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Iqos

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Iqos (/ˈaɪkoʊs/ EYE-kohs, stylized as IQOS) is a line of heated tobacco products designed to be used with tobacco and zero-tobacco nicotine-containing consumables. They are manufactured by Philip Morris International (PMI).[1][2] The brand was first introduced in November 2014 in Japan and Italy. At the end of 2023, smoke-free products made up nearly 40% of PMI's total net revenue and gross profit, with Iqos surpassing Marlboro in terms of net revenue.[3]

Iqos
Iqos devices, from Accord to Iluma
Product typeHeated tobacco products
OwnerPhilip Morris International
Introduced2014; 10 years ago (2014)
MarketsWorldwide
Websitehttps://www.iqos.com

The World Health Organization states that there is currently no evidence to show that heated tobacco products such as Iqos are less harmful than other tobacco products.[4] A recent systematic review reached the same conclusion.[5] The European Respiratory Society states that heated tobacco products are addictive and cause cancer in humans.[6]

History

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Philip Morris took its first commercial steps in the field of heated tobacco in the 1990s with "Accord" and "Heatbar" before they were withdrawn from the market.[7][8] In 2014 Iqos was introduced by Philip Morris International, first in Japan and Italy.[9] Starting in 2016, Philip Morris began heavily promoting a "smoke-free future", stating an intent to increasingly focus commercial efforts on products that are alternatives to cigarettes.[10] In 2020, the U.S. Food and Drug Administration authorized the marketing of "IQOS Tobacco Heating System" as modified risk tobacco products (MRTPs) while pointing out that "these products are not safe nor FDA approved".[11] Philip Morris International's efforts toward a "smoke-free" business transition allowed the company to begin the process of issuing sustainable bonds to finance itself in August 2021, which raised fears of greenwashing.[12]

 
The Heets/Heatstick system heats tobacco from a blade.
 
Terea sticks have a metal insert in the tobacco stick itself and work through induction heating.

Construction

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Components

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Most Iqos models consists of a charger and a pen-like holder.[13] A disposable stick (called "HeatStick" or "Heets") containing processed tobacco and glycerin is inserted into the holder, which then heats it to temperatures up to 350 °C for inhalation.[14] Iluma, a more recent iteration, relies on induction to heat the tobacco sticks (called "Terea").[15][16]

Waste

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Philip Morris claims that Iqos reduces waste and carbon emissions compared to a cigarette, and presents the product as being part of its sustainability initiatives.[17][18] The company is also promoting itself as a player in the circular economy by arguing that Iqos devices can be recycled by being returned to manufacturing centers.[10][18] These claims were disputed by the Public Health Law Center at Saint Paul, Minnesota, as used HeatSticks constitute waste similar to conventional cigarette butts. Furthermore, it was noted that "new products such as e-cigarettes, or heated cigarette products like Iqos, will increase the overall supply of e-waste. It is most likely impossible to create any e-cigarette without a battery, poisonous liquid, metals and plastics joined in small devices, each of which cannot be recycled or disposed of responsibly."[19]

Health effects

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Many of the early studies of Iqos were funded by the tobacco industry. A 2021 independent systematic review noted some reduction in risk markers among users compared to cigarette users.[5] However, it's also noted Iqos use was reported to alter mitochondrial function, which could further exaggerate airway inflammation and lung cancer.[5] The review concluded that "research seems to be necessary to assess the frequency of HTP use and its potential negative health effects."[5] A 2022 Cochrane review of 13 studies concluded:[20]

We do not know whether using heated tobacco helps people to stop smoking cigarettes (no studies measured this). We are uncertain whether the chances of getting unwanted symptoms from being asked to use heated tobacco are different compared with cigarettes (6 studies, 1713 participants) or no tobacco (2 studies, 237 participants). Serious unwanted symptoms in the short time period studied (average 13 weeks) were rare in all groups, which means we are uncertain about any differences. Toxin levels were probably lower in people using heated tobacco than those smoking cigarettes (10 studies, 1959 participants), but may be higher than in people not using any tobacco products (5 studies, 382 participants).

Marketing

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The Iqos 2.2 was the first commercially launched device under the brand name.[21] In 2023, Iqos products had 28.6 million users in 84 countries.[22] Among them, the United States, Canada, New Zealand, South Korea, Israel, United Arab Emirates, Ukraine, Belarus, Moldova, Georgia and most European Union countries have chosen to adopt a specific approach to supervise the sale of heated tobacco.[23][24] In Canada and Israel, the packaging of Iqos devices is fully covered with a warning message.[23] In the United States, the FDA granted Philip Morris authorization to make a "reduced exposure" marketing claim, considering that switching completely from cigarettes to Iqos reduces exposure to harmful chemicals, but specifically did not allow Philip Morris to make any claim that switching from cigarettes to Iqos reduces the user's risk of disease.[11][23] The decision to allow for reduced exposure claims was criticized by the World Health Organization as misleading to consumers.[25]

Direct marketing

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Philip Morris is regularly accused of circumventing laws prohibiting the promotion of tobacco by claiming that Iqos is not a tobacco product. Canada updated its tobacco laws to clearly include heated tobacco devices in the list of regulated tobacco products.[23] In France, it was reported that Philip Morris was promoting its devices at private parties, with salespersons sometimes offering alcoholic beverages to interested customers.[26][27]

Philip Morris has been accused of using unregulated or illegal marketing strategies: a 2018 report stated that "Iqos boutique stores are the focus of aggressive promotion including exchanging a pack of cigarettes or lighter for an Iqos device, launch parties, 'meet and greet' lunches and after-hour events".[28] According to Reuters "The marketing strategy mimics that of tobacco companies in the mid-20th century, when they started associating cigarettes with Hollywood and high society."[29]

Philip Morris has also reportedly carried out several marketing campaigns directly mentioning Iqos, presenting the product as a "smoke-free" and a "reduced-risk" alternative, encouraging consumers to quit smoking or switch to Iqos.[29][30] This marketing approach has come under criticism. A critical review of reports submitted by PMI to the FDA in support of its application claimed that "Consumers may misunderstand what is meant by 'switching completely' [and] are likely to misunderstand the unsupported claims of reduced risk". In granting the exposure order the FDA however stated that adult consumers correctly understood the messages that were authorized.[11]

Youth-oriented marketing

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In 2019, Reuters reported that Philip Morris was using social media influencers in several countries to make them "ambassadors" for the brand and promote Iqos to a young audience.[31] PMI responded that it would cease use of influencers.[31] According to Matthew Myers, president of the Campaign for Tobacco-Free Kids, the company "is changing its behavior only when caught red-handed."[31]

Also in 2020, a report on Philip Morris' Iqos implementation strategy in Australia pointed out that "Philip Morris has strongly lobbied the Australian government to legalize heated tobacco products, while simultaneously making plans to sell Iqos at young adult-friendly premises such as bars, clubs and pubs if its proposed legislative changes are made."[32]

Criticism and controversies

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Lobbying

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In December 2017, Reuters published documents and testimonies from former employees alleging irregularities in the clinical trials conducted by PMI for the approval of the Iqos product by the U.S. FDA.[33] This investigative work reported that Philip Morris was lobbying to block or weaken the provisions made under the WHO Framework Convention on Tobacco Control (FCTC), going against the idea that the company would support a smoke-free future.[34]

Toxicity

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A number of third-party toxicity studies had findings which often contradicted those of Philip Morris International.[35] UCSF-based Professor Stanton Glantz concluded that in terms of harmfulness, "Iqos is not detectably different from conventional cigarettes."[36] A 2020 systematic review of the available scientific literature found very limited available data on the effects of Iqos on a smoker's health and recommended further studies.[37]

In October 2018, the Belgian Cancer Foundation issued advice on Iqos, based on previous independent studies published on the subject. The Foundation claimed that "Iqos is not a solution" for quitting smoking."[38] It further stated that "if the tobacco giant is positioning itself in this innovative market, it is to compensate for the financial losses resulting from the reduced sales of cigarettes (...). The tobacco industry is therefore exploring solutions in order to continue to make profits and keep dependent consumers."[38]

In July 2020, the World Health Organization (WHO) published a "statement on heated tobacco products and the U.S. FDA decision regarding Iqos", which read: "WHO reiterates that reducing exposure to harmful chemicals in Heated Tobacco Products (HTPs) does not render them harmless, nor does it translate to reduced risk to human health. Indeed, some toxins are present at higher levels in HTP aerosols than in conventional cigarette smoke, and there are some additional toxins present in HTP aerosols that are not present in conventional cigarette smoke. The health implications of exposure to these are unknown. (...) Given that health may be affected by exposure to additional toxins when using HTPs, claims that HTPs reduce exposure to harmful chemicals relative to conventional cigarettes may be misleading."[25]

According to the University of Bath's TobaccoTactics website, "There is very little evidence that Iqos is effective as a [cigarette] quit tool at the individual level or population level."[39] According to the Netherlands National Institute for Public Health and the Environment, Iqos is "harmful to health, but probably less harmful than smoking tobacco cigarettes".[40]

In June 2022, the European Commission proposed to prohibit the sale of flavoured heated tobacco products, including TEREA sticks. This proposal follows a “beating cancer plan”, to tackle the significant increase in the volumes of heated tobacco products sold across the EU.[41]

Patent

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In September 2021, the U.S. International Trade Commission ruled that Philip Morris International and its commercial partner Altria must stop the sale and import of the Iqos device in the United States because of a patent case filed by R.J. Reynolds.[42] The U.S. International Trade Commission found that the cigarette alternative infringed on two of Reynolds' patents. Philip Morris International announced its plans to appeal the trade agency's decision.[43] The disagreement with British American Tobacco (BAT) got resolved in February 2024.[22] PMI and BAT came to a non-monetary agreement that settled the ongoing patent infringement lawsuits between them regarding their heated tobacco and vapor products.[22]

References

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  1. ^ "Philip Morris sees six million U.S. smokers switching to iQOS device if cleared". Reuters. 24 January 2018. Retrieved 3 December 2021.
  2. ^ "Philip Morris develops zero-tobacco heat stick that may avoid regulations". Reuters. 28 September 2023. Retrieved 26 August 2024.
  3. ^ "Outside U.S., Marlboro Revenue Eclipsed by Sales of a Cigarette Alternative". The Wall Street Journal. 8 February 2024.
  4. ^ "Heated tobacco products: information sheet - 2nd edition". www.who.int. Retrieved 14 March 2023.
  5. ^ a b c d Znyk, Małgorzata; Jurewicz, Joanna; Kaleta, Dorota (January 2021). "Exposure to Heated Tobacco Products and Adverse Health Effects, a Systematic Review". International Journal of Environmental Research and Public Health. 18 (12): 6651. doi:10.3390/ijerph18126651. ISSN 1660-4601. PMC 8296358. PMID 34205612.
  6. ^ ERS (17 June 2020). "ERS Position Paper on Heated Tobacco Products". ERS - European Respiratory Society. Retrieved 14 March 2023.
  7. ^ Elias, Jesse; Dutra, Lauren M.; Helen, Gideon St; Ling, Pamela M. (1 November 2018). "Revolution or redux? Assessing IQOS through a precursor product". Tobacco Control. 27 (Suppl 1): s102–s110. doi:10.1136/tobaccocontrol-2018-054327. ISSN 0964-4563. PMC 6238084. PMID 30305324.
  8. ^ "Heated Tobacco Products - TobaccoTactics". tobaccotactics.org. Retrieved 3 December 2021.
  9. ^ "Philip Morris to launch Marlboro HeatSticks system in Milan". Reuters. 19 November 2014. Retrieved 4 December 2021.
  10. ^ a b Lester, Toby (14 July 2020). "How Philip Morris Is Planning for a Smoke-Free Future". Harvard Business Review. ISSN 0017-8012. Retrieved 4 December 2021.
  11. ^ a b c Office of the Commissioner (7 July 2020). "FDA Authorizes Marketing of IQOS Tobacco Heating System with 'Reduced Exposure' Information". Food and Drug Administration. Retrieved 4 December 2021.
  12. ^ Mutua, David Caleb; Gretler, Corinne (27 August 2021). "Philip Morris to Court ESG Investors Whose Mantra Is Shunning It". Bloomberg. Retrieved 4 December 2021.
  13. ^ "Philip Morris unveils smoke-free cigarette in Korea". The Korea Times. 17 May 2017. Retrieved 4 December 2021.
  14. ^ Auer, Reto; Concha-Lozano, Nicolas; Jacot-Sadowski, Isabelle; Cornuz, Jacques; Berthet, Aurélie (22 May 2017). "Heat-Not-Burn Tobacco Cigarettes". JAMA Internal Medicine. 177 (7): 1050–1052. doi:10.1001/jamainternmed.2017.1419. ISSN 2168-6106. PMC 5543320. PMID 28531246.
  15. ^ "ITC Recommendation Against PMI Should Have Limited Impact". LaVerne Investing. 18 May 2021. Archived from the original on 1 October 2022. Retrieved 4 December 2021.
  16. ^ "Virtual Expo Exhibitor of the Day: Phillip Morris International "revolutionises" heated tobacco sector with IQOS ILUMA". The Moodie Davitt Report. 7 November 2021. Retrieved 4 December 2021.
  17. ^ "Exec: Innovative IQOS sits at the top of PMI's sustainability efforts". BusinessMirror. 30 August 2020. Retrieved 4 December 2021.
  18. ^ a b "Jacek Olczak: "Our vision for a smoke-free future remains our top priority"". To Vima. 1 July 2021.
  19. ^ "To End the Tobacco Industry's Pollution, Put an End to the Tobacco Industry". www.publichealthlawcenter.org. Retrieved 4 December 2021.
  20. ^ Tattan-Birch, H.; Hartmann-Boyce, J.; Kock, L.; Simonavicius, E.; Brose, L.; Jackson, S.; Shahab, L.; Brown, J. (6 January 2022). "Do heated tobacco products help people to quit smoking, are they safe for this purpose, and have they led to falls in smoking rates?". The Cochrane Database of Systematic Reviews. 1 (1): CD013790. doi:10.1002/14651858.CD013790.pub2. PMC 8733777. PMID 34988969.
  21. ^ "The evolution of novel tobacco and nicotine products over the last decade". Tobacco Intelligence. 5 April 2024.
  22. ^ a b c "Turning Up the Heat". Tobacco Reporter. 1 April 2024.
  23. ^ a b c d "Heated Tobacco Products - Global regulation" (PDF). tobaccofreekids.org.
  24. ^ "Heated Tobacco Products : Global Regulation and Recommended Measures" (PDF). Tobacco Free Kids. 1 May 2023.
  25. ^ a b "WHO statement on heated tobacco products and the US FDA decision regarding IQOS". www.who.int. Retrieved 3 December 2021.
  26. ^ "Le cigarettier Philip Morris jugé pour publicité déguisée à cause de son produit Iqos". Le Parisien (in French). 23 September 2021. Retrieved 4 December 2021.
  27. ^ "Tabac : les soirées de promotion illégales de Philip Morris à Paris". Le Parisien (in French). 13 March 2018. Retrieved 4 December 2021.
  28. ^ Mathers, Annalise; Schwartz, Robert; O'Connor, Shawn; Fung, Michael; Diemert, Lori (1 March 2019). "Marketing IQOS in a dark market". Tobacco Control. 28 (2): 237–238. doi:10.1136/tobaccocontrol-2017-054216. ISSN 0964-4563. PMID 29724866. S2CID 19103708.
  29. ^ a b "Inside the Philip Morris campaign to "normalize" a tobacco device". Reuters. 21 February 2020. Retrieved 4 December 2021.
  30. ^ "Controversy Regarding U.S. Marketing of New Heated Tobacco Product IQOS". International Association for the Study of Lung Cancer. 20 January 2021. Retrieved 4 December 2021.
  31. ^ a b c "Exclusive: Philip Morris suspends social media campaign after Reuters exposes young 'influencers'". Reuters. 11 May 2019. Retrieved 4 December 2021.
  32. ^ Watts, Christina; Burton, Suzan; Freeman, Becky (8 November 2020). "Creating a market for IQOS: analysis of Philip Morris' strategy to introduce heated tobacco products to the Australian consumer market". Tobacco Control. 31 (3): 458–463. doi:10.1136/tobaccocontrol-2020-056057. ISSN 0964-4563. PMID 33191270. S2CID 226960901.
  33. ^ "Scientists describe problems in Philip Morris e-cigarette experiments". Reuters. Retrieved 5 December 2021.
  34. ^ Olivier, Wurlod (15 July 2017). "Une enquête de Reuters fait tousser Philip Morris". Tribune de Genève (in French). ISSN 1010-2248. Retrieved 4 December 2021.
  35. ^ "Two more peer reviewed papers find that PMI's own data shows IQOS is more dangerous than PMI claims, likely as bad as cigarettes". Center for Tobacco Control Research and Education. 30 August 2018. Retrieved 5 December 2021.[permanent dead link‍]
  36. ^ Glantz, Stanton A. (21 August 2018). "PMI's own in vivo clinical data on biomarkers of potential harm in Americans show that IQOS is not detectably different from conventional cigarettes". Tobacco Control. 27 (Suppl 1): s9–s12. doi:10.1136/tobaccocontrol-2018-054413. ISSN 1468-3318. PMC 6202159. PMID 30131374.
  37. ^ Kopa, Paulina Natalia; Pawliczak, Rafał (18 September 2019). "IQOS - a heat-not-burn (HnB) tobacco product - chemical composition and possible impact on oxidative stress and inflammatory response. A systematic review". Toxicology Mechanisms and Methods. 30 (2): 81–87. doi:10.1080/15376516.2019.1669245. ISSN 1537-6524. PMID 31532297. S2CID 202673535.
  38. ^ a b "IQOS : aussi nocif que la cigarette | Fondation contre le CancerIQOS cause autant de dégâts aux poumons et aux artères que la cigarette classique". www.cancer.be (in French). Retrieved 5 December 2021.
  39. ^ "PMI's IQOS: Use, "Switching" and "Quitting" - TobaccoTactics". tobaccotactics.org. Retrieved 5 December 2021.
  40. ^ "Addictive nicotine and harmful substances also present in heated tobacco | RIVM". www.rivm.nl. Retrieved 5 December 2021.
  41. ^ Directorate-General for Health and Food Safety. "Europe's Beating Cancer Plan: Commission proposes to prohibit flavoured heated tobacco products". Europa.eu. Euroean Commission. Retrieved 29 October 2024.
  42. ^ Lucas, Amelia (30 September 2021). "Philip Morris, Altria banned from importing or selling Iqos tobacco device in the U.S." CNBC. Retrieved 5 December 2021.
  43. ^ Maloney, Jennifer (30 September 2021). "U.S. Trade Body Rules Against Import of IQOS Heat-Not-Burn Tobacco Devices". Wall Street Journal. ISSN 0099-9660. Retrieved 5 December 2021.
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