Amid a raging debate over the use of e-cigarettes, experts from all over the world will assemble in Poland this week to debate on the role of safer nicotine products that can help people switch from smoking. 



The theme for the sixth edition of Global Forum on Nicotine (GFN) 2019 is "It's time to talk about nicotine". The three-day conference will be held from June 13 in Warsaw. The forum will examine the rapidly developing science in relation to nicotine and its use, including policy and regulatory responses. Academics, researchers, politicians and policy makers, from all sides of the debate, along with nicotine consumers and advocates, will participate in various plenary and parallel sessions at the conference.

E-cigarette is a battery-powered vaporiser that simulates smoking by providing some of the behavioral aspects of smoking, including the hand-to-mouth action of smoking, but without combusting tobacco. India is the second largest consumer of tobacco with over one in 10 of the world's smokers and incurs a staggering economic burden of approximately USD 26 billion per annum. 

According to the World Health Organisation (WHO), more than 10 million die each year due to tobacco use in India and there are about 120 million smokers in the country. In August last year, the Health Ministry issued an advisory to all states and Union Territories to stop the manufacture, sale and import of Electronic Nicotine Delivery Systems (ENDS).

Apex research body - Indian Council of Medical Research (ICMR) - has recommended a "complete" ban on ENDS, including e-cigarettes, saying their use can initiate nicotine addiction among non-smokers, but the debate on its health impact is a continuing topic of discussion between experts.

Pankaj Chaturvedi, Deputy Director at Tata Memorial Hospital, said nicotine is a highly toxic chemical and potentially carcinogenic. "In fact, it will not be an exaggeration if it is considered as a poison. Therefore, any nicotine product should be taken under strict medical supervision for controlling withdrawal symptoms during cessation therapy," he said. "I laud the Government of India for taking a tough stand against these newer nicotine delivery devices. We should not commit the same mistake by allowing ENDS like the United States that is regretting their decisions," Chaturvedi claimed.

Aparajeet Kar, Consultant Pulmonologist at Narayana Health in Bangalore, holds a counter-view that e-cigarettes unlike conventional cigarettes do not burn tobacco, thereby producing no tar or carbon monoxide, two of the most damaging elements in a conventional cigarette. "Almost all of the harm from smoking that comes from thousands of chemicals (4,000 known and others unknown) in tobacco smoke, which are highly toxic are absent in e-cigarettes," Kar said.

"One of the major benefits of vaping is the ability to control the amount of nicotine that a person is ingesting and there is no evidence so far that vaping causes harm to people around which is in contrast to secondhand smoke," the consultant said. Harit Chaturvedi, Chairman of Cancer care, Director and Chief Consultant Surgical Oncology at Max Hospitals claimed these new nicotine products are just another way for companies to increase their profits. "I observe that the tobacco industry is devising new ways and launching new products specially to lure the young generation. Currently, we are facing the new challenge of ENDS and as doctors are deeply concerned since it is being promoted as a 'harm reduction device'," he said.

Sree T Sucharitha, Associate Professor at the Department of Community Medicine at Tagore Medical College Hospital in Chennai said a survey of e-cigarette consumers across India revealed that a significant majority opted for them with the intention to quit smoking and they strongly believe in the harm reduction potential of such devices.  "A majority of the current users reported almost nil side effects with use of e-cigarettes and are aware that they are not totally harmless. Meta studies also reveal the potential of e-cigarettes as tobacco harm reduction alternatives and thus I favour evidence-backed policy reflection from federal systems in India," he said.

U S Vishal Rao, Head Neck Surgical Oncologist & Robotic Surgeon HealthCare Global (HCG) Cancer Center and a member of Karnataka government's High Power Committee on Tobacco Control expressed concern over the aggressive promotion and marketing of ENDS as harm reduction, safe and cessation device in India. "There is no evidence to show that ENDS are less harmful, safe and helpful towards cessation efforts. In fact, there is adequate evidence to show how harmful ENDS is," he said, quoting US Surgeon General's 2016 report on E-cigarette (ENDS) and WHO report 2016. "Both the reports showed that these (ENDS) possess dangers to the youth, pregnant women and fetuses. There is not enough research to quantify the relative risk of ENDS over combustible products," Rao said.

Samrat Chowdhery, a tobacco harm reduction advocate, said empirical data does not support the claim that e-cigarettes lead to cigarette use. "If this were the case, there would have been corresponding rise in smoking. Instead, countries that have regulated ENDS are witnessing accelerated decline in smoking rates, including among teens," he said.