Tag Archives: HnB

The year tobacco control officially came to own e-cigarettes

by Carl V Phillips

I have seen several year-end posts about the state of e-cigarettes, most from cheerleaders who naturally made optimistic predictions. Overly optimistic, I would say. Continue reading

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Tobacco control turn their long knives on heat-not-burn cigarettes

by Carl V Phillips

I intend to write a proper post or two on PMI’s iQos and heat-not-burn (HnB) cigarettes more generally, but haven’t had much chance to blog lately. Those products have very serious potential to be the most important thing that ever happened in THR (and, yes, I know what I said there). For now, I can just do a quick one on the back of a recent post by Dick Puddlecote, and recommend reading it.

DP recounts how ASH (UK), true to form, are marketing their doubt and general anti attitude, trying to block the huge benefits that these products could bring. He invokes my concept of anti-tobacco extremism, and links to one of my posts that invokes the concept. Here is another one, about how anti-tobacco extremism naturally results in stronger opposition to low-risk products than to cigarettes, just as we have seen. Continue reading

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.