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Heated tobacco products: the example of IQOS
  1. Stanton A Glantz
  1. Department of Medicine, Center for Tobacco Control Research and Education, Cardiovascular Research Institute, Philip R. Lee Institute for Health Policy Studies, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94143-1390, USA
  1. Correspondence to Professor Stanton A Glantz, Department of Medicine, Center for Tobacco Control Research and Education, Cardiovascular Research Institute, Philip R. Lee Institute for Health Policy Studies, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94143-1390, USA; glantz{at}medicine.ucsf.edu

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Heated tobacco products (HTP) represent the latest in a long line of products tobacco companies have developed and marketed as less dangerous than conventional cigarettes, beginning with so-called ‘safer cigarettes’ in the 1960s.1 2 HTP (figure 1) heat tobacco to generate an inhaled nicotine aerosol and are marketed using messages that explicitly or implicitly claim they are safer than cigarettes.3–8

Figure 1

(A) The Philip Morris International IQOS charger, holder and HeetStick (tobacco stick). (B) Schematic drawing of holder. (C) Schematic of HeetStick tobacco stick.10

In 2018, HTP were available in many countries (table 1). In the USA, before marketing new tobacco products, the Family Smoking Prevention and Tobacco Control Act9 (FSPTCA) requires premarket review by the Food and Drug Administration (FDA) to demonstrate that marketing them would be ‘appropriate for the protection of the public health’ (FSPTCA sections 910 and 905(j)). Additionally, to market any new tobacco product in the USA with claims of reduced risk or reduced exposure to toxins compared to other tobacco products (‘Modified Risk Tobacco Product’; MRTP), the company must first obtain an MRTP marketing order from the FDA. In December 2016, Philip Morris International (PMI) submitted an application to market IQOS, one of its HTP, with MRTP claims.10 PMI’s MRTP application included extensive details about the product, the chemistry of the aerosol it produces, related toxicology, effects on clinical measures in people, perceptions of the product and its packaging (including warning labels), and behavioural factors. This application sought FDA approval of PMI’s claims that smokers who switched completely to IQOS would reduce their health risks or exposure to dangerous substances compared with smoking cigarettes.

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Table 1

Availability of heated tobacco product by major cigarette company and country of availability (January 2018)

As of November 2017, there were 31 studies of HTP published in the peer reviewed …

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