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Invisible smoke: third-party endorsement and the resurrection of heat-not-burn tobacco products
  1. Jesse Elias1,
  2. Pamela M Ling1,2
  1. 1 Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
  2. 2 UCSF Department of Medicine, Division of General Internal Medicine, San Francisco, California, USA
  1. Correspondence to Dr Pamela M Ling, Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA 94143, USA; Pamela.Ling{at}


Background Tobacco companies are introducing new ‘heat-not-burn’ cigarettes in dozens of countries. Historically, these products failed commercially, and independent researchers contested their health claims. The most prominent early heat-not-burn cigarette was RJ Reynolds’s (RJR’s) Premier, introduced in the USA in 1988. Curiously, The Lancet endorsed Premier as a ‘near-perfect low tar cigarette’ in a 1991 editorial, 2 years after Premier had been removed from the market. We examined the context of this endorsement.

Methods To ascertain what RJR knew about this endorsement, we systematically searched and analysed previously secret RJR documents in public archives and triangulated the industry document data with other published work.

Results RJR had a long-standing interest in collaborating with outside scientists to endorse potentially reduced harm cigarettes. The author of The Lancet editorial had previously corresponded with RJR regarding Premier’s health effects and market potential. Internally, RJR regarded The Lancet’s editorial, its stance on novel tobacco products, and its endorsement of Premier as major successes. While the editorial came too late to save Premier, RJR saw future business opportunities for novel products if endorsed by health authorities.

Conclusions Endorsement by high-impact medical journals and health authorities may be critical in helping heat-not-burn’ products succeed where previous attempts have failed. Conflicts of interest influenced these endorsements in the past. Health leaders and academic journals should consider both conflicts of interest and the ethics of endorsing tobacco product substitution, as tobacco companies simultaneously work to promote cigarette smoking and undermine tobacco control globally.

  • tobacco industry
  • harm reduction
  • advertising and promotion
  • tobacco industry documents

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  • Contributors JE led data acquisition, analysis and led writing of the paper. PML obtained funding, supervised and contributed to analysis and critical revision of the paper. Both authors approved the final manuscript for submission. Both authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding This work was supported by the National Cancer Institute, National Institutes of Health (Grant R01-87472).

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All documents are publicly available at https: