Banning e-cigarettes is no solution to the huge health burden of tobacco use in India
Scientists appeal for conducting India centric research before deciding on any hasty move
India has the second largest cigarette smoking population in the world. Added to which is a large population consuming tobacco in other forms such as the local non-cigarette alternatives including bidi, hukkah and chilam, and tobacco/Areca nut based chewing products. These products have been proven to be major causes of oral, oropharyngeal and lung cancers, as well as other health issues. For an overview of tobacco use in India see here.
Therefore, policies of the governments and other health regulators in India should create favourable conditions for reduction in tobacco use. A recent newspaper report suggests just the contrary! It appears that the Indian government and Ministry of Health and Family Welfare (MOHFW) is contemplating putting in place an outright ban on electronic nicotine delivery systems - e-cigarettes, which have started showing positive impacts on smoking cessation in European Union and the USA.
WHO has promoted nicotine in safe forms as patches, gums, and sprays, as nicotine replacement therapy (NRT) – which is today a ‘gold standard’ for smoking cessation and tobacco control worldwide. WHO did it because the primary cause of cancer is not nicotine – the addictive component of tobacco and the cause of craving – but the constituents of the ‘smoke’ in combustible tobacco, and ‘other’ constituents in chewing tobacco. Unfortunately, the poor efficacy of such nicotine replacement options at a population level has posed a challenge to all public health professionals globally for better options. E-cigarettes are showing potential benefit at a population level and governments and policy makers in several countries (within the EU, in New Zealand, and the USA), are increasingly recognizing this. The Royal College of Physicians (UK) report titled ‘Nicotine Without Smoke’ (2016), has reviewed the evidence that supports this. The FDA in the USA has recently changed direction and become supportive of e-cigarettes. New Zealand is now supportive, and a review of the legal status of nicotine is underway in Australia.
At a time when there is growing support for e-cigarettes in many countries it is regrettable that India appears to be moving in a negative direction. Given the scale of tobacco use in India there is huge potential for tobacco harm reduction.
Therefore, Dr. M. Siddiqi and I have appealed to Dr. J.P. Nadda, Union Minister of Health and Family Welfare, Government of India, via a letter to look into the matter and not take a hasty decision to out rightly ban e-cigarettes in India. Banning e-cigarette technology could be potentially disastrous from a public health perspective. We have jointly appealed to the Union Minister to consider regulating e-cigarettes appropriately instead of banning them outright without considering the international evidence or collecting any research data from our own population in the country. We believe that public health in India is at a greater risk under a prohibitive environment than by allowing smokers, who wish to cease tobacco use, an alternative option based on nicotine replacement via e-cigarettes.
Prof. R. N. Sharan