Combustion-Free Alternatives – Philip Morris’ Misleading Harm Reduction Pitch

As the health risks of both active and passive smoking have become better documented and known, as the social acceptability of smoking has declined and as many tobacco control measures have been implemented worldwide, the cigarette market - where tobacco companies make most of their profits - has begun to decline. In order to gain new markets and to regain and improve their image, tobacco companies have launched various new tobacco and nicotine products, such as heated tobacco and electronic cigarettes, which they have developed and marketed, following the example of Philip Morris and its "combustion-free alternatives".

There are 1.3 billion tobacco users worldwide. Tobacco is most commonly consumed in the form of manufactured cigarettes, but other products include rolling tobacco, waterpipe tobacco, various smokeless tobacco products, cigars, cigarillos, pipe tobacco, bidis, and kreteks. Although the number of tobacco users worldwide remains high, it is trending downward. In 2000, about one-third (32.7 %) of the world's population (both sexes) aged 15 years and older used tobacco. By 2020, this rate had fallen to less than one-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 has led to a decline in tobacco consumption and sales as illustrated in the graph below, and this development has prompted the tobacco industry to predict the end of the cigarette market by 2040 by adapting to continue selling new products with high profit margins and massive consumption based on nicotine addiction.

Although they are often presented as "new", tobacco manufacturers are bringing to market products that were often designed several decades ago. However, the current investments made by manufacturers in these products should not obscure the fact that the core business around traditional cigarettes remains unchanged. Newer products represent only a minority share of revenues, compared to traditional products.

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

Philip Morris' diverse portfolio of "alternatives" to cigarettes

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 mainly indicates the phenomenon of concentration in the sector over the past decades in order to increase value for large manufacturers and dominate the market in an oligopoly. May 2022, Philip Morris International has launched a takeover bid for tobacco and nicotine product maker Swedish Match (SWMA.ST). In November 2022, PMI completely absorbed the Swedish company in a $16 billion deal, allowing it to reduce its reliance on cigarettes. The acquisition is PMI's fifth major acquisition since the start of 2021, following Fertin Pharma, OtiTopic and Vectura, which signaled its desire to establish itself in the medical and "well-being" sector. The acquisition would confirm Philip Morris' diversification objectives and is intended to give more weight to its harm reduction narrative. The aim is to increasingly appear as a "health company", in line with its strategy 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 brand name “Shiro,” stating that it was an “emerging product category that they are examining.”[7].

In 2016, PMI began marketing its new heated tobacco product IQOS under the slogan “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 launched on the French market in May 2017. Initially marketed in two pilot regions (Île-de-France and the Provence Alpes Côte d'Azur region), it was then rolled out 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 theANSES in 2021.

Late investment in e-cigarettes

As with snus, PMI was the last of the international cigarette manufacturers to enter the e-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, in marketing terms, with the IQOS heated tobacco brand. This product was first launched in the UK in 2016, but has not been released in 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 its research and development had focused on its heated tobacco products, which it had "deliberately prioritized."[10] However, in 2019, PMI said 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 flavourings. This generates a vapour containing nicotine ".

“Combustion-free” alternatives: the misleading marketing argument

Philip Morris' main argument is that the absence 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 making these products potentially reduced-risk products. On its website, the manufacturer states: IQOS heats a specially prepared tobacco blend at a temperature just below 350°C, without combustion, flame, ash or smoke. This produces a nicotine-containing vapour that delivers 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 government agency, the Food and Drug Administration, FDA, has deemed the IQOS product to be a "modified risk product". The agency has formally rejected the claim that use of the device reduces the risk of tobacco-related diseases, pointing to the lack of evidence of reduced long-term and population-level harm. This FDA decision has been widely taken up 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 of the manufacturer of the brand IQOS has been approved by the FDA or that the product is "safer" than traditional cigarettes. In France, PMF quickly welcomed the decision of the FDA in a press release and affirmed the existence of a "independent international scientific consensus" on the reduced danger of IQOS, but also that "The FDA concluded that IQOS is intended to benefit the health of the general population, both those who currently use tobacco products and those who currently do not use tobacco products."In fact, in its decision, the FDA cautioned PMI against making such statements, stating that claims such as “Scientific studies have shown that switching completely from conventional cigarettes to the IQOS system can reduce the risk of tobacco-related diseases” and “Switching completely to the IQOS system poses less risk of harm than continuing to smoke cigarettes” are unfounded.[15]For its part, the World Health Organization points out that there is no evidence to show that heated tobacco is less harmful than conventional tobacco products.[16].

Philip Morris claims that heating tobacco instead of burning it produces " on average 90 to 95% less » of toxic substances, making IQOS safer for smokers and those around them. The company has consistently highlighted to government officials and journalists what it claims are “independent studies” designed 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. The independent studies[17] and theexam Data from Philip Morris data highlight the presence of certain toxic and potentially toxic components in IQOS aerosol at levels higher than those found in cigarette smoke. This is particularly the case for glycidol, which an independent report shows is 400% more present in IQOS than in conventional cigarettes, while the International Agency for Research on Cancer has identified it as a probable carcinogen. According to the researchers, these results demonstrate the need for independent analyses of IQOS aerosol, in particular 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 the 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 claims that the aerosol produced by IQOS devices reduces the amount of chemicals on the Food and Drug Administration's list of harmful and potentially harmful compounds. However, this study shows charring after consumption of HEETS, which confirms the presence of volatile organic compounds, polycyclic aromatic hydrocarbons, carbon dioxide and nitric oxide. This contradicts the claim that tobacco pyrolysis is marginal in IQOS. In conclusion, although 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 70°C and 300°C.

Last September, a study conducted by The Bureau of Investigative Journalism[19] revealed that the amount of nicotine in Philip Morris heated tobacco mini-cigarettes (HEETS) for use with the IQOS device is 8 times higher than the manufacturer's stated amount and that the user inhales twice as much nicotine as the manufacturer reported. The Bureau commissioned Unisanté, a university centre for general medicine and public health in Switzerland, to carry out the assays, the results of which were analysed by Force Technology in Denmark. On average, each tobacco mini-cigarette contains 4.1 mg of nicotine. Consistent with promotional materials on its website available in several languages, PMI has claimed to Bureau staff posing as consumers that each mini-cigarette (branded HEETS) contains 0.5 mg of nicotine, which is inaccurate. This figure of 0.5 mg was the response given by IQOS sales representatives in 11 European countries, creating confusion between the amount of nicotine in each mini-cigarette and the amount inhaled by the smoker. An employee of the Swedish PMI website even claimed that the amount of nicotine in a HEETS was 24 times lower than that in a regular cigarette.

It is certain that these high amounts of nicotine inhaled with IQOS are the result of a strategy aimed at inducing nicotine addiction and maintaining it in the long term. For the researchers, all of these results demonstrate that IQOS cannot be considered a risk reduction tool, and require additional and independent studies to accurately 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 tobacconists and online on a dedicated website in June 2022, 5 years after its IQOS heated tobacco device.[20]. To announce the launch of its electronic cigarette, Philip Morris has gradually removed the term "tobacco" from its communications when mentioning its IQOS device, replacing it with "combustion-free alternatives", allowing its electronic cigarette to be integrated into it. The manufacturer is thus marketing its two products under the name "combustion-free alternatives" in points of sale. On tobacconist shelves, HEETS tobacco refills, previously indicated by "heated tobacco", are placed alongside VEEV refill pods surrounded by a white square "combustion-free alternatives". This new name, in addition to being illegal in terms of advertising at the point of sale (the regulations require the retailer to have "neutrality" of the shelves), is misleading. Indeed, as mentioned above, these devices induce pyrolysis, which is partial combustion. This marketing argument is also a way for Philip Morris to improve its image in the eyes of the public and public decision-makers, or even to present itself as a player committed to health. Furthermore, this common communication misleads consumers who believe they are consuming an equivalent product (heated tobacco and electronic cigarette) in terms of health risks.

This cross-communication is also found on the merchant sites of the two manufacturer's products. On the IQOS France website, there are many links to technological statements made for IQOS products that 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 supposedly guaranteeing the reliability of the product and its many "advantages" compared to traditional smoking.

These articles often contain imprecise statements about the actual function of the product and present futuristic images of the heating blade technology. All of the statements appeal to the “common sense” and intelligence of the customer, making the connection between the use of IQOS and the right choice to make while giving them the freedom to choose the version of IQOS, their range of HEETS and to personalize their device with colors. Right from the home page we find the sentence “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.

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

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 as well as their names are intentionally evasive and avoid traditional flavor categories by generally using colors with descriptors such as menthol, citrus, nuts, dried fruits, vanilla, cocoa and herbs.

The refills for the VEEV electronic cigarette also come in 7 flavors, never indicating the actual taste on the packaging. We find the flavors "Classic Amber" "Classic blond (tobacco)", classic mint, mint touch (mentholated), ruby touch, red touch, mauve touch (fruity)). Both types of refills are packaged in a clean, white packaging, referring at the level of symbolism to a quasi-medical scientific 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 to tobacconists, who are the main prescribers of Philip Morris products in France, the manufacturer recently distributed a booklet "Our combustion-free 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 smokers wishing to stop traditional smoking, or for any potential customer whether or not they are tobacco consumers, obscuring the different risks for these two products.

A desire to maintain confusion between vaping and heated tobacco

Heated tobacco products and electronic cigarettes are often confused by the general public and in the media. This confusion is deliberately sought and maintained by Philip Morris. Philip Morris' communication states 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 selected associations between VEEV and IQOS indicate that the products are interchangeable and can be used simultaneously. A similar strategy has been 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.

This confusion is part of the tobacco company's recovery strategy, which it has been pursuing in recent years. Its communications are positioned in favor of a "smoke-free world" through new tobacco and nicotine products. The tobacco industry uses vaping products as an icebreaker for promoting other tobacco products, particularly heated tobacco. In this case, Philip Morris is using its VEEV e-cigarette to promote its IQOS device. The goal is to obtain more flexible regulations for the latter, particularly in terms of taxation.

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 by public health policies. The president of Philip Morris France, Jeanne Pollès, deplores the fact that many smokers do not receive accurate information on "non-combustion alternatives", in particular PMI's heated tobacco, " 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 existing regulations on heated tobacco and to influence a market that has become declining for traditional tobacco products due to government policies to reduce consumption. In addition, encouraging non-smoking vaping users to use IQOS and switch from VEEV to IQOS appears to contradict PMI’s own harm reduction model. Another element that contradicts the manufacturer’s harm reduction claims is that the retail price of vaping refills is 50 cents higher per pack than its HEETS refills (€8.00 versus €7.50) while the potential health benefits of vaping products are widely considered to be greater. This strategy shows that Philip Morris is actually trying to steer consumers towards heated tobacco where the manufacturer can make 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 VEEV is marketed under the name "IQOS", simply implying that heated tobacco belongs to the same category as the electronic cigarette.

In May 2019, Philip Morris International CEO André Calantzopoulos said in an interview that Philip Morris plans to roll out e-cigarette sales internationally in 2020, under the brand name of its heated tobacco product IQOS.

PMI claims to have introduced the IQOS system in order to reduce sales of traditional cigarettes and the company says it wants to make products available that are less toxic. In this perspective of curbing the tobacco epidemic, the target countries should be those where cigarette sales are increasing. However, IQOS was launched in countries where cigarette sales are declining and in high-income countries that have implemented strong tobacco control measures, 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 initial cost.

The reality is that Philip Morris designs all of its tobacco and nicotine products as possible entry points into nicotine addiction and as ways to prevent current users from quitting smoking. This approach, coupled with a marketing approach that focuses on its higher-margin products, allows it to maintain and even grow its markets for the future. PMI's "no-burn" strategy appears to be a reproduction of the tobacco industry's approach to smokeless tobacco. Industry documents had 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 " to make new profits rather than cannibalize 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 heated tobacco product and the associated profit margins.

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

©Generation Without Tobacco

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