Systematic analysis of the scientific literature on heated tobacco

Introduction. - The tobacco industry (TI) reports that heated tobacco reduces risk of tobacco use and will replace cigarettes. An analysis of the scientific literature was conducted in order to enlighten professionals and decision-makers. Method. - After a Medline query in February 2018, a systematic analysis was conducted. Results. - Of the 100 papers published in 2008-2018, 75 have authors affiliated or linked to TI. Emissions contain gases, droplets and solid particles, so are smokes. The main products are: THS2.2 (Iqos (R)) which heats mini-cigarettes at 340 degrees C, the THP1.0 (Glo (R)) which heats at 240 degrees C sticks delivering about half as much nicotine, Ploom (R) which uses reconstituted tobacco microcapsules heated at 180 degrees C. Under the experimental conditions, there is a reduction of toxic emissions and biological effects, but the expected risk reduction is not demonstrated. Symptoms related to passive smoking are described. The 4 epidemiological articles report that heated tobacco is used in 10 to 45% of cases by non-smokers and demonstrate the effectiveness of TI promotion campaigns. Thus, the THS2.2 is more a gateway to smoking (20%) than an exit door (11%); moreover, it is not expected risk reduction among the 69% who are mixed users. Conclusions. - While reducing emissions is documented, reducing the risk to the smoker who switches to heated-tobacco remains to be demonstrated. On the other hand, the worsening of the global tobacco risk related to the promotion of the products by the TI is anticipated, justifying that the authorities take the appropriate measures to control the promotion of heated tobacco. (C) 2018 SPLF. Published by Elsevier Masson SAS. All rights reserved.