The Korean Ministry of Food and Drug Safety (KMFDS) recently completed an intensive 11-month probe into heat-not-burn (HNB) cigarette products, which many manufacturers market as a reduced-risk alternative to conventional combustible cigarettes.1 On June 7, KMFDS released data showing that several HNB devices emit harmful substances—some linked to carcinogenicity—and even generate higher tar yields than traditional cigarettes. These findings challenge the core safety claims made by HNB producers and raise urgent questions about regulatory oversight.

Industry representatives argue that raw tar concentration alone offers an incomplete picture of relative harm. British American Tobacco points out that the chemical complexity of both vapor and smoke demands more nuanced assessment methods. The World Health Organization similarly acknowledges the presence of specific toxicants in HNB aerosols while emphasizing the broader challenge of accurately comparing diverse tobacco and nicotine delivery systems. In other words, a single metric cannot capture the full spectrum of potential health risks.

At an August 30 news conference in Seoul, Philip Morris International presented its own evidence suggesting that HNB products may reduce lung cancer risk relative to conventional smoking.2 This conclusion directly contradicts KMFDS’s results, illustrating the deepening divide between manufacturer-funded research and independent public health evaluations. Such conflicting reports can undermine public confidence and obscure the real health implications for users considering a switch.

Consumer confusion may carry unintended consequences. Faced with mixed messages, some smokers might revert to combustible cigarettes, which are known to deliver thousands of harmful compounds. By contrast, the United States Food and Drug Administration has reported that electronic cigarettes generally contain lower levels of toxicants and carcinogens compared to combustible tobacco products.3 This body of evidence supports the notion that complete substitution with electronic alternatives could markedly reduce exposure to many hazardous chemicals.

Given the complexity and contradictions in the current data landscape, it is imperative to conduct comprehensive, independent studies on HNB devices alongside rigorous longitudinal research into electronic cigarettes. Key research priorities should include measurement of a wide array of toxic components—such as volatile organic compounds, nitrosamines, and carbonyls—under realistic user conditions. Equally important is tracking biomarkers of exposure and early health effects in diverse populations over extended periods.

Regulators, researchers, and manufacturers must collaborate to develop standardized testing protocols that reflect real-world usage patterns. Peer-reviewed studies should employ harmonized methodologies, transparent funding disclosures, and open data sharing to facilitate meta-analyses and systematic reviews. Only through coordinated international efforts can we clarify whether HNB products represent a net public health benefit or pose unforeseen risks.

Remaining vigilant and well-informed will empower public health officials, clinicians, and consumers to make evidence-based decisions about tobacco and nicotine alternatives. As we navigate the evolving landscape of harm reduction, our collective goal must be to minimize disease burden and protect user well-being. By demanding greater transparency, fostering independent research, and refining regulatory standards, we can ensure that any purported “safer” products truly deliver on their promise.

https://doi.org/10.5051/jpis.2018.48.4.201