Last month, a new tobacco product made its American debut. The sleek, oblong devices made their premiere in minimalist cases at Atlanta’s Lenox Square mall; a few weeks later, they went on sale at another Georgia mall. This is Iqos, and it likely won’t be long before it expands across the country.
Not an e-cigarette, but also not quite a combustible cigarette, Iqos is a heat-not-burn tobacco product and the newest nicotine technology to vie for the lungs of Americans. The idea behind it is to limit the amount of harmful particles smokers inhale. By warming—not burning—the tobacco, and mixing it with other solvents, Iqos creates an aerosol that lets smokers inhale a more pure form of nicotine and avoid the tar that can contribute to lung disease. At least that’s the theory.
The Iqos arrives in the US just as the backlash against e-cigarettes has reached new heights. On Friday, US representative Mark DeSaulnier (D-California) will introduce a bill that would institute the first nationwide ban on e-cigarettes. It would also pull all e-cigarettes off the market until the products are approved by the US Food and Drug Administration. “Until the FDA goes through its due diligence and makes sure that it’s safe, we shouldn’t be allowing these things to be sold,” says DeSaulnier.
But FDA approval is no guarantee that new nicotine products are safe. Unlike e-cigarettes, the Iqos device has scored the agency’s blessing and can be legally sold. But tobacco researchers question just how safe it really is, and public health advocates now worry the US will see more respiratory illnesses and a rise in youth nicotine users too.
“The fact that FDA gave it a greenlight is pretty troubling,” says Erika Sward, a spokesperson for the American Lung Association. “I want to see the FDA have a heck of a stricter standard when it comes to looking at what’s appropriate for the protection of the public health.”
Iqos’s design consists of two components. Heets, sometimes called HeatSticks, are cigarette-like sticks that hold a mixture of ground up, dried tobacco leaves and other elements including propylene glycol and glycerine, two common solvents in e-cigarette cartridges. Those sticks are then inserted into a pen-like holder that contains a heating element. Once the tobacco is warmed up, the glycerine helps create an aerosol, which gives users a smoking experience reminiscent of regular cigarettes without some of the toxic byproducts created by combustion.
“Clearly, the best thing somebody can do is to quit nicotine and tobacco altogether,” says Moira Gilchrist, a spokesperson for Philip Morris International, which developed the Iqos. Short of quitting, though, Gilchrist says the Iqos is a “better alternative.”
In April, the FDA allowed the product to go on sale in the US through a process called pre-market authorization. After reviewing the device and reams of data presented by Philip Morris, the agency decided that although Iqos isn’t risk-free, it was “appropriate for the protection of the public health,” because the devices had “fewer or lower levels of some toxins.” The authorization doesn’t mean the FDA approves of the device or thinks it’s safe, it just means the FDA believes Iqos isn’t more dangerous than regular cigarettes.
But scientists say the FDA’s logic is flawed, in part because Iqos may present unique dangers that aren’t measured in traditional toxicity tests. “Because it has glycerin that’s been heated it’s actually putting stuff out that no cigarette ever put out and that hasn’t really been studied very well,” says Robert Jackler, a tobacco researcher at Stanford.
What’s more, other research suggests the devices do present many of the same risks as regular cigarettes. Stanton Glantz, a professor at the University of California San Francisco’s Center for Tobacco Control Research and Education, analyzed Philip Morris’s data and concluded that Iqos’s toxicity is “indistinguishable from a cigarette.” An independent study from researchers at the University of Bern in Switzerland found that Iqos contains the “same harmful constituents of conventional tobacco cigarette smoke.” Another study suggested the devices could cause more damage to the liver than regular cigarettes.
Glantz is troubled by the FDA’s interpretation of the product as “appropriate for the protection of the public health.” Few legal items are more dangerous for your health than cigarettes, he says, so the agency should apply a higher standard to such products. DeSaulnier says his proposed legislation is just a first step, and agrees the FDA’s standards are not adequate. “I want to look at how the FDA process is being implemented,” he says. “It’s not stringent enough.”
The FDA did not comment for this story but in a press release, the agency explained that one reason it authorized Iqos sales is because the agency determined the product was unlikely to attract kids or people who don’t already smoke.
Iqos is more complicated to use than an e-cigarette. It has to be cleaned and users have to charge both the sticks and the heating device. But it comes with mint and menthol options, which are among the most popular e-cigarette flavors with kids. And the devices’ design mimics the trendy tech that teenagers gravitate to. “They’re selling you an iPhone of tobacco products,” says Sward. According to SEC filings, the product was even initially spelled iQOS. (The company ultimately opted for all-capital letters.) Iqos’s Lenox Square store has a glass front wall, long, rectangular display tables, and intricate packaging that call to mind Apple stores and iPhone boxes.
Kids can’t get into the stores—you need a government-issued ID proving you’re 21 or older—but that doesn’t mean teens won’t be attracted to the products. “Any high-tech gadget is going to have interest on the part of young people,” says Jackler, who put together a comprehensive report on how e-cigarette marketing campaigns appeal to teenagers. Iqos ran similar social media campaigns in Japan and Italy, where the device has been on the market since 2015. Thousands of posts under hashtags like #iqos and #iqosfriends show young, attractive people posing with their devices.
Philip Morris says they are no longer running those social media campaigns. It might not matter. Jackler’s research found that after Juul stopped their official influencer campaign, the rate of posts using #juul actually increased. A spokesperson for tobacco company Altria, which is distributing Iqos in the US, says it plans to use Instagram and Facebook to advertise the device, but that it won’t use influencers and that all posts will be restricted to viewers over the age of 21. The FDA also classified Iqos as a cigarette, so it can’t be advertised on the radio or on television.
Even though smoking rates in the US have decreased over time, cigarettes still remain the leading cause of preventable death in the US, according to the Centers for Disease Control and Prevention. Jackler says he’s not necessarily opposed to new nicotine products or technologies that could help the 34 million American adult smokers avoid illness. If there are safer products out there, “I think we should be open to it,” he says. But the emphasis should be on legitimately less harmful products, meaning they’ve been rigorously examined and and meet a very high bar of scientific evidence.
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