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As of this month, about 500 tobacco stores in Atlanta, Georgia are the first tobacco stores in the United States to start selling IQOS, a heated tobacco product of tobacco giant Philip Morris International.

Traditionally, heated tobacco products have not been so popular: IQOS is one of two tobacco products sold in the United States. (The first was launched in the 1990s and is now on the market and quickly went public.) But as CNBC pointed out, the timing of IQOS’s debut in the United States seems to be accidental to its marketers, as the country’s most popular One of the alternatives to cigarettes-e-cigarettes-is under attack.

PMI is currently licensing IQOS technology to Altria, which owns 35% of Juul, the e-cigarette market leader. Last month, due to a series of concerns about the safety of e-cigarette use and the high rate of e-cigarette smoking among young people, Juul’s CEO stepped down and Altria’s former chief growth officer KC Crosthwaite took over. According to reports, Crosswait was largely responsible for getting IQOS to land in the United States.

Altria is now in charge of the sales, marketing and distribution of IQOS in the United States. The device has been waiting for authorization from the U.S. Food and Drug Administration (FDA) for nearly two years, and the regulatory agency finally approved IQOS in April 2019. If sales in the Atlanta test market go well, it will expand to other regions in the United States in a few years.

Like e-cigarettes and traditional cigarettes, IQOS provides nicotine, the addictive ingredient in tobacco products. It is not surprising if smokers or e-cigarettes who are looking for alternatives have brought IQOS a turn for the better in the next few months. Here's more about how this latest smoking product works and why the FDA allows US residents to buy it.

IQOS is a device designed to imitate the smoking experience, but does not actually burn tobacco. It consists of three parts: a pen, a box, and "heating rods" that look like small cigarettes (though they can't smoke themselves). HeatSticks is a Marlboro brand and has a natural tobacco flavor or one of two menthol flavors.

The tobacco in HeatSticks is actually a folded tobacco paste mixed with glycerin. Glycerin is a substance that forms a fluffy white cloud that can convey the taste of nicotine and tobacco. When smoking, IQOS users insert the tobacco-filled end of the HeatStick into the pen. That part of the device contains a ceramic heating blade that heats the tobacco to 350°C (about 662°F)—enough to atomize nicotine, glycerin, and flavors.

Each HeatStick contains roughly the same amount of nicotine as a cigarette, and the duration is about 15 puffs, or 6 minutes. The battery of the pen can only be continuously pumped with a heating rod before it needs to be charged in the suitcase. The suitcase looks like an extended Airpod case. After that, the tobacco in the used heating rod appears to have been burnt and cannot be reused.

Because they don't actually burn tobacco (this process occurs at 600°C or 1,112°F), IQOS pens are not suitable for trying household cigarettes or other substances, such as marijuana. (They are also not suitable for putting in traditional cigarettes.) But they are designed to imitate the experience of smoking ordinary cigarettes in other ways.

According to PMI, this acronym does not mean anything. Although there have been rumors that IQOS stands for "I Quit Ordinary Smoking", a PMI spokesperson pointed out that the English name is meaningless because the device has been sold in Japan since 2014. PMI has since expanded to sell to South Korea, Germany, Russia, the United Kingdom and Italy.

Unlike medical drugs and devices, the FDA does not approve any tobacco products because they are inherently unsafe. Instead, it authorizes their sales with extremely specific guidelines.

More than two years ago, PMI submitted IQOS through the FDA's Pre-Market Tobacco Product Application (PMTA). In the PMTA, the FDA is looking for evidence that allows a new tobacco product to be “fit to protect public health”—that is, it will not be more toxic than existing tobacco products, and will not attract anyone who does not already smoke. . Priscilla Callahan-Lyon, a scientist at the FDA's Tobacco Products Center, said in a grand presentation yesterday (October 10) that the IQOS application is one million pages long. The research conducted by the company covers everything from toxicology to practical use.

Based on the FDA’s review of these studies, the agency believes that through proper labeling (the FDA requires all tobacco products), IQOS may not pose a greater threat to public health than traditional cigarettes, and may be better for smokers to switch to only Use IQOS (more on this later). Based on surveys in the United States and usage in countries/regions where the device has already been sold, IQOS does not seem to have a huge appeal to teenagers. Unlike many e-cigarettes, this device cannot be used to smoke illegal products such as marijuana.

As far as overall safety is concerned-maybe. But the long-term data on IQOS is still not good.

The data submitted by PMI to the FDA shows that the levels of toxic chemicals such as carbon monoxide and formaldehyde produced by IQOS are lower than cigarettes. Short-term studies did not find serious adverse events related to IQOS. Interim observations of people using IQOS in other countries did not give the FDA reason to believe that the long-term health consequences are any different from smoking.

IQOS does contain nicotine and tobacco, just like cigarettes. Although glycerin is "generally considered safe" by the FDA, the name is mainly for ingested glycerol-not inhalation. Glycerin is one of the commonly used carriers in electronic cigarette cases.

PMI also submitted an application requesting the FDA to mark IQOS as an improved risk tobacco product. The application applies to tobacco products that are "good for the health of the entire population", presumably because they are less dangerous than products already on the market. But the agency has not yet approved the label. It is worth noting that, to date, none of the 35 applications for modified risk tobacco products have been approved.

This is unclear. PMI only conducted safety studies on IQOS compared with traditional cigarettes, not e-cigarettes. Although e-cigarettes do not contain tobacco and IQOS does, there are no good data on the long-term safety of e-cigarettes.

With IQOS, users can at least know that studies have been conducted-some are conducted by PMI, some are conducted by the FDA, and have all been reviewed by regulatory agencies. Although the tobacco is a known risk, it is at least well-known.

The assumed advantage of e-cigarettes is that they do not contain tobacco-but there is growing evidence that they may also be unsafe. As of October 10, VAPI or e-cigarette-related lung diseases have sickened nearly 1,300 people in the United States and 26 people have died. There is no clear reason. One of the biggest problems with e-cigarettes is that even though the FDA has authorized their sales, people have been extensively modifying their devices and e-cigarettes to smoke nicotine, marijuana, and thousands of unregulated flavors.

In Atlanta, Altria sells the complete device and 200 heating rods for $80, while the price of a single device is $100. You can also buy IQOS online, but you must go to a physical store in Atlanta to pick it up-this process ensures that the supplier confirms that they only sell IQOS to adults.

Correction (October 11): An early version of this story stated that the FDA has approved multiple heating tobacco devices. It only authorized IQOS because other products were already on the market before the FDA regulated it.

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