From September 21st to 24th, 2020 the GTNF (Global Tobacco and Nicotine Forum) virtual meeting was held under the theme: Sustainable Change through Innovation and Regulation.

Considered as the world’s leading annual forum discussing the future of the tobacco and nicotine industries, this year’s discussions focused on how the industry could achieve sustainable change through innovation and regulation by responding to the growing demand from consumers for new improved products.

On September 22nd, a panel discussion was held by the GTNF on the topic “Modified-Risk Tobacco Products (MRTP) – as tobacco products that undergo an FDA scientific and technical assessment process may, if successful, be alluded to as -  and communicating relative risk”.

MRTP products are considered by the  Food and Drugs Administration of the United States (FDA) when they “demonstrate that the product will or is expected to benefit the health of the population as a whole” (FDA official page)

One of the leading tobacco companies in the world,  Philip Morris International,  was invited to participate on this panel discussion as they recently, in July,  received an authorization from the FDA that they have waited for years: risk-modification orders that state that their product – IQOS – presented by the manufacturer as a better alternative to cigarette exposes smokers who switch to reduced toxicants.

The FDA in its decision actually refers to IQOS as a system that“ heats tobacco but does not burn it. This significantly reduces the production of harmful and potentially harmful chemicals. Scientific studies have shown that switching completely from conventional cigarettes to the IQOS system significantly reduces your body’s exposure to harmful or potentially harmful chemicals.”

During this debate, Moira Gilchrist, Vice-president of strategic and scientific communications at Philip Morris International, shared her view after this rare authorization, stating that the consumer is the real winner:

“Now not only do cigarette smokers have access to better alternatives, but they also have information that we believe can help guide their choices. For us as a company, it’s a historic milestone and it is validation that the path that we've set out upon for many years, is viable. We believe that not only does IQOS have the potential to help public health in the U.S. but around the world. I also think this FDA decision is an important milestone for our industry- everybody involved in advocacy, decision making and science. Now we have a really clear example of evidence based decision making that shows that products like IQOS and snus are fundamentally different from cigarettes. This is information that needs to get to consumers.”

Moira Gilchrist mentioned Snus, which is another smoke-free alternative to traditional tobacco. Snus has obtained a risk-modification order as well, just before IQOS, and thus, was able to be marketed with these specific claims: “Using General Snus instead of cigarettes puts you at a lower risk of mouth cancer, heart disease, lung cancer, stroke, emphysema and chronic bronchitis.”

The main opponents to heated tobacco argue that those new products are attractive for the youth who could easily become first time nicotine consumers. The World Health Oganzation (WHO) is one of the biggest opponents of this strategy.

The United Nations agency reminded the public, a few days after the FDA decision, that “FDA orders also require the company to monitor youth awareness and use of the products to help ensure that the marketing of the MRTPs does not have unintended consequences for introduction of  youth use. The company must also keep the FDA apprised of efforts to prevent youth access and exposure.”

The WHO also specifies that claiming that heated tobacco is potentially less harmful than cigarettes could be ambiguous: “Given that health may be affected by exposure to additional toxins when using HTPs (Heated Tobacco Products), claims that HTPs reduce exposure to harmful chemicals relative to conventional cigarettes may be misleading.”

Clifford E. Douglas, director of the Tobacco Research Network and an adjunct professor in the Department of Health Management and Policy at the University of Michigan School of Public Health was also part of the conversation. For him, a targeted communication campaign is a critical requirement in the protection of youth.

 “We understand that the public and medical communications to date have suffered from a significant misunderstanding of the impact of nicotine and the role it plays in different types of products. As long as people believe that nicotine causes smoking related diseases, it will distort this whole process. It disincentives people from finding alternatives to combustible products. With kids, the concern is that these nuances, conveying distinctions between products, are not appropriate for kids to consider. If they think some products are less harmful, it will actually incentivize them to use them because kids are risk takers. The segmentation of the market is something we can do more effectively now to target where adults receive the messages they need to and where kids are not exposed to or have acess to this information.”

He also regretted that the tobacco industry’s intentions seem to always be perceived as malicious:

“The public health community has insisted on understanding fully the impact of MRTP products will have on youth - initiation, addiction. The challenge is that the industry is somewhat handcuffed in developing the information. Even if it does, it is seen as suspect if industry is involved.”

The Global Tobacco and Nicotine Forum was first launched in Rio de Janeiro, Brazil,  in 2008.

It has become the international conversation platform for dialogue on views and ideas among public health experts, government representatives, investors and members of the tobacco and nicotine industries.

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