Smoke-free GCC? Why a new heat-not-burn cigarette may make smoking less harmful

The product is being promoted as part of an emerging category that has a “significant potential to represent a reduced-risk alternative for smokers”.

:: One of the biggest tobacco companies in the world is hoping to introduce a ‘smoke-free’ cigarette to the GCC that will encourage the region’s four-million smokers to switch to a potentially less harmful product.

Philip Morris International (PMI), the US giant known for its Marlboro brand, has developed a ‘heat-not-burn’ (HNB) device called the IQOS that contains real tobacco that is heated below regular combustion-level temperatures. Said to stand for ‘I-Quit-Ordinary-Smoking’, the product is being promoted as part of an emerging category that has a “significant potential to represent a reduced-risk alternative for smokers”.

How is this possible? The IQOS, which consists of a heating device and disposable sticks called HEETS, apparently retains a high level of nicotine – which itself has been proven not to be harmful – while reducing the toxic cancer-causing substances found in the smoke of regular cigarettes.

“Although smoking prevalence has declined in many countries over the last years, the World Health Organization (WHO) estimates that there will be over a billion smokers by 2025 – roughly the same number of smokers of today,” explains Lana Gamal Eldin, Director Corporate Affairs ME, Philip Morris Management Services (ME) Limited. “Meeting the demand of adult smokers who are looking for less harmful, yet satisfying, alternatives to smoking represents PMI with a chance to make a significant, positive impact on public health.”

According to the WHO, tobacco use kills up to half of its users, with it accounting for the deaths of more than 7 million people worldwide every year.

In Saudi Arabia, around 23% of men and 2.2% of women smoke, with the Kingdom’s health minister Dr Tawfiq Al-Rabiah stating that around 70,000 individuals die annually from smoking-related diseases.

Meanwhile in the UAE, figures released by the Cleveland Clinic Abu Dhabi indicate that almost a quarter of all men smoke, at 24.3%, with smoking among women being less common at 0.8%. It is estimated that 26 people die every week due to smoking-related diseases.

“The scale of the challenge in ending smoking and the harm it causes is clear,” says the clinic’s Dr Iyaad Hasan, who specializes in smoking cessation. “Seventy percent of smokers want to give up the habit, but most make a number of attempts through their lives – often between six and nine. Despite this willingness to give up smoking, only 5% are able to quit without help or medications.”

Switch if you won’t quit

With its new device, PMI is keen to assert that it is not encouraging people to take up smoking; it is tapping into the segment of smokers who simply won’t give it up.

“Potentially less harmful products that now exist are a better option for smokers who wouldn’t otherwise quit smoking. But for smokers to switch to these alternatives, it is important that governments and public health embrace the opportunity represented by advancements in technology, science and design regulations that encourage smokers to do so,” continues Gamal-Eldin. “Governments have an opportunity to create a regulatory environment that promotes innovation and competition by manufacturers and encourages smokers to switch to better alternatives as quickly as possible. For instance, it is important for health warnings to reflect the fact that smoke-free products do not have the same degree of risk as cigarettes.”

For respiratory medicine specialist Dr Trilok Chand of the UAE’s Burjeel Hospital, the reason some governments are yet to introduce this type of device is “due to lack of sufficient research and safety data available so far”.

The question of revenue

Tobacco is big business, of course. In Saudi Arabia, the combined revenues of the world’s six largest tobacco companies in 2013 was $342 billion, equal to 45% of the Kingdom’s Gross National Income (GNI). The UAE, meanwhile made the same revenue in the same year, but here it was equal to 97% of its GNI.

With the general perceived decline in smoking – more individuals quitting, more turning to e-cigarettes (commonly referred to as vaping) and so on – it’s perhaps little surprise that manufacturers are coming up with alternatives as a way of making up for potential lost revenue.

And PMI has invested big bucks in the IQOS, reportedly spending $3 billion to develop the device.

However, since e-cigarettes have been championed as a safer alternative in recent years, why is heated tobacco now being promoted seemingly all of a sudden?

Says Gamal-Eldin: “HNB products provide as much as possible the taste, nicotine delivery and ritual characteristics of an ordinary cigarette, but uses technology that heats the tobacco instead of burning it – this process significantly reduces or eliminates the toxicants produced as oppose to when tobacco is burnt in conventional cigarettes.

“Vaping delivers flavors and nicotine without using tobacco, by heating a liquid.”

Medical professionals remain skeptical.

“As far as I’m aware, there is little data to support heated tobacco as being a less harmful alternative to smoking,” says Dr Hasan. “Even if that should prove to be the case, while harm reduction is of course a positive step, the only way to eliminate the risks associated with tobacco and smoking is, of course, to stop using those products entirely.”

Dr Chand agrees: “To verify this statement, more unbiased research is needed in this field. There is no reliable evidence regarding a lower risk of HNB products. The claims may be based on tobacco industry-funded research, but there is no evidence-based research available so far.”

However, he does acknowledge that a product like the IQOS could contain less harmful chemicals compared to conventional cigarettes.

“There is less risk [relating to] second-hand smoke too.”

Launching soon?

Today the IQOS is available in 25 markets globally and by the end of 2017, PMI hopes to have reached a total of 30-35 markets. And while it is currently sold online in the UAE as an unregulated product – for example, it is available on Abu Dhabi-based website for AED 1,100 ($300) – there is still no word on the official launch date for the region. Additionally, it is currently under review in the United States by the US Food & Drug Administration.

“This is about creating an encouraging environment for smokers – who otherwise will not quit smoking – to switch to better alternatives and for manufacturers to compete to offer more, innovative new products. Regulation is perhaps the most critical component of that,” states Gamal-Eldin. “The GCC is an important market for Philip Morris, and we believe that this smoke-free product can improve the health and quality of life of smokers in the region.

With the company’s “significant efforts to accelerate the transition away from cigarettes to smoke-free products”, PMI hopes to make the product available as soon as “proper regulations” are in place.

“More than two million smokers have already given up smoking and [have] switched to heated tobacco products,” Gamal-Eldin concludes. “The GCC governments should cease this opportunity to create an environment where smokers are encouraged to switch to these better alternatives as quickly as possible.”

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