October 7, 2025
I’m Dr. Diana Zuckerman, president of the National Center for Health Research. Our non-profit think tank does not accept funding from any entities that have a financial interest in our work, so we have no conflicts of interest.
Research showing low IQOS (i-cos) use when they were very briefly on the market during the COVID pandemic in 2021 is not relevant to future use. There is new research and a new understanding of the impact of these products on quitting smoking, on potentially harmful exposures, and on health. We also know more about the marketing of these products and about consumers’ understanding of the risks. I will briefly summarize these issues.
- These products have the potential to help people quit smoking, but the most recent research shows they usually don’t. In a study published this year in the Journal of Epidemiology, which was based on all published studies since 2022, 68% of users of heated tobacco products also smoked cigarettes.
- Although the short-term biomarker data says that traditionally identified toxic exposures are lower for IQOS than cigarettes, there are no long-term data that would be needed to show that IQOS are a healthier alternative to cigarettes in the long-run. Meanwhile, FDA has identified many other potential toxic exposures that we heard today are higher for IQOS than for cigarettes.
- Consistent with those findings, rodent studies indicate respiratory, cardiovascular, and reproductive harm that is equal to or greater than the harms of cigarettes. I don’t like to rely on rodent studies, but we can’t ignore those important findings. Especially because in research based on 55 studies of humans or human cells that was published this year in the journal Healthcare, heated tobacco devices increased respiratory disease, hypertension, heart rates, and other predictors of serious disease.
These products have been on the market for 10 years, and the company should have provided longer term data to support their claim of reduced risk rather than telling you that their short-term exposure data shows that lower risk is reasonably likely.
4. The Campaign for Tobacco Free Kids has described some of the marketing techniques that PMI uses to reach young consumers. These include ads in fashion magazines and sponsoring concerts that appeal to teens and young adults. Even more harmful, 2 of the heat sticks you’re considering today are menthol products. We all know that menthol appeals to nonsmokers and those just starting to use tobacco. Why encourage the use of a product that will encourage young people to become dependent on nicotine?
5. I’ve worked with thousands of consumers to evaluate their understanding of health warnings. While many consumers may understand a statement that they have just read that they would need to switch completely from cigarettes to IQOS to reduce risks, that doesn’t mean they will remember that message exactly later in the day or later in the week. After all, health professionals always tell us that moderation is the key – we can eat fried foods or ice cream or hot dogs, or anything else in moderation, so smokers will assume that using IQOS and smoking less is a good way to lower risk. And, the message about lower exposure to chemicals is inevitably going to be misunderstood as meaning less harmful.