Heated Tobacco: The Product That Neither Side Wants to Talk About

Heat a cigarette to 350°C instead of burning it at 900°C, and the chemistry changes dramatically. The aerosol that's produced contains nicotine, glycerol, and significantly lower levels of the combustion-derived toxicants that make cigarette smoke lethal. This is the principle behind heated tobacco products (HTPs)—devices like Philip Morris International's IQOS, British American Tobacco's glo, and Japan Tobacco's Ploom—that have become a multi-billion-dollar global product category while remaining curiously invisible in Western policy debates. Vaping gets the headlines, both positive and negative. Cigarettes get the regulation, both aggressive and insufficient. Heated tobacco sits in the middle, too tobacco-like for vaping advocates to embrace and too harm-reduction-adjacent for the tobacco control establishment to comfortably address.

The Japanese experience with IQOS is the most important natural experiment in heated tobacco that almost no one in Western public health has meaningfully engaged with. IQOS launched in Japan in 2014 and achieved something unprecedented: it captured roughly 30% of the cigarette market within five years without significant marketing to youth and without creating the kind of teenage epidemic that characterized JUUL in the United States. Japanese cigarette sales, which had been declining at roughly 2% annually, began declining at 10% annually after IQOS's introduction. The product was adopted overwhelmingly by existing smokers, not by never-smokers. By 2023, Japan's smoking rate had fallen to record lows, and IQOS had become the country's most popular nicotine product after cigarettes themselves. This is, by any reasonable standard, a public health success story. It's also a story that neither side of the nicotine debate wants to tell.

The toxicological profile of HTPs is complex and contested—and importantly, most of the contestation comes from studies funded either by the industry or by tobacco control organizations with an explicit antipathy to the industry. Independent studies, including those conducted by government laboratories in the UK, the Netherlands, and the United States, generally find that HTP aerosol contains 80–95% fewer toxicants than cigarette smoke, comparable to the reductions achieved by e-cigarettes. But HTP aerosol is not harmless. It contains carbonyl compounds, volatile organic compounds, and tobacco-specific nitrosamines at levels that are substantially lower than cigarette smoke but substantially higher than the background levels found in pharmaceutical nicotine products. The WHO's position is that HTPs are 'harmful' and that there is 'no evidence' they are less harmful than cigarettes—a formulation that's technically true (harmful ≠ harm-FUL; HTPs aren't safe) while misleading about the dose-response relationship (the harms are almost certainly lower, which is what most people mean when they ask 'is it safer?'

The regulatory classification of HTPs varies wildly across jurisdictions and reveals the deep conceptual confusion at the heart of nicotine product regulation. In the United States, the FDA authorized IQOS as a 'modified risk tobacco product' but explicitly withheld the right to market it as less harmful than cigarettes—an authorization so constrained that PMI has largely deprioritized the U.S. market. In the UK, HTPs are regulated as tobacco products under the same framework as cigarettes, with the same tax rate and the same advertising restrictions, effectively eliminating any incentive for smokers to switch. In Japan, HTPs are regulated as a distinct category—neither cigarettes nor pharmaceuticals nor consumer products—with their own tax rate and marketing rules. The incoherence is not accidental. It reflects a deeper conflict: the existing regulatory frameworks were designed for a binary world of cigarettes (bad) and cessation products (good), and nobody has figured out how to classify a product that's a cigarette that doesn't burn.

The industry's role in HTP development is simultaneously the most promising and most suspicious aspect of the technology. On one hand, the world's largest tobacco companies are investing billions in products designed to replace the cigarettes that generate most of their current profits—a transition that would not be happening at this scale or speed without commercial motivation. On the other hand, these are the same companies that spent decades denying the harms of cigarettes, and their claims about HTP safety deserve the same skepticism that was warranted for 'light' and 'low-tar' cigarettes. The industry's behavior in the HTP space has been characteristically Janus-faced: investing in research that demonstrates reduced toxicant exposure while simultaneously fighting the independent research and post-market surveillance that would verify those reductions under real-world conditions; marketing HTPs as a 'better choice' in developed countries while continuing to aggressively promote cigarettes in developing ones.

For smokers trying to navigate the heated tobacco landscape, the evidence supports a pragmatic interpretation that aligns with common sense: HTPs are almost certainly less harmful than cigarettes (because most of the harm from cigarettes comes from combustion products that HTPs produce at much lower levels) and almost certainly more harmful than not using any tobacco product. The risk hierarchy—cigarettes > HTPs > e-cigarettes/NRT > nothing—is supported by the available toxicological data and makes mechanistic sense. The question for individual smokers is whether the reduction in risk is sufficient to justify switching, given the uncertainties, the cost, and the reality that HTPs maintain nicotine dependence. For a smoker who cannot or will not quit using conventional methods and who finds vaping unsatisfactory, HTPs represent a harm-reduction option that's supported by logic if not yet by decades of epidemiological follow-up.

Heated tobacco's awkward position in the nicotine landscape may ultimately be its undoing—or its salvation. The most likely regulatory trajectory is that HTPs will be treated as reduced-risk products in jurisdictions that have embraced harm reduction (the UK, New Zealand, Canada) and as tobacco products to be restricted in jurisdictions that follow the precautionary principle (Australia, much of the EU, the WHO). This bifurcation will create a natural experiment that, over the next two decades, will generate the epidemiological evidence that the debate currently lacks. By 2045, we'll know whether populations with access to HTPs have lower smoking-related mortality than those without. The tragedy is that millions of people will die of smoking-related diseases in the meantime—some of whom might have switched to HTPs if the regulatory environment hadn't made it easier and cheaper to keep smoking.