Promise or Threat for India?

Posted 10th October 2017 by Mawsley
A new study poses the simple question: “E-cigarettes: promise or threat?” It is a question is demanding an urgent answer given that moves are afoot to deny Indian smokers access to a technology that represents around 5% of the risk of smoking traditional tobacco products.

The paper opens up with the grim reality of the situation: “The biggest public health threat the world has ever faced is the tobacco epidemic. It kills more than 7 million people a year, of which approximately 1 million deaths occur in India.”

The article has been written by Arun Nachiappan, Nottingham University Hospitals, and T. S. Selvavinayagam, Institute of Community Medicine at the Madras Medical College. In it they give credit to the work politicians have already done in tackling the tobacco-related death toll: “India has been successful in bringing down the use of tobacco among adults from 34.6% (14% smokers) in 2009-10 to 28.6% (11% smokers) in 2016-17”. What is of great concern is that “India seems to be edging towards a total ban.”

Nachiappan and Selvavinayagam pose a number of questions about vaping before listing out (what they see as) the pertinent facts. The first of these is whether ecigs offer an effective solution to giving up smoking and, to that end, they note that many surveys of users in the Western world report that smokers take up vaping out of the desire to quit smoking and reduce tobacco-related harm. The pair cite a number of studies where the efficacy of vaping as a cessation tool is shown.

In the hope that influential politicians read the paper, they point out that harm reduction potential of the technology. “Clinically, [ecigs] have a more favourable short-term adverse effect profile than conventional cigarettes, with no serious adverse effects reported.” What they missed out was that this becomes more significant with each passing year; vaping has now been taking place for around ten years in the UK and there is still not one case of linked illness.

“If used as intended, [ecig] products do not put vapers at risk of nicotine poisoning,” they add, as well as pointing out that the risk of poisoning has been very overhyped. They illustrate that most studies demonstrating the presence of toxins are linked to dry burning and therefore poor methodology.

But it is back to the core question of whether or not vaping aids tobacco control aims where the arrows hit the target squarely in the bull’s eye.  Data is presented from the UK showing how smoking rates have plummeted while vaping has taken off – and how “it is estimated that 800,000 smokers have switched to vaping and another 650,000 smokers who vaped have stopped both.”

Nachiappan and Selvavinayagam do present some areas of concern, as one would expect from a balanced coverage of the topic, but fall firmly on the side of adopting vaping as a means to harm reduction.