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Heat not Burn “as bad as smoking” says study – but what’s the truth?

And so it begins. A new paper presented to the American Heart Association claims that Heat not Burn products harm blood vessel function in the same way as smoking. No doubt there are a dozen other studies underway right now that will soon produce papers linking HnB to heart attacks, lung disease and various cancers. Carefully tailored press releases, all including some form of the phrase “as bad as smoking”, will be leaked to sympathetic journalists. Public health activists don’t even need to go looking for friendly hacks; they can just get in touch with the ones who wrote negative articles about e-cigarettes.

If I sound cynical about the new paper, it’s because I am. I switched from smoking to vaping five years ago, just in time to see the tobacco control industry gearing up its campaign against e-cigs. I have to confess that, at the time, I watched it unfold with total incredulity. Here was a product that got smokers to stop smoking, but the activists and scientists who’re always demanding new action to stop smokers from smoking were opposed to it! What the hell was going on?

Well, five years later, I know what’s going on. The tobacco control industry is, in big-picture terms, split between two main factions – and neither of them is really interested in helping smokers to quit. One faction is motivated by a blind, unreasoning hatred of the tobacco companies; if Philip Morris invented a cure for cancer tomorrow, this group would try to have it banned.

The other faction is no fan of the tobacco companies either, but it has different priorities. Its goal isn’t to stop smokers from smoking; it’s to campaign to stop smokers from smoking. Obviously, if all the smokers become vapers or Heat not Burn users, there won’t be any smoking to campaign against – and that means they’ll have to find new jobs, which might involve some actual hard work rather than just being handed taxpayers’ money to complain about things.

Tinfoil hat time?

Claiming that public health campaigners are more worried about their jobs than public health sounds a bit paranoid, but what’s happening in the UK right now tends to back it up. Local councils who’re trying to save money are starting to take a good look at the stop smoking services they fund – and it appears that some of them don’t like what they see. Several services, including Smokefree South West, have had their council funding stopped, and for nanny state groups that’s usually a death blow. Nobody actually wants to give them money, so if the tax tap is turned off that’s the end of them. Smokefree Southwest announced its closure within 24 hours of being defunded.

The reason councils are starting to defund anti-smoking groups is that it’s obvious they aren’t doing anything. Most councillors aren’t daft; they see smokers switching to e-cigs by the thousand, and the UK’s smoking rate falling faster than ever before. Then they see so-called “public health” groups demanding that e-cigs are taxed, restricted and banned out of existence. Finally it occurs to them that not only are these groups not doing anything to reduce smoking; they’re actively campaigning against products that are. So they pull the plug, and another dozen tobacco controllers are forced to get a proper job.

And all this is happening because of e-cigs. Just imagine what’s going to happen when HnB goes mainstream. Personally, I wouldn’t be surprised if a decade from now the UK’s smoking rate has fallen from its current 16% to around 5%. If that happens a lot more tobacco control funding is going to evaporate, which is why all the usual suspects are already moving to condemn HnB.

What does the science say?

Anyway, back to the paper. What exactly is it saying, and should we take it seriously? The short answer is “Not much and no.” That isn’t very informative, though, so let’s look at it in slightly more detail.

The paper was written by the tobacco research department at the University of California, San Francisco. If you follow the vaping debate that’s probably ringing alarm bells already, because who runs UCSF’s tobacco research department? Yep, it’s Stanton Glantz, the failed aircraft engineer who’s managed to get a job as a professor of medicine despite never having studied medicine in his life. The reality is that Glantz is an activist, not an academic, and this department is shaped in his image: Before they even start doing any research, they know exactly what results they plan to get.

What they wanted to find here was evidence that HnB is just as bad for you as smoking. Now, this is obviously a ridiculous idea. Probably the most harmful single ingredient in cigarette smoke is carbon monoxide, which is produced by combustion, and HnB doesn’t involve combustion.

What they actually mean is that one specific effect of HnB is the same as an effect of smoking. That is obviously not the same thing as saying that using HnB is as bad for you as smoking is. In this case they’re talking about something that isn’t really bad for you at all.

The paper claims that using a HnB product – specifically, iQOS – has the same effect on “Flow-Mediated Dilation”, a way of measuring the efficiency of blood vessels, as smoking a cigarette. In general terms this is true; it’s likely (not certain, but we’ll come back to that) that iQOS will cause a similar short-term effect on blood vessels to a cigarette. Where it all comes unstuck is that the authors go on to say that HnB “does not necessarily avoid the adverse cardiovascular effects of smoking cigarettes”. That statement is a massive problem.

Smoking cigarettes is really bad for your heart. Smoking cigarettes also causes short-term stiffness in your arteries every time you light up and take a puff. But these two facts are not connected. It isn’t the short-term stiffness that makes cigarettes bad for your heart; it’s the couple of hundred daily doses of carbon monoxide, which causes long-term stiffness and the build-up of arterial plaque. Many other things also cause short-term stiffness – caffeine, watching scary movies and exercise are among them. It doesn’t matter, though, because it only lasts a few minutes. Smoking is dangerous because it makes your arteries stiffer all the time, plus promote the build-up of plaque which slowly blocks them. iQOS, being free of carbon monoxide, doesn’t do this.

So what’s really going on with this paper? Leading e-cig expert and cardiologist Dr Konstantinos Farsalinos has the answer, as already reported on this site. According to the UCSF paper, the iQOS delivered 4.5 times as much nicotine to the test subjects (who, it should be pointed out, weren’t people – they were mice) as a cigarette did. As nicotine is known to cause temporary stiffening, that would certainly explain the effect. It would also suggest that it’s nothing to worry about. After all, licensed nicotine products like patches and gum cause an identical effect, and they’re sold over the counter and approved for long-term use.

If we take its data at face value, this paper shows that HnB has the same effect on blood vessels as a nicotine patch, which is regarded as very safe – in other words, there’s nothing to worry about. In fact, what the data show is that the researchers have made a very serious mistake somewhere. According to them, iQOS delivers about 350% more nicotine than a cigarette does – but three independent studies all agree that it delivers about 30% less nicotine. As Dr Farsalinos points out, it is impossible for iQOS to deliver that much nicotine. Therefore the UCSF team have screwed up somewhere, and if they’re working on terminally flawed data, that the whole paper can safely be ignored.

Unfortunately, while this one might be (it doesn’t seem to have gained much traction outside crank medical websites), as HnB becomes more popular we can expect to see more “research” being done and negative stories starting to appear in the press. It’s likely that all the smear stories that have been aimed at e-cigs will be recycled to attack HnB too. If you doubt that, consider this: Just two months ago, a paper from Sweden claimed that e-cigs have the same effect on arterial stiffness as smoking does. Sound familiar?

Heat not Burn is going to get exactly the same treatment as vaping did; I guarantee it. In fact, if anything it will be worse, because the leading HnB products actually are made by the dreaded tobacco companies. Vapers couldn’t really believe what was happening at first, and lost a lot of ground to bad science and scaremongering media before advocates started fighting back. If you’re a fan of HnB, don’t make the same mistakes; start pushing back now.

 

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Will heat not Burn make Britain smoke free?

Ever since the first Heat not Burn devices appeared, they’ve been controversial. Most of that controversy has come from politicians and the public health industry, who seem to have hated the technology right from the beginning. If you’re a vaper their complaints will be pretty familiar; HnB users haven’t really quit, they’re still addicted to nicotine, it’s just a different kind of cigarette, it’s all a Big Tobacco plot to get children hooked… you know the sort of thing. It’s all hyped up, it’s all alarmist – and it’s all untrue.

What is true? It’s true that Heat not Burn has the potential to make smoking go away. Public health say they want this to happen, but over the past few years they’ve been very hostile to any new alternatives to smoking. The cynical might think they’re more worried about protecting their jobs than helping smokers find safer alternatives.

This might explain why all the targets set by the traditional anti-smoking lobby are slightly unambitious. Currently the British government’s tobacco control plan – largely written by taxpayer-funded activists like ASH – aims to create a “smoke free generation” by reducing the smoking rate to 5% (it’s currently around 16%). Obviously a 5% smoking rate isn’t “smoke free” in any way that resembles reality, because 5% of the UK population is actually quite a lot of people, but that’s their target. According to the trend in smoking rates over the last few years, that target should be achieved around 2040.

Now that figure is being challenged from an unexpected source. A couple of weeks ago Philip Morris released a report produced for them by Frontier Economics, an analysis consultant. Frontier have looked at the data on smoking rates in the UK, examined the current trends and what’s driving them, and come to an interesting conclusion.

The government might think that they can achieve their 5% target by 2040, but Frontier and PMI are saying that, in fact, they could get there much sooner – by 2029, just twelve years from now. It might seem surprising to hear a tobacco company advocating a faster decline in smoking, but in fact PMI have been saying this for a while now. When I visited their research centre at the Cube back in April they were very open about the fact that they plan to move away from cigarettes as fast as possible, and that the future is in alternative products.

What about vaping?

The problem is that, right now, the most common alternative product in the UK is e-cigarettes – and it looks like they might be running out of steam. The number of vapers in Britain is still rising, and an ever-increasing percentage of them have switched away from cigarettes completely (just under half of UK vapers also smoke, down from 70% two years ago), but growth is slowing down. In 2014, 800,000 British smokers started vaping, but it’s likely that by the end of 2017 the year’s total will be just 100,000. The most likely reason for this fall is that smokers have been scared off by false claims about health risks.

Now PMI say that it’s possible to reach the “Smokefree” target eleven years early – but only if the number of smokers switching to safer alternatives starts to accelerate again, back to where it was in 2014. The question is, what alternative should they switch to?

E-cigarettes are still a popular option – according to Public Health England they’re now the UK’s top choice among smokers who want to quit. It’s possible that, if people like ASH stop talking nonsense about them, the number of smokers switching to them every year could rise again. On the other hand, it’s also possible they could be overtaken by Heat not Burn. In fact I think that’s very likely.

When it comes to quitting smoking, e-cigs have been a game changer. The number of smokers in Britain is falling faster than it ever has before, even though fewer people are buying nicotine gum or using NHS quit services. They’re not ideal for everyone, though. Some smokers find them too complicated; others just want something that tastes like their favourite cigarette.

Is Heat not Burn the future?

I think a lot of smokers who aren’t interested in e-cigs are going to be very interested in HnB, for a couple of reasons. Firstly, a device like iQOS isn’t as simple as a cigarette – what is? – but it’s a lot less complicated than a high-end e-cig. Secondly, HnB can recreate the taste of cigarette smoke almost perfectly and that’s important to a lot of people. Many vapers love the array of new flavours they can use, but there are also plenty smokers who just want something that tastes like the smoke they’re used to. E-cigs are never going to recreate that flavour – they just don’t work that way – but PMI have spent a lot of money making sure iQOS tastes as much like a Marlboro as possible, and it’s paid off.

If you want to see how well it’s paid off, just look at Japan. iQOS launched there three years ago, and as of last month it’s taken 13.3% of the country’s nicotine market. It’s already broken even, paying for the enormous cost of developing it, and it isn’t even on sale in most countries yet. E-cigs have been growing fast, but not that fast.

It doesn’t stop with iQOS, either. As well as its direct competitors, like Glo and the new Lil from KT&G, there are more products due on the market soon. A couple of paragraphs back I asked what’s as simple as a cigarette. Well, PMI’s next product is. Using the same concept as RJ Reynold’s Revo, but apparently working much better, these are exactly as easy to use a cigarette. Just take it out the pack, light the end – which contains a charcoal heating pellet – then, when you’re finished it, stub it out in an ashtray. If it works as well as PMI are hoping, this could be even bigger than iQOS.

There’s a lot going on in the world of HnB right now, with new products appearing and existing ones being rolled out into new markets. There’s also a lot of opposition from the usual suspects in tobacco control, and that has the potential to put smokers off trying HnB for themselves. If we’re lucky, however, smoking could more or less disappear from the UK before 2030, and it won’t be plain packs or nagging health campaigns that do it; it will be e-cigs and heated tobacco products.

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More Heat not Burn science – Glo has been tested!

Back in April we looked at the latest research on the safety of iQOS compared to traditional cigarettes, and it looked very encouraging for heat not burn devices. Studies carried out for PMI by independent labs found that the vapour from an iQOS had much lower levels of toxic chemicals than cigarette smoke – in most cases, 90% or 95% lower. That’s impressive, especially considering that the tests looked at a much larger range of chemicals than any research done by public health groups.

The down side to this research was that it only looked at iQOS. Yes, that particular product is much safer than smoking, but does it apply to HnB in general? Realistically it’s going to be a while before we know that for sure, but this week some more results were released, this time by British American Tobacco. We recently did the first full UK review of BAT’s new Glo, their entry in the HnB market; now there’s some science to go with our impressions of this device.

Real science?

Although research done by the tobacco industry in the past has had a bad reputation, things have moved on a long way since the 1960s. Companies like BAT know that anything they publish is going to be scrutinised in minute detail by activist scientists looking for the slightest hint of foul play, so they don’t take any chances. These days they’re scrupulous about following good research procedures and releasing details of their methods, so the research can be studied and replicated. How well are they doing at that? Well, all the criticism of PMI’s research on iQOS has been about where the money comes from; nobody has said a word against the science. That probably tells us all we need to know.

BAT seem to have been just as careful with their own research, which makes the results worth looking at. For a start, they didn’t just bodge up some shonky equipment, like one university did recently when they used syringes to collect vapour from e-cigs. Instead, they studied how people actually use Glo then programmed a robot smoking device to replicate that. Then they tested Glo, collecting the vapour for comparison with a range of other products.

In total seven products were tested:

  • Glo
  • Three conventional cigarettes, including the standard 3R4F reference cigarette used in most smoking research.
  • “Another THP (tobacco-heating product)”, almost certainly an iQOS.
  • “A hybrid product”, BAT’s iFuse
  • An e-cigarette.

This is a good selection of products, covering all the main categories on the market right now. BAT also tested for a wide range of chemicals. They used the Health Canada testing method to collect vapour, because it’s one of the most thorough methods in use, combined with their own list of chemicals. The FDA test for 28 different toxins in cigarette smoke; the International Agency for Research on Cancer only measure fifteen. BAT’s list has 44 substances in it – not quite as extensive as the 58 that PMI look for, but still much more impressive than what most health researchers are doing.

Checking the chemistry

What’s really impressive is the results of all this testing. Unsurprisingly, most of the vapour from Glo consisted of water vapour and glycerine, which is added to increase the vapour output. That’s interesting, because when we looked at the innards of a NeoStik the tobacco in it looked much less processed than the contents of a Heet. Obviously, even though what the Glo is heating looks like normal cigarette tobacco, BAT have added a considerable amount of glycerine to it somehow. That doesn’t cause any worries, though; glycerine is perfectly safe to inhale.

The nicotine content of the vapour was about 62% of that found in cigarette smoke. This makes sense; using the Glo, it felt similar to a light cigarette, while the 3R4F cigarette is a full-strength blend. In any case, this sort of nicotine dose is close enough to a cigarette that it’s an effective replacement.

Moving on to the less welcome substances, the tests showed sharp reductions in all of them. The lowest reductions were for mercury, at 57.1%, followed by ammonia at 64.3%. Neither of these chemicals are at high enough levels in cigarette smoke to be much of a worry anyway, but any reduction is welcome. For the other 41 chemicals tested, 39 had a reduction of at least 80% and 36 saw levels reduced by 90% or more. Almost half had at least a 99% reduction. The total reduction in toxins was around 90%.

Does this mean it’s safe?

It’s worth pointing out that a 90% reduction in toxins is impressive, but it doesn’t tell the whole story. For example, the single most harmful chemical in cigarette smoke is carbon monoxide, and smoke contains a lot of it. The level in Glo vapour was 98.6% lower. Benzene is another major problem for smokers; Glo reduces the leve by 99.3%. Hydrogen cyanide – 98.8% lower. What this means is that while switching from cigarettes to Glo cuts total toxins by 90%, it almost certainly cuts the health risk by a lot more.

More good news from the study is that iQOS and the e-cigarette gave roughly similar results to Glo (although many of the toxins aren’t found in e-cig vapour at all).

Between this new research and what PMI have already released about iQOS, it seems obvious that HnB is much safer than smoking, and probably about the same as vaping an e-cigarette. A reduction in risk of at least 95% seems likely to be about right. Does this mean that switching to Glo cuts your risk of premature death by 95%? No – it almost certainly cuts it by a lot more than that. Jumping from a ground-floor window is about 95% less risky than jumping from a fourth-floor one, but the risk that’s left doesn’t mean your chance of dying drops from 50% to “only” 2.5%. It means that, if you’re really unlucky, you might twist your ankle.

If you need a final vote of confidence in BAT’s new research it’s just been published in a peer-reviewed medical journal, Regulatory Toxicology and Pharmacology. Peer review means a panel of experts have examined and decided that the experiments were good science and the data has been properly interpreted. Of course some extremists will refuse to accept it simply because it was funded by BAT, but open-minded people like our readers can find it here.

 

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What Effects Might Heat Not Burn Have?

As Heat not Burn products become more popular they’re steadily generating debate among the public, health activists and scientists. So far, the medical profession want to know how much safer they are than traditional tobacco products. Activists want to know if they’re part of a cunning plot to create more smokers. Smokers want to know how good they taste. This already seems like quite a lot to discuss – but it turns out some people are already thinking a lot further.

A few days ago Heat Not Burn UK had the opportunity to interview David O’Reilly, the director of science, research and development at British American Tobacco. David is a real expert on HnB and I had a fascinating discussion with him (so expect to see his name a few  times on this blog over the next month or so), and he’s been thinking way ahead of just about everyone else I’ve spoken to.

This Is The Future

One thing David was very clear on is that BAT, like Philip Morris, see non-combustible products as the future. While I was talking to him I noticed that he mentioned, more than once, moving to HnB. Eventually I asked him if he saw it as expanding their product range or repositioning it. “Our customers are moving to safer products,” he said. “We can move with them, or go out of business.” So BAT definitely seem committed to technological change.

What I hadn’t thought about was how far-reaching these changes could be. One of the products we talked about was Glo, BAT’s heated tobacco product. Glo uses “Neostiks”, similar to the Heets that feed PMI’s iQOS, and as you probably know there really isn’t a lot of tobacco in these. David explained just how inefficient a traditional cigarette is; about 90% of the tobacco in it ends up either in the filter or escaping as sidestream smoke; only about 10% of it is actually inhaled.

With a Glo this inefficiency just doesn’t exist. A Neostik has a filter but, like the one on a Heet, it’s mostly just there to give a familiar cigarette-like fee; it’s small and permeable enough that it traps very little of the vapour. Meanwhile there’s no sidestream problem either. In fact once a Glo is powered up and at working temperature it’s generating vapour constantly, but this stays in the heating chamber until you take a puff and inhale it – it doesn’t escape.

The end result is that a Neostik contains about 10% as much tobacco as a traditional cigarette, but it’s pretty much equivalent to it; if you smoke a pack of twenty every day, you’ll probably get through a pack of twenty Neostiks when you switch to Glo – but that’s as much tobacco as just two cigarettes.

Consequences?

I have to admit, I was sitting there making admiring noises about this efficiency when David said, “Of course, we have to think about what effect that will have on the tobacco farmers.”

Well, of course we do. After all, tens of thousands of people rely on tobacco farming for their livelihood. Many of them are in poor countries, too. A 90% fall in tobacco production could have a devastating effect on their economies. Tobacco controllers sometimes argue that tobacco takes up farmland that could be used for food, but the truth is the world isn’t short of food. When famines happen, which is a lot less often than they used to, it’s generally because there’s no way to get the food to the people who need it. Cutting tobacco production by 90% isn’t going to solve world hunger, but it could make a lot of people unemployed.

Then again it might not. The truth is, right now we simply don’t know. Will tobacco production fall significantly in the first place? We don’t know. A lot of it depends on what sort of reduced-risk products smokers actually move to. If they all switched to Glo then yes, a lot less tobacco would be needed. But so far the most popular alternatives are snus and e-cigarettes. Snus is made of tobacco, and e-cigs need nicotine – which is extracted from tobacco.

The most likely outcome is that there will continue to be a range of products, including snus, dissolvables and e-cigs as well as Heat not Burn devices. Total demand for tobacco will probably fall, but not dramatically at first. From the point of view of the farmers that’s likely to be good news. If demand changes gradually they can adjust and cope with it; it’s a sudden shock that would cause mass poverty.

What matters is that people are thinking about issues like this – and they are. Ironically it’s the tobacco industry, usually painted as the villain of the piece, who’s looking into the possible future effects of changing technology. Public health tend to just dismiss the fate of tobacco farmers, airily assuming that they can all start growing organic quinoa instead. Unfortunately life is rarely that simple.

Upping Their Game

The tobacco industry has a bad reputation, and leaked documents from the 1960s and 70s show that, a few decades ago at least, it was far from undeserved. They do also deserve some credit, though. BAT’s research facility in Southampton has been trying to develop a safer cigarette for decades; now they’ve abandoned that apparently hopeless quest and moved on to alternative products instead. They might have been late to the game on HnB and e-cigs, but they’re putting a lot of time and resources into it now.

In the last ten weeks I’ve spoken to researchers and senior executives from two of the world’s largest tobacco companies, and the impression I get is that they’re very serious about harm reduction. It’s unrealistic to expect them to stop selling cigarettes tomorrow, but they seem very determined to stop selling them at some point in the not too distant future. Another thing David O’Reilly, his colleagues from BAT and their opposite numbers at PMI all stressed to me is that products like Glo, iFuse and iQOS are early iterations of the technology. Some very clever people with very large research budgets are already working on improved versions that are simpler to use and give even better performance. The future for Heat not Burn, and every other category of reduced-risk tobacco product too, is looking very exciting.

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E-cigs don’t work everywhere – Heat not Burn does

I’m a freelance writer, and I love e-cigarettes. Since I switched to vaping my desk isn’t cluttered with smelly ashtrays anymore, and I don’t have to brush ash off my keyboard twice a day. I spend most of the day at my PC, so I can keep a charger on the desk for my batteries and there’s a nice long USB cable for pass-through mods. The top shelf in one side of the desk holds an assortment of e-liquids; in my job, vaping works perfectly.

On the other hand, before I became a writer I spent years in the British Army. Like many soldiers I smoked, and I remember a lot of early mornings happily puffing away in some cold, wet forest. No matter how soaked, frozen and miserable you get, a cigarette is a reliable way to inject some very welcome morale into your life.

The thing about cigarettes, of course, is that they couldn’t be simpler. You take one out the pack, stick the brown bit in your mouth and set fire to the other end. Unless you’ve let them get soaked, or you’ve sat on the packet and squashed them (a waterproof tobacco tin will avoid both these issues) they’re guaranteed to work.

War is hell – for e-cigs

But how is an e-cig going to cope with the hardships of a soldier’s life? All the liquid is probably going to leak out, turning the contents of your pocket into a slippery mess. The tank’s probably going to get broken the first time you trip over a stump in the darkness and fall flat on your face. The ability of most box mods to survive being soaked with rainwater is pretty dubious. Worst of all, your batteries aren’t going to last forever and there won’t be any USB ports in the tree you’re living under. E-cigarettes are great as long as you’re surrounded by civilisation, but they’re not going to work out in the field.

It isn’t just soldiers, either. What if your workplace is the deck of a trawler? The first wave that knocks you down, and leaves you flailing around in a pool of seawater and fish guts, is going to destroy every electronic device in your pockets. Let’s not even start thinking about rebuilding a coil in a cramped cabin that’s rolling through sixty degrees.

So it’s pretty obvious that there are some people who e-cigarettes just aren’t going to work for. But does that mean they’re doomed to a lifetime of smoking? Not so fast. There’s probably a heat not burn product that’s going to work just fine.

What’s the solution?

Last month I visited Philip Morris International’s research facility at Neuchatel in Switzerland, where they’re making the Heets that feed their iQOS device as well as working on the next generation of HnB technology. It was a very interesting visit – I’ve already discussed their latest research on safety – and left me feeling very optimistic about the future of heated tobacco products. There were some lively discussions, too, and during one of these I explained that I’d been a soldier for a long time and, based on my experiences, I didn’t think iQOS was going to be much use in the field. The PMI rep didn’t even blink. “We know,” she said. “That’s why we’re working on three other products.”

One of those products is the Mesh e-cigarette, which is already on the market. I have one, and it’s pretty good; the Mesh is an extremely simple and fairly sturdy gadget, and its disposable cartridges are more compact and probably a lot tougher than cigarettes, but if you’re doing hard work outdoors in bad weather it has the same drawbacks as any other e-cig; it isn’t very waterproof, and it needs charged a couple of times a day. Then there’s a completely different product in the development pipeline that isn’t HnB, but isn’t an e-cig either; it uses a chemical reaction to create a nicotine-containing vapour. The interesting thing about this is that it doesn’t need any batteries, so it might be a good solution for people who don’t have regular access to a charger; that depends on how robust it is, and I can’t comment on that because I haven’t seen one yet.

That’s three of PMI’s Smokefree nicotine products. The fourth one is a heat not burn product that uses the same concept as RJ Reynolds’s Revo. It’s a disposable item that contains a stick of processed tobacco and a charcoal pellet that provides the heat. All you have to do is light the pellet and puff away.

Revo isn’t really a new product; it’s basically a rebranded version of the 1990s Eclipse, which was a complete flop. Reynolds relaunched it under the new name because they decided the market had moved enough to make it viable this time around, but it’s still basically the same thing. I’m not very familiar with it but I do have some doubts about how effective it is.

So far, at least, those doubts don’t apply to the PMI product, which the company are currently calling Platform 2. It works on the same principle as the Revo, but it’s a completely new design. That gives PMI a chance to iron out any bugs, and hopefully come up with something that delivers a consistent vape with no risk of accidentally burning the tobacco.

Keeping it simple

The benefits of this sort of design are obvious. If you can manage to smoke, you can use a HnB product like Revo or Platform 2. It works exactly like a cigarette; you just have to take it out the pack, put it in your mouth and light it. There’s nothing fiddly to play with, it doesn’t need electricity and it’s no more vulnerable to the weather than a cigarette. In fact it’s probably less likely to get damaged by water; Revo has a metal foil tube to hold the tobacco, which is a lot more waterproof than cigarette paper.

A lot of smokers have switched to vaping – probably over ten million by now – but it’s not going to work for everyone. Improved technology will eventually increase battery life and make the hardware easier to use and more robust, but it’s not likely e-cigs will ever be as simple as a traditional cigarette. Heat not burn has the potential to solve that problem, because the basic principle – get some tobacco and heat it – is a lot more flexible. Inside a few years there will be HnB products that anyone can use, no matter how tough their job is.

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Heat Not Burn Safety Update

the cube neuchatel

Over the last year we’ve seen a lot of progress for heat not burn products, with the iQOS now available in several countries including right here on this website and a few new devices set to be released soon. The market looks like it could be on the brink of some serious growth, and within a few years HnB could have made as big a dent in smoking rates as e-cigarettes already have.

There’s one thing still missing, though. If heated tobacco products are really going to grab a sizable percentage of the cigarette market it’s important that their makers can show they’re safer than smoking. As we’ve mentioned before, common sense tells us they pretty much have to be a lot safer, because the tobacco isn’t being burned, but there’s a distinct lack of actual data. Isn’t anyone doing the research on this? It turns out the answer is yes.

Of course, you won’t see this research appearing in the medical journals just yet, because it’s actually being carried out on behalf of the tobacco industry. Philip Morris International have invested more time and money in HnB than anyone else, and a lot of that has gone towards looking into how much risk can be removed by switching from lit to heated tobacco. Some world-class laboratories have been asked to investigate how HnB is working and what that means in terms of health effects. Last week Heat not Burn UK got a chance to visit the Cube, PMI’s European research HQ at Neuchatel in Switzerland, to find out what’s going on.

How hot is too hot?

By now everybody knows that smoking-related diseases aren’t caused by tobacco; it’s the combustion process that creates the worst toxins and cancer-causing substances. Tobacco-free herbal cigarettes aren’t any better for you than Benson & Hedges, because you’re still inhaling burning plants. However, PMI have found out that making a safe HnB product isn’t as simple as not setting fire to the tobacco.

The tip of a lit cigarette, between puffs, is at between 600°C and 800°C; when you take a drag on it this rises to over 900°C. That’s the sort of temperature tobacco burns at. However, at much lower temperatures it goes through a process called pyrolysis, where it’s being broken down by heat but not actually burning. Pyrolysis starts at around 350°C, much lower than combustion temperatures – and pyrolyzing tobacco still gives off a lot of nasty chemicals. Not as much as burning it, of course, but probably still more than you really want to be inhaling.

So the trick to safe HnB is to heat the tobacco to just below the point where pyrolysis begins. If you were wondering why iQOS heats its sticks to 350°C when tobacco doesn’t start burning until hundreds of degrees above this temperature, now you know. PMI have opted for the highest safe temperature, where there’s little or no pyrolysis going on but the tobacco is still hot enough to generate a decent vapour. Because HnB products like iQOS, Glo and PAX 2 are electronically controlled it’s easy to get them to produce a constant temperature and avoid pyrolyzing or burning the tobacco.

Tracking the toxins

Obviously the big question is, what effect does HnB have on the levels of chemicals you’re inhaling? It’s unrealistic to insist on zero chemicals, because many of the toxins in cigarette smoke are very common substances. For example, smoke contains high levels of formaldehyde – but human bodies contain formaldehyde, too. Our metabolism produces it, and there are detectable levels of it in exhaled breath. What we’re looking for are levels that might not be zero, but are much lower than you’d get from a cigarette.

To test this, PMI analysed the smoke from a reference cigarette – this is a standardised cigarette used for lab testing – then compared it with the vapour from their two HnB products. One of these is iQOS; the other, known as Platform 2, hasn’t been released yet but works in a different way. What they found was that for every chemical they tested, levels were dramatically reduced in both HnB products. The highest levels were for ammonia, with iQOS having about half the level of a cigarette and Platform 2 around 40%. Is that enough to worry about? No; even cigarette smoke doesn’t have anywhere near enough ammonia to be an issue. For the other chemicals they tested levels were reduced by at least 80%, and in most cases 90 to 95%. Overall it looks like HnB eliminates more than 90% of the harmful chemicals found in cigarette smoke.

One impressive point about PMI’s research is that they’ve been extremely thorough. Different agencies have different lists of chemicals in smoke that concern them. For example the FDA have a list of 28 different substances; the International Agency for Research on Cancer’s list has fifteen. To be on the safe side, Philip Morris have simply combined everyone else’s lists; they test for fifty-eight different chemicals – far more than anyone else does.

Attention to detail

PMI aren’t just measuring what’s in the vapour; they’re also testing smokers who’ve switched to their HnB products to see how they compare with people who’ve either quit entirely or continued to smoke. What they’re doing here is looking to see if switchers’ blood chemistry is more like a smoker or a quitter. For every chemical they’ve tested – including carbon monoxide, benzene and acrolein – HnB users either have identical levels to smokers who’ve quit entirely or (for acrolein) the level is slightly higher than a quitter but much lower than a smoker.

At Heat not Burn UK we might not be scientists, but we do know how science is supposed to be done. The research that’s being carried out on the health effects of HnB is very good science. It’s extremely thorough and detailed. The actual analysis is being carried out by independent labs, which should deal with any accusations of bias. PMI are being completely open about the experimental methods, so anybody who has doubts can replicate the research themselves.

Why so modest?

That leaves one question: With all this research to back them up, why aren’t PMI shouting from the rooftops about how safe HnB really is? Most likely that’s down to an understandable wariness of being sued. If they say that iQOS is 90% safer than smoking, and then at some point in the future evidence shows it’s only 89.9% safer, how long is it going to be until swarms of Californian lawyers descend on them with a fistful of class action suits? Not long, probably.

So, for now, they’re playing a cautious game. The data is there, and steadily growing. Sooner or later it will be presented to some government agency, probably the FDA, and they’ll confirm that these products are much safer than smoking. That’s when the manufacturers will start publicising it. Until then we’re just going to have to rely on common sense.

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BAT’s glo – sneak preview

A couple of months ago we looked at BAT’s glo, their stick-fed iQOS rival that’s currently being trialled in Japan. It still hasn’t been released in other markets, and BAT haven’t revealed their plans for it yet, so it could be a while before smokers in the UK have a chance to try it. Just so you know what you’re waiting for, however, Heat Not Burn UK set out to track one down. It was a struggle, but last week one of our agents finally managed to get his hands on the elusive device.

Because of how our glo was obtained (no, we didn’t steal it) it didn’t come in its usual retail packaging, so that won’t be included in this review. It did come with a full pack of Bright Tobacco sticks to feed it with, so it was thoroughly tested as well as being poked, prodded and generally fiddled with. So what’s it like?

The device

The Glo is a neat, simple device. The silver oval on top slides to reveal the NeoStik socket.

The glo device looks like a small, simple box mod e-cigarette. It’s about the height and thickness of a pack of cigarettes, and maybe two-thirds of the width. The aluminium body is rounded on both sides, making it comfortable to hold, and it’s not too heavy. It does feel solid and well made, and the build quality looks excellent. The end caps are textured plastic, the metal body has a nice satin finish and there’s a laser-etched glo logo on the front.

Looking at the top, there’s an oval silver cover. On the bottom is a micro-USB charging port and a small cover that looks like it should open, but was left well alone in case it broke. After some discussion we think that’s the airflow vent; there has to be some place for air to flow into the heating chamber so you can inhale the vapour, and we couldn’t see anything else that might do that job.

The only actual control on the glo is a single button on the front. Its placement looks odd if you’re used to e-cigs; most box mods now have the fire button on one side, because that way it falls naturally under your thumb. However the glo’s button is just the on/off switch, and you won’t need to touch it when you’re actually using the device. The button itself is metal and surrounded by a ring of translucent plastic, which turns out to be LED-illuminated – but we’ll get to that.

The Tobacco

Like the iQOS, glo uses cigarette-like sticks which BAT call NeoStiks. Compared to PMI’s HeatSticks these are longer and slimmer – almost exactly the same size as a traditional cigarette. Instead of a filter there’s a hollow plastic tube, which makes sense – why fit a filter when there’s no smoke? The centre of the stick is filled with finely shredded tobacco. Actually it looks like the bottom is, too, but BAT say that’s not tobacco. It could be shredded cork or something similar.

In Japan the NeoStiks are priced about the same as normal cigarettes, as are iQOS HeatSticks. Industry gossip suggests the reason for this is that nobody’s quite sure how they’ll be taxed yet, so BAT and PMI are both playing it safe. If they end up being taxed at a lower rate the price may fall in the future.

Some of the stuff inside is tobacco. Some, according to BAT, isn’t.

How does it work?

Using the glo is very simple. The cover on top slides to one side, revealing a hole about the size of a cigarette. All you have to do is insert a NeoStik into this hole until it won’t go any further. This is quite simple, like the iQOS, as long as you don’t rush it.

Once the stick is fully inserted all you have to do is press the button to turn the glo on, then wait for it to warm up. Progress can be tracked by watching the surround on the button; this progressively lights up as the coil temperature rises, the glow of the LEDs advancing clockwise wound the circle, and when the whole thing is illuminated it’s ready to go. Just in case you miss that the glo will also vibrate with a faint buzz when it reaches operating temperature. Then all you have to do is take a puff.

So the big question is, what’s it like? The answer is that it’s very good. Our agent was lucky enough to try the iQOS and glo together, and thinks the glo is just as good at producing vapour and has a slightly better taste. This was a bit surprising, as it runs at a much lower temperature – 240°C, rather than 350°C for its PMI competitor.

Each stick gives about as many puffs as a traditional cigarette, and when the glo decides you’ve fully vaped it, the device will vibrate again and turn itself off. This seems to be aimed at making sure you don’t overheat the tobacco to the point where it starts producing nasties.

Looking at the used stick was interesting. The heat seems to be applied in a narrow ring, just below the end of the plastic tube. It’s hard to say how much of the tobacco is being affected by it. On the other hand it doesn’t matter much, because whatever the glo is doing, it works.

Conclusions

The overall concept of glo is very similar to the iQOS, but BAT have taken a different approach to the hardware. Our first impression is that this has paid off. Battery life is much better than the PMI device – although it’s hard to say yet if it lives up to BAT’s claims of a 30-stick life between charges, because we didn’t get that many sticks. The downside is that the device itself is much bulkier, and unlike iQOS you certainly can’t hold it like a traditional cigarette.

It does seem to do the job, though. There’s a satisfying amount of vapour and the taste is very good. The device itself is simple and well made, and disposing of used sticks is a lot less messy than emptying an ashtray. This is a very interesting product, and if it’s released in the UK we think it has a lot of potential.

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WHO notices Heat not Burn

Heat not Burn products are coming to the attention of a new audience – and that might not be good news. The World Health Organisation is gearing up for its latest tobacco control junket and, for the first time, heated tobacco products are on their radar. They haven’t attracted as much of the WHO’s dislike as electronic cigarettes yet, but this could be just a matter of time.

The WHO event is the Seventh Conference of Parties to the Framework Convention on Tobacco Control, which is a bit of a mouthful. Unsurprisingly it usually goes by the less awkward title of COP 7. The previous one, COP 6, was held in Moscow two years ago and attracted quite a lot of bad press. The organisers, who include the UK’s Action on Smoking and Health, seem to be somewhat paranoid, and they claim to be terrified that the tobacco industry will somehow manage to sneak observers in to find out what’s happening. Last year they avoided this risk by first banning all members of the public, in case any were Big Tobacco spies, then banning all members of the press.

As COP is funded from taxpayers’ money not everyone was happy about the oppressive secrecy, especially as some hints of what was going on did slip out. Although it was supposed to be a conference to set tobacco control policy, the reality is that no dissent from the organisers’ position was allowed. It’s been alleged that the health minister of a fairly large country was physically forced back into his seat when he disagreed with one of the proposals. Obviously it’s hard to say if this really happened or not, because any potential witnesses had been locked out.

They’re paranoid, and they are out to get us

This year’s event will be held in India, and it seems the paranoia has got even worse since 2014. The organisers are talking seriously about banning representatives of any government that’s involved with tobacco sales in any way, which is most of them. The Indian government itself might be shut out, despite paying to host the event.

So what does this have to do with heat not burn? The agenda for COP 7 was released last week, but for a couple of weeks before that there has been a sudden increase in interest among tobacco control activists. Anti-smokers have been asking questions about heat not burn on Twitter, mainly trying to find out what e-cigarette users think of it.

Some people were puzzled about this. Why ask vapers for their opinions about heat not burn? Obviously there are connections – both are alternatives to smoking – but they’re very different products. Surely it would have made more sense to ask smokers what they thought, but there was no sign of anyone doing that. Of course that could just have been the usual dismissive public health attitude towards smokers, but was there something more significant behind it?

As it turned out, yes there was. One of the documents the WHO released last week was their new position paper on electronic cigarettes, and as well as e-cigs it mentions heat not burn products. It’s not a big mention, but it’s there – just a single sentence about how the tobacco industry “has launched alternative nicotine delivery systems that heat but do not burn tobacco”.

Bad attitudes

Unfortunately the WHO has been extremely negative about e-cigarettes right from the start, and the tone of this new paper suggests they’re going to be exactly the same about HnB. This probably shouldn’t be a big surprise – the organisers of FCTC lost interest in keeping people healthy long ago. Their priority now is attacking the tobacco industry every chance they get, and heat not burn is an obvious target. After all the leading products are all actually made by tobacco companies, unlike most e-cigs. They contain tobacco, and some of them have well-known cigarette brands. It’s pretty much inevitable that HnB is going to be painted as another evil tobacco industry plot.

So does this attention from WHO mean heat not burn is doomed before it even has a chance to get off the ground? No, not really. Look at what’s happening with e-cigarettes. Yes, the USA and EU have introduced tough new laws – but they haven’t actually banned them, and that’s what the WHO was demanding as recently as last year. There’s now so much evidence they’re safer than cigarettes that even the WHO can’t justify a ban.

It’s almost certain that the same will happen with HnB. Not much research has been done yet, but when the evidence starts coming in it’s likely to show that these products are much safer than conventional smoking. The FCTC crew will huff and puff, but governments aren’t likely to ban the products. They’ll get health warnings, and possibly plain packs, but they aren’t going to be banned except in a few totalitarian states.

Hints of positivity

Actually it could be good news that WHO seem to have been talking to tobacco control people about HnB. While a lot of them are driven by hatred of the industry, some of the more open-minded ones will be interested in anything that gives a safer alternative to smoking. One or two of those were among the ones asking questions, including the chief of an NHS stop smoking service. The same service was the first in Britain to start recommending e-cigs to smokers who wanted to quit; if HnB looks like being a real alternative – and with the current technology it certainly does – it could find supporters in unlikely places.

Sadly it’s a fact of life in today’s world that, whenever something new and enjoyable appears, a lot of people will instinctively want to ban it. Sometimes they succeed, worse luck. More often they manage to cause some problems, but the new technology goes on to eventually become widely accepted. Remember how mobile phones would cause sterility and brain cancer? Now everybody has one. Heat not burn will be opposed by people like the WHO, but the chances are it’s not going to go away. Technology has caught up to the point where it really works, and it’s just going to keep getting better.