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A growing body of independent research supports HTP reduced-risk claims. Image generated by ChatGPT
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Large tobacco companies cannot afford to deliberately falsify research outcomes. Image generated by Microsoft Copilot.
Industry-funded studies tend to be criticized as being biased, but are frequently corroborated by independent research also.
The debate surrounding heated tobacco products (HTP) continues to smolder in the public health and regulatory arenas. Often promoted by tobacco companies as reduced-risk products (RRP), these devices have met with skepticism from anti-smoking advocates and policymakers. Critics argue that industry-funded research lacks impartiality and may downplay potential dangers. However, it is less frequently acknowledged that the body of peer-reviewed, independently conducted studies, while cautious, frequently echoes the industry’s central assertion that HTP are significantly less harmful than combustible cigarettes. Though not completely risk-free (and even industry-funded studies routinely point this out!), HTP may represent a pragmatic avenue for harm reduction—especially for current smokers unable or unwilling to quit.
1Public Health England (PHE): Systematic Review of Evidence
A systematic review commissioned by Public Health England (PHE) critically evaluated 20 studies on HTP, focusing on emissions, nicotine delivery, and environmental effects. While 12 of the studies had some degree of industry backing, seven were funded independently. PHE acknowledged that industry studies tended to interpret results in more favorable terms, underscoring the need for greater objectivity.
Lower harm… but not no harm
Despite variance in methodology, independent studies within the review consistently reported that HTP emitted lower levels of harmful and potentially harmful compounds (HPHC) than cigarettes. That said, levels often exceeded those found in e-cigarettes, placing HTP in an intermediate tier of risk. Furthermore, environmental emissions from HTP, though lower than cigarette smoke, were not negligible, contradicting some manufacturer claims.
Nicotine delivery and behavior
The PHE review found that HTP deliver 70-84% of the nicotine found in cigarettes. Interestingly, users often modified their puffing behavior to compensate for lower satisfaction, a factor which could influence real-world exposure levels. Overall, the review recommended further long-term studies but recognized that switching completely from cigarettes to HTP likely reduces health risks substantially.
2Committees on Toxicity, Carcinogenicity and Mutagenicity (COT, COC, COM), UK
COT, COC, and COM are scientific advisory groups commissioned by and serving the British government. As part of their work tasks, the committees jointly performed a toxicological evaluation of two HTP brands available in the UK, namely PMI’s IQOS and BAT’s glo, comparing their emissions and toxic profiles to those of combustible tobacco cigarettes. The results revealed a substantial decrease in exposure to several toxicants, with some HPHC reduced by 50% and others by more than 90%.
Toxicology and cancer risks
While some mutagenic and carcinogenic compounds were still present in HTP aerosol, their concentrations were considerably lower than those in cigarette smoke. Importantly, sidestream emissions in indoor environments were reduced, suggesting lower risks of secondhand exposure.
Policy concerns and public messaging
COT, COC, and COM emphasized that despite the reductions, HTP are not “safe” and should not appeal to non-smokers, particularly youth. They called for continued independent research and surveillance to monitor population-level impacts and to inform public health messaging appropriately.
3German Federal Institute for Risk Assessment (BfR): Chemical and Toxicological Review
BfR noted that unlike conventional cigarettes, which combust tobacco at over 700°C, HTP operate at approximately 350°C. This significant temperature drop drastically alters the emission profile, with independent studies reporting reductions of 80-99% in aldehydes, polycyclic aromatic hydrocarbons (PAHs), and tobacco-specific nitrosamines (TSNA).
Reduced metals and carbon monoxide
Toxic heavy metals like cadmium and combustion byproducts such as carbon monoxide were also diminished by over 90%, the BfR study found, enhancing the evidence for reduced harm. Importantly, this analysis covered not only user exposure but also environmental output.
Regulatory viewpoint
While the reductions were notable, BfR nevertheless cautioned against interpreting them as a green light for unrestricted use.
The agency advocated for further validation through longitudinal, epidemiological studies before endorsing any harm reduction claims unequivocally.
4University of Catania, Italy: A Focus on COPD Patients
One of the most compelling studies comes from the University of Catania in Italy, where a longitudinal study tracked chronically obstructed pulmonary disease (COPD) patients over three years. The research focused on individuals who had fully or partially switched from cigarettes to HTP. COPD, together with lung emphysema, is among the most commonly seen diseases to develop in decades-long smokers of combustible tobacco smokers.
Clinical improvements and quality of life
Among those patients who transitioned to exclusive HTP use, annual COPD exacerbations dropped from 2.1 to 1.3, while respiratory symptoms, measured via the COPD Assessment Test (CAT), showed consistent improvement. Participants also demonstrated marked progress in their six-minute walk distance, an indicator of overall physical resilience.
Cessation and harm reduction
By the study’s end, 57.9% of participants had stopped smoking cigarettes altogether. Even dual users – meaning those who continued smoking along-side HTP – reduced their cigarette consumption by over 70%. These outcomes suggested to the researchers that HTP may serve as effective harm-reduction tools for high-risk populations.
Independence and potential conflicts Though largely independent, the study’s principal investigator, Dr. Riccardo Polosa, post-study has acknowledged some affiliations with harm reduction advocacy organizations, drawing occasional criticism. Nonetheless, the study’s peer-reviewed methodology and robust clinical outcomes offer valuable insights.
Conclusion: the need for a balanced perspective
While the tobacco industry remains a polarizing force in global health policy, it’s increasingly clear that dismissing all research linked to harm reduction out of hand may hinder public health progress. Independent evaluations of HTP conducted by government agencies, academic institutions and public health bodies generally align in showing that these products significantly lower exposure to harmful substances compared to conventional cigarettes.
Although none of these independent studies outline in this article suggest that HTP are completely safe or suitable for non-smokers, they do acknowledge that, for current smokers who are unable or unwilling to quit, switching entirely to HTP may reduce the health burden associated with smoking. The path forward lies not in vilifying harm-reduction tools, but in rigorously scrutinizing them independently, transparently, and continuously.
It also might be good advice for anti-tobacco lobbies to adopt a policy to not routinely reject industry-funded research as “biased” or untrustworthy. Large tobacco companies, particularly the multinationals cannot afford – for a multitude of legal and ethical reasons – to deliberately falsify research outcomes or conduct studies with the desired result already in mind. Instead, industry-funded research should be embraced as an honest effort by the tobacco sector to offer transparency regarding its products.
Citations:
1McNeill A, Brose LS, Calder R, Bauld L & Robson D; “Evidence Review of e-Cigarettes and Heated Tobacco Products”; published in February 2018 as a report commissioned by Public Health England. London, United Kingdom
2”Statement on the Toxicological Evaluation of Novel Heat-Not-Burn Tobacco Products “; Committees on Toxicity, Carcinogenicity and Mutagenicity of Chemicals in Food, Consumer Products and the Environment (COT, COC and COM); United Kingdom; December 2017
3Nadja Mallock, Elke Pieper, Christoph Hutzler, Frank Henkler-Stephani and Andreas Luch; “Heated Tobacco Products: A Review of Current Knowledge and Initial Assessments Risk: Assessment of Heated Tobacco Products”; Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany; 2018/2019
4Riccardo Polosa, Jaymin B. Morjaria, Umberto Prosperini, Barbara Busà, Alfio Pennisi, Gualberto Gussoni, Sonja Rust, Marilena Maglia, Pasquale Caponnetto; “Health Outcomes in COPD Smokers Using Heated Tobacco Products: A 3-Year Follow-Up”; Dept. of Internal and Emergency Medicine, University of Catania, Italy; 2021