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Comment & Response
November 2017

Perplexing Conclusions Concerning Heat-Not-Burn Tobacco Cigarettes—Reply

Author Affiliations
  • 1Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
  • 2Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
  • 3Institute for Work and Health (IST), University of Lausanne and Geneva, Lausanne, Switzerland
JAMA Intern Med. 2017;177(11):1699-1700. doi:10.1001/jamainternmed.2017.5861

In Reply There is general agreement on the need for rigorous independent studies of IQOS that will accurately inform the public. When we began our research,1 Phillip Morris International (PMI) advertisements claimed IQOS produced “no smoke.” We thus designed our exploratory study to detect chemicals typical of pyrolysis, the presence of which defines an aerosol as “smoke.” We chose a comparison cigarette (a brand regularly smoked by millions) based on convenience, because the comparison was incidental, rather than the heart of the experiment. We did not set out to provide a benchmark for the regulatory industry, so comparison with a 3R4F standard cigarette was unnecessary. Tobacco content naturally varies, and differences may be compounded by process fluctuations in cigarette manufacture.2 Standard cigarettes reduce such variations, but they are no more representative of cigarettes used by smokers worldwide than any other single brand of cigarette. Because we were not benchmarking, using the more expensive standard cigarette and waiting for its delivery would have held up our real work, which was identifying the presence of harmful chemicals in IQOS smoke. Our validated and standardized analytical methods are not likely to have caused the wide standard deviation in our measures of IQOS smoke: variation in IQOS tobacco content is the likely explanation.

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