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Smoking cigarettes remains at alarmingly high rates worldwide 1. Efforts to curb this epidemic continue growing, including tobacco control policies, information campaigns, cessation care, and harm reduction approaches. During the last two decades, many nicotine and tobacco products have been introduced with reduced exposure and risk claims 2 , 3. These alternative products with harm reduction potential include oral nicotine pouches, electronic cigarettes ECs , and heated tobacco products HTPs.
IQOS was introduced into test markets in Japan and Italy in , and within six years, its sales have expanded to over 60 countries 5. IQOS relies on heating reconstituted tobacco at a temperature well below the temperatures measured in combustible cigarettes 4. For example, one report criticized the population health impact model used by PMI to justify that IQOS would benefit the individual and public health, and argued that this model excludes morbidity and underestimates mortality related to IQOS use in the population 9.
Also, independent researchers examined PMI data and found that claims of reduced exposure and risk are unsupported by the data 10 - Moreover, some independent researchers have encouraged policymakers to consider independent evidence before authorizing the marketing of IQOS and similar products that may harm public health 11 , Also, some health professional societies recommended that the toxicity of newly introduced tobacco products like IQOS should not be compared to combustible cigarettes but to no tobacco product use situations, i.
In this article, we conduct a literature review to assess the data on IQOS toxicity and health impact published by PMI-sponsored research affiliated authors or funded studies and independent research. Data from in vitro , in vivo , and systems toxicology studies were extracted to assess IQOS toxicity. The systems toxicology approach integrates multi-level biological data to comprehensively understand systemic molecular and functional changes from an omics-based method using computational modeling to extrapolate classical toxicology findings to risk assessment 15 , In addition, clinical studies were assessed for biomarkers of exposure and health effects of IQOS.
