Link between Heat-not-burn Tobacco Products and Risk to Health

1 Mr Leon Perera asked the Minister for Health (a) what evidence is available to determine if heated tobacco products will reduce the overall risk to both the smoking and non-smoking populations; and (b) whether HSA is assessing or has assessed heated tobacco products to decide this question.

The Senior Minister of State for Health (Dr Amy Khor Lean Suan) (for the Minister for Health): Existing evidence suggests that heat-not-burn tobacco products are not significantly different from traditional cigarettes in terms of risk to both smokers and non-smokers.

HSA has also done preliminary tests on such products and found that the nicotine content is comparable to traditional cigarettes. Evidence from other countries suggests that heat-not-burn tobacco products are not significantly different from traditional cigarettes in terms of emissions.

While there have been claims that such tobacco products are less harmful than traditional cigarettes, these claims are made by the tobacco industry and, to date, there is very little independent evidence supporting such claims.

Mr Leon Perera (Non-Constituency Member): I thank the Senior Minister of State for her answer. Just a few supplementary questions. There would appear to be a scientific division of opinions on this question. For example, I believe the British Royal College of Physicians does believe that lower risk tobacco products can be a gateway to help smokers to move away from higher risk products, tobacco-based products which have tar, although I know there are some other bodies that disagree with it.

Would the Ministry consider two things: firstly, conducting a study to evaluate the health effects on users as well as on those in the surroundings, in terms of the passive smokers? Secondly, depending on the results of the study, would the Ministry consider perhaps a pilot or trial programme to allow only smokers who have registered, perhaps with the smoking cessation programme of the HPB, to have access to those products on a very limited basis − if the results of the study suggest that the positive effects outweigh the negative effects?

Dr Amy Khor Lean Suan: I thank the Member for the supplementary questions. First, let me say that there is no documented evidence of any safe level of tobacco use. I think that when people talk about the value of lower risk tobacco products for harm reduction, this is really debatable. The fact is that such so-called lower risk tobacco products are still harmful because it exposes the users to cancer-causing chemicals. As I have noted, HSA did some preliminary tests. There is no significant difference in the nicotine content between the heated tobacco products and the traditional products.

Our concern really is with the fact that allowing the use of such products could attract a much larger group of users, especially among the youths, and that could be the gateway to nicotine addiction and, eventually, smoking. We note the UK reports but despite reports from the UK, the experience of US is quite different. The US CDC has reported that e-cigarette use among high school students between 2011 and 2015 increased by more than 10 times, from 1.5% to 16%. The US Surgeon-General also reported that the use of e-cigarettes is closely associated with cigarette smoking among youths and young adults.

What we are doing is to adopt and aim for a very high and precautionary level of public health protection against known as well as potential harms of emerging tobacco products, including heat-not-burn tobacco products.

There is really no compelling reason or practical benefit in allowing such emerging products. For heat-not-burn tobacco products, there has been no claim by anyone that these can be used for smoking cessation. If indeed these were to be used for smoking cessation, then, these products would have to comply with the rigorous requirements, undergo rigorous scientific findings to make sure that they are safe and effective, just like the nicotine-replacement therapy that is approved under the Medicine Act. If they claim so, then, they need to show that these products are, indeed, safe and effective.

I do not think we want to do an experiment that will harm potential users.