Heated tobacco: no clear evidence of benefit for smokers

A new one synthesis An independent study conducted by the University of Bath casts doubt on the effectiveness of heated tobacco products as a beneficial alternative to cigarettes. The results show persistent harmful effects, even in smokers who have completely substituted cigarettes for these products, and reveal a lack of robust data to support the tobacco industry's claims of "reduced risk."[1].

The researchers examined 49 clinical trials of heated tobacco products, the majority of which were funded or conducted by the tobacco industry. Only a minority were independent. The analysis focused on biomarkers of potential harm, allowing for the assessment of the impact of exposure to toxic substances present in the emissions of heated tobacco products. Most of the trials analyzed were at high risk of bias. They were short-term, conducted in laboratory conditions, and poorly representative of real-world consumer use. Few comparisons were made with validated smoking cessation devices or with complete cessation situations.

Mixed results and no demonstrated benefit for smokers

A systematic review of clinical trials of heated tobacco products conducted by the University of Bath highlights the lack of clear and sustained health benefits for smokers, including those who have completely replaced cigarettes with these devices. The results show that the use of heated tobacco products leads to negative effects both in users who have stopped smoking cigarettes and in users who co-use conventional cigarettes and heated tobacco products. This directly contradicts the "reduced risk" claims made by manufacturers.

One of the most studied dimensions concerns the effect of these products on blood pressure. In controlled environments (confined clinical trials), some studies suggest a modest reduction in systolic and diastolic blood pressure levels after short-term use of heated tobacco products, compared to conventional cigarettes. However, these results are not reproducible in real-life conditions. In studies conducted in outpatient settings, i.e., outside of a clinical setting, the effects on blood pressure appear very heterogeneous: some data indicate an increase in risk markers, others a reduction, and several observe no significant change. This significant variability, combined with the short duration of the trials analyzed, makes any overall interpretation very uncertain.

More broadly, the researchers emphasize that the available studies do not allow for a clear hierarchy of risk between heated tobacco products, e-cigarettes, and complete smoking cessation. Few data directly compare heated tobacco products to validated cessation devices or sustained abstinence, which prevents their risk reduction benefits from being assessed at the population level. Furthermore, the beneficial effects observed in certain biological parameters are often transient, inconsistent across trials, and rarely statistically significant.

Furthermore, several serious adverse events have been reported in the medical literature, reinforcing concerns about the safety of these products. These include acute nicotine poisoning, rare cases of pneumonia, and incidents related to the accidental ingestion of the devices' metal components by children. These clinical data, although scattered, highlight that the risks associated with heated tobacco products cannot be considered negligible, and that they concern both regular users and vulnerable populations.

Ultimately, the authors conclude that the available data are too limited, too time-limited, and too often biased by industry funding to allow for the assertion that heated tobacco products offer a clear health benefit for smokers. The expected benefits, in light of the industry's marketing campaigns, are neither proven nor consistent. In this context, caution remains warranted, the study's authors remind.

Marketing strategies at odds with public health objectives

Although the tobacco industry claims that heated tobacco products are intended exclusively for adult smokers who want to quit, the data collected by researchers reveals a completely different reality. Several studies have highlighted a significant prevalence of heated tobacco product use among youth, including adolescents who have never smoked cigarettes. Globally, adolescents are now more than twice as likely as adults to have experimented with or adopted a heated tobacco product. This trend cannot be interpreted as an unintended side effect, but rather as the result of targeted marketing strategies, documented in numerous contexts.

Independent investigations show that Philip Morris International (PMI) has made extensive use of communication channels popular with young people: partnerships with influencers, sponsorship of cultural and sporting events, online marketing, and attractive product design inspired by high-tech codes. Moreover, leaked internal documents demonstrate that the development of heated tobacco products was never primarily aimed at replacing cigarettes, but rather at conquering new market segments with high-margin products while maintaining sales of conventional cigarettes in areas where regulations are weaker.

PMI's strategy in Japan, the pilot country for the launch of IQOS, illustrates this strategy. In a context where e-cigarettes are banned, PMI has deployed an aggressive approach, including indirect funding of scientific studies, the mobilization of communications consultants to build ties with the academic world, and repeated attempts to influence decision-makers. The Japanese subsidiary's internal action plan explicitly mentions the desire to accelerate the acquisition and conversion of new users, particularly among the younger generations, thus consolidating a long-term nicotine addiction.[2]-[3].

Furthermore, the company's claims that heated tobacco products are a smoking cessation aid are sorely lacking in scientific evidence. While PMI claims that more than 23 million people have "quit smoking thanks to IQOS," independent data indicates that the majority of users actually continue to use other nicotine products, often in parallel. This multiple or concurrent use increases health risks and contradicts the official "harm reduction" narrative. In some countries, PMI even denies that heated tobacco products are intended for smoking cessation, tailoring its arguments to local laws and deliberately sowing confusion.

These practices reflect a comprehensive strategy aimed at normalizing tobacco use in a new form, eroding prevention policies, and weakening existing regulations. In this context, researchers and public health experts are calling on public health authorities to remain particularly vigilant in the face of industry-sponsored rhetoric and to deny any health legitimacy to products whose risks are poorly assessed and whose benefits are unproven.

©Generation Without Tobacco

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[1] Press release, New Analysis Shows No Clear Evidence That Heated Tobacco Products Are a Better Alternative to Cigarettes or That They Help Smokers Quit, STOP, published on April 30, 2025, consulted the same day

[2] Tobacco-free generation, Heated tobacco: internal document reveals Philip Morris' offensive in Japan, published July 1, 2024, accessed April 30, 2025

[3] Tobacco-free generation, Japan: Academics Secretly Funded by Philip Morris to Promote IQOS, published July 9, 2024, accessed April 30, 2025