Invisible smoke: third-party endorsement and the resurrection of heat-not-burn tobacco products

Abstract

BackgroundTobacco companies are introducing new ‘heat-not-burn’ cigarettes in dozens of countries. Historically, these products failed commercially, and independent researchers contested their health claims. The most prominent early heat-not-burn cigarette was RJ Reynolds’s (RJR’s) Premier, introduced in the USA in 1988. Curiously, The Lancet endorsed Premier as a ‘near-perfect low tar cigarette’ in a 1991 editorial, 2 years after Premier had been removed from the market. We examined the context of this endorsement.MethodsTo ascertain what RJR knew about this endorsement, we systematically searched and analysed previously secret RJR documents in public archives and triangulated the industry document data with other published work.ResultsRJR had a long-standing interest in collaborating with outside scientists to endorse potentially reduced harm cigarettes. The author of The Lancet editorial had previously corresponded with RJR regarding Premier’s health effects and market potential. Internally, RJR regarded The Lancet’s editorial, its stance on novel tobacco products, and its endorsement of Premier as major successes. While the editorial came too late to save Premier, RJR saw future business opportunities for novel products if endorsed by health authorities.ConclusionsEndorsement by high-impact medical journals and health authorities may be critical in helping heat-not-burn’ products succeed where previous attempts have failed. Conflicts of interest influenced these endorsements in the past. Health leaders and academic journals should consider both conflicts of interest and the ethics of endorsing tobacco product substitution, as tobacco companies simultaneously work to promote cigarette smoking and undermine tobacco control globally.

Association between Intention to Quit Cigarette Smoking and Use of Heated Tobacco Products: Application of Smoking Intensity Perspective on Heated Tobacco Product Users

“…Tobacco companies have designed sophisticated marketing strategies for HTPs, and many smokers are exposed to advertisements purporting that HTPs can replace combustible cigarettes [ 27 ]. However, the results of the present study suggested that a complete replacement of combustible cigarettes with HTPs was unlikely.…”

Heated tobacco products: another tobacco industry global strategy to slow progress in tobacco control

“…Thus, in the past decade and a half, the tobacco industry became a vocal proponent of tobacco harm reduction and has invested millions of US dollars in research and development of new products, such as HTP, which the tobacco industry is now using to gain access to scientists, opinion leaders and decision makers as a ‘solution’ to address the tobacco epidemic. Elias and Ling 89 describe the role the tobacco industry played a role in funding the earliest efforts to promote ‘clean nicotine’ for harm reduction and conclude that the tobacco industry will continue to seek endorsement from health authorities to its proposition of HTP as a ‘harm reduction’ strategy.…”

New ideas, old problems? Heated tobacco products – a systematic review

“…All these activities have the potential to change social norms and attitudes towards tobacco use, and suggest to the public that HTPs are a safe form of tobacco use. Elias and Ling emphasized the key role of respected health leaders in shaping public attitudes towards novel tobacco products and their impact on the commercial fate of HTPs [97]. The authors encouraged public health experts to carefully formulate opinions, bearing in mind the past experience with the industry-backed "safer tobacco products," such as filtered and low-tar cigarettes, which served to undermine and delay the global tobacco control efforts [97].…”

“…Elias and Ling emphasized the key role of respected health leaders in shaping public attitudes towards novel tobacco products and their impact on the commercial fate of HTPs [97]. The authors encouraged public health experts to carefully formulate opinions, bearing in mind the past experience with the industry-backed "safer tobacco products," such as filtered and low-tar cigarettes, which served to undermine and delay the global tobacco control efforts [97]. Lempert and Glantz pointed out legal uncertainties regarding HTPs, especially electronic devices used to heat up tobacco sticks [98].…”