Japanese psychiatrist questions fear-based warnings in UK heated tobacco plan

A Japanese addiction psychiatrist has challenged the case for graphic disease warnings on heated tobacco, as the UK weighs extending pictorial warnings to the category. Tomohiro Shirasaka, director of the Kotoni Shirasaka Mental Clinic in Sapporo, made the argument at Philip Morris International’s Technovation Manila event on 10 November 2026.

He told 2Firsts that complete cessation is not necessarily a treatment goal under a harm-reduction approach, and that quality of life should take priority. The interview was held on the sidelines of the Manila event, which PMI described as covering tobacco harm reduction, scientific research and smoke-free innovation.

Shirasaka says abstinence and harm reduction can work together

Asked how specialists should judge patients who stop smoking cigarettes but keep using nicotine from non-combustible products, Shirasaka said treatment goals should fit individual circumstances. He said continued nicotine use is not necessarily the main concern where improving a patient’s life takes precedence.

He gave the example of a smoker with young children who wants to quit to protect them but cannot. In that case, he suggested switching to a non-combustible product could be considered, calling such products not ideal but possibly less problematic for the children than continued cigarette smoking.

Shirasaka said he helped organise the first Congress of the Asia-Pacific Society of Harm Reduction and Addiction (ASHRA), held in Sapporo in October. He described harm reduction and abstinence as potentially complementary, with reduced harm helping patients stay in treatment and build confidence for further change. He said how to define treatment success remains unresolved, and that assessments should also weigh physical health, mental wellbeing and patients’ own priorities.

UK warning proposal draws criticism from the clinician

Asked about UK proposals to extend packaging restrictions and pictorial health warnings to heated tobacco products, Shirasaka questioned graphic messages centred on severe smoking-related disease. He compared warnings that emphasise lung cancer and other serious outcomes to a punitive approach, and said he does not like that method.

He argued that people should have the right to choose how to address their own tobacco use, and that public health communication should pay more attention to why people keep smoking, including loneliness and fear. He said he would prefer messages offering support, giving the example of telling people to call if they feel lonely, and said he believes such communication could work better than disease images alone.

The interview does not state the current legal status of the UK proposal or a timetable for a decision. Shirasaka’s remarks describe the proposal as a proposal; no government decision is reported in the material.

Japan’s cigarette-to-heated-tobacco shift is gradual

On Japan, Shirasaka pointed to declining cigarette use and growing heated tobacco consumption. He said he believes many smokers are trying to move from conventional cigarettes to heated tobacco products, and that the transition will take time.

He said he does not believe heated tobacco growth is necessarily raising the overall number of tobacco users in Japan. He noted the products have been sold in Japan for about a decade.

Mental illness complicates quitting, and data is thin

Shirasaka said people with mental illness can face particular difficulty stopping smoking, and that his first priority would be treating the underlying psychiatric condition. Better mental health could make cessation attempts easier, he said.

He recalled that some psychiatric hospitals in Japan previously permitted smoking, and that cigarettes had sometimes featured in approaches to managing patients with schizophrenia. He raised the possibility that switching to heated tobacco might be preferable in some circumstances, but said he had no data to support that view and described it as supposition.

Philippines work favours support over exclusion

Drawing on addiction treatment work in the Philippines, Shirasaka criticised approaches that use punishment or exclusion to force people to stop using addictive substances. He said such methods were also common in Japan, where people with alcohol or drug dependence could face threats of divorce, dismissal or social exclusion.

He argued that exclusion can leave people isolated and without support, and said what people need is support rather than punishment. He described a shift in Japanese addiction treatment towards respecting patients’ rights and understanding individual needs.

In the Philippines, he said his team observed elements of older practices at some facilities and sought to introduce Japanese approaches, including educational and treatment materials based on cognitive behavioural therapy, which targets patterns of thought and behaviour.

What this changes for manufacturers and distributors

Shirasaka’s comments carry no regulatory weight, and the material gives no indication that the UK proposal has advanced or been withdrawn. Manufacturers preparing heated tobacco packs for the UK should treat pictorial-warning requirements as unresolved rather than settled. For supply-chain planning, the practical variable remains the timing of any UK decision, which the material does not give.

What happens next

The material states no date for a UK decision on heated tobacco warnings. The next dated marker it identifies is ASHRA’s first congress, already held in Sapporo in October; Shirasaka said the definition of treatment success remains an open question for that network.

Questions readers ask

Has the UK decided on pictorial warnings for heated tobacco?

The source material does not say. Shirasaka was asked about UK proposals to extend packaging restrictions and pictorial health warnings to heated tobacco products; no decision or effective date is reported.

What does Shirasaka say about abstinence?

He said complete cessation is not necessarily the treatment goal under a harm-reduction approach, and that improving quality of life is the most important aim.