Non-Combustion Alternatives – Philip Morris' Misleading Harm Reduction Talk

As the health risks of smoking, both active and passive, have become better documented and known, as the social acceptability of smoking has diminished and as numerous tobacco control measures have been implemented throughout the world, the The cigarette market - where tobacco companies make most of their profits - began to decline. To win new markets and with a view to reconquering and improving their image, tobacco manufacturers have put on the market various new products based on tobacco and nicotine, such as heating tobacco and electronic cigarettes, which they developed and marketed, following the example of Philip Morris and its “non-combustion alternatives”.

There are 1.3 billion tobacco users worldwide. Tobacco is most commonly consumed in the form of manufactured cigarettes, but there are other products such as rolling tobacco, water pipe tobacco, various smokeless tobacco products, cigars, cigarillos, tobacco for pipe, bidis and kreteks. Although the number of tobacco users worldwide remains high, it is tending to decline. In 2000, approximately one third (32.7 %) of the world population (both sexes combined) aged 15 and over used tobacco. In 2020, this rate fell to less than a quarter (22.3 %) of the world's population.

The late 1990s and early 2000s marked a turning point in the fight against tobacco, with a significant number of victories and advances in the effort to stem the tobacco epidemic. First, in 1998, six million secret documents, totaling over 35 million pages, were made public, revealing everything nine tobacco companies knew about the dangers of their products, when they knew it, and what they did to cover it up. In addition, these companies were accused of increasing the effects of nicotine in cigarettes while denying that nicotine was addictive. Finally, they were accused of deliberately seeking to attract new smokers among underage children through marketing campaigns. This contributed to lasting damage to the image of the tobacco industry.

Then, thanks to the adoption in 2003 of the Framework Convention on Tobacco Control (FCTC) of the World Health Organization, ratified to date by 182 Parties including the European Union and all its Member States, a legally binding and global response exists for the reduction of demand and supply of tobacco products. Bans on advertising and smoking in enclosed spaces are among the flagship measures. Quitting tobacco is thus becoming a reality in some countries and a goal for many others.

This results in a decline in tobacco consumption and sales as illustrated in the graph below and this development has pushed the tobacco industry to predict the end of the cigarette market by 2040 by adapting to continue to sell new products with high profit margins and massively consumed by relying on nicotine addiction.

Although they are often presented as "new", tobacco manufacturers market products often designed several decades ago. The investments currently made by manufacturers for these products should not, however, obscure the fact that the core business around classic cigarettes remains unchanged. Newer products only represent a minority share of revenue, compared to traditional products.

Philip Morris International (PMI) was the leading company in this market development but was quickly followed by other manufacturers. The manufacturer has been building a narrative around "smokeless transformation" for over a decade, coupled with the launch of its flagship heated tobacco product IQOS. In 2021, tobacco “alternatives” accounted for approximately 29 % of its total net revenues, based on data released in May 2022[1], the company’s so-called “smoke-free” products are now available in more than 70 countries around the world.

Philip Morris' diverse portfolio of cigarette 'alternatives'

In May 2021, PMI acquired Danish snus manufacturer AG Snus[6], which manufactures tobacco leaf products and nicotine pouches. This acquisition was not widely publicized but above all indicates the phenomenon of concentration in the sector over these decades in order to increase value for large manufacturers and dominate the oligopoly market. In May 2022, Philip Morris International has launched a takeover bid for tobacco and nicotine product maker Swedish Match (SWMA.ST). By November 2022, PMI had completely absorbed the Swedish company in a $16 billion deal, allowing it to reduce its dependence on cigarettes. This acquisition is PMI's fifth major acquisition since the start of 2021, after those of Fertin Pharma, OtiTopic and Vectura, which marked its desire to establish itself in the medical and “well-being” products sector. This acquisition would confirm Philip Morris' diversification objectives and is supposed to give more weight to its discourse based on risk reduction. The aim is to appear more and more like a “health company”, in line with its strategy intended to improve its image.

Although its competitors have invested in nicotine pouches, PMI only expressed interest in these products in late 2019 by developing and marketing pouches under the "Shiro" brand, stating that it was a "category emerging products they review »[7].

In 2016, PMI began marketing its new heated tobacco product IQOS under the tagline “this changes everything”[8]. At the same time, PMI began to claim its transformation and a commitment to a "smoke-free" future. IQOS, for "I Quit Ordinary Smoking", uses mini-cigarettes (called HEETS) - containing a filter and tobacco - to be inserted into a small device that heats the tobacco to a temperature of 330°C (compared to 600°C to 900°C for conventional cigarettes) and releases an aerosol of tobacco to be inhaled using an electronically controlled heating blade. There is therefore no complete combustion, but a pyrolysis phenomenon (partial combustion). The average duration of use of the device during normal use is 6 minutes or 14 puffs, a duration similar to the consumption of a classic cigarette. The device switches off automatically after 6 minutes of use. After each use, the cigarette is removed from the device, and it must be recharged.

The first device appeared in 2014 in Japan and Italy. Gradually, PMI introduced IQOS to new markets and the product is now present in 70 countries. It was placed on the French market in May 2017. First marketed in two pilot regions (Île-de-France and the Provence Alpes Côte d'Azur region), it was then deployed throughout France. IQOS is the most widely available heated tobacco product, with by far the largest share of the heated tobacco market worldwide. In France, it is the only heated tobacco available to date. British American Tobacco has registered its trademark (NeoStick for Glo) with theHANDLES in 2021.

A late investment in electronic cigarettes

As with snus, PMI was the last of the international tobacco companies to enter the electronic cigarette market.[9]. In November 2013, PMI announced that the company would produce its own e-cigarette and in 2016, an e-cigarette called IQOS Mesh was developed and closely associated, marketingly, with the heated tobacco brand IQOS. This product was first launched in the UK in 2016, but has not been released to other countries.

By 2019, the company had three e-cigarette brands in its product portfolio, two of which were sold only in the UK and Ireland, and the other only in Spain and Israel. Most of the research and development had focused on their heated tobacco products, which they had “deliberately prioritised”.[10] However, in 2019, PMI stated that they had not been "idle" on vaping products, investing heavily in them and were ready to introduce them on a large scale[11]. The controversy over lung injuries linked to vaping in the United States[12] and the Covid19 pandemic delayed the launch of the product which was finally launched under the name VEEV in September 2020. This product appears to be a “modified” version of the IQOS MESH. The Philip Morris website defines the VEEV electronic cigarette as “ a device that uses IQOS MESH heating technology - a metal rod with tiny holes to heat a pre-filled, pre-sealed pod containing nicotine and flavorings. This generates a vapor containing nicotine ".

“No-combustion” alternatives, the misleading marketing argument

Philip Morris' main argument is that the lack of complete combustion would make them less toxic tobacco products than traditional cigarettes. For the manufacturer, heating tobacco to this temperature would limit the generation and concentrations of toxic compounds inhaled by the user, thus, these products would be potentially reduced risk products. On its website, the manufacturer states “ IQOS heats a specially prepared tobacco blend to a temperature just below 350°C, without combustion, without flame, without ash and without smoke. This generates a vapor containing nicotine which releases the true taste of heated tobacco " This contrasts with e-cigarettes which are almost entirely a liquid mixture of propylene glycol and glycerin to which is added tobacco-derived nicotine (or even synthetic nicotine which has nothing to do with tobacco anymore), but no tobacco leaf.

July 7, 2020[13], the US public agency, the Food and Drug Administration, FDA, has deemed the IQOS product a “modified risk product”. The agency formally rejected the claim that use of the device would reduce the risk of tobacco-related diseases, pointing to a lack of evidence of reduced long-term and population-level harm. This FDA decision has been widely echoed and regularly distorted by Philip Morris. As a result, many media outlets around the world are misrepresenting the decision[14]. It is thus indicated that the heated tobacco from the manufacturer of the IQOS brand has been approved by the FDA or that the product is “safer” than traditional cigarettes. In France, PMF quickly welcomed the FDA's decision in a press release and affirmed the existence of a "independent international scientific consensus" on the less dangerous nature of the IQOS, but also that “The FDA has concluded that IQOS is intended to benefit the health of the population as a whole, both for users of tobacco products and [for] individuals who do not currently use tobacco products.nt”. In fact, in its decision, the FDA warned PMI against making such claims, stating that claims such as "Scientific studies have shown that completely switching from conventional cigarettes to the IQOS system can reduce the risks of related illnesses." smoking” and “Completely switching to the IQOS system poses less risk of harm than continuing to smoke cigarettes” are unfounded[15]. For its part, the World Health Organization recalls that there is no evidence showing that heated tobacco is less harmful than traditional tobacco products.[16].

Philip Morris claims that heating tobacco instead of burning it produces “ on average 90 to 95% less » of toxic substances, making the IQOS safer for smokers and those around them. The company continues to highlight to the attention of public authorities and journalists what it claims to be “independent studies” intended to demonstrate that IQOS is healthier than a traditional cigarette. While the IQOS device may expose users to lower levels of some toxic substances than cigarettes, it also exposes users to higher levels of other toxic substances. Independent studies[17] and theexam Data from Philip Morris data highlight the presence of certain toxic and potentially toxic components in the IQOS aerosol at levels higher than those found in cigarette smoke. This is particularly the case of glycidol, of which an independent report shows that it is 400% more present in IQOS than in conventional cigarettes, while the International Agency for Research on Cancer has identified it as being a probable carcinogen . According to the researchers, these results demonstrate the need to conduct independent analyzes of the IQOS aerosol, particularly to identify components with unknown potential for toxicity.

Another study published in the journal Tobacco Control[18] examined the validity of the manufacturer's claims that this device does not burn tobacco. The study describes tobacco pyrolysis as an endothermic reaction that occurs at temperatures between 200°C and 600°C, during which the majority of volatile and semi-volatile components of cigarette smoke are formed. Philip Morris says the aerosol produced by IQOS devices reduces the amount of chemicals on the Food and Drug Administration's list of harmful and potentially harmful components. This study, however, shows carbonization after consumption of HEETS which confirms the presence of volatile organic compounds, polycyclic aromatic hydrocarbons, carbon dioxide and nitric oxide. This contradicts the assertion that tobacco pyrolysis is marginal in the IQOS. In conclusion, although the IQOS operates at temperatures below 350°C, this does not prevent the formation of harmful volatile and semi-volatile components of tobacco smoke, which tend to have boiling points between between 70°C and 300°C.

Last September, a study conducted by The Bureau of Investigative Journalism[19] revealed that the quantity of nicotine contained in heated tobacco mini-cigarettes (HEETS) for use with the Philip Morris IQOS device is 8 times greater than that indicated by the manufacturer and that the user inhales twice as much nicotine as reported by the latter. The Bureau commissioned Unisanté, a university center for general medicine and public health in Switzerland, to carry out the assays, the results of which were analyzed by Force Technology in Denmark. On average, each mini tobacco cigarette contains 4.1 mg of nicotine. In accordance with certain promotional documents on its website available in several languages, PMI stated to Bureau staff posing as consumers that each mini-cigarette (HEETS brand) contained 0.5 mg of nicotine, which is turns out to be inaccurate. This figure of 0.5 mg was the response provided by IQOS salespeople from 11 European countries, maintaining confusion between the quantity of nicotine present in each mini-cigarette and that inhaled by the smoker. An employee of the Swedish PMI website even claimed that the amount of nicotine in a HEETS was 24 times less than that in a regular cigarette.

It is certain that these high quantities of nicotine inhaled with IQOS are the result of a strategy aimed at inducing nicotine addiction and maintaining it over the long term. For the researchers, all of these results demonstrate that the IQOS cannot be considered as a risk reduction tool, and call for additional and independent studies to precisely assess the dangerousness of Philip Morris' heated tobacco.

Similar communication for the IQOS device and the VEEV electronic cigarette

In France, Philip Morris launched its new VEEV device in tobacco shops and online on a dedicated website in June 2022, i.e. 5 years after its IQOS heated tobacco device[20]. To announce the launch of its electronic cigarette, Philip Morris gradually removed the term “tobacco” from its communications when mentioning its IQOS device to replace it with “non-combustion alternatives”, allowing its electronic cigarette to be integrated into it. The manufacturer thus markets its two products under the name “non-combustion alternatives” at points of sale. In tobacconists' shelves, HEETS tobacco refills, previously indicated as "tobacco to heat" are placed alongside VEEV refill pods surrounded by a white square "non-combustion alternatives". This new name, in addition to being illegal in terms of advertising at the point of sale (the regulations require the retailer to maintain “neutrality” of the shelves), is misleading. Indeed, as mentioned previously, these devices induce pyrolysis, which is partial combustion. This marketing argument is also a way for Philip Morris to improve its image among public opinion and public decision-makers and even present itself as a player committed to health. Furthermore, this common communication misleads the consumer who believes they are consuming an equivalent product (heatable tobacco and electronic cigarette) in terms of health risks.

Figure 1 - Stand of a Philip Morris salesperson (Parisian outlet - November 2022) - ©CNCT

This cross-communication is also found on the merchant sites of the manufacturer's two products. On the IQOS France website, there are numerous links to technological declarations made for IQOS products which explain the progress and novelty of the product. Scientific discourse has a prominent place in the communication around the IQOS device on the website, highlighting the many hours of research supposed to guarantee the reliability of the product and its numerous “advantages” compared to traditional smoking.

These articles often contain imprecise claims about the actual function of the product and present futuristic images of hot blade technology. All of the statements appeal to the customer's “common sense” and intelligence, making the link between the use of IQOS and the right choice to make while leaving them free to choose the version of IQOS. , its HEETS range and personalize your device with colors. From the home page we find the phrase “IQOS 3 DUO – a better choice than cigarettes”, implying that IQOS is the only alternative to smoking, obscuring complete cessation. The health “benefits” are then detailed in short explanatory videos.

Figures 2 and 3- Screenshot of the French IQOS site (July 2022)

 

This scientific discourse and the lexical field of innovation are also present on the VEEV website which highlights the fact that the VEEV “heats” the liquid (just like the IQOS heats tobacco).

Figure 4 - Screenshot of the French VEEV site (July 2022)

Regarding Heated Tobacco HEETS (IQOS), there are currently 7 flavors available in France (the Teak flavor above is not for sale). The descriptions of these flavors and their names are intentionally evasive and avoid traditional flavor categories by generally using colors with descriptors such as menthol, citrus, nuts, dried fruit, vanilla, cocoa and herbs.

Refills for the VEEV electronic cigarette also come in 7 flavors, never indicating the actual taste on the packaging. We find the aromas “Classic Amber” “Classic blond (tobacco)”, classic mint, mint touch (menthol), ruby touch, red touch, mauve touch (fruity)). Both types of refills are packaged in clean, white packaging, symbolically referring to a scientific, quasi-medical dimension and emphasizing the clarity of the product.

These elements constantly support Philip Morris' communication to give the impression that these alternatives would be safer or even healthier.

In its communication with tobacconists, who are the main prescribers of Philip Morris products in France, the manufacturer recently distributed a booklet “Our non-combustion alternatives to cigarettes to accelerate your transformation” by affixing the IQOS and VEEV logos side by side . The manufacturer presents its two alternatives to traditional cigarettes and places them on the same level “Unlike cigarettes, IQOS and VEEV precisely heat tobacco or e-liquid, so there is no combustion or smoke.” The manufacturer invites tobacconists to maintain a similar discourse on vaping and heated tobacco for the attention of smokers wishing to stop traditional smoking, or for any potential customer whether or not they are a tobacco consumer, obscuring the different risks for these two products.

Figures 5 and 6 - Flavors available for IQOS and VEEV

A desire to maintain confusion between vaping and heated tobacco

Heated tobacco products and electronic cigarettes are often confused among the general public and in the media. This confusion is deliberately sought and maintained by Philip Morris. Philip Morris' communication claims that IQOS and VEEV "reduce the harmful components generated by an average of 95% compared to cigarette smoke", implying that vaping products and heated tobacco have very similar risk profiles. These carefully chosen combinations between VEEV and IQOS indicate that the products are interchangeable and can be consumed simultaneously. A similar strategy was noted in New Zealand[21] when Philip Morris marketed its IQOS and VEEV device on a single website and offered “discovery kits” combining the IQOS heated tobacco device and the VEEV electronic cigarette.

 

Figure 6 - Discovery kit on sale for the IQOS device and VEEV on sale on the New Zealand site

 

This confusion is part of the tobacco company's strategy of reconquest, undertaken in recent years. It positions itself in its communication in favor of a “smoke-free world” through new tobacco and nicotine products. The tobacco industry uses vaping products as an icebreaker to promote other tobacco products, including heated tobacco. In this case, Philip Morris uses its VEEV electronic cigarette to communicate around its IQOS device. The objective is to obtain more flexible regulations for the latter, particularly in terms of taxation (see figure 7).

Figure 7 - Slides from a 2014 PMI internal presentation entitled “Reduced Risk Briefing”. The objective is to “take advantage of the dynamics of taxation of electronic cigarettes to recommend new relevant categories” (the IQOS being among these products[22].

 

In June 2022, according to an Ifop survey commissioned by Philip Morris France, a majority of French people would like non-combustion alternatives to cigarettes to be better known and recognized, particularly through public health policies. The president of Philip Morris France, Jeanne Pollès deplores that many smokers do not receive accurate information on “non-combustion alternatives”, in particular heating tobacco from PMI, “ especially since there are nearly 60 % who consider that alternatives should be a lever in their own right for public health policies, similar to what is done in many countries in Europe and around the world."

Through this survey, Philip Morris is primarily seeking to relax current regulations on heated tobacco and to influence a market that has become declining for traditional tobacco products due to public policies to reduce consumption. Additionally, encouraging non-smoking vaping product users to use IQOS and switch from VEEV to IQOS appears to contradict PMI's own harm reduction model. Another element which contradicts the manufacturer's claims of risk reduction: the selling price of vaping refills is 50 cents higher per pack than its HEETS refills (€8.00 compared to €7.50) while the potential benefits for The health of vaping products are widely considered more important. This strategy shows that Philip Morris actually wants to direct the consumer towards heated tobacco where the manufacturer can achieve its margins and further secure its markets.

While in France, Philip Morris seems, for the moment, to distinguish its two alternatives by different brands "IQOS" and "VEEV", this is not the case in other countries where the VEEV is marketed under the name “IQOS”, simply implying that heated tobacco belongs to the same category as electronic cigarettes.

Figure 8 – Screenshot of a Greek reseller on Instagram

 

In May 2019, André Calantzopoulos, director of Philip Morris International, indicated in an interview that Philip Morris planned to deploy the sale of electronic cigarettes internationally in 2020, under the brand of its heated tobacco product IQOS.

PMI claims to have introduced the IQOS system to reduce sales of traditional cigarettes and the company says it wants to make products available that would be less toxic. In this perspective of stopping the tobacco epidemic, the target countries should be those where cigarette sales are increasing. However, IQOS has been launched in countries where cigarette sales are declining and in high-income countries that have strong tobacco control measures in place, particularly in Europe. One of the reasons PMI is targeting these markets is that consumers have more income and are more willing to start using the IQOS system given its significant upfront cost.

The reality is therefore that Philip Morris designs all of its tobacco and nicotine products as possible entry points into nicotine addiction and as means to prevent smoking cessation among people. current consumers. This approach coupled with a marketing approach oriented towards its products with a higher profit margin allows it to maintain or even develop its markets for the future. PMI's "no-burn" strategy appears to be a replication of the tobacco industry's approach to smokeless tobacco. Industry documents had also revealed that smokeless products were seen as a way to create a new form of tobacco consumption among those who no longer wished to start smoking and “ make new profits rather than cannibalizing existing cigarette profits »[23]. With this range of products, if the classic cigarette were to be banned in the coming decades, the manufacturer hopes to have time to impose its flagship product of heated tobacco and the associated profit margins.

Keywords: Philip Morris, non-combustion alternatives, harm reduction, heated tobacco, vaping, electronic cigarette, IQOS, VEEV, marketing

©Tobacco Free Generation

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