FDA OKs marketing of IQOS tobacco heating system; public health impact is unclear
The FDA recently authorized Philip Morris International to market its IQOS Tobacco Heating System. Physicians told Healio Primary Care that the public health impact of the agency’s decision is not immediately apparent.
The FDA’s website states that IQOS consists of a paper-wrapped tobacco stick placed in an electronic heating device, which punctures the stick with a glass-covered ceramic blade that heats the tobacco, making an aerosol. IQOS is not the same as traditional cigarettes, which use an open flame, nor is it the same as e-cigarettes, which use an electric source to heat a liquid.
Philip Morris CEO André Calantzopoulos said in a press release that with the FDA authorization, the company can “inform adults that switching completely to IQOS is a better choice than continuing to smoke.”
Although IQOS is promoted as a safer alternative to smoking, Frank T. Leone, MD, MS, a pulmonologist and director of comprehensive smoking treatment programs at Penn Medicine, explained that “cancer is not the only definition of harm.”
“The size of the particles in the aerosol, the temperature, pH, and other physical characteristics — these make a difference in how a device impacts the body,” he told Healio Primary Care. “I'm not suggesting there's something nefarious going on with the FDA, but the agency is making decisions based on basic logical fallacies.”
Richard O’Connor, PhD, professor of oncology at Roswell Park Comprehensive Cancer Center in Buffalo, N.Y., said that Calantzopoulos’ premise of adults switching “completely to IQOS” is critical to understanding the public health impact of IQOS.
“If current cigarette smokers switch completely to IQOS in large numbers, then their exposure to harmful chemicals will go down and health benefits may be realized,” O’Connor told Healio Primary Care. “But the benefit is predicated on complete switching. Emerging studies from markets where these products are more popular indicate that most IQOS users continue to smoke.”
Researchers have found mixed evidence of the safety of IQOS, according to Maciej Goniewicz, PhD, an oncology professor at Roswell Park Comprehensive Cancer Center.
“Independent studies, including studies published by researchers from Roswell Park, have revealed that although IQOS emits lower levels of selected toxicants that cause lung cancer in smokers (called tobacco-specific nitrosamines) compared to combustible cigarettes, the levels are significantly higher in IQOS than what has been detected in e-cigarettes,” he told Healio Primary Care.
“Another study by our team revealed that when lung cells were exposed to emissions from IQOS, e-cigarettes and combustible cigarettes, IQOS showed reduced cytotoxicity relative to a combustible cigarette but higher toxicity than an e-cigarette,” Goniewicz said. “Those studies suggest that although IQOS may be less toxic than combustible cigarettes, these products may be actually more toxic than e-cigarettes.”
References:
- FDA. How are non-combusted cigarettes, sometimes called heat-not-burn products, different from e-cigarettes and cigarettes? https://www.fda.gov/tobacco-products/products-ingredients-components/how-are-non-combusted-cigarettes-sometimes-called-heat-not-burn-products-different-e-cigarettes-and. Accessed July 9, 2020.
- Philip Morris. https://www.pmi.com/media-center/press-releases/press-details/?newsId=22631. FDA authorizes marketing of IQOS as a modified risk tobacco product. Accessed July 9, 2020.