Better than smoking? Debate on smoke-free tobacco products heats up
The name says it all: Heated tobacco products don't burn the tobacco, they just make it hot. This is good because fewer pollutants are released, tobacco companies say. Addiction researchers see it differently. Sebastian Kahnert/dpa

Recognition of tobacco smoke's destructive health effects has diminished social acceptance of smoking and led to extensive restrictions on lighting up in public spaces, tobacco advertising bans, anti-smoking campaigns and higher cigarette taxes. So tobacco companies have pivoted to "safer," smoke-free alternatives such as e-cigarettes, heated tobacco products and nicotine pouches.

Now they're being squeezed on this front as well. In Germany, for instance, a ban on outdoor advertising of heated tobacco products went into effect on January 1, forcing the brands IQOS by Philip Morris International (PMI) and British American Tobacco's (BAT) glo from billboards and advertising columns. Outdoor advertising of e-cigarettes is prohibited beginning in 2024.

The tobacco companies are fighting back. Alexander Nussbaum, head of scientific and medical affairs for PMI in Germany, argues that since many smokers are unable or unwilling to quit smoking completely, it would be better if they switched to smoke-free alternatives such as heated tobacco products. Broad public information on these products is therefore necessary.

"Using e-cigarettes or heated tobacco products has a lower potential for harm than continuing to smoke," he says. "There's still no widespread awareness of this."

PMI has a substantial economic interest in "heat-not-burn" products, which along with e-cigarettes and nicotine pouches are part of an expensive change of tack by the company. In recent years it has invested $9 billion in "reduced-risk products" (RRPs) in order to secure a profitable line of future business as sales of regular cigarettes face ever stricter legal restrictions.

And intensive street advertising of IQOS is aimed at helping to make it a mass-market brand.

The German Association of the Tobacco Industry and New Products (BVTE) expresses certainty that the market share of these products will continue to grow. The only question is how rapid the growth will be, according to BVTE General Manager Jan Mücke, who calls the ban on outdoor advertising of heated tobacco products "a major political mistake."

The tobacco industry has ambitious goals for its heated tobacco products. PMI hopes to have more than 40 million IQOS users worldwide by 2025, more than double the current number. In Germany there are 670,000 users, says PMI, which puts the brand's share of the German tobacco market at 3.7%, 0.9% more than in autumn 2021.

PMI rival BAT is touting a "transformation" too, and aims to jack up sales of glo. "The pace at which adult smokers are switching to these alternatives continues to pick up," a company spokeswoman says.

PMI in Germany is using a recent survey that it commissioned, conducted by the Nuremburg-based market research institute GfK, to support its argument that smokers should be better educated about "the role of tobacco combustion as the primary cause of smoking-related diseases."

The survey, among 1,000 adult cigarette smokers in Germany, found that 54% of them didn't want to quit, 17% wanted to quit in principle but didn't know when they'd try, and 11% wanted to quit at all costs but hadn't thought about when. Among the 29% who wanted to stop smoking and had set a timeframe, only 3% were planning to quit within a month.

The older the smokers were, the less motivated they were to stop.

Since many cigarette smokers can't be persuaded to give up tobacco, Nussbaum says, switching to smoke-free tobacco products - which also contain the addictive chemical compound nicotine - would at least reduce the harm they do to their bodies.

Addiction researchers are highly critical of PMI's argumentation. "The tobacco industry is presenting itself as a problem solver, but it caused the problem of countless cancer deaths itself," remarks epidemiologist Daniel Kotz.

The industry wants to create the impression that it's putting a product for health protection on the market, he says, which is "hypocritical and misleading." What it really wants, he goes on, is to bind customers to another nicotine product.

Kotz is director of the government-funded German Study on Tobacco Use (DEBRA). According to the study, 0.3% of the German population aged 14 years and older used heated tobacco products in 2021, 0.1% more than in 2020. Kotz expects figures for 2022 to show a slight increase as well.

Dr Katrin Schaller, head of the cancer prevention department of the German Cancer Research Centre (DKFZ), warns against portraying heated tobacco products as "good alternatives."

"They're not good - they're risky," she asserts, and says smokers should be supported in efforts to quit smoking and "not guided towards the next harmful, risky product." What's more, she adds, the long-term health effects of heated tobacco products are unclear because long-term studies on them have yet to be done.

The German federal government's commissioner for drug and addiction policy, Burkhard Blienert, also expresses disapproval of heated tobacco products. While it's true they contain fewer toxic substances than tobacco cigarettes, he says, "they're still harmful to health."

His message to smokers is to "stop completely if at all possible" and make use of professional help and support if needed.