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Tob Control. 2018 Nov;27(Suppl 1):s96-s101. doi: 10.1136/tobaccocontrol-2018-054433. Epub 2018 Jun 6.

Invisible smoke: third-party endorsement and the resurrection of heat-not-burn tobacco products.

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Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA.
UCSF Department of Medicine, Division of General Internal Medicine, San Francisco, California, USA.



Tobacco companies are introducing new 'heat-not-burn' cigarettes in dozens of countries. Historically, these products failed commercially, and independent researchers contested their health claims. The most prominent early heat-not-burn cigarette was RJ Reynolds's (RJR's) Premier, introduced in the USA in 1988. Curiously, The Lancet endorsed Premier as a 'near-perfect low tar cigarette' in a 1991 editorial, 2 years after Premier had been removed from the market. We examined the context of this endorsement.


To ascertain what RJR knew about this endorsement, we systematically searched and analysed previously secret RJR documents in public archives and triangulated the industry document data with other published work.


RJR had a long-standing interest in collaborating with outside scientists to endorse potentially reduced harm cigarettes. The author of The Lancet editorial had previously corresponded with RJR regarding Premier's health effects and market potential. Internally, RJR regarded The Lancet's editorial, its stance on novel tobacco products, and its endorsement of Premier as major successes. While the editorial came too late to save Premier, RJR saw future business opportunities for novel products if endorsed by health authorities.


Endorsement by high-impact medical journals and health authorities may be critical in helping heat-not-burn' products succeed where previous attempts have failed. Conflicts of interest influenced these endorsements in the past. Health leaders and academic journals should consider both conflicts of interest and the ethics of endorsing tobacco product substitution, as tobacco companies simultaneously work to promote cigarette smoking and undermine tobacco control globally.


advertising and promotion; harm reduction; tobacco industry; tobacco industry documents

[Available on 2019-11-01]
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