Eclipse: does it live up to its health claims?

Should IQOS Emissions Be Considered as Smoke and Harmful to Health? A Review of the Chemical Evidence

The chemical evidence that IQOS emissions fit the definition of both an aerosol and smoke, and that IQOS and potentially other heated tobacco products (HTPs) pose some harmful health threats from the range of compounds released even at somewhat lower concentrations is reviewed. Further, we address the yields of harmful and potentially harmful compounds (HPHCs), including polycyclic aromatic hydrocarbons (PAHs), and the constituents of IQOS emission that are diagnostic of pyrolysis to provide information on the temperatures reached in IQOS tobacco sticks. The HPHCs present in IQOS emissions are the same as in conventional cigarette smoke (CCs), analogous to emissions from earlier generation of HTPs classed as smoke. However, Philip Morris International (PMI) studies have to some degree underestimated IQOS aerosol HPHC yields, which are a factor of between 3.2 and 3.6 higher when expressed on a tobacco rather than an IQOS stick basis compared to the reference 3R4F cigarette. Further, IQOS emissions contain carbon particles, which fit definition of both aerosol and smoke. Continual reheating of deposited tar in the IQOS device will occur with real-life use, likely leading to generation of even higher concentrations of HPHCs and particulate matter. Despite IQOS not exceeding 350 °C, local hot spots could exist, causing formation of species (phenol/cresols, PAHs). It is recommended that the impact of repeated use to determine the levels of black carbon (insoluble organic matter) in the particulate matter, and the extent to which compounds in IQOS emissions are formed by pyrolysis need to be assessed rigorously. To address whether uneven temperature profiles in heat sticks can lead to potential hot spots that could, for example, lead to PAH formation, it is recommended that pyrolysis studies on tobacco and other constituents of HTPs are required in conjunction with more effort on heating tobacco blends under controlled temperature/time conditions.

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

Background

Tobacco 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.

Methods

To 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.

Results

RJR 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.

Conclusions

Endorsement 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.

Comparison of the Pharmacokinetics of Nicotine Following Single and Ad Libitum Use of a Tobacco Heating System or Combustible Cigarettes

Introduction:

We aimed to compare the pharmacokinetics of nicotine between the heat-not-burn Tobacco Heating System 2.1 (THS 2.1) and combustible cigarettes (CCs). We also examined whether the subjective urge to smoke was associated with the pharmacokinetics of nicotine.

Methods:

This open-label, randomized, two-period, two-sequence crossover study conducted in 28 healthy smokers assessed the pharmacokinetics of nicotine after single and ad libitum use of the THS 2.1 or CCs. During the 7-day confinement period, blood samples were drawn for pharmacokinetic analysis. Subjective effects related to THS 2.1 or CC use were assessed using the Questionnaire of Smoking Urges (QSU-Brief).

Results:

The nicotine delivery rate was similar with the THS 2.1 and CCs after single and ad libitum use. The time to the maximum nicotine concentration was 8 minutes after single use of the THS 2.1 and CCs. The time to the peak concentration following ad libitum use was similar between the THS 2.1 and CCs. The maximum plasma nicotine concentration after single use of the THS 2.1 was 8.4ng/mL, 70.3% of that obtained with CCs. A transient reduction from baseline in the urge to smoke of 40% was observed 15 minutes after the single use of both the THS 2.1 and CCs. The mean QSU-Brief total scores following single and ad libitum use were similar for the THS 2.1 and CCs.

Conclusions:

These results suggest that the THS 2.1 effectively delivers nicotine and achieves similar pharmacokinetic profiles to CCs. The THS 2.1 also reduced the urge to smoke similarly to CCs.

Implications:

Reducing exposure to toxicants and safer delivery of nicotine are among the strategies that may reduce the harm of smoking-related diseases. In the present study, we investigated the pharmacokinetics of nicotine and their effects on the urge to smoke using the THS 2.1. It was developed to replicate the ritual of smoking as closely as possible by providing nicotine in a way that mimics CC smoking, but limits pyrolysis and combustion by heating tobacco at a much lower temperature than CCs (heat-not-burn).

Cigarette company trade secrets are not secret: an analysis of reverse engineering reports in internal tobacco industry documents released as a result of litigation

OBJECTIVES

Use previously secret tobacco industry documents to assess tobacco companies' routine claims of trade secret protection for information on cigarette ingredients, additives and construction made to regulatory agencies, as well as the companies' refusal to publicly disclose this information.

METHODS

We analysed previously secret tobacco industry documents available at (http://legacy.library.ucsf.edu) to identify 100 examples of seven major tobacco companies' reverse engineering of their competitors' brands between 1937 and 2001.

RESULTS

These reverse engineering reports contain detailed data for 142 different measurements for at least two companies, including physical parameters of the cigarettes, tobacco types, humectants, additives, flavourings, and smoke constituents of competitors' cigarettes. These 100 documents were distributed to 564 employees, including top managers in domestic and foreign offices across multiple departments, including executive leadership, research and design, product development, marketing and legal. These documents reported new competitors' products, measured ingredient changes over time, and informed companies' decisions regarding ingredients in their own products.

CONCLUSIONS

Because cigarette companies routinely analyse their competitors' cigarettes in great detail, this information is neither secret nor commercially valuable and, thus, does not meet the legal definition of a 'trade secret.' This information is only being kept 'secret' from the people consuming cigarettes and the scientific community. Public agencies should release this detailed information because it would provide valuable information about how ingredients affect addictiveness and toxicity, and would help the public health community and consumers better understand the impact of cigarette design on human health.

Extracts from presumed "reduced harm" cigarettes induce equivalent or greater toxicity in antigen-presenting cells

The tobacco industry has promoted certain cigarette products with claims that their use may be less harmful to the smoker as they purportedly deliver lower amounts of toxic chemicals compared to conventional cigarettes. This study was designed to compare the relative antigen presenting cellular toxicity of Eclipse, a presumed reduced exposure product (PREP) cigarette, when compared with the reference research 3R4F cigarettes (Kentucky University). Utilizing a murine macrophage cell line, murine bone marrow derived dendritic cells (DCs) and human monocyte-derived DCs incubated with extracts generated from Eclipse and Kentucky reference 3R4F cigarettes, we determined the relative toxic effects of the different cigarette smoke extracts on cellular viability, oxidative stress, T-helper-1 (Th-1) polarizing cytokine production and general gene expression. Eclipse and 3R4F cigarette smoke extracts induced equivalent oxidatively-mediated cellular heme oxygenase-1 (HO-1) protein levels in macrophages and DCs. Cellular viability determination demonstrated greater induction of cell death by apoptosis and necrosis by Eclipse extracts in DCs. The production of the key Th-1 polarizing cytokine interleukin-12 (IL-12) by activated DCs or macrophages was suppressed to an equivalent or greater extent by Eclipse extracts. Microarray studies performed on bone marrow derived murine DCs incubated with Eclispe or 3R4F cigarette extracts showed identical genotoxic profiles. These studies imply that presumed reduced harm Eclipse cigarettes induce equivalent or greater antigen presenting cell dysfunction relative to 3R4F cigarettes and illustrate the importance of independent validation and testing of similar products claimed to be associated with reduced toxicity relative to other cigarettes.

The use and perception of electronic cigarettes and snus among the U.S. population

BACKGROUND

E-cigarettes have generated controversy in the tobacco control field similar to that of Swedish snus, which came to the U.S. market six years earlier. Some argue that e-cigarettes have great potential to help smokers quit regular cigarettes while others contend they should be banned for lack of safety and efficacy data. This study examined population data from the U.S.

METHODS

A U.S. population survey with a national probability sample (N=10,041) was conducted (February 24 to March 8, 2012, before any major paid advertisement of e-cigarettes appeared on television). Survey respondents were asked if they had heard about e-cigarettes, where they had heard about them, whether they had used e-cigarettes or snus, how often they used them, and why they used them. Responses were weighted to represent the entire U.S. population.

FINDINGS

A high proportion, 75.4%, reported having heard about e-cigarettes. Television ranked as the number one source of information, followed by "in-person conversation" and "Internet." About 8.1% had tried e-cigarettes, and 1.4% were current users. These rates were twice those of snus (4.3% and 0.8%, respectively). Among current smokers, 32.2% had tried e-cigarettes, and 6.3% were current users. Over 80% of current e-cigarette users were non-daily users. Women were significantly more likely to have tried e-cigarettes than men. Those who had tried e-cigarettes were more likely than those who tried snus to report their products being safer than regular cigarettes (49.9% vs. 10.8%). Almost half (49.5%) of current smokers were susceptible to using e-cigarettes in the future.

CONCLUSIONS

That e-cigarettes have surpassed snus in adoption rate, even before any promotion by major tobacco companies, suggests that the former have tapped into smokers' intuitive preference for potentially harm-reducing products, probably due to the product design. E-cigarette use is likely to increase in the next few years.

Postmarketing surveillance for "modified-risk" tobacco products

INTRODUCTION

The U.S. Food and Drug Administration (FDA) acquired authority to regulate tobacco products in 2009. This authority will provide a structured process for manufacturers to introduce products that may have "modified-risk" for morbidity or mortality relative to traditional tobacco products, with postmarketing surveillance and studies a condition of marketing.

METHOD

A narrative review approach was taken. The author searched and integrated publicly accessible literature on tobacco product surveillance as well as drug and medical device postmarket activities currently performed by FDA.

RESULTS

FDA relies on active and passive methods for postmarket surveillance and can require specific studies and risk evaluation and mitigation strategies for certain products, including those with abuse liability. Past efforts at examining the individual and population effects of reduced harm tobacco products provide an example of integrating different data streams.

DISCUSSION

Postmarket surveillance can be viewed in terms of the Agent-Host-Vector-Environment model, and concepts from diffusion of innovations are relevant to understanding factors associated with the adoption of new products by the population. Given that active and passive surveillance approaches have different strengths and weaknesses, multiple approaches may be necessary to evaluate population-level effects. Assuring that required studies are properly conducted and reported and that data indicating significant public health harms are quickly recognized will be important going forward.

CONCLUSIONS

The advent of broad regulatory authority over tobacco provides opportunities for policy evaluation research. The research community can provide FDA with the independent science it needs to evaluate the public health impact of novel tobacco products.

Surveillance methods for identifying, characterizing, and monitoring tobacco products: potential reduced exposure products as an example

Tobacco products are widely sold and marketed, yet integrated data systems for identifying, tracking, and characterizing products are lacking. Tobacco manufacturers recently have developed potential reduced exposure products (PREP) with implied or explicit health claims. Currently, a systematic approach for identifying, defining, and evaluating PREPs sold at the local, state, or national levels in the United States has not been developed. Identifying, characterizing, and monitoring new tobacco products could be greatly enhanced with a responsive surveillance system. This article critically reviews available surveillance data sources for identifying and tracking tobacco products, including PREPs, evaluating strengths and weaknesses of potential data sources in light of their reliability and validity. With the absence of regulations mandating disclosure of product-specific information, it is likely that public health officials will need to rely on a variety of imperfect data sources to help identify, characterize, and monitor tobacco products, including PREPs.

Reconciling human smoking behavior and machine smoking patterns: implications for understanding smoking behavior and the impact on laboratory studies

BACKGROUND

Recent Food and Drug Administration legislation enables the mandating of product performance standards for cigarette smoke and the evaluation of manufacturers' health claims for modified tobacco products. Laboratory studies used for these evaluations and also for understanding tobacco smoke toxicology use machines to generate smoke. The goal of this review is to critically evaluate methods to assess human smoking behavior and replicate this in the laboratory.

METHODS

Smoking behavior and smoking machine studies were identified using PubMed and publicly available databases for internal tobacco company documents.

RESULTS

The smoking machine was developed to generate smoke to allow for comparing cigarette tar and nicotine yields. The intent was to infer relative human disease risk, but this concept was flawed because humans tailor their smoking to the product, and chemical yields and toxicologic effects change with different smoking profiles. Although smoking machines also allow for mechanistic assessments of smoking-related diseases, the interpretations also are limited. However, available methods to assess how humans puff could be used to provide better laboratory assessments, but these need to be validated. Separately, the contribution of smoke mouth-holding and inhalation to dose need to be assessed, because these parts of smoking are not captured by the smoking machine. Better comparisons of cigarettes might be done by tailoring human puff profiles to the product based on human studies and comparing results across regimens.

CONCLUSIONS

There are major research gaps that limit the use of smoking machine studies for informing tobacco control regulation and mechanistic studies.

Impact of corrective health information on consumers' perceptions of "reduced exposure" tobacco products

OBJECTIVE

To determine whether providing corrective health information can reduce the tendency of consumers to believe that the implied marketing message that two "potentially reduced exposure products" (PREPs) are safer than regular cigarettes.

DESIGN

Face-to-face interviews with smokers assigned to one of four conditions, which varied in terms of the presence or absence of health information that qualified claims made in advertising for two PREPs.

SUBJECTS

A convenience sample of 177 smokers in Boston area.

INTERVENTIONS

Health information detailed the extent to which exposure to toxins and health risks of the brands were unknown.

MAIN OUTCOME MEASURES

Respondents' assessments of the health risks and toxicity of the two combustible PREPs, Advance and Eclipse.

RESULTS

The health information had a modest but significant effect on ratings of health risk, and reduced perceptions that switching to the new brands would lower a smoker's risk of cancer (OR 0.75; p<0.05). The health information had no effect on perceptions of toxicity.

CONCLUSIONS

A small dose of corrective information was effective in tempering smokers' perceptions. A higher dose of public health campaigns would be needed to affect misperceptions likely to follow a full-scale tobacco marketing effort.

Potential reduced exposure products (PREPs) in industry trial testimony

OBJECTIVE

To identify patterns in trial testimony that may reflect on the intentions or expectations of tobacco manufacturers with regard to the introduction of potential reduced exposure products (PREPs).

DESIGN

Research was conducted using the Deposition and Trial Testimony Archive (DATTA) collection of trial testimony and depositions housed online at Tobacco Documents Online (www.tobaccodocuments.org). Relevant testimony was identified through full-text searches of terms indicating PREPs or harm reduction strategies. The role and function of PREPs in testimony were classified according to common and contrasting themes. These were analysed in the context of broader trial arguments and against changes in time period and the market.

RESULTS

Analysis of testimony suggests that the failure of PREPs in the market tempered initial industry enthusiasm and made protection of the conventional cigarette market its major priority. The "breakthrough" character of PREPs has been de-emphasised, with trial arguments instead positioning PREPs as simply another choice for consumers. This framework legitimises the sale of conventional brands, and shifts the responsibility for adoption of safer products from the manufacturer to the consumer. Likewise, testimony has abandoned earlier dramatic health claims made with regard to PREPs, which had undermined industry arguments regarding efforts to reduce harm in conventional products. More recent testimony advocates the broad acceptance of independent guidelines that would validate use of health claims and enable the industry to market PREPs to consumers.

CONCLUSION

Trial testimony reflects the changing role and positioning of PREPs by the tobacco industry. The findings are of particular importance with regard to future evaluation and potential regulation of reduced harm products.

Tobacco industry litigation position on addiction: continued dependence on past views

This paper reviews the tobacco industry's litigation strategy for addressing the addiction issue through trial testimony by its experts, and opening and closing statements by its lawyers. Despite the fact that several companies now claim to accept, in varying degrees, the conclusions of the Surgeon General concerning tobacco addiction, the tobacco industry litigation strategy pertaining to addiction is essentially unchanged since that of the early 1980s when the issue emerged as crucial. The industry uses its experts and the process of cross-examination of plaintiff's experts to imply that the addictiveness of tobacco and nicotine are more comparable to substances such as caffeine, chocolate, and even milk, than to heroin, cocaine and alcohol. Furthermore, the tobacco industry contends that the definition of addiction has now become so broadened as to include carrots and caffeine and hence that any concurrence that smoking is addictive, does not imply that cigarettes are addictive to the standards that drugs such as heroin and cocaine are addictive. Finally, the industry has continuously asserted that tobacco users assumed the risks of tobacco since they understood that quitting could be difficult when they began to use, and moreover, that the main barrier to cessation is lack of desire or motivation to quit and not physical addiction. These positions have been maintained through the 2004-2005 US Government litigation that was ongoing as the time of this writing.

New tobacco products: do smokers like them?

BACKGROUND

There is little information about smokers who tried potentially reduced exposure products (PREPs) (Eclipse, Omni, Advance Lights, Accord, or Ariva), why they tried them, if they liked these products, and if they will continue to use them.

OBJECTIVES

The objectives of this qualitative study were to understand: (1) how smokers who tried PREPs learned about them, (2) reasons for first trying PREPs, (3) which PREP(s) they tried, (4) what they thought of the product at first trial, (5) reasons for continuing or discontinuing use, and (6) whether they would recommend PREPs to others.

DESIGN

In October 2002, 16 focus group sessions were conducted with current cigarette smokers aged 30-50 years: eight groups in Chattanooga, Tennessee, and eight in Dallas, Texas. Specific focus groups were composed of white men, white women, African American men, African American women, Hispanic men, or Hispanic women.

RESULTS

The majority of the participants learned about PREPs through advertising or promotion, family, friends, and co-workers; major reasons given for first trying PREPs were that the products were free or inexpensive, they wanted to stop smoking, they believed the product claims of fewer health risks, or they were curious; most of them tried Eclipse probably because the focus groups were conducted in the same cities where Eclipse was introduced; most participants did not like PREPs; most discontinued the use of PREPS, some who continued to use them did so infrequently and also kept smoking their regular brands of cigarettes; and most would not recommend PREPs, although a few might recommend them to specific groups (for example, new smokers, the young, women, curious or health conscious people).

CONCLUSIONS

Although most established smokers did not like the PREPs they tried and will not recommend them to anyone, a minority of established smokers believe that there may be a market for these products.

Preliminary investigation of the advertising and availability of PREPs, the new "safe" tobacco products

The tobacco industry recently introduced a new set of "safe" cigarettes and nicotine delivery devices that purportedly entail reduced tobacco-related disease risk due to their lower level of some carcinogens and toxins. Little is know about the biological impact of these potential reduced exposure products (PREPs) and nothing is known about their advertising and availability. Hence, two pilot studies were conducted to examine the latter issues for the first time. In Study 1, we examined tobacco ads in 10 popular magazines 1998--2002 and found that only 1% of ads were for PREPs. In Study 2, we attempted to purchase PREPs in a random sample of 113 small stores and found that only 4.4% sold any PREP. These preliminary findings tentatively suggest that the industry might not yet be heavily invested in products that have the potential to increase tobacco use by decreasing its perceived harm. Studies with larger samples are recommended.

A Premiere example of the illusion of harm reduction cigarettes in the 1990s

OBJECTIVE

To use the product launch of Player's Premiere as a case study for understanding the new cigarette product development process during the 1990s. We determine the (in)validity of industry claims that: (1) development of the physical product preceded the promotional promise of "less irritation"; (2) "less irritation" was actually realised; (3) advertising informed consumers; and (4) advertising regulations caused the product's failure in the marketplace.

SETTING

Court proceedings assessing the constitutionality of Canada's Tobacco Act, which substantially restricts cigarette advertising. The 2002 Quebec Superior Court trial yielded a new collection of internal documents from Imperial Tobacco Ltd (ITL), including several about the development and marketing of Player's Premiere.

METHOD

Trial testimony and corporate documents were reviewed to determine the validity of the industry representations about the new cigarette product development process, focusing on the case history of Player's Premiere.

RESULTS

In direct contradiction to industry testimony, the documentary evidence demonstrates that (1) communications for Player's Premiere, which claimed less irritation, were developed long before finding a product that could deliver on the promise; (2) ITL did not sell a "less irritating" product that matched its promotional promise; (3) the advertising and other communications for Player's Premiere were extensive, relying on the hi-tech appearances ("tangible credibility") of a "unique" filter, yet were uninformative and vague; and (4) Player's Premiere failed in the marketplace, despite extensive advertising and retail support, because it was an inferior product that did not live up to its promotional promise, not because of regulation of commercial speech.

CONCLUSIONS

New product development entails extensive consumer research to craft all communications tools in fine detail. In the case of Player's Premiere, this crafting created a false and misleading impression of technological advances producing a "less irritating" cigarette. This product was solely a massive marketing ploy with neither consumer benefits, nor public health benefits. The industry attempted to deceive both consumers and the court.