Even taking human life as a simple line item on a budget, it is never desirable for a company to kill its customers. Death renders consumers, medically speaking, unable to consume. PMI also stands to benefit from a product that allows people to consume tobacco less conspicuously and so, theoretically, in greater quantities. People could use it without stinking up everything they own, and without having to go outside in the middle of winter to stand alone. The devices extract nicotine from tobacco more efficiently than combustion does, meaning better profit margins. And they’re not subject to the heavy taxes imposed on cigarettes in much of the world.
A world where no one smokes, then, may be in the company’s interest. Though a world where everyone spends more living years consuming tobacco discreetly—all day, every day—is not everyone’s ideal vision of a “smoke-free world.”
The arrival of this tobacco-rich world—at least in the U.S.—is contingent on a decision by the FDA. The decision could come at any time. If the agency allows PMI to advertise the IQOS as safer than smoking, then experts predict that the floodgates will open and the product will become commonplace.
David Ashley, who spent seven years at the FDA regulating tobacco, considers this approval quite plausible. “It appears that if a person who is a smoker switches completely to this product, their risk of diseases will be reduced,” he says. Ashley is a professor at Georgia State School of Public Health, and he reviewed the data that PMI submitted to the FDA at length. He says he has no reason to doubt their accuracy. But he raises the crucial concern: How many people will switch completely?
The safety of anything that people put into their body is not determined by chemistry alone, but by how that chemistry fits into daily routines, cultures, and psychological proclivities. Smokers who purchase IQOS may be likely to continue to smoke, and will simply add the device into the gaps between stepping outside into the bleak winter air. In its FDA application, PMI provided only data from people who switched entirely from cigarettes to heated tobacco. More often, Ashley says, people become dual users—which of course would benefit a seller of both cigarettes and heated tobacco.
Earlier this year, a study from the American Cancer Society offered some amount of reassurance. Researchers tracked cigarette sales by region in Japan from 2014 to 2018. They saw significant declines in sales that correlated with local IQOS launches. The cautious conclusion: “The introduction of IQOS likely reduced cigarette sales in Japan. The net population health impact, however, cannot be assessed without resolving several key uncertainties related to the direct harms of IQOS.”
Such uncertainties would ideally be resolved before a national rollout of any product. And in an ideal model of reviewing new devices like this one, safety data would not depend on studies done by the company itself. Instead, researchers would study products and assess health effects, and would have no financial stake in any outcomes they might find. The National Academy of Sciences proposed something like this in 2012. In the process of laying out scientific standards for studying e-cigarettes, the group suggested a new third-party entity to oversee testing of new tobacco products. Since universities don’t take grant money from tobacco companies, funding would come from fees and taxes on tobacco companies, or from money won in settlements.