The Indian government’s decision last fortnight to ban Electronic Nicotine Delivery Systems – also known as known as ENDS or e-cigarettes – has sent a shock wave through the tobacco lobby.
With its profits dwindling globally, the cigarette industry is heavily investing in other strategies to remain profitable. As the awareness about the dangers of tobacco use has increased and stricter regulations are being introduced, the industry desperately needed to invent a product that would continue nicotine addiction. ENDS is one such device. It is claimed to deliver pure nicotine, without the other harmful ingredients present in traditional cigarettes.
A false narrative was created by the tobacco lobby to portray ENDS as being 95% less harmful than cigarettes. It was projected as a powerful aid to help smokers quit. With the Indian government’s ban, the tobacco lobby has hit back with a high-decibel campaign of misinformation and distorted evidence.
This article aims to clear the smoke screen created by ENDS supporters. Here are some of the bits of misinformation they are using.
1 A British report says e-cigarettes are 95% safer
On August 19, 2015, the British government publicised a new report commissioned by Public Health England by issuing a press release with the headline “E-cigarettes around 95% less harmful than tobacco, estimates landmark review.” It stated that ENDS are a harm-reduction strategy that minimise the risks associated with conventional cigarettes. It was a claim for safety, suggesting that smokers and potential smokers could use this device with virtually no risk of health harm.
The Public Health England report was adopted by the ENDS industry and groups that support vaping – inhaling the vapours of e-cigarettes. These lobbyists used the report to derail any proposed legislation on ENDS. But the report authored by two academics is seriously flawed.
The central thesis of the report that e-cigarettes are 95% safer than conventional cigarettes relies on just one study. This paper (“Estimating the Harms of Nicotine-Containing Products Using the MCDA Approach”, published in European Addiction Research) does not rely on clinical and epidemiological evidence but is a quasi-model of assumptions and conjectures. It is a string of opinions of the 12 authors. Only three authors declare that they had received funding from tobacco industry or work closely with pharmaceutical industry with an interest in cessation of tobacco use.
Since the study, other authors have been roped in by the industry to receive grants, advocate on their behalf or participate in scientific discussions to promote ENDS through medical associations in key populations and markets.
A more critical view of the British report was taken by medical journals. The Lancet in its August 29, 2015, editorial and the British Medical Journal on September 15 that year highlighted the serious flaws and conflicts of interest of the paper on which the report relies.
A careful examination of the European Addiction Research paper bases its analysis on an Independent Scientific Committee on Drugs constituted by its lead author, David J Nutt, in 2010 to understand drugs and narcotic abuse in the United Kingdom. This Committee met for a two-day workshop in London on July 2013 to rank the “relative importance of different types of harm related to the use of nicotine-containing products”.
The criteria of harms and associated risks (established through arbitrary weights) are scored by these experts for a range of products for harm. The workshop report and the subsequent paper to label ENDS as relatively safe is based entirely upon the opinion of a set of carefully selected group of experts, many of whom have little or no experience or understanding in tobacco control or of tobacco products in other parts of the world.
Sadly, the authors of the report do not see the serious flaws of the paper. The report that the tobacco and vaping industry is touting is based on ridiculously thin grounds. The tragedy is that it has stoked a passionate fire among vape promoters, and the smoke screen needs be cleared. The relative safety of nicotine over tobacco is a myth. Being less harmful does not mean e-cigarettes are harmless.
2 India has not banned cigarettes or bidis so why ban ENDS?
The success of a ban depends upon the size of consumer base: the larger the number of consumers, the lower the success rate. There are 270 million adult tobacco users in India who require their nicotine fix several times in a day. E-cigarettes have a small consumer base and so a ban will most probably prove to be be highly effective. Moreover, since e-cigarette firms are actually the cigarette companies themselves, they could take the lead in voluntarily stopping the cigarette business.
Starting from 2012, Indian states began to impose a ban on gutka or flavored smokeless tobacco. India also became the first country to make the sale of tobacco to minors a non-bailable offence with seven years of rigorous imprisonment as the punishment. As a consequence, India enjoyed a 17% relative decrease in tobacco consumption between 2010 and 2016, the steepest ever reported in any part of the world.
The tobacco cultivation industry is complex. The organised tobacco industry began in 1910, with the establishment of ITC’s previous avatar, the Imperial Tobacco Company. Cultivation was formalised only in 1976, with the establishment of the Tobacco Board, which only covers the tobacco required by cigarette manufacturers. Bidi and smokeless tobacco were kept out for political reasons. As a consequence, their activities are less regulated. The inputs that go into making these products (such as tendu leaves, areca nut, katha and tobacco) are even less regulated.
The government aims to reign in the tobacco sector through structural changes. Through the launch of the National Tobacco Control Programme in 2007-’08, the government hopes to reduce demand for tobacco products and persuade farmers to gradually to shift to other crops. A sudden ban would harm the entire sector. A comprehensive ban would require a multi-sectoral approach and tremendous political will. That is why no country in the world (except for Bhutan) has been able to ban tobacco.
3 Why not regulate ENDS just like cigarettes?
The cigarette and e-cigarette industries are essentially same. The tobacco industry has a proven record of manipulation, deception, corruption and violating the law. It cannot be trusted. Vape products are helping cigarette industry by recruiting young persons into nicotine addiction, which cigarettes are not able to do as effectively since they have been controlled. Public health experts across India have unanimously and consistently said that e-cigarettes will increase India’s public health problems rather than reduce them.
India is already struggling to control several addictions such as tobacco, alcohol, areca nut and cannabis. Adding a new addiction would only worsen the situation.
4 Why has India not adopted ENDS as a cessation strategy?
It is strange that manufacturers themselves do not claim that their products are an aid to tobacco cessation. To our knowledge, e-cigarette manufacturers have never applied to be categorised as a cessation tool in any country. The Drug Controller of India has certified that they have not received any application from any e-cigarette manufacturer. There is no evidence to prove that ENDS is actually an effective cessation tool. After all, 80% of those who utilise ENDS for cessation remain addicted to nicotine.
Nicotine is a harmful chemical and potentially carcinogenic. On the ground, most ENDS are being used for non-cessation purpose. As is the experience of the US, it entices youth to take up smoking.
Prof Pankaj Chaturvedi is the deputy director of the Tata Memorial Centre in Mumbai. Dr PC Gupta with the director of the Healis Sekhsaria Institute of Public Health in Navi Mumbai.