Dutch doctors skeptical of Philip Morris’ cigarette replacement

By Storm Gibbons

Philip Morris International (PMI), the largest tobacco company outside of China, launched their controversial IQOS ‘heat stick’ in the Netherlands last month. While PMI hails the new heat stick as a less harmful product that will help phase out traditional cigarettes, Dutch health experts and doctors remain skeptical. They fear that a lack of regulation may mislead consumers and call for future government investigation into new tobacco products, before they enter the market.

The cigarette replacement, which heats tobacco rather than burning it, has become available at their fi rst IQOS shop in the middle of Amsterdam’s Negen Straatjes, as well as 25 other tobacco shops throughout the city. The full IQOS kit consists of a ‘heat stick’ holder, a portable battery pack, and tobacco sticks, called HEETS. When HEETS tobacco sticks are placed in the holder, the IQOS heats the sticks at 350 degrees Celsius. The IQOS holder and battery pack are available for a combined total of € 70, while its tobacco sticks are similarly priced to traditional cigarettes in the Netherlands and cost € 6 per pack of twenty.

PMI’s claims that the IQOS, which cost the fi rm $3bn to create, provides its users with the same hit of nicotine as traditional cigarettes, but releases 90-95% less dangerous toxins, based on its own research. Furthermore, early trials in Japan demonstrated 70% of smokers switching to substitute after having tried it for a week, with users claiming the IQOS produces signifi cantly less smoke and smell than conventional cigarettes. This has led the Netherlands Food and Consumer Product Safety Authority (NVWA) to classify the IQOS a “smokeless tobacco product”.

Under current legislation, this means IQOS packaging is not required to contain the same warnings as traditional cigarettes. Instead of cigarettes’ ominous “smoking kills” catchphrase, as well as frightening images depicting the effects of smoking, the following warning is suffi cient for IQOS packaging: “this tobacco product harms your health and is addictive”.

This has been met with discontent from Dutch doctors and health experts. The Dutch Association for Physicians in Chest Medicine and Tuberculosis (NVALT) argue that the true effects of the IQOS will only become clear in twenty years and that the absence of frightening images on its packaging seriously misleads consumers. Onno van Schayk, professor in preventive medicine at Maastricht University, and Wanda de Kanter, lung specialist at the Antoni van Leeuwenhoek hospital in Amsterdam, agree with the NVALT. They claim that IQOS users are still breathing in cancerous toxins, whether or not smoke is visible. Research in the upcoming edition of the Journal of the American Medical Association, confi rms that vapour from heat sticks contains the same deadly toxins as traditional cigarettes, but in lower concentrations.

This follows earlier international criticism of PMI’s ‘post-smoking future’, as the IQOS had earlier become available in more than ten other countries including the UK, Switzerland, Italy and Japan in November 2016. In particular, PMI is condemned for continuing to promote traditional cigarettes in developing world, using methods that would be considered illegal in the UK or Netherlands. Deborah Arnott, a British anti-smoking campaigner, insists that instead of offering a less harmful alternative, PMI should focus on preventing people from starting smoking.

Martin van Rijn, Dutch State Secretary for Health, Welfare, and Sport has asked the National Institute for Health and Environment (RIVM) to research the effects of the heat sticks and will wait for results before taking any next steps, with results expected in autumn. In the meantime, the government and van Rijn are looking into possibilities for an approval procedure for new tobacco products entering the Dutch market, based on similar schemes already in the US, Australia and New Zealand.