Centre Bans E-Cigarettes: Exploring The Debate in India

What’s the truth about e-cigarettes? Are they a healthy alternative or just as dangerous as regular cigarettes?

There’s plenty of smoke around the e-cigarette debate and few hard facts.

(Photo: iStockphoto)

On 18 September, the Centre announced its decision to put an immediate ban on e-cigarettes. The production, manufacturing, import and export, transport, sale, distribution, storage, and advertising of e-cigarettes are banned, said Finance Minister Nirmala Sitharaman at a press conference.

There has been a long history of proving and disproving benefits of vaping since its introduction in early 2000.

In August 2018, the Ministry of Health issued an advisory against Electronic Nicotine Delivery Systems (ENDS) – calling nicotine a tumour promoter with multiple adverse health effects – which led to its ban in 16 states in India. In March, the Central Drugs Standard Control Organisation (CDSCO) directed all drug controllers in states and union territories to not allow the manufacture, sale, import and advertisement of ENDS in their jurisdictions.

Earlier this year, on 31 May, the Indian Council of Medical Research (ICMR) had released a white paper calling for the total banning of ENDS in India. And to counter that, 62 global specialists and members of the Trade Representatives of ENDS (TRENDS) in India had questioned and countered ICMR’s position.

The Good, The Bad, The Un-Researched: What Are ENDS?

Image is for representational purposes only.(Photo: iStockphoto)

E-cigarettes are battery-powered devices that contain varying degrees and concentrations of vaporized nicotine, although any drug can be put in. They take many forms and can look like pens, regular cigarettes and even USB drives - sleek and tiny.

The key difference between e-cigarettes and regular cigarettes is that the former does not contain tobacco and the many other harmful chemicals found in commercial cigarettes.

Because of this, they are seen as a less dangerous alternative to traditional smoking and touted as a way to reduce tobacco dependence among smokers.

But studies say that smoking regular and e-cigarettes together may do more harm than good, and according to research by Centers for Disease Control and Prevention (CDC) in the US in 2015, 58.8% of smokers (adults) who switch to e-cigarettes do not completely give up regular smoking.

Besides, in 2008, the World Health Organisation said that e-cigarettes should not be marketed as a safe alternative to smoking as there was little evidence to support this.

Vaping and Children: A Cool New Toy?

The risks of vaping include bringing a whole new generation of smokers into the fold. The US’ Food and Drug Administration (FDA) called it an “epidemic of youth e-cigarette use”. In 2018, FDA reported that 3.6 million middle and high-schoolers used e-cigarettes. These included kids who had never smoked before.

The most recent study on the risks, published in the journal Radiology on August 20th, concluded that vaping could temporarily affect the functioning of our blood vessels. This comes on the back of studies investigating a link between vaping and seizures and other neurological problems - between 2010 and 2019, the FDA received 127 such reports.

Additionally, especially when unregulated, the liquid inside e-cigarettes can also be customised and mixed and matched at varying concentrations. This is especially harmful for teens and young users.

Bhavna Mukhopadhyay from Voluntary Health Association of India, an organisation that works for public health, added that, “E-cigarettes are just a mechanism to deliver nicotine in an attractive format. They are being marketed as a harm reduction product which is contrary to the truth as their health risks are frighteningly similar to those of conventional cigarettes. Youngsters are being lured, as it is easily available in different flavours.”

India's Position on E-Ciggs: Navigating Murky Waters

Are e-cigarettes any better than regular cigarettes? Is vaping a safer alternative to smoking?(Photo: iStockphoto)

Amidst growing global popularity, the e-cigarette wave is coming to India.

One of the supposed advantages of e-cigarettes is their use as a cessation device, although Praveen Rikhy, convenor of TRENDS did say they “are not claiming it as a cessation device.”

However, Dr Mohit Varshney, an addiction psychiatrist from AIIMS, claimed that e-cigarettes were “twice as effective as other cessation products, like the chewing gum.”

The main argument made by these 62 protesting specialists is that the ban would halt any further research on the topic and would push the product into the black market.

To get some clarity, we spoke to Dr Gaurang Nazar of Public Health Foundation of India (PHFI). Dr Nazar says he favours ICMR’s decision, saying,

“It should be banned till the safety of the product is proven, it can’t be available in the market without safety assurances.”

He also added that research is on-going and will continue despite the ban, adding, “PHFI itself is conducting research into its effectiveness.”

He added that fears of the product going into the black market are exaggerated as only “0.7% of India uses e-cigarettes, and there are many other tobacco/nicotine products flooding the markets. Sure, there might be a rise if there is a ban, but the awareness of e-cigarettes is still very low for this to happen.”

Advocates for ENDS say the focus should be on regulation and not on banning.

To this Dr Nazar says, “It is already difficult to regulate the existing tobacco cigarettes. There was a gutka ban, but that has not been effectively implemented.”

“Besides, the major danger of e-cigarettes is it’s attractiveness to the youth and despite age warnings on normal cigarettes it is difficult to keep them away from cigarettes. No one checks the age of the buyer diligently, so why would you introduce a more attractive alternative?”

But Rikhy, a representative for TRENDS says, “Kids who will try cigarettes will do it anyway and this is a healthier alternative,” while Dr Varshney repeats that is is important to have “stringent punishment” to avoid underage selling.

But like Dr Nazer mentioned, implementation and regulation in India is not that easy.

Are E-Cigarettes Really a Healthy Alternative to Normal Tobacco Cigarettes?

Are vaping products really less harmful than conventional cigarettes?(Photo: iStockphoto)

Dr Varshney mentioned that “e-cigarettes are 95% healthier than normal cigarettes.”

This figure was first attributed to a study by Public Health England (PHE) in the British Journal of Family medicine in 2015, however The Lancet offered a swift take down of this claim.

“The opinions of a small group of individuals with no prespecified expertise in tobacco control were based on an almost total absence of evidence of harm. It is on this extraordinarily flimsy foundation that PHE based the major conclusion and message of its report.”

The Lancet

Dr Nazer added, “E-cigarettes are indeed less harmful than normal cigarettes but I won’t go by the high percentage. There is a clear effect on health too, with evidence of e-cigarettes linked to cardiovascular and respiratory problems.”

He added that claims of it being a cessation device also rest on flimsy grounds.

“Many credible research institutions, like The University of California, have said that it is not as effective as other cessation products. For e-cigarettes to be proven as an effective cessation product, there needs to be proper clinical trials approved by the drug controller general of India. So far we already have nicotine replacement therapy, cessation by tested and effective drugs, and behavioural therapies.”

Dr Harit Chaturvedi, Chairman of cancer care, director and chief consultant surgical oncology at Max Hospitals added, “I treat patients suffering from cancers caused by tobacco use. I observe that the Tobacco industry is launching new products especially to lure the young generation. Currently, we are facing the new challenge of ENDS and as doctors are deeply concerned since it’s being promoted as a harm reduction device. In reality, these new nicotine products are just another way for the companies to increase their profits with no concern about the impacts of lifelong nicotine addiction on the users.”

Dr Nozer concluded by saying that there is already a growing population addicted to cigarettes, and it is better to nip this new product in the bud (and perform clinical trials and testing on its effectiveness). “The prevalence of this product is low currently, and we know it is dangerous so it is better to ban it.”