It’s combustion in cigarettes that kills, not nicotine
The burning of tobacco at high temperatures, and not nicotine, makes smoking so deadly according to two of the world’s leading cancer experts.
“People smoke for nicotine but die from the burning of tobacco at over 350°C. The combustion of tobacco generates smoke and ash containing a toxic mix of chemicals that causes serious health effects, including fatal lung diseases and cancer,” said Dr. Peter Harper.
“Nicotine does not cause cancer. Doctors even prescribe nicotine replacement therapy [NRT] to help smokers quit. Exposure to the carcinogens present in the smoke of combustible cigarette is what causes cancer. There is a dose-response relationship – the greater the exposure to a carcinogen, the higher the risk to develop cancer,” said Dr. David Khayat.
Dr. Harper is a consultant medical oncologist at Guy’s and St Thomas Hospital in London and chairman of the Toulouse Cancer Centre in France. Author of more than 400 papers and chapters in peer-reviewed publications, he is acknowledged globally for his work in researching new drugs and developing improved forms of cancer treatment.
Dr. Khayat is a professor of Oncology at Pierre et Marie Curie University and head of Medical Oncology at La Pitié-Salpétrière Hospital, both in Paris. He is also adjunct Professor at the MD Anderson Cancer Center in Houston, Texas.
Dr. Harper and Dr. Khayat underscored the value of tobacco harm reduction (THR), which includes innovative smoke-free and less-harmful nicotine delivery devices such as e-cigarettes (vapes) and heated tobacco products. THR is a public health strategy that aims to provide smoke-free alternatives to reduce harms caused by smoking and to provide nicotine to people who cannot or do not want to quit smoking by themselves or with currently approved methods.
The two experts lauded the enactment in July 2022 of the Vape Law, which regulates the importation, manufacture, sale, packaging, distribution, use and communication of vapes and heated tobacco products in the Philippines. More than 14 million Filipino adults are smokers, according to the latest Global Adult Tobacco Survey (GATS 2021). The global survey also revealed that the Philippines has a dismal 3.9% smoking quit rate, which reflects the ineffectiveness of currently approved smoking cessation strategies such as “quitting cold turkey” and NRT.
“Heated tobacco products heat tobacco to a lower temperature of less than 350°C, ensuring combustion does not occur while delivering nicotine to the user. Because there is no combustion, heated tobacco products have 95% less harmful chemicals compared to cigarettes,” Dr. Harper explained.
“Heated tobacco products deliver the same nicotine peak delivered by combustible cigarettes, so heated tobacco product users get the nicotine fix they are looking for. However, nicotine is not the only factor in addiction to tobacco; there is also the so-called ‘smoking ritual’ where the smoker lights the cigarette, puts it in their mouth, puffs on it, and so on. Heated tobacco products provide the same ritual involved in combustible cigarettes, which is why there has been a rapid uptake of heated tobacco products among former smokers, particularly in Japan,” Dr. Khayat said.
Japan has the highest prevalence of heated tobacco use and is the country where heated tobacco products have captured the highest share of the tobacco market, according to research done by Philip Morris International (PMI). The most popular brand is IQOS, a product of PMI. PMI research revealed that heated tobacco uptake in Japan coincided with an accelerated decline in the sales of the predominant combustible tobacco categories, cigarettes and cigarillos. Across all brands, Heated tobacco products reached almost one third of the total tobacco market by 2021.
The Japanese National Health and Nutrition Survey (NHNS) also showed that a profound decline in adult cigarette smoking prevalence occurred following the introduction of heated tobacco products. While 20% of adults reported smoking every day or some days in 2014 (prior to the introduction of heated tobacco products), smoking prevalence dropped to 13% in 2019. The survey also showed that an overwhelming majority of heated tobacco users, 76% in 2019, did not report any cigarette smoking.
In July 2020, the U.S. Food and Drug Administration (FDA) authorized the marketing of IQOS as modified risk tobacco products (MRTPs), making IQOS the first tobacco product to receive “exposure modification” orders from the agency. Exposure modification orders permit the marketing of a product as containing a reduced level of or presenting a reduced exposure to a substance or as being free of a substance when the issuance of the order is expected to benefit the health of the population.
According to the US FDA, the following are the available evidence to date on IQOS that the agency has validated: “The IQOS system heats tobacco but does not burn it. This significantly reduces the production of harmful and potentially harmful chemicals. Scientific studies have shown that switching completely from conventional cigarettes to the IQOS system significantly reduces your body’s exposure to harmful or potentially harmful chemicals.”