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Did Philip Morris International use the e-cigarette, or vaping, product use associated lung injury (EVALI) outbreak to market IQOS heated tobacco?
  1. John W Ayers1,2,
  2. Eric C Leas2,3,
  3. Mark Dredze4,
  4. Theodore L Caputi5,
  5. Shu-Hong Zhu3,
  6. Joanna E Cohen6
  1. 1 Department of Medicine, University of California San Diego, La Jolla, California, USA
  2. 2 Center for Data Driven Health at the Qualcomm Institute, University of California San Diego, La Jolla, California, USA
  3. 3 Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
  4. 4 Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, USA
  5. 5 Department of Economics, Massachusetts Institute of Technology, Boston, Massachusetts, USA
  6. 6 Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr John W Ayers, Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA; ayers.john.w{at}

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25 July 2021 will mark the second anniversary1 of the e-cigarette, or vaping, product use associated lung injury (EVALI) outbreak.2 The concerns raised and news media attention focused on EVALI created a fertile environment for the tobacco industry to promote their e-cigarette alternatives,1 3 but this has not been studied.

One such product is Philip Morris International’s (PMI) heated tobacco product: ‘IQOS’.4 5 We used ‘Tobacco Watcher’ (, a fully automated and publicly available tobacco media analysis engine that warehouses news from more than 500 000+ sources. We plotted trends in news stories mentioning ‘IQOS’ finding the largest number of stories mentioning IQOS occurred on 25 September 2019, with 261 articles, more than double the next highest day previously recorded. The analysis was performed on a publicly accessible database that anyone can replicate The authors must abide by the data sharing principles of the publishers and data aggregators. The full results are available on tobacco watcher but cannot be published as part of this article.

While investigating this anomaly we discovered an official PMI public statement published on the company's media centre webpage entitled ‘Lung illnesses associated with use of vaping products in the US’ was published the previous day.6 In the statement (see online supplemental material), PMI recounted the EVALI outbreak beginning: ‘Skepticism and fear around vaping has emerged following the cases of respiratory illness and deaths in the US associated with the use of e-cigarettes.’ PMI then contrasted this against their IQOS heated tobacco product, writing ‘on April 30 2019, the FDA authorized IQOS for sale in the US, finding that marketing of the product would be ‘appropriate for the protection of public health’’ (quotes …

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  • Contributors All authors contributed to the drafting and revising of the work.

  • Funding This work was supported by funding from the Burroughs Wellcome Fund, Tobacco-Related Disease Research Program and Bloomberg Philanthropies.

  • Disclaimer The funders played no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

  • Competing interests JWA owns equity positions in Health Watcher and Good Analytics. ECL has received consulting fees from Health Watcher and Good Analytics. MD holds equity in Good Analytics and has received consulting fees from Bloomberg LP. TLC received fees from Good Analytics and holds equity in Data Science Solutions. JWA, JEC and MD are the creators of, a project of the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health for the Bloomberg Philanthropies.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.