How many times can the old-fashioned cigarette be reinvented?
JUUL did it and almost got away with it. The young vaping company quickly became the controlling player in the emergent e-cigarette marketplace. JUUL’s downfall, however, was almost as fast as its rise: The beleaguered company has seen its sales drop by $500 million and faces thousands of lawsuits over its marketing practices, which aggressively targeted young people and hooked them on its highly addictive vaping products. Last month, JUUL settled one lawsuit with North Carolina for $40 million.
It was the fast and somewhat unchecked rise of vaping among youth — which has been referred to as an epidemic — that spurred Massachusetts lawmakers to action. In late 2019, the Commonwealth enacted landmark legislation, the strictest in the country, banning all sales of flavored tobacco and vaping products.
Now comes Big Tobacco’s latest push to elude regulation on Beacon Hill: electronic devices that heat tobacco instead of burning it, which the industry claims is a safer alternative to combustible cigarettes. IQOS is one such device and looks like a small high-tech gadget. It has been sold overseas for a few years and is produced globally by Philip Morris International. In the United States, Altria — a major tobacco holding corporation that includes the maker of Marlboro cigarettes in its portfolio and owns a stake in JUUL — holds the license for IQOS. Philip Morris International, which is a separate entity from Altria, received an important authorization a year ago from the Food and Drug Administration. The order allows Philip Morris International to market the devices as a modified-risk tobacco product, a troubling but legal designation that could have significant public health implications.
Three Massachusetts state lawmakers — Senator Patrick O’Connor, who represents Weymouth, Hingham, and other South Shore communities, and Representatives Daniel Cahill of Lynn and Daniel Ryan of Boston — sponsored legislation this year to exempt modified-risk tobacco products from the state’s landmark flavor ban. The move is instructive, since it comes from the same decades-old Big Tobacco playbook. It’s an attempt to insert a loophole for the industry to grow its dying business by attempting to create, yet again, a new generation of nicotine-addicted teens — just like JUUL tried to do.
“[Philip Morris International] claims these [heat, not burn] products will provide a healthier alternative to combustible cigarettes,” said Dr. Rose Marie Robertson, deputy chief science and medical officer at the American Heart Association. “But the public needs to understand that even though the FDA granted their application, [the manufacturer] is supposed to show that, as it is used, the product significantly reduces harm and the risk of tobacco-related disease, and that it benefits the population, both users and nonusers.”
Robertson said Philip Morris International markets heavily to youths in Italy and Japan, which is why she believes the FDA was setting a dangerous precedent authorizing IQOS to be sold in the United States. According to American Heart Association, it is currently sold in Atlanta, Georgia, and South Carolina.
Philip Morris International claims that using tobacco heating systems like IQOS is less harmful than smoking regular combustible cigarettes. But a study in Italy contradicts those claims. “Studies vary; some say that IQOS can deliver an amount of nicotine ranging from two-thirds to 96 percent of what you get from combustible cigarettes,” Robertson told me. How much you get depends on how long and how deeply you inhale, she said.
Locally, anti-tobacco advocates believe the bill that would allow IQOS flavored HeatSticks (some sold under the Marlboro brand) isn’t likely to go anywhere. “We always want to make sure that any anti-tobacco legislation we propose includes future tobacco products,” said Gwen Stewart, executive director of the Tobacco Free Mass coalition. It’s no accident that Massachusetts’ adult cigarette smoking rate is among the nation’s lowest. “But the industry is like a shark. They’re always circling, and if something doesn’t work, they’ll try something else.”
Big Tobacco is also engaging in the polishing and rebranding of their image, pushing “alternatives” to combustible cigarettes and sometimes overstating their benefits. JUUL, as reported by The New York Times, paid $51,000 to have an entire issue of the American Journal of Health Behavior dedicated to running 11 studies, funded by the company, showing that JUUL products help smokers quit. Philip Morris International has been buying sponsored-content advertising in media outlets, including The New York Times, The Washington Post, and the Globe.
Philip Morris International says it’s transitioning to a smokeless future and is planning to stop selling regular cigarettes in Britain within the next decade. The company “is cloaking itself in science, claiming that [the company] is offering science to solve a problem,” said Stewart. “What they’re not mentioning is that the problem is them. They are creating the problem and actively pushing a new tobacco product to allegedly ‘solve’ it.”
Big Tobacco’s con is as simple as it is old: to get more people addicted to nicotine. Who are the easiest marks? Young people. And to get teens hooked on tobacco, adding flavors is a must. Massachusetts must keep playing defense to hold off the industry’s advances.