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Please do not be fooled by the sophistry and lies of heated tobacco.
● Many carcinogens and harmful substances are emitted from heated tobacco devices without
combusting tobacco. Some substances are emitted only from heated tobacco devices.
● Even if the amounts of harmful substances are reduced to 1/10 of the original levels,
potential damage to health remains, and nicotine amounts remain elevated.
● Nicotine and other substances in heated tobacco could cause depressed immunity,respiratory diseases, heart disease, and cancer.
● Please do not be fooled by the sophistry and lies of the tobacco industry.
Manabu Sakuta, Chairperson, Japan Society for Tobacco Control, General incorporated
Director Michiyuki Matsuzaki
1. Nicotine, menthol, glycerin, acetaldehyde, diacetyl, acrolein, and glycidol were detected in themainstream (exhaled) aerosol from IQOS, and 33 additional substances including benzene wereidentified in sidestream aerosol. Among these substances, acetaldehyde is a clear carcinogenand diacetyl is known to cause respiratory illness. Glycidol is also a carcinogen, and acrolein isotherwise highly toxic. Amounts of these substances in mainstream areosol are higher, but thesidestream aerosol of IQOS also contained significant levels of acetaldehyde, acetone, which isharmful to the respiratory tract, and 2-butanone, which is designated as a toxin.
Lucia Cancelada, et al., "Heated Tobacco Products: Volatile Emissions and Their Predicted Impact on Indoor
Air Quality." Environmental Science & Technology, Vol.53, 7866-7876, 2019

2. The heated tobacco product “IQOS” manufacturer Philip Morris said that IQOS heats but
does not burn its ingredients, so that the amounts of harmful substances other than nicotine issignificantly reduced compared to combusted tobacco (to about 1/10 of the level). The
company has published many advertisements in major newspapers stating that their newproduct will significantly decrease health hazards. Moreover, they stated that there is no"smoke from combustion", and implied that nicotine alone does not cause any harmful effects.
This latter statement is a lie.
3. [Evidence part 1] Even if the amounts of harmful substances is said to be reduced to 1/10 of
the original amount, it can not be expected that cases or risks of diseases will likewise be
reduced to 1/10 of their original amounts. Likewise, even if the consumption of combustible
cigarettes is reduced to 1/10 of an original amount (from 20 sticks/day to 3 sticks/day or less),the risk of contracting heart and lung diseases was shown not to significantly decrease. (Seegraph below.)

喫煙本数と虚血性心疾患リスク

1日20本で2倍だが、1日3本以下でも1.7倍

調整相対リス
ク

虚血性心疾患●心血管疾患 ●心肺疾患●-3本/日4-7

1日あたり喫煙本数
8-12
13-17
18-22

23-PM2.5曝露量/日，㎎Pope CA et al. Cardiovascular mortality and exposure to airborne fine particulate matter andcigarette smoke: shape of the exposure-response relationship. Circulation. 2009 Sep
15;120(11):941-8

The amount of smoking and the risk of ischemic heart disease
20 sticks/day has a relative risk of 2, but 3 sticks or less/day still has a relative risk of 1.7
4. [Evidence part 2] About the same amount of nicotine is released in the body when using
Philip Morris's "IQOS" heated tobacco device as from combustible tobacco cigarettes. A
current Philip Morris advertisement claims that one need not worry about health hazards
from nicotine alone, but various research studies have shown that nicotine could be harmful
to many organs in the body. Although combusted smoke has higher levels of toxins, nicotine
alone could have an adverse impact on one’s health.

Adverse effects of nicotine(Reference：Mishra A, et al. Harmful effects of nicotine. Indian J Med Paediatric Oncology 2015 JanMar; 36(1):24-31)

Type of illness
Nicotine addiction

Effects from administering nicotine (clinical data, cell biologicalexperiments, animal experiments, et cetera)
Nicotine is a powerful addictive drug comparable to cocaine andheroin (US Public Health Secretary 2010). 70% of people who switchedfrom combustible cigarettes to heated tobacco continued to smoke
cigarettes, a dual habit which can be labelled "harm maintenance"
instead of "harm reduction".

Nicotine and cancer

Nicotine and lungcancer
Nicotine and livercancer
Nicotine andstomach cancerNicotine andpancreatic cancer
Nicotine and breast
cancerNicotine andcardiovasculardiseaseNicotine andrespiratory disease

Nicotine anddigestive organs

Nicotine andimmunity

Nicotine stimulates nAChRs, leading to the generation andproliferation of cancer cells. In the body, nicotine is transformed into
carcinogens such as tobacco-specific nitrosamines. It also increases
blood vessels in existing cancer tissue, causing its growth andmetastasis, and extends the survival of cancer cells. It has asynergistic effect with other carcinogens and shortens the time tocarcinogenesis. (Human/animal cell experiments)
Nicotine administration → Lung cancer cells are generated, and their
growth and metastasis are promoted. (animal experiment)
Nicotine administration → Cancerous hepatocytes (liver cells) arepromoted. Effectiveness of anticancer drugs is decreased. (humanliver cancer cell experiment)
Nicotine administration → Gastric (stomach) cancer cells proliferate,metastasis of cancer is also promoted. (human gastric cancer cellexperiment)
Nicotine administration → Pancreatic cancer develops, metastasis ofcancer is promoted, and effects of anticancer drugs are suppressed.
(animal experiment)
Nicotine administration → Cancerous mammary gland cells arepromoted. (human mammary gland cell experiment)
Nicotine administration → Increased heart rate, increased bloodpressure, decreased blood flow to the skin and myocardium,
deteriorated cardiac function, lower coronary blood flow from nicotine
gum, deteriorated response of vasodilation from blood flow, increased
risk of angina and myocardial infarction, increased atherosclerotic
plaque, accelerated arterial occlusion. (Clinical data from manysources)
Nicotine administration → Elasticity of fibers in the lungs isdiminished (pulmonary fibrosis), the onset of emphysema is facilitated,
the parasympathetic nervous system is stimulated, bronchi areconstricted and resistance in the respiratory tract is increased→leading to dyspnea (labored breathing).
Nicotine administration → Increased secretion of gastric acid,decreased blood flow to mucus membranes, decreased
gastrointestinal motility → leading to an increased risk of reflux
esophagitis (gastroesophageal reflux disease) and gastric ulcers, and adecreased ability to eliminate Helicobacter pylori within thegastrointestinal tract.
Nicotine administration → signal transmission from antigens andreceptors to lymphoid tissues is inhibited → leading to a decreased
immune response. It also decreases the number of T cells withimmunological memory and interferes with the phagocytic function ofbreaking down invading tuberculosis. It inhibits the accumulation offibroblasts and inflammatory cells (ex., lymphocytes) at an inflamedsite → leading to inhibited epithelialization and cell adhesion at awound site and delayed wound healing. It inhibits ACTH secretion→ leading to a decreased immune response. (Human/animal cell
experiments, clinical data, et cetera)
Nicotine and eyes
Nicotine administration → age-related macular degeneration ispromoted (human clinical data and animal experiments) and risk ofcataracts for diabetics is increased. (animal experiments)
Nicotine and kidneys Nicotine administration → cyclooxygenase-2 (COX-2) is induced →causing inflammation of the glomerulus and obstruction of the urethra.
The ability of protecting kidney tissue from fluctuations in bloodpressure is reduced. (human/animal cell experiments, et cetera)
Nicotine and male
Nicotine inhibits nitric oxide production → arterial blood flow to thereproductive function corpus cavernosum of the penis is inhibited → leading to anincreased risk of impotence. It also causes atrophy of theseminiferous tubules and decreases sperm volume, and it inhibits thesynthesis of testosterone. (clinical data/experimental data)
Nicotine and female Nicotine administration → risks of deformed ova, impaired maturation
reproductive function of ova and infertility are increased. It reduces estrogen → leading
to a decreased frequency of ovulation, irregular menstruation,
abnormal bleeding, and increased production of follicle-stimulating
hormone. It inhibits fetal growth and increases the risk of low birthweight when administered during pregnancy. (clinical data, animalexperiments)
5. [What happens twice will happen thrice] Traditionally, tobacco companies tried to hooknicotine-addicted consumers by advertising that "filtered tobacco is less harmful than
unfiltered tobacco" and "low tar tobacco is less harmful than high tar tobacco". But thesestatements have since been proven to be false. The advertised statement that "heatedtobacco (IQOS) is less harmful than combusted tobacco (manufactured cigarettes)" is now athird claim to encourage nicotine-addicted customers to continue to use tobacco products.

Tobacco industry claims
Filtered tobacco is much safer than unfiltered tobacco
Low tar tobacco is much less harmful than high tar tobacco
Heated tobacco (IQOS, Plume Tech, and others) is much less harmful
than combusted tobacco

Results of scientificresearchLieLieNot proven

6. [Dual use] Philip Morris has "encouraged" its customers to switch to "safer" heated tobacco
devices such as IQOS by quitting the use of combusted tobacco. But, in reality a majority ofpeople use both products concurrently, contrary to the "better option" proposed by Philip
Morris of using only heated tobacco.

72% of users of heated tobacco and nicotine vaporizers also smoke combustible tobacco.
And dual-use has been shown to be more harmful than smoking only combustible tobacco.
https://pubmed.ncbi.nlm.nih.gov/33857396/
http://www.jstc.or.jp/uploads/uploads/files/essay/20210426.pdf"For young people, a “gateway effect” might have occurred in that they first started to use
nicotine vaporizers and then also tried to smoke combustible tobacco. Adults switched tonicotine vaporizers to quit smoking, but then perhaps could not stop using both. (Krisha Lady etal., American Journal of Respiratory and Critical Care Medicine)7. The tobacco industry is advised to stop fraudulent advertising and to encourage smokers toquit smoking by advertising the truth about the harms of active smoking and passive smoking.
It should even state that "people who don't smoke should not start smoking, and the best
choice is for people who smoke to quit smoking."