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Bad news: FCTC will declare war on heat not burn

FCTC

Bad news: FCTC will declare war on heat-not-burn (they just haven’t gotten organized yet.)

by Carl V Phillips, PhD.

The World Health Organization’s Framework Convention on Tobacco Control (WHO’s FCTC) is the most influential tobacco control enterprise in the world. Consumers in rich Western countries may not often notice FCTC’s impact because their dominant domestic tobacco control, such as the FDA in the US, are large and powerful enough to set their own agenda. But even in the West, FCTC’s agenda creates marching orders that a lot of tobacco control organizations follow. Thus, all heat-not-burn consumers should feel some trepidation about FCTC slowly getting organized to attack them. Their next attempt to attack heat not burn will be at the upcoming eighth session of the Conference of the Parties (better known as COP8) taking place in Geneva, Switzerland from 1st to 6th October 2018.

That “slowly” is the good news here. FCTC is a morass cheap-talk meetings, position statements, and bureaucracy (in the pejorative sense of the term). In theory it is an international treaty, but in practice it is a reactionary collection of people who would rather complain and make excuses for their failures than actually do the hard work needed to accomplish their goals.

The bad news is also embedded in that characterization, in “reactionary” and “their goals.” As I previously explored in detail, tobacco control in general, and FCTC in particular, is primarily concerned not about affecting consumers, let alone helping them, but with hurting what they call “the industry.” This mythical monolithic actor includes everyone who sells tobacco products, and if convenient for them, is expanded to include any consumer advocate or anyone else that questions their diktats. FCTC officially claims their goal is improving health, but this simply is not true, as evidenced by their active opposition to promoting the substitution of low-risk products for cigarettes.

They do not even recommend that policy interventions focus on cigarettes and other high-risk products. Instead, they explicitly insist that the same effort be devoted to discouraging all product use, regardless of risk. For example, they explicitly state that tax rates be the same on all products. While this is technically nonsense (what tax rate on a tin of snus or bottle of e-liquid is “the same” as a given tax on a pack of cigarettes?), the spirit of it is a clear lack of concern about health. One of the reasons so many Japanese switched to heat-not-burn is its favorable tax treatment (which might end).

FCTC declares their goals are diametrically opposed to those of industry, and spend as much energy focusing on attacking industry as on all anti-smoking policies combined. In some sense this is good news, because it slows them down a lot. But it makes them entirely reactionary, defining their policies in terms of industry actions: Whatever “the industry” tries to do, FCTC tries to interfere with. This is especially true for the major tobacco companies, which is to say, the companies that have introduced heat-not-burn devices. It does not matter to FCTC that people, not companies, want and use heat-not-burn; in their mind, attacking heat-not-burn use is attacking PMI and BAT. Consumers are an afterthought for them, at best.

One might hope that FCTC’s relative silence suggests they are not entirely opposed to a low-risk product that replaced almost 20% of the smoking in Japan and has made impressive inroads in other countries. But keep in mind that they did not get around to seriously attacking e-cigarettes until the last couple of years. They are slow, not flexible.

Amusingly, some of FCTC’s most emphatic policy recommendations focus on setting up research centers, what someone might call spy agencies, devoted to reporting on industry activities in a particular country or region. FCTC calls this “monitoring,” and the goal is to strangle innovations in their crib and be ready to “respond to myths created by the tobacco industry” (by which they mean “contradict anything said by industry, regardless of whether it is true or not”). The obvious subtext is “we blew it on e-cigarettes, and are only now managing to trick people into believing they are dangerous, so we have to get ahead of the next innovation.”

Of course, they already failed to do that with heat-not-burn. These are not good spy agencies. Their expensive monitoring efforts would have been more effective if they just had on staffer whose job it was to read Twitter.

Still, whatever industry wants to sell, FCTC will want to stop, and they will probably get organized about heat-not-burn over the next year. Their catch-up playbook is easy to predict based on what happened with e-cigarettes. It includes pressuring countries where the products are not yet popular to preemptively ban them, spreading disinformation about risks from the products, and demanding that all anti-cigarette efforts be expanded to cover the new product. Indeed, they will probably push for anti-cigarette efforts to be redirected to focus more on the low-risk product than on smoking.

The only policy area in which the FCTC agenda differentiates among tobacco products is smoking place bans, because the ostensible goal is trying to protect people from environmental smoke (never mind that their policies do not really protect people). They will inevitably lobby governments to include heat-not-burn products in all smoking place bans, even those that do not cover e-cigarettes.

To finish on a more optimistic note, regulators in many rich countries are much friendlier with big corporations than with their smaller competitors. FCTC hates PMI and BAT far more than they hate the independent vapor sector (though they are quite happy to destroy the latter also). US FDA, by contrast, has an institutional preference for dealing with big companies who can navigate the agency’s kafkaesque procedures. They would prefer to eliminate small vapor product companies (and are on a path to do so) and deal only with the majors.

FDA recently approved the sale of BAT’s current Eclipse heat-not-burn products, based on them being “substantially equivalent” to long-extant, though barely noticed, RJR products (as of last year, RJR is a wholly-owned subsidiary of BAT). They did not have to do this, and have denied “substantial equivalence” applications by smaller companies for reasons that could have been used in this case.

On the other hand, FDA is still sitting on PMI’s application to sell iQOS as a “modified risk tobacco product,” a more onerous approval process than “substantial equivalence.” They are already in violation of the legal deadline for responding to the application, and anything could happen. But the Eclipse approvals bode well. Positive outcomes can be expected in rich countries with self-confident regulators (and thus ignore FCTC pressure) who have a cozy relationship with big business. Unfortunately, most of the world’s smokers have little protection from the FCTC.


As passionate as we are about reduced risk products Heat Not Burn UK will campaign strongly for your own personal right to choose when it comes to harm reduction, as we believe the more options out there the better.

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So What’s A Pod Mod?

Pod mod

When I started writing about Heat not Burn I didn’t think it was going to be controversial. Well, I was wrong. The thing is, I’m a vaping advocate and my name isn’t exactly unknown in the e-cigarette debate. As far as I was concerned, HnB was all part of the same concept – a safer alternative to cigarettes that has the potential to save the lives of smokers.

Unfortunately, it seems not all vapers agree. Over the last couple of months there’s been an astonishing string of attacks on HnB by some people who, even if they’re just YouTube reviewers, really should know better.

The actual arguments these people use are silly, with a bit of ignorance sprinkled on top – did you know a Heet was just a cigarette that’s been dipped in PG? I sure didn’t, and I’ve watched them being made. There’s also a lot of conspiracy theory rubbish about how PMI are trying to take over vape shops by asking them if they want to sell iQOS. PMI have enough money that, if they wanted to take over vape shops, there’s a much simpler way to do it – just buy them.

Anyway, after a few conversations, I’ve worked out that what really annoys them is they think HnB is the “wrong” way to use nicotine. Part of that is that it that they use tobacco. It’s amazing how completely some vapers have swallowed the line that tobacco itself is bad, when in fact it’s just the smoke you should avoid. The involvement of the tobacco companies seems to cause a lot of tears, too; some vapers sound scarily like Deborah Arnott of ASH when they get onto the subject of PMI, BAT and all the other companies whose products they were happy enough to buy for decades. Lastly, some of them just seem to be vape snobs. If you’re not getting your nicotine from a boutique liquid, vaporised by hand-built coils powered by the latest high-end mod, you’re no better than a filthy smoker.

Well, I don’t care about any of this. I’m fine with tobacco, I’m too adult to blame the tobacco industry for all the cigarettes I freely chose to buy from them, and I’m not a snob. If someone couldn’t care less about fancy mods and liquids, and just wants a nice simple device they can pick up at Tesco’s tobacco counter, I’m fine with that. And this brings us, finally, to pod mods.

What’s a pod mod?

The first thing I should say about pod mods is that they’re not really mods; the name seems to have stuck to them because it’s sort of snappy and it rhymes. What they really are is the latest incarnation of the old-style cigalikes a lot of us started vaping with. The difference is that while cigalikes were awful, pod mods are actually rather good.

If you’ve already seen a pod mod you’re probably thinking that they don’t actually look very much like cigalikes. You’re right; they don’t. The basic concept is pretty much the same, though. They have a compact battery with an automatic switch, no controls, and the liquid is contained in a disposable cartridge (the pod) that snaps on to one end. There are three main differences, though:

  • Abandoning the cigarette shape lets them pack in a lot more battery capacity while staying slim and compact enough to be held like a cigarette.
  • The coils are a lot more powerful and efficient than a traditional cigalike
  • Using sealed pods, rather than wick-stuffed open cartridges, leaves space for a lot more liquid

So that’s the advantages of a pod mod over cigalikes; how do they compare to the typical devices used by experienced vapers like myself? Well, this is where things get subjective. I like my big, heavy, leaky devices. I spend most of the day at my desk writing articles and blog posts for you, so the fact my mod is stuffed with multiple 18650 batteries and is about the size of a half brick doesn’t bother me at all. All my tanks are a bit dribbly, and my favourite RDTAs tend to dump their entire contents if you tip them too far, but when they’re sitting on my desk that isn’t a problem.

On the other hand, when I actually have to go outside for some reason the e-cig I always reach for is my Vype Pro Tank, which is small, light and never leaks (and it’s sold by a tobacco company, if anyone cares). If I had an even smaller device that was still capable of delivering a decent vape, I’d take that. I’ve actually had some experience of this, thanks to a couple of pod mods I was given to test last year; I wouldn’t use them at home, but for going out and about they’re excellent. Here are some of the leading pod mods:

 

JUUL

JUUL starter kit

The pod mod everybody’s talking about right now (although mostly for the wrong reasons) is the JUUL. This ultra-slim device was only available in the USA and Israel, but it’s now available in the UK and the company, in between arguing with idiots who’re imagining an epidemic of teenage “JUULing”, is planning to roll it out around the rest of the world over the next couple of years.

JUUL is a tiny rectangular device with a USB port at one end, so it can be plugged directly into a laptop to charge. It’s fed on tiny leakproof pods that hold 0.7ml of liquid; the liquid itself is a bit special, and part of the reason for JUUL’s amazing success – it currently makes up 70% of e-cig sales in US convenience stores. Instead of the usual freebase nicotine it contains nicotine salts, which deliver a faster, cigarette-like hit, and it’s also very strong at 5% nicotine (although this has to be cut to 2% for the European market, thanks to the ridiculous EU TPD).

Heat Not Burn UK being all about harm reduction has a sister website that may well start selling the JUUL here  in the UK in the very near future, so watch this space!

MyBlu

MyBlu starter kit

Previously sold as the Von Erl until Fontem Ventures (part of Imperial Tobacco) bought the brand, MyBlu is about the same size as JUUL but has a more rounded shape. It’s also generally more conventional – it uses standard e-liquid at 1.6% concentration.

Mesh

IQOS Mesh

PMI’s Mesh is much larger than the JUUL or MyBlu (so it also has better battery life), but it’s exactly the same concept – you just plug disposable pods onto the end of the battery. I have one of these and it’s very good. It also produces more vapour than the other pod mods, so it might be a better option for anyone who’s used to conventional e-cigs.

iFuse

BAT iFuse

About the same size as the Mesh, BAT’s iFuse is a sort of hybrid – its pods contain a layer of finely shredded tobacco which is supposed to give the vapour a tobacco flavour as it passes through. It’s a great idea, but we’re not sure how well this pod mod actually works.

Pebble

BAT Vype Pebble

BAT’s Pebble is the most unconventional-looking of the pod mods. It’s shaped like the sort of flat stone you’d skip across a pond, and while it looks odd it’s also very comfortable to hold. There’s a nice big battery in there too.

 

So there are already a few pod mods to choose from, but the runaway success of JUUL means we can probably expect to see a lot more options appearing soon, as manufacturers jump on the bandwagon. Overall that’s great news, because pod mods are exactly what a lot of smokers are looking for – a reduced harm option that’s smaller and simpler than a conventional e-cig.

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What growth path can we expect for heat-not-burn in new markets?

Growth

The explosive growth of heat-not-burn products in Japan and Korea, which has taken a huge chunk out of the market for traditional cigarettes, has everyone wondering where else we might see that happen. No one knows the answer for sure, of course, but there are a few patterns that seem fairly safe to predict.

 

Modeling work I did about the uptake of e-cigarettes a few years ago (example) suggests that the uptake of a low-risk tobacco product will have two distinct periods of rapid growth. The first is caused by pent-up demand. Before the product was introduced, there were people who wanted it, though they did not know this yet, of course. As soon as it was introduced, and knowledge about it became widespread, they started buying it. This causes an initial uptick in consumption rather than steady growth along the lines of “X new consumers per week, every week, for a year.”

 

Of course, that increase might not stick. Japan Tobacco introduced an alternative product, Zero Style Mint, in 2010 which was superficially like an e-cigarette or heat-not-burn device. However it basically just consisted of inhaling room-temperature air through a tube past some processed tobacco. This delivered neither enough nicotine nor a sufficiently smoking-like experience to be appealing to smokers. Sales spiked (pent-up demand for an alternative to smoking) and then crashed (almost no one actually liked it). Heat-not-burn has cleared that hurdle. Lots of smokers in Japan and elsewhere really like it.

 

The perfect low-risk substitute for many smokers would be something that was exactly like a cigarette in all ways (aesthetics, appearance and other factors that contribute to cultural acceptability, delivery of nicotine and other psychoactive chemicals, price) except that it posed little health risk, and as a possible added bonus did not make such a mess. Heat-not-burn checks most of those boxes.

 

Of course some smokers actively embrace contrasts with cigarettes, such as the variety of flavors available for e-cigarettes. Some are not be willing to accept any variation on their beloved cigarettes in pursuit of lower risk. But for many, heat-not-burn is close enough (in terms of what they want) and enough lower risk to make that worthwhile.

 

After the initial spike and after the acceptability hurdle is cleared, we can expect a period of slower growth until a particular critical mass of consumers is reached. My modeling was built around the assumption (correct, I still believe) that the “cultural acceptability” hurdle is one of the largest. Someone’s culture, in this case, is a combination of the people who influence him the most (relatives, friends, patrons of the same pubs) and overall popularity in whatever he considers “his” population to be (everyone in the country, people in the region, people in his socioeconomic class). If someone has no friends who use a product and only a tiny portion of the population does, it takes greater determination and confidence for him to make a switch, and he might not even know about the product. If the new product seems just as normal as regular smoking in his culture, acceptability and knowledge are no longer barriers.

 

My modeling suggested that for almost any parameterization (i.e., input assumptions about the distribution of preferences and how people interact) there would come a point when slow growth hit a critical mass. The next few people who switched would be enough to raise the cultural acceptability enough to ensure that even more people quickly switched, and so on. This would feed-forward, creating a rapid rise until most of those who have not switched really do not want to.

 

I did this in the context of e-cigarettes, which had a rather larger cultural acceptability and knowledge hurdle than heat-not-burn. The better early generation products were sufficiently strange and challenging that the pent-up demand spike was modest. The easiest cigarette-like product were not very satisfying, so suffered the Zero Style Mint problem. For almost all smokers, this was not the alternative they were looking for, but just did not have yet. The second phase of growth in those models was much greater, as it seemed to be in real-life where vaping really took hold (particularly England).

 

Heat-not-burn will probably not play out the same way. The first growth phase ought to be a lot bigger for reasons already noted. That, however, means that it will comprise a larger portion of the total potential market, reducing the potential size of the second fast growth phase before everyone who is a good candidate for switching has switched.

 

So, how many is that? And what happens after the second period of rapid growth? Will it be indefinite continuing inroads into the smoking market, or a hard ceiling?

 

That depends. Indeed, that is the answer to every other quantitative question you might be asking here (e.g., How big is each period of high growth? How long between the various phases?) Unfortunately, to answer any of those requires having great precision in model inputs. It is fairly clear that those modeling the market for heat-not-burn have no idea, as evidenced by the irrational spike in PMI’s market capitalization due to the iQOS’s early success in Japan, followed by a crash when investors discovered that the initial growth phase does not continue forever (a bit more about that here).

 

Switching patterns can vary wildly. For example, it took decades before smokers Norway, which shares a great deal of cultural influence with Sweden, started to switch to snus in droves. Why the delay? Snus has been popular and mainstream in Sweden for almost half a century and has long been more popular than smoking. But Norway only saw a major shift a few years ago. Meanwhile, Finland and Denmark, where the influence might acted sooner, were hobbled by the European Union ban on snus (Sweden has an exemption and Norway is not in the EU), which is one of a whole different set of policy variables.

 

Still, it seems safe to draw a few conclusions. Japan was probably the best-case-scenario for pent-up demand for heat-not-burn. Smoking is popular among relatively well-educated and well-off people who are strong candidates for switching. Adding a bit of tech gadgetry to a stick is not exactly going to be seen as odd in such a tech-forward population. Meanwhile, e-cigarettes are banned and snus was always a cultural non-starter. In a population where e-cigarettes have already grown in popularity there is less pent-up demand. Some vapers might switch, of course, but most have settled in to what they do. Thus, we will probably not see as bit an initial growth phase for heat-not-burn sales in new markets.

 

However, it seems likely that there is a much higher ceiling for uptake compared to e-cigarettes, because heat-not-burn better checks all of the boxes. This is not based on any modeling, but rather is the type of observation that is needed as an input into the modeling. It is possible that a large fraction of smokers in some countries could switch over the course of five or ten years.

 

However, both heat-not-burn and e-cigarettes fail to check one of the boxes in most of the world: These tech products are only price competitive because of the high prices for cigarettes in rich countries (which include high taxes, which have usually been lower for low-risk products in markets where they took off). Cigarettes are a simple product whose price reflects the local cost-of-living like food prices do, and the same is true for smokeless tobacco. But high tech imports will have prices that reflect their higher real resource costs and the higher costs of doing business where they are made. Thus, the idea of migrating more than a small fraction of the world’s smokers to heat-not-burn seems like fantasy for the foreseeable future.

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BAT invests a billion dollars in Romanian HnB factory

HnB Factory Romania

There’s been a lot of talk recently from opponents of Heat not Burn – including, regrettably, some of the less intelligent vape reviewers – about how the technology has already peaked. Growth has slowed, they say; fewer smokers are switching to HnB, and the market is already saturated. It’s true that iQOS sales in Japan have slowed over the last quarter, but does this mean the great heated tobacco experiment is fizzling out?

Well, I’m not convinced. Has iQOS reached market saturation in Japan? It might have done. That wouldn’t really be a huge surprise. After all, iQOS is the first generation of HnB that’s really gone mass market. Maybe all the Japanese smokers who feel like switching have done so already, and sales are going to fall back to existing users replacing their devices. This happens when a new product disrupts an existing market.

What’s the good news?

Japan isn’t the only market for HnB, though – not by a long way. iQOS, the most widely available product, is now on sale in most of Europe as well as in Asia, but it hasn’t hit the huge US market yet. It’s still going through FDA approval, but if it gets there (and it probably will) millions more smokers are likely to switch. Then there’s Glo, which so far is only available in selected countries. Maybe KT&G will release their Lil outside South Korea – and I hope they do, because I have one on my desk right now and it’s excellent.

Then, of course, there’s the technology itself to consider. HnB has been around since the 1990s at least, but iQOS, Glo and Lil are the first generation of really effective devices. Compare that with e-cigarettes for a moment. The first really effective, widely available e-cig was probably the JoyeTech eGo. Now compare an eGo with today’s entry-level devices. There’s a bit of a difference, isn’t there? Well, iQOS and Glo are the eGo of heated tobacco.

Philip Morris, British American Tobacco, Japan Tobacco International and others are all working to improve and refine the technology that’s gone into their existing HnB systems. Over the next few years we can expect to see improved versions appearing – devices that will be even easier to use, come even closer to the experience of smoking a cigarette, and reduce the harm even more. A lot of smokers who weren’t quite convinced by the first generation of products will decide to switch once something even better is on the market.

Again, this is exactly what we saw with vaping. I found my first e-cig on a market stall in Kabul. It was an old-style three piece cigalike, and it was bloody awful. There was no way a device like that was going to replace my smoking habit, which seeing as 200 Marlboro cost a whole $10 in the PX was pretty heavy. On the other hand it did work just fine to keep nicotine deprivation at bay on my regular seven-hour flights home, so it was enough to keep e-cigs in my mind. Later, when I decided I really had to quit smoking, I found an eGo-C kit and that was actually good enough to do the job. What I’m using now, of course, blows an eGo – or a Marlboro, for that matter – right out of the water.

Growth to come

Anyway, I don’t think the market for Heat not Burn products has peaked, or even come close to its full potential. And, it seems, neither do British American Tobacco. I can say that pretty confidently, because BAT have just announced that they plan to spend a billion dollars upgrading one of their factories and turning it into their European centre for HnB manufacturing.

Romania was the first European market for Glo – and also an early one for iQOS – and BAT already have an established manufacturing capability there. The company’s market share in Romania is around 55%, and to support that they have a large factory at Ploiești. This is the factory that’s going to benefit from that billion-dollar investment over the next five years.

BAT’s plan is to roll Glo out across more European countries in the second half of this year, and to do that they need a reliable supply of Neostiks – ideally a supply that doesn’t involve shipping them from Asia. The plan is for Ploiești to become the sole European manufacturing and supply centre for Neostiks. The plant already supplies the European market with pods for the iFuse hybrid device, so it looks set to become a major centre for BAT’s reduced-harm products.

A bright future

If BAT weren’t anticipating strong sales of Glo in Europe, they’d be very unlikely to spend €800,000,000 on the infrastructure to support those sales. Clearly they’re confident, and I think they’re right to be. Glo will suit a lot of smokers who just didn’t get on with iQOS. Personally I think iQOS comes closer to the taste and sensation of a cigarette, but that has to be balanced against Glo’s huge battery capacity. Both devices have their strong points and I think Glo is going to do well as it hits new markets.

I’m not the only one who thinks that, either. The Times made BAT last week’s Share of the Week, citing the company’s investment in reduced harm products as a likely source of future growth. PMI might have seen their profit growth slow along with iQOS sales in Japan, but investors can obviously see a big market waiting to be tapped into.

Meanwhile, BAT’s Ploiești factory is going to get an extra 7,000 square metres of manufacturing space and plans to take on an extra 200 people to work on the new production line. PMI are also expanding in Romania, spending over $500 million to convert a cigarette factory near Bucharest into a HEET factory. I don’t expect these to be the last HnB projects launched in Europe.

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There’s a new HnB study – and you should ignore it

new HnB study

I’ve been involved in e-cig advocacy for years, so I’ve seen some truly awful studies. It takes a lot to surprise me these days because I’ve seen it all: Badly conducted experiments, tortured statistics, misrepresented data and straight-out bad science. It isn’t often I find myself shaking my head at just how crap something is, but step forward anyway South Korea’s Ministry of Food and Drug Safety, because you’ve achieved it.

After Japan, South Korea is one of the biggest markets in the world for Heat not Burn products. For South Koreans, conventional vaping is just a niche hobby; if you want to quit smoking you go with HnB. The country is also one of the most varied markets. As well as the now-familiar iQOS and BAT’s newer Glo, there’s an indigenous competitor, too – the Lil from Korean Tobacco and Ginseng. We’re still waiting for KT&G to send us a Lil, by the way, but when they do you’ll be the first to know what it’s like.

UPDATE: We now have the Lil! Read our detailed review of it here.

Anyway, lots of South Koreans like HnB. All three products are selling well despite recent tax rises on the tobacco sticks for them, and smokers seem to be switching in pretty large numbers. So, as you’d expect, people who make a living telling smokers to quit are getting annoyed that the tobacco industry is doing their job better than they can.

So the knives are out for HnB in South Korea, and the Ministry of Food and Drugs just decided to have another go. This time their weapon of choice is an “independent” report by a group of Korean researchers that claims HnB isn’t less dangerous than smoking. At this point I’m going to stick in a disclaimer and say that there’s no formal evidence that it is less dangerous than smoking. That’s going to take decades of research and data collection, and with the products being so new we obviously don’t have that yet. What we do know is that, according to absolutely everything we understand about toxicology, it would be very surprising indeed if they weren’t significantly safer.

The shocking details

So what does this report say? Well, nothing good. It’s basically a toxicological analysis of the sticks for all three of the devices on the market. The media aren’t reporting any details of the study – such as the methods it used or even who conducted it – so there’s no way to tell what sort of science is behind this, but going by the results it’s extremely poor.

The headline conclusion is that HnB is no safer than smoking because it has nasty chemicals in it. This is in fact true; HnB sticks – and the vapour they produce – do have nasty chemicals in them. The problem is that, while true, this isn’t actually very informative. As any toxicologist will happily tell you, almost everything has nasty chemicals in it. If the mere presence of nasty chemicals was actually a problem, none of us would live long enough to be born.

What matters is how much of those chemicals is present. This is often expressed as “The dose makes the poison,” and it isn’t exactly a radical new concept that the “independent researchers” weren’t aware of yet – it goes back to Paracelsus, and he died in 1541. Some public health activists might claim there’s “no safe level” of whatever they’re attacking this week – second-hand smoke, alcohol, sugar – but they’re talking rubbish. The fact is that there’s a safe level of anything – arsenic, cyanide, even plutonium. That safe level might be extremely low, but it does exist. No matter how toxic or carcinogenic something is, there’s a level below which it just isn’t going to do you any harm.

Obviously, if it’s above that level there is potential for harm, but it isn’t a simple harm/no harm binary. If you swallow slightly above the safe level of arsenic you might feel a bit ill, but you’re not going to die. Similarly, if you inhale slightly above the safe level of some of the chemicals in cigarette smoke your risk of some cancers may rise slightly, but it’s not going to skyrocket like it would if you were firing up 20 Bensons every day.

And the authors of this shoddy study totally ignore that fact. They accurately picked up on the fact that HnB tobacco contains some of the same carcinogens as any other tobacco, but they totally ignored the relative concentrations in the vapour – and that is the only thing that matters. If they’d done their job properly they would have analysed the relative quantities and estimated a relative risk for that; instead they just found some nasty stuff and said “Yep, just as bad!” Sorry, but there’s no excuse for that – and their own data blows their argument to bits.

According to the report, analysis of HnB tobacco sticks found that they contained “up to five” human carcinogens. Just to put that into perspective, cigarette smoke contains at least 33 and even a humble carrot has over a dozen. If this report shows anything it’s that using an HnB device is, at least in terms of cancer risks, about as dangerous as eating salad.

Grasping at straws

The team also looked at two other components of both smoke and vapour – nicotine and tar. This is where they really lost contact with reality. They claimed that two of the products they tested produced more tar than an actual cigarette. This is where I would really like to know how they carried out the experiment, because in normal use there is just no way this is true. Tar is a mixture of combustion products, produced when tobacco burns – and HnB devices don’t burn the tobacco. It’s easy to see this by comparing the filters of a used Heet and a smoked cigarette; it’s tar that turns cigarette filters brown.

As for nicotine, their complaint about that was that all three products contained as much nicotine as a cigarette. Yes, they do. They’re supposed to, because if they don’t the devices won’t do what they’re supposed to do – give smokers an acceptable alternative to cigarettes. Any alternative to smoking depends on delivering enough nicotine that smokers are satisfied and don’t reach for a cigarette to deal with their cravings. Basically, the study is criticising HnB for being fit for purpose.

So does this study raise serious concerns about the risks of heated tobacco? Well, I think you can already guess what I’m going to say about that, can’t you? No, of course it doesn’t. It’s picking up on something that we already knew – that HnB vapour does contain some carcinogenic substances, although fewer of them and at lower levels than smoke does. It’s a reduced harm product, after all. The whole point is that, even if the harm isn’t totally eliminated, it’s much lower than continuing to smoke. That’s what basic toxicology tells us – and any study that conflicts with basic principles of science is wrong.

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Heat not Burn news roundup – May 2018

heat not burn news

As you’ve probably guessed, the team at Heat not Burn UK take a keen interest in anything related to heated tobacco products, so we’re always watching the news to see if anyone’s saying anything we think you should know about. Sometimes we find a big story, and we’ll always let you know about that right away. Other times we just feel like giving you an update on what’s happening.

This week we couldn’t find any big stories to tell you about, so we’ve put together a few of the more interesting smaller ones. We think this is a good way to stay up to date on what’s happening, as well as warning of any threats that might be approaching. We can take it for granted that there will be threats; any vaper knows how vindictive the tobacco control industry can be. This week we’ve picked up one story about health warnings on HnB products, for example.

It’s not all bad news though. There’s some more good news in New Zealand’s bizarre iQOS court case, plus a study from Russia that looks very positive on the health front. Interesting times certainly lie ahead for HnB, but right now we’re feeling pretty optimistic about it all.

 

New Zealand gives up on Heet ban

One of the most positive HnB stories in April was the defeat of the New Zealand health ministry’s legal bid to ban Heets. Last May the ministry, for some bizarre reason, launched a court case against Philip Morris; their argument was that Heets fell under New Zealand’s ban on chewing tobacco, although they’re not actually supposed to be chewed.

It’s not clear why the ministry decided to do this; the case was brought under a 1990 law banning any tobacco product “described as suitable for chewing or any oral use other than smoking”. The law was specifically aimed at chewing tobacco, which carries a risk of oral cancer and sparked a series of health scares in the late 1980s and early 90s; no product like Heets was on the market at the time. However, the ministry came up with an eccentric interpretation of the law that would have banned Heets.

Luckily, Wellington District Court disagreed and threw the case out. They weren’t subtle about it either – the court basically told the ministry that what they were doing was the opposite of what the law was supposed to achieve. Of course, the ministry still had the option of appealing to a higher court.

This week’s good news is that they’ve decided not to do that. It seems that they’ve realised just how weak their legal position was, and backed down rather than face another defeat. This means Heets will stay legal in New Zealand, which is good news for the country’s smokers.

 

South Korea does something silly

South Korea has played a big part in the growth of HnB – after Japan, it’s one of the countries that has adopted the technology most enthusiastically, and BAT chose it as an early test market for their Glo. There’s also at least one indigenous Korean product, KT&G’s Lil /which we’re trying to get a hold of for a review). So at first glance it’s all looking pretty positive – but there seem to be political problems on the horizon.

Seoul’s Ministry of Health and Welfare has just announced that, from now on, HnB products will have to carry graphic health warnings in the packaging. These are the gory pictures that many countries already require on cigarette packets; now South Korea wants them on reduced-harm products too.

In fact graphic warnings were already required in South Korea, but some activists have complained that the image – a needle, representing drug addiction – was unclear. The new ones will show tumours. The ministry’s aim, unfortunately is to spread the message that HnB isn’t safer than smoking – despite all the evidence showing that it is.

 

PMI credits iQOS for growth

Philip Morris International announced a 9,4% revenue growth for 2017, and said this was down to demand for their iQOS device and the Heets it uses. According to CEO André Calantzopoulos the company’s HnB sales are projected to double in 2018. This is a positive sign for PMI’s ambition to establish itself as a leader in HnB, and gain an advantage over its competitors.

There are no guarantees,, though, and PMI shares fell by 17.5% in April following disappointing iQOS sales figures. Some people have interpreted this as a sign that the HnB bubble is already deflating: others aren’t so sure. So far Japan has accounted for the bulk of iQOS sales, and it’s possible that market is saturated for now – most of the smokers who want to switch could already have done so. If that’s the case there’s still a lot of potential for iQOS to sell well in other countries.

 

Science stacks up

HnB hasn’t been studied anywhere near as much as either vaping or smoking, but evidence of its safety is starting to build up. Anti-nicotine activists attacked the first studies because, although they were carried out by independent labs, they were funded by tobacco companies – a classic case of playing the man, not the ball. However, now there’s a new study that can’t be dismissed so easily.

Many governments are interested in the health risks of new tobacco products, and Russia is no exception. A few months ago Moscow seems to have asked a group of researchers to investigate, and their paper was released on the 7th of May. The results make encouraging reading.

The Russian team, from Kazan University, tested the urine of smokers, HnB users and never-smokers. What they found was that, in every case, levels of various toxins in the HnB users were comparable to what they found in the non-smokers – and much lower than in smokers. At the same time they found similar nicotine levels between HnB users and smokers. This backs up the existing evidence that HnB is an effective way of using nicotine that also eliminates most of the risks of smoking.

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Public health, e-cigs and heat not burn. Why all the hatred?

Public health

Keep smoking we need the money.

We have been monitoring the entire public health movement since 2015 and we have decided to impart our thoughts on what we think about the cult of public health.

Firstly it is fairly obvious that public health stop-smoking groups do not want people to stop smoking, because if everyone stopped smoking they would all be out of a job. But it is much more complex than that. Public health have to be *seen* actively trying to get people to stop smoking so that they can continue to get rewarded with enormous grants, usual funded by public money.

Until e-cigarettes came along the options on the market were truly dire, it mainly consisted of patches, gums and tablets. The patches and gums were truly woeful with around a 6% success rate. The tablets were more successful but had some shocking side effects including suicidal thoughts, leading to some people actually committing suicide. The classic scenario was the old “quit, relapse, quit, relapse” cycle with the patches and gums, people would try to quit using them then fail and go back to smoking for a while, then try again and fail again with the patches and gums, and so the dreadful cycle continued. Public health groups like the UK’s ASH (Action on Smoking and Health) wasted millions of pounds of public money for nothing, the smoking rate remained stubborn and refused to move…..then along came e-cigarettes and much more recently heat not burn.

By crikey these work!

The main reason that e-cigs and HnB work is because they both mimic the action of smoking perfectly, this is the reason they have been phenomenally successful, to be honest they are both brilliant inventions and in just a few short years we have seen the smoking rate start to fall after years of flat-lining. The smoking ban of 2007 we were told would vastly reduce the smoking rates, the smoking rate barely moved in the UK the preceding years. All the smoking ban did was shut down thousands of pubs and bingo halls, decimating communities and pit smokers against non-smokers, and generally make smokers feel like social pariahs.

E-cigs and heat not burn have really put the cat among the pigeons for the public health racket though, in the case of e-cigarettes it has basically been a grass roots movement and thousands have managed to quit smoking without any help from either the government or public health. It hasn’t cost the government a penny either, people are actually buying the equipment out of THEIR OWN MONEY. Even though they can get a prescription for traditional NRT such as the patches and gums for free, they don’t bother, they actually pay for e-cigarettes and heat not burn devices out of their own money. How can that be? Are these people crazy? They’re not crazy at all, the reason they are paying for e-cigarettes and heat not burn devices is because THEY WORK. It really is as simple as that. Not everyone will get on with e-cigs, some prefer the actual taste of the smoke that they’re used to and that is where heat not burn comes in. That is why there is a market for both e-cigarettes and heat not burn devices and why both will thrive despite all the fake news and cherry picked studies.

“Not enough evidence”/”We don’t know what’s in them” etc. etc.

So, back to public health, what do they do about these new modern devices? At first there was a kind of twitchy knee-jerk reaction and they immediately condemned them, seeing the possibility of hundreds of thousands of pounds of grant money going down the drain. It would have been a massive shock to them to see e-cigs doing what their NRT had manifestly failed to do for years (decades?) and that was to get people to actually stop smoking. First of all there was the old “we need more evidence” line, naturally as each year goes by with nobody dropping dead from vaping that argument weakens pretty quickly. You will still hear some of the more crazy people in public health trotting that line out in 2018 even though some early adopters have been vaping now for over 10 years. Another classic line trotted out is the famous “we don’t know what’s in them” with regards to the e-liquid, even though all e-liquid bottles are now required to list the ingredients.

The manufactured diacetyl scare.

They absolutely love to mention the study that found some diacetyl in certain e-liquids even though most e-liquids have completely removed diacetyl from their e-liquids and the amount of diacetyl found in the e-liquid was FAR LOWER than the diacetyl levels found in traditional cigarettes. These crackpots will clutch onto any straw that they can find. Diacetyl is thought to be responsible for a disease called “popcorn lung” a disease that popcorn factory workers used to get from years of breathing in the dust of this flavouring agent. It is also worth noting that there have been no cases of popcorn lung directly attributed to regular cigarette smokers, let alone vapers. This was another manufactured scare story bought to you by people that absolutely hate e-cigarettes.

Among many reasons that public health hate e-cigarettes is because public health didn’t invent them, if public health did invent them then they would be the best thing since sliced bread. The same goes for heat not burn, but heat not burn is even worse because they are primarily an invention of those EVIL BIG TOBACCO COMPANY BASTARDS.

Now we are seeing some public health orgs actually getting behind vaping, there’s a good chance that they are doing this so that they can take some credit for the drop in the smoking rate in the last couple of years. It’s very cheeky and dishonest but that’s what modern day public health do. They will do anything and everything that is required to keep the grant money rolling in.

How’s that MSA looking?

We have primarily been talking about UK public health organisations but over in the USA the rise of e-cigarettes and heat not burn are even more acute. There is something called the Tobacco Master Settlement Agreement (MSA) where tobacco companies have done a deal with individual US states. It’s basically a massive bribe whereby the state allows tobacco products to be sold so long as the tobacco companies pay that particular state vast amounts of money. Now e-cigs and heat not burn are starting to affect the MSA future projections because the payments are calculated in advance on projected cigarette sales, the more people that stop smoking traditional cigarettes the worse it is for those cosy MSA deals. This is why e-cigs are under constant attack in the USA including a de-facto ban by 2022 unless things change markedly. Heat Not Burn is currently going through a similar struggle, this is all part of the plan. Basically the “wrong” people are making money out of e-cigarettes and heat not burn.

There are going to be some massive battles ahead that much we can be sure of, but at the end of the day it always boils down to one thing and one thing only: money.

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Wikipedia – encyclopaedic or idiotic?

Wikipedia

Everyone’s familiar with Wikipedia – “the encyclopedia that anyone can edit”. It sounds like a great idea, doesn’t it? A vast, sprawling reference work that everyone in the world can add their knowledge to, with administrators and fact-checking mechanisms to make sure nobody’s contaminating it with nonsense. In theory at least, it should end up containing all the open-source information in the world and be constantly checked for accuracy by thousands of dedicated users.

The trouble is that’s not exactly how it works. If the topic of an article isn’t controversial, Wikipedia is generally pretty reliable. Apart from the odd intentional vandalism or clumsy editing by a well-meaning newcomer, both of which usually get removed pretty quickly, articles about places, objects or anything else straightforward tend to be accurate and informative. I do research every day and I regularly use Wikipedia; the articles themselves give a good overview, and there’s a handy list of references at the bottom so you can dig deeper and verify facts.

Where it gets complicated is when you start dealing with any subject that’s at all controversial. That’s when special interests slither out of the woodwork, whether it’s creationists, IRA supporters or political extremists, and start gaming Wikipedia’s tortuous rules to push their point of view.

The whole idea of Wikipedia is that everyone can edit, but in practice that’s not how it works. Apart from a few basic principles the rules for resolving disagreements are made by committee, and we all know the sort of person who likes to join unpaid committees. Unsurprisingly there’s now a mass of rules, guidelines, essays and procedures that would take a lifetime to read, so of course nobody reads them. That means nobody understands them except a hard core of dedicated fanatics, and this brings us neatly to the subject of tobacco harm reduction.

Meet the Medics

I used to be a pretty active Wikipedia editor, until I got banned a couple of years ago. Officially I got banned because I was paid to edit an article, but this isn’t actually against Wikipedia’s rules. The real reason was that I upset the key people in Wikiproject Medicine, a group that’s supposedly responsible for ensuring the accuracy of medical articles on Wikipedia. Because e-cigarettes can potentially have an impact on health, WikiMed has ruled that any articles on them have to obey the stringent rules they’ve created for medical content, and who gets to decide whether they obey those rules or not? Wikiproject Medicine, of course!

This is where the problems begin, because all the leading figures in WikiMed are fanatical opponents of tobacco harm reduction. The project is led by “Doc James” – Dr James Heilman – a socially inept GP from the wilds of rural Canada. Heilman is notable for his poor grasp of logic, even poorer grasp of the English language and a stubborn inability to admit that he might ever be wrong about anything. We’re talking about a guy who thought “A cup of coffee is drug” was a winning argument. Heilman is a complete idiot.

And, like any complete idiot who finds himself in charge of a committee, he’s assembled a collection of even worse idiots to help him out. There’s a Norwegian medical student who can’t spell “cigarette” – I am not making this up – and a few other people who’ve only escaped having personality disorders because they don’t have personalities. However the worst of the lot, by a long way, is the individual known as QuackGuru.

I don’t know what, if any, medical expertise QuackGuru has. He seems to have started on Wikipedia as an opponent of “alternative medicines,” an objective that I’m fine with, but somewhere along the way he became Doc James’s most devoted follower and, just to round off his uselessness, an anti-vaping zealot. On top of that he’s terrible at actually editing. His logic and English are both even worse than Heilman’s, and he has a maddening habit of just repeating the same obviously wrong statements over and over again. He also violates Wikipedia’s rules with monotonous regularity, and although he does get the occasional short suspension – usually just from specific topics – Heilman’s influence has protected him from the permanent ban he richly deserves.

A couple of years ago, until I was banned, I and a few others fought a long battle against the WikiMed clique to try to add some semblance of reality to the article on electronic cigarettes. This is unrelentingly negative; at one point a single paper by notorious Californian aircraft mechanic Stanton Glantz was referenced more than all the other sources put together. QuackGuru was a major source of the problems on the page, blindly applying simplistic definitions of Wiki rules to exclude any references that were positive about vaping. In the end even Heilman couldn’t protect him anymore, and he was banned from editing the page for a few months, but by that time most of the pro-vaping editors had been banned or given up in disgust.

Now it’s all happening again at the Heat not Burn page. Nobody in their right mind would say that an iQOS is a medical device, but WikiMed have claimed authority over it on the basis that it can have health effects. Well, so can a bunch of other things WikiMed doesn’t bother with – guns, for example, or cars. Both of these kill a lot more people every year than HnB ever will, but for some reason they’re not seen as medical subjects. Vaping and HnB are still just about niche enough that Heilman and his little bunch of cranks can take over, though, and that’s exactly what they’ve done.

Looking at the edit history for the HnB page, two names dominate the list – Doc James and, even more so, QuackGuru. For example, on 2 February there were eight edits made to the page; one by Doc James, one by a bot and six by Quack. Out of the last 50 edits, Quack as made 21 – often in rapid strings of minor edits, aimed at correcting the one before but actually making things worse with every attempt.

The Idiots’ Playground

About the only good thing about Quack’s atrocious sentence structure is that it obscures some of the terrible information in the article itself. The lead section says “There is no reliable evidence that (HnB) products are any less harmful than other cigarettes,” so I was already boiling with rage by the second line of the article – because HnB products are not cigarettes (got that yet, Vic?).

The first section in the body of the article is called “Health Effects”, and in the best WikiMed tradition it starts with an ad hominem smear attack on anyone who disagrees with Doc James – “Claims of lowered risk or health benefits for heat-not-burn tobacco products are based on industry-funded research”. Well so what? Why does it matter who funded the research? What matters is that it’s been peer-reviewed (it has) and the experimental methods and analysis have been found to be reliable (they are). Every medicine on the shelf at your local chemist’s was certified as safe thanks to “industry-funded research”, but you never hear anyone complaining about that.

Moving on, another of Quack’s trademarks starts to show up – his touching belief that “a scientist stated” is the same thing as evidence. It doesn’t matter what some Spanish doctor believes; what matters is what the research shows, and all the research on Heat not Burn shows that users are exposed to vastly lower levels of toxic substances. The first rule of toxicology is “the dose makes the poison”, so reduced exposure to toxins means less risk of harm.

The final section is titled “Regulation”, but as there are few regulations in place for HnB yet WikiMed have padded it with quotes from anti-harm reduction extremists. They even shoehorned in Stan Glantz’s lunatic suggestion that safer tobacco products be banned until tobacco companies stopped selling actual cigarettes. It seems none of these idiots have learned the lessons of Prohibition and what happens when you ban something a significant percentage of your population enjoys. As for Glantz himself, the suggestion that the safer products should be banned has to raise serious questions about his mental health.

 

Wikipedia can be a great resource, but it’s also a flawed one. The way it’s run creates immense problems for anyone who disagrees with the self-appointed cliques that dominate many areas of the site. Unfortunately tobacco harm reduction is one of those areas, so the world’s most popular encyclopaedia is also one of its most dangerous sources of anti-THR propaganda.