Heat not burn “less harmful” than cigarettes: a new way out of smoke?

Its health risks have been known for more than half a century and it causes some five million deaths each year, yet more than one billion people continue to smoke across the globe. In Europe, smoking numbers are on the decline thanks to a number of factors. People are more aware than ever of its dangers, while there have also been wide-spread bans on tobacco advertising. Price hikes – smoking is now 27 per cent less affordable in the UK than it was in 2005 – have also had an impact.

The introduction of less harmful alternatives such as electronic cigarettes is also being hailed as a game-changer. Figures from the Center for Disease Control and Prevention and Euromonitor International suggest that there are roughly 21 million vapers worldwide. Given its popularity, and the fact that vaping is at least 95 per cent less harmful than smoking, it is little wonder that it is seen as a vital tool in the battle against cigarettes.

A new breed of alternatives is also now available on the market: heat-not-burn products. The IQOS, manufactured by Philip Morris International, heats tobacco to approximately 350C, while the British American Tobacco-made iFuse reaches just 50C – warm enough to produce a vapor, yet well below the 800 degrees of a conventional cigarette which causes so much damage.

A UK government advisory panel, the Committee on Toxicity, analyzed data on the two and found that while users are exposed to between 50 and 90 per cent fewer ‘harmful and potentially harmful compounds’ found in regular cigarettes, they still produce ‘a number of compounds of concern’, some of which can cause cancer.
In October, Germany’s Federal Institute for Risk Assessment concluded that using the IQOS reduced the intake of dangerous carbonyl compounds such as formaldehyde and acetaldehyde by 80 to 90 per cent, while the emission of volatile organic compounds decreased by 90 to 99 per cent.

As encouraging as that is, it seems incredible that such products need to be introduced in the first place to tempt smokers away from cigarettes. In the US, for example, almost one in every five deaths – about 480,000 – is caused by smoking, yet 36 million Americans continue to smoke. In 1962, the Royal College of Physicians published what is now widely viewed as a seminal work in the dangers of smoking, yet more than 50 years later, smoking numbers are only in gentle decline across the developed world and continue to increase in developing countries.

Smoking is not the only area where public health bodies grapple with the difficulties of changing people’s behavior. Public Health England has concluded that the number of people eating the recommended five portions of fruit and vegetables a day is declining, despite the long-running five-a-day campaign and increased rates of obesity in the UK. People are also eating too much sugar, fat, and processed and red meat, in spite of the widely-publicised health risks.

Whether it is eating or smoking, altering the habits of millions of people is no easy task – particularly when it involves abstaining from something enjoyable. What is clear from those two examples is that it takes time, combined with an effectively implemented coherent strategy. Harm reduction – reducing the damage caused by something rather than trying to eradicate it altogether – has been widely acclaimed as having an impact on smoking numbers. It is now being actively pursued by a number of countries, with the UK leading the way in the field of smoking. Critics of policies designed to tackle obesity claim that, for decades, they have been piecemeal and not far-reaching enough. That is slowly starting to change – look at the so-called sugar taxes now being introduced across Europe, for example.

Yet one thing is clear: simply telling people that something is bad for their health is often not enough to make them stop doing it. A coherent strategy, viable alternatives and patience are all vital in changing the behavior of a nation.

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