Is heat-not-burn destined to become a serious harm reduction alternative?

by Carl V Phillips

I, along with most THR advocates, have long been a bit skeptical about heat-non-burn (HnB) alternative cigarettes.  These are devices that apply heat from some source (like an external burning coal or a heating element) other than combustion to a cigarette-like stick of tobacco, vaporizing nicotine and other constituents, but without creating/releasing all the toxicants that result from combustion.  It has never been entirely clear where in the space between smoking (which they are clearly healthier than) and smokeless tobacco or e-cigarettes (which they are clearly less healthy than) they fall, so the rule of thumb has tended to be “call it halfway”.

Previous HnB products have released more carbon monoxide than cigarettes, though less of almost every other toxicant.  You might have seen the studies of hookahs (which are a HnB device, albeit one that is not always so well controlled) that reported this, and this was also true for the mass-produced cigarette-like devices that existed some years ago (and never caught on with smokers).

But during my recent series of meetings, I had a brief conversation with someone who insisted that I would be wowed by the low toxicant profile of the HnB products that are being developed.  I have no reason to doubt the claim, though I will wait to see something concrete.  I have been promised an opportunity to do so, and will report on it to the extent I am allowed by confidentiality.

Assuming it is true, it will have some interesting implications.  The “halfway in between” level of risk was, frankly, just not good enough.  If someone was going to make a fundamental change in their choice of product, I was inclined to dig in and say “go with approximately 99% less harmful, and don’t waste your effort on something that is still really harmful”.  But what if it seems like it is 80% less harmful, but far more appealing to many smokers than a completely smoke-free(*) alternative?  That is a tough one.

(*Note:  Exactly what deserves to be called “smoke” is complicated.  I recently heard the argument that e-cigarette vapor technically meets the definition of smoke, though this depends on which definition (some it does, some it does not).  The cloud of particulates generated by a HnB is even more ambiguous.)

To date, it was never necessary to even worry about the residual risk of THR products.  The ANTZ, of course, have all their rhetoric about “net population effects”, and the FDA is now echoing that.  But for products that are 99% less harmful, that is obviously complete nonsense.  The risk is so low that it can just be rounded to zero for any practical (honest) purpose.  But something like, say, 20% as bad as smoking does not round to zero.  It is obviously enormously better than smoking for would-be smokers.  But if it attracted would-be users of the low-risk products who like smoking back to something in between, the impacts would have to be calculated.

Of course, if it attracted them to make that free choice, it would mean that it was making them happier, which by any ethical standard would be considered a good thing.  Unfortunately, real ethical standards are largely absent from the discussion of tobacco.

Sorry — I have nothing to offer today other than questions and musings.  I will try to get back to asserting definitive answers in my next post.

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17 responses to “Is heat-not-burn destined to become a serious harm reduction alternative?

  1. Pingback: Is Heat-Not-Burn Destined to Become A Serious Harm Reduction Alternative? • The Spinfuel News Blog

  2. Welcome back, Dr. Phillips. Quite honestly, your “questions and musings” are usually more interesting, informative, and thought-provoking than others’ “definitive answers,” so keep them coming. Please!

  3. I didn’t think the definition of smoke was questionable. Webster defines it as the cloud of black, gray, or white gases and dust that is produced by burning something. Nothing is burning in an ecig, therefore no smoke. If vapor is smoke then so are the clouds in the sky, fog, steam, vapor from a humidifier, that white stuff rising from a hot cup of coffee, etc. I just don’t see a problem here with vapor not being smoke. Antz just hate smokers (and probably have deep seated personal issues as well) and if we quit using an asthma inhaler then asthma inhalers would be under attack. (A hookah is indeed lit with fire and creates smoke) The PG/VG mix is used in theater to create fog/vapor and is not considered smoke (And vapor will not set off a smoke detector) :) ~ Peace n Love

    • Carl V Phillips

      Many definitions refer to combustion explicitly. By those definitions, e-cigarettes are clearly not producing smoke, though it can be ambiguous for HnB. It turns out, as with most phenomena, that the while it is often easy to identify clear “yes” and “no” cases, the border is fuzzy even for something like “does this count as burning?” However, some definitions can get as broad as “a visible cloud of suspended particulate matter”, which would include all of them (and, fwiw, a dense enough concentration anything fitting that definition will set off some types of smoke detectors). This is one of the several reasons why trying to respond to regulation by arguing about common-language meanings will seldom be useful.

  4. Carl: A Hookah is not a “heat not burn” device. It burns charcoal. Through this combustion process, it generates concentrations of carbon monoxide so high that I believe that the light-headed sensation desired by hookah users is really partial asphyxiation from carbon monoxide poisoning.

    Not only that, but the charcoal emits many of the same toxins as emitted in cigarette smoke, creating a situation in which the hookah might actually be more harmful than cigarettes. This has not been subjected to scientific study because, (at least this is my impression) no one has ever found a significant number of hookah users who did not also smoke cigarettes.

    My suspicion is that relatively little in the way of major toxins (other than the nicotine and flavoring) may be extracted from the tobacco when using the hookah, but the charcoal fumes make up for this deficit. Some have tried electric hookahs that don’t use charcoal. My impression, based entirely on anecdotal comments, is that these have simply not been satisfying for hookah users.

    Either way, hookahs and e-cigarettes should not be considered as posing similar risk to the user.

    Joel

    • Carl V Phillips

      HnB refers to what happens to the tobacco (and whatever it is mixed with). There is always a heating element and sometimes it burns, but you do not inhale the burning bit. The charcoal in a hookah is the heating element, and it burns (or smolders, the emphasize that grey area about what constitutes burning from the previous comment), but the user does not inhale it (except to the extent that it creates indoor air pollution and the user inhales a little bit of it from the environment). The tobacco mixture does not burn if things are working right (which they do not always do, which means that any single observation in the research is suspect unless there is very good methods reporting). Ergo, hookahs are clearly HnB.

      Burning charcoal, along with with most burning solids and liquids, does indeed emit many of the same toxicants as burning tobacco (though charcoal is a lot cleaner than burning tobacco or wood). Fortunately, the user is not inhaling the concentrated smoke from it. High CO exposure from some HnB devices, apparently including hookahs, comes from the oxidation of the tobacco itself, since the emissions from that are what are being inhaled. It is not about the heat source — unless hookahs are used in a poorly ventilated area, in which case the environmental exposure can add up.

      Lots of hookah users do not smoke cigarettes, so there is no problem finding a population to study if that is what someone wants to do. There is no serious doubt that using a hookah is less harmful than cigarettes (in comparable doses) but as I pointed out in the post, we have never been exactly sure where the harm falls. As I said, it is safe to say that such low-tech HnB devices are high enough risk that I am not inclined to include them the list of THR options. But if the new high-tech HnB devices get the toxicants down in the neighborhood of smoke-free alternatives, then that could be a different story.

  5. I used the HnB “cigarettes” for a while, and was never really happy with them. I forced myself to use them while they were available in my area. The little piece of coal (or whatever it was) would often fall out and burn clothes, carpet, whatever. They tasted awful, made traditional cigarettes taste overly sweet when smoked occasionally, and people were always confused by the spent ones (which resemble unlit cigarettes). Folks would always ask me why I had an ashtray of unlit cigarettes in front of me when I was out…

    Not long after I started using electronics, I did a little research on those particular HnB products and the history of the strategy, If memory serves, they were actually in line with the worst traditional cigarettes on the market in terms of TSNAs. Unfortunately I don’t remember the specifics, and a cursory search hasn’t turned up the document I was reading, but I remember thinking I had wasted my time with those HnBs that were no better for me and were pretty awful.

    When I say I tried everything, I mean it.

    Sorry to ramble, but my point is that I’d be very impressed if they manage to get it right. Even awful early tobacco flavors of electronic cigarettes tasted more like traditional cigarettes than those HnBs from 2003 or so…

    • Carl V Phillips

      Interesting. Thanks for the testimonial. I think they were probably less bad for you than regular cigarettes, but perhaps not all that much.

      They definitely were not popular, and it turned out that the people who knew the most about them (the people who worked for the manufacturers) were the only ones who kept using them. We have often joked that we could actually do an epidemiology study of their use, but it would require using the headquarters of a tobacco company as the study population. That says a lot about their qualities — apparently reduced risk enough to attract those with detailed knowledge, but not appealing enough to attract others.

  6. I’m grateful to see this discussion taking place here, as I (on a personal level) have been interested in the concept of HnB for awhile now. I tried the Eclipse, but did not find it to be satisfying (though it wasn’t horrible). I also tried vaping ryo tobacco straight out of a pen-style vaporizer, but unfortunately, the taste was not was I was looking for.

    Then I tried the Ploom Model (a HnB vaporizer that uses tobacco pods) One a couple of years ago….didn’t care for that either. fast forward a couple of years: Recently, I went ahead and purchased the Ploom Model Two and I have to say that I really like it. I have to honestly say that I have only had about one or two cigarettes in the last month & 1/2 as a result (…just to see if I still liked them…lol). Truthfully, I have never been a heavy smoker to begin with, but this is still significant, as I am a dedicated tobacco user in the sense that I enjoy it in moderation on a regular basis.

    Have you ever heard of this brand/product? It is the creation of two Stanford graduates and it is (the company, that is) now a subsidiary of Japan Tobacco. For me, this is the closet thing to the “real” thing yet. It actually tastes like the real thing, but almost better in some ways. I wonder what the potential for a product like this is. I am aware of the fact that other companies are working on their own HnB brands as well. It’s all rather exciting to be honest, especially being that the technology is there to make (via healthy regulation) it so that TSNAs are largely something of the past.

    Thanks for this post. I look forward to your next post with regards to this issue.

    • Carl V Phillips

      Yes, I am aware of it, though I will admit not much more. (Note: I have had some dealings with JT, but not on this particular issue, so I am talking solely from the point of an outside observer here.) I have not learned anything about the chemistry of the… uh, I guess it would have to be called the plume, let alone any toxicology. Again, from a total outside observer perspective, I almost get the impression that it is being market positioned to compete with ecigs as an alternative to smoking, though this may be inevitable for any HnB these days

      It is good to hear that it is appealing (especially if the toxicant profile is looking good).

      I am not surprised that improvising HnB does not work out so well. I have gotten a pretty good impression about what it takes to make these products really work, and it is damn complicated — far more so than ecigs.

  7. “Again, from a total outside observer perspective, I almost get the impression that it is being market positioned to compete with ecigs as an alternative to smoking, though this may be inevitable for any HnB these days”

    Kind of…but, then again maybe not entirely. The way that I see it (as a consumer) is that both are competing with the traditional cigarette. HnB, however, has the potential to become an attractive smoking alternative to the smoker that hasn’t been sold on the e-cigarette. Many of us just like the taste of the tobacco itself. Some people are going to prefer the e-cig and some are going to prefer HnB. Hell, some of us may become “dual” users of both. If both are less harmful, then the net outcome has got to be positive for anyone who makes the switch to either (or both).

    The objective of the FDA (and others in the field of health) should be to get as many smokers as possible turned on to products that are less harmful than, but just as (or more) satisfying as that of the traditional cigarette. I’m babbling….you know this already Carl. I’m just echoing the sentiment bit further.

    I’m quite surprised that the whole concept hasn’t been studied more. The only studies/info that I can seem to find on vaporizing plant material-apart from those that mention the Eclipse or the Accord- are those that pertain to vaporizing cannabis, which ironically, has many of the same bad constituents as tobacco when burned. Studies on vaporizing cannabis confirm/claim that vaping is in fact safer than smoking. I would assume that the same could/should be said for tobacco as well (especially for low TSNA tobacco heated through a heating device that does not utilize any combustion whatsoever).

    It sure would be nice to get an honest response from health authorities on this issue,but I’m not holding my breath (pun intended). Just think about all of the lives that could be saved as a result.

    • Carl V Phillips

      You and I are definitely in full agreement (about this — we have had our disagreements about some things in the past, of course). That is what FDA and all regulators should be doing. Everything we know says these will be lower risk. Many smokers do not want to switch to ecigs (just as many have not wanted to switch to snus over the last decade) so something that appeals to more of them (like you) is a good thing, even if a bit higher risk.

      Of course, as I indicated, my opinion will ultimately depend on exactly what “a bit” turns out to be.

      We should have much more detailed and consistent data about the HnB tobacco devices than anything we have about cannabis, since the engineering is tight and the testing is massively well funded. It would have been nice to know more earlier, but we should soon know a lot.

      • Well, it’s nice that we can agree on something. For sure, we should have had much more data about HnB devices by now, but it’s comforting to know that is about to change. I just hope that the results are based on science and not on politics. I also hope that the risk is comparable with that of snus or an e-cigarette….or at least lower than that of a Now/Carlton or an Eclipse:-)

  8. Pingback: Anti-THR liar of the year #3: The World Health Organization (and a Dishonorable Mention for the Continuumistas) | Anti-THR Lies and related topics

  9. I recently purchased an arizer solo vaporizer , as i have tried for long while to get by using e-cigs , then snus , then both together and found that neither seemed to help much at all. It is a portable vaporizer with temperature control functions that is sold as being used for aromatherapy – although it doesn’t take a genius to figure out what ‘Herbs’ the majority of its users put in it- It is a very well made piece of kit . I haven’t actually used it yet, but am planing to put some unprocessed tobacco leaf in it and see how it goes .

    • Carl V Phillips

      Let me know how it works for you (and if you want to tell me more about why the other products did not work for you — either here or privately — I would be very interested in learning about your experience).

      I assume you are planning to use something like RYO or pipe tobacco. Actual unprocessed leaf would probably not be very appealing.

    • Alex,

      Not trying to be a salesperson here, but Ploom’s Blend X pipe tobacco is made specifically for this purpose. I’ve been down your path and I have found (thus far) that they are the only company (that I know of in the U.S.) that currently has tobacco products out on the market that actually taste good when vaporized. Ploom’s modelTwo is even better (ie., tasty). Unfortunately, the pods are quite pricey (probably because it’s tobacco), but they are quite good. That’s what ultimately did the trick for me.

      In my humble opinion, Blend X is probably the way to go for the Arizer. I say that because who really knows at this point if other pipe tobaccos are meant for this purpose (?). Maybe it’s ok to use other pipe tobaccos, maybe it’s not(?). Blend X doesn’t use humectants/added flavorings like the pods do, hence the flavor isn’t quite as intense as the pods that go with the modelTwo, but I have mixed it with peppermint/licorice tea with decent results. A little goes a long way and I have found when vaping tobacco early in the day I can go for a long period of time without feeling the need for more. Watch out for regular ryo tobacco though, it can taste like CRAP in a vaporizer. Trust me…lol..I’ve been there, but who knows, you may have an entirely different experience. One more thing: vaping tobacco is (obviously) quite a bit different than smoking a cigarette. I have found it to be much more enjoyable when not inhaling it directly, ie., more like a pipe or a cigar. …just my two cents.

      I really wish that this topic would be studied more.

      Cheers:-)

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