the US Institute of Medicine's 2001 Clearing the Smoke report on harm reduction included a continuum of relative risk, implicitly condoning less harmful tobacco products, 45 the barrier between medically prescribed NRT and the industry's reduced-harm tobacco products became more porous. 46 What is pharmaceuticalisation? ...
Context
Declining smoking prevalence and denormalisation of tobacco in developed countries reduced transnational tobacco company (TTC) profit during 1990s and 2000s. As these companies faced increasingly restrictive policies and lawsuits, they planned to shift their business to socially acceptable reduced-harm products. We describe the internal motivations and strategies to achieve this goal.
Methods
We analysed previously secret tobacco industry documents available through the Truth Tobacco Documents Library. These documents were triangulated with TTCs’ investor and other professional reports, websites and public statements.
Findings
Mimicking pharmaceutical business models, tobacco companies sought to refurbish their image and ensure long-term profitability by creating and selling pharmaceutical-like products as smoking declined. These products included snus, heated tobacco products, e-cigarettes, nicotine gums and inhalers. Tobacco companies created separate divisions to develop and roll out these products, and the majority developed medical research programmes to steer these products through regulatory agencies, seeking certification as reduced-harm or pharmaceutical products. These products were regarded as key to the survival of the tobacco industry in an unfriendly political and social climate.
Conclusions
Pharmaceuticalisation was pursued to perpetuate the profitability of tobacco and nicotine for tobacco companies, not as a sincere search to mitigate the harms of smoking in society. Promotion of new pharmaceuticalised products has split the tobacco control community, with some public health professionals and institutions advocating for the use of ‘clean’ reduced-harm nicotine and tobacco products, essentially carrying out tobacco industry objectives.
... The existence mode and thermal stability of nicotine have a direct impact on its transfer efficiency into smoke. For example, it is reported that nicotine carboxylic acid salts can be transferred to the gas phase via three mechanisms: deprotonation, carboxylic acid anion decomposition, and disproportionation in the lower temperature (Elias and Ling, 2018). Additionally, nicotine salts are more stable, more soluble in water, and less volatile than regular nicotine. ...
Volatile organic chemicals (VOCs) released from e-cigarettes are a special source of air pollutants. In this work, we investigated the VOCs released from six nicotine salts (namely, nicotine benzoate, nicotine tartrate, nicotine citrate, nicotine malate, nicotine lactate, and nicotine levulinate) that are commonly used in e-cigarettes. The pyrolysis-gas chromatography/mass spectrometry (Py-GC/MS) and thermogravimetric methods were used to analyze the thermogravimetric characteristics and product release behavior of different nicotine salts. Moreover, the kinetic models and thermodynamic parameters of nicotine salts during the thermal decomposition process were obtained. Thermogravimetric characteristic parameters of six nicotine salts showed significant differences. By the use of Py-GC/MS, our data showed that the pyrolysis products of nicotine salts were mainly from nicotine, acid anhydrides, carboxylic acids, and N-heterocycles, while more than 90% of the nicotine of citrate, tartrate, and malate was transferred to smoke. The result revealed that activation energies of the nicotine salts range from 21.26 to 74.10 kJ mol⁻¹, indicating that the pyrolysis of the nicotine salts is a non-spontaneous heat absorption process, and the organic acid was the key factor affecting the release of nicotine into the ambient air.
... Public understanding of associated harms is complicated by the diversification of the tobacco-product landscape (21); which challenges "traditional conceptualizations of smoking and non-smoking" (22), and normalizes tobacco use. Recent evidence suggests that tobacco industry language, specifically language relating to heated tobacco products and ENDS, continues to "foster confusion" among consumers (23) and influences the beliefs of both tobacco users and the public about tobacco-related harms (24)(25)(26)(27)(28). The persistence of misleading product-related language is most likely a manifestation of the long term strategy of normalization, which seeks to rebuild credibility to boost sales and profits (10). ...
Influencing public perception is a key way in which all transnational corporations (TNCs) maintain market dominance and political power. Transnational tobacco companies (TTCs) have a long history of leveraging narratives to serve commercial ambitions. The global reach of these companies' narratives has been highlighted as a challenge in combatting public health problems caused by tobacco. The corporate power of TTCs is carefully curated, and their narratives play an important role in the setting of governance dynamics at local, national and transnational levels. This qualitative work explores and compares the language used by British American Tobacco (BAT) and Philip Morris International (PMI) around harm, harm reduction and terms used to refer to newer nicotine and tobacco products, including electronic cigarettes and heated tobacco products. We systematically examine framings used by these two TTCs through company reports published between 2011 and 2021. Qualitative coding was carried out by four coders, according to a protocol developed specifically for this work. We firstly identified the presence of pre-selected keywords and then assigned chunks of text containing those key words to one or more associated frames drawn from Boydstun's policy frames codebook (2013). Qualitative coding identified the most common frames from Boydstun's codebook and thematic analysis highlighted three overarching themes. The most common frames assigned were “capacity and resources”, “health and safety” and “economic” frames. The overarching themes were individualization, normalization, and regulation. These themes capture how both BAT and PMI use particular framings to downplay the role of TTCs in the perpetuation of population- and individual-level harms related to tobacco use. They seek to normalize their role in public discussions of health policy, to cast themselves as instrumental in the redress of tobacco-related inequalities and shift responsibility for the continuation of tobacco-product use onto individual consumers. These tactics are problematic for the effective and impartial development and implementation of local, national and international tobacco control agendas.
... Phillip Morris International (PMI) is spearheading this new "technology." Their new product (I-Quit-Ordinary-Smoking (IQOS) is being marketed to 1 day replace conventional cigarettes (205). Before this product gains traction, studies on its acute and long-term CVD safety are urgently needed. ...
Electronic cigarettes or e-cigarettes are the most frequently used tobacco product among adolescents. Despite the widespread use of e-cigarettes and the known detrimental cardiac consequences of nicotine, the effects of e-cigarettes on the cardiovascular system are not well-known. Several in vitro and in vivo studies delineating the mechanisms of the impact of e-cigarettes on the cardiovascular system have been published. These include mechanisms associated with nicotine or other components of the aerosol or thermal degradation products of e-cigarettes. The increased hyperlipidemia, sympathetic dominance, endothelial dysfunction, DNA damage, and macrophage activation are prominent effects of e-cigarettes. Additionally, oxidative stress and inflammation are unifying mechanisms at many levels of the cardiovascular impairment induced by e-cigarette exposure. This review outlines the contribution of e-cigarettes in the development of cardiovascular diseases and their molecular underpinnings.
... The tobacco industry is a multinational oligopoly with a global reach. It is adaptive, moving from market to market, and continuously exploring new products, such as e-cigarettes 1 and heat-not-burn 2 tobacco systems (Elias & Ling, 2018;Huang et al., 2019). As a result, there is a continuing constellation of health and economic issues attributed to tobacco that represents the most serious global public health problem and the leading cause of preventable death in the world. ...
The promotion of sex- and gender-based analyses (SGBA) is ongoing in health outcomes research. However, challenges exist in the research process with the continuous use of sex and gender concepts interchangeably. There has been increased confusion in the contribution of both sex and gender to population health and health outcomes, leading to missed opportunities for the development of appropriate population health policies and interventions. A review of existing but limited data regarding SGBA was conducted. A case study demonstrating how sex-based analysis has been used in a national HIV survey to inform the response and policy is utilized. The chapter highlights that SGBA is largely missing in research, practice, and policymaking. It is a progressive development in population health as not only is it inclusive of the individuals affected or involved but also is important in addressing the gaps in research, literature, policy, and data. In response to gender inequalities in disease prevention and health promotion, a multi-sectoral policy approach is required. Joint policy commitment is required whereby the establishment of objectives related to gender equity in health, the identification of determinants, and strategic development of contributing determinants affecting health equity, documentation, and dissemination of efficacious gender-sensitive policy that facilitates cross-country and regional learning is essential.
Carbon-heated tobacco products (CHTPs) recently emerged as a type of safer nicotine product. To prevent the discharge of harmful substances, the heating and pyrolysis of tobacco should be precisely controlled. Herein, we investigate the heat transfer mechanism and pyrolysis characteristics of tobacco using computational fluid dynamics (CFD) modeling of a CHTP. In addition, we analyze the yields of volatile species, the thermal stability of the CHTP during pyrolysis, and the optimal combination of holes. We also fabricated a prototype heat source and used the temperature distribution thereof in the CFD modeling. Using one particular hole location, puffing exhibited a significant effect on the temperature distribution of the tobacco plug and the yields of volatile species. Furthermore, in terms of nicotine yield distribution, the air flow rate through this hole was a significant factor. However, an extremely high air flow rate increased the yields of harmful substances by leveling the temperature of the tobacco plug. In the cases investigated, the maximum overall nicotine yield was 81.1%, while nicotine, tar, CO, and other gases were obtained in respective yields of 76%, 75%, 26%, and 63% under the condition minimizing the ratio between the combined yield of harmful substances and the yield of nicotine. To the best of our knowledge, this is the first published CFD study regarding CHTPs and yields valuable insight into their manufacturing parameters.
Introduction:
Heated tobacco products (HTP) have diversified global tobacco markets, and user characteristics remain understudied. This study evaluated sociodemographic characteristics, nicotine-related perceptions and behaviors of current HTP users within a sample of adult (18+ years) nicotine users across four countries.
Methods:
Data were from current smokers or nicotine vaping product (NVP; known as "e-cigarettes") users from Canada, England, the United States and Australia (n=11,421) who participated in the 2018 ITC Four Country Smoking and Vaping Survey. Current (at-least-monthly) HTP users were characterized (n=441), and weighted multivariable logistic regressions examined correlates of HTP use.
Results:
Compared to non-users, current HTP users were younger (mean age: 44.4 vs 31.0 years; p<0.001) and had higher socioeconomic status (p<0.001). A majority of current HTP users used HTPs non-daily (daily: 40.3% vs non-daily: 59.7%). Most HTP users concurrently used both cigarettes and NVPs (90.5%). Among concurrent cigarette-HTP-NVP users, 36.2% used all three products daily. Use of other combusted tobacco products (cigars, cigarillos, pipe, waterpipe/hookah), cannabis, and binge drinking were each associated with current HTP use. HTP use was more common among smokers intending to quit within 6 months or reporting a quit attempt in the past 18 months, and vapers who had experienced negative side effects.
Conclusion:
HTP users in this sample tended to be younger and more affluent. Most reported concurrent use of multiple nicotine products and other substances. Those cigarette smokers who used HTPs appeared more interested in smoking cessation, while some characteristics of concurrent HTP-NVP users were suggestive of dissatisfaction with NVPs.
Implications:
Few studies have scrutinized characteristics of HTP early-adopters in emerging markets. Our results indicate that in 2018, characteristics of established nicotine users who adopted HTP use in four high-income Western countries mirror those of HTP users in East Asian markets (South Korea and Japan) where HTPs are popular. HTP users reported high levels of concurrent use of non-cigarette combusted tobacco products (e.g., cigars, pipe tobacco). These findings point to the need for future longitudinal studies of HTP use given the implications of those use patterns on the harm reduction potential of HTPs. HTP user characteristics may yield important information to consider in regulation of these products.
Tobacco use is the most serious global public health issue and the leading cause of preventable death in the world, killing 7.1 million people per year. One billion people will die of tobacco use in this century. Patterns of tobacco use are gendered, with more men than women using tobacco, and often starting and quitting first. Ending tobacco use is the subject of the world’s first and only public health treaty, the World Health Organization Framework Convention on Tobacco Control, with 168 signatories worldwide. While the tobacco industry has consistently applied a sex- and gender-based analysis to tobacco as a marketing strategy, public health has failed to do so. Feminist writers have critiqued the generic, “one size fits all” public health approach for several decades arguing for more tailored, equitable, and gendered responses. In the face of new e-cigarette products generating dependence among users, the call for a tailored gender-based analysis of smoking behaviours and cessation is even more important and urgent. This chapter discusses the need for sex-, gender-, and diversity-based analysis to be brought to bear on the topic of girls, women, and smoking, the resistance to date by public health and much needed directions going forward.
Background
Tobacco addiction is a complex, multicomponent phenomenon stemming from nicotine’s pharmacology and the user’s biology, psychology, sociology, and environment. After decades of public denial, the tobacco industry now agrees with public health authorities that nicotine is addictive. In 2000, Philip Morris became the first major tobacco company to admit nicotine’s addictiveness. Evolving definitions of addiction have historically affected subsequent policymaking. This article examines how Philip Morris internally conceptualized addiction immediately before and after this announcement.
Methods and findings
We analyzed previously secret, internal Philip Morris documents made available as a result of litigation against the tobacco industry. We compared these documents to public company statements and found that Philip Morris’s move from public denial to public affirmation of nicotine’s addictiveness coincided with pressure on the industry from poor public approval ratings, the Master Settlement Agreement (MSA), the United States government’s filing of the Racketeer Influenced and Corrupt Organizations (RICO) suit, and the Institute of Medicine’s (IoM’s) endorsement of potentially reduced risk products. Philip Morris continued to research the causes of addiction through the 2000s in order to create successful potentially reduced exposure products (PREPs). While Philip Morris’s public statements reinforce the idea that nicotine’s pharmacology principally drives smoking addiction, company scientists framed addiction as the result of interconnected biological, social, psychological, and environmental determinants, with nicotine as but one component. Due to the fragmentary nature of the industry document database, we may have missed relevant information that could have affected our analysis.
Conclusions
Philip Morris’s research suggests that tobacco industry activity influences addiction treatment outcomes. Beyond nicotine’s pharmacology, the industry’s continued aggressive advertising, lobbying, and litigation against effective tobacco control policies promotes various nonpharmacological determinants of addiction. To help tobacco users quit, policy makers should increase attention on the social and environmental dimensions of addiction alongside traditional cessation efforts.
A major theme in the later work of Foucault is the rise of a new form of power over life — bio-power. While the sovereign exercised power over life by commanding ‘the right to take life or let live’, the advent of capitalist society was preceded by a new concern with the productive administration of life, and the power ‘to foster life or disallow it to the point of death’ (Foucault 1990). Bio-power aspires to power over life ‘throughout its unfolding’ and understands death as marking the limit of its dominion. Foucault also saw bio-power as corresponding with a re- spatialization of power. While the generic space of operation for sovereign power is the territory, the equivalent space of bio-power is that of circulation. Due to its overriding concern with fostering life, optimizing it and multiplying it, bio-power favours circulation, but it recognizes the ambiguous and dual nature of productive patterns of exchange and intercourse. The circulation of food may avert famine, but the greater free-flow of people, goods and services also allows for the broader spread of infectious diseases. Thus, bio-power is concerned with ‘organizing circulation, eliminating its dangerous elements, making a division between good and bad circula-tion, and maximizing the good circulation by diminishing the bad’ (Foucault 2007).
The cigarette is the deadliest artifact in the history of human civilization. It is also one of the most beguiling, thanks to more than a century of manipulation at the hands of tobacco industry chemists. In Golden Holocaust, Robert N. Proctor draws on reams of formerly-secret industry documents to explore how the cigarette came to be the most widely-used drug on the planet, with six trillion sticks sold per year. He paints a harrowing picture of tobacco manufacturers conspiring to block the recognition of tobacco-cancer hazards, even as they ensnare legions of scientists and politicians in a web of denial. Proctor tells heretofore untold stories of fraud and subterfuge, and he makes the strongest case to date for a simple yet ambitious remedy: a ban on the manufacture and sale of cigarettes.
Purpose – With reference to the long-term struggle to confirm cigarette smoking as a manifestation of nicotine addiction, this chapter explores the extent to which new understandings of addictions as ‘appetitive disorders’ rather than ‘dependence disorders’ derive from treatment technology development as well as advances in basic scientific research.
Approach – Through historical analysis it is discussed how cigarette smoking only became widely accepted as a real drug problem in the 1980s after it had been shown to be amenable to treatment as such through the use of novel nicotine replacement therapies.
Findings – These replacement therapies succeeded in showing that the same drug that drew users into addiction could be redeployed to help draw up them out of it. Nicorette® could serve as at least the partial antidote to nico-wrong (cigarettes). However, as relapse to smoking has remained the most likely outcome of any smoking cessation attempt, so medicinal nicotine has also served to demonstrate that nicotine addiction is ultimately a problem of an uncontrollable appetite for cigarettes in excess of drug dependence.
Implications – Pharmaceutical incursion on cigarette smoking commencing in the late 1970s pointed to the need for a new mental disease model of drug-related problems while also providing valuable new tools and insights for ensuing brain research.