Cigarette emissions contain over 400 toxins, including 69 carcinogens.At a time when cigarette smoking is estimated to cause around 6 million deaths globally each year, various alternative nicotine delivery mechanisms such as Electronic Nicotine Delivery Systems (ENDS), or e-cigarettes, have emerged as an alternative. Professor R N Sharan of North-Eastern Hill University and others recently published a study in Indian Journal of Clinical Practice (IJCP) which reviewed the health and safety implications of ENDS. Sharan tells ANURADHA MASCARENHAS the study indicates that ENDS poses minimal health and safety concerns.
Many doctors and experts still maintain that ENDS are a public health threat and should be banned. What is your stance on this?
Cigarette emissions contain over 400 toxins, including 69 carcinogens, while ENDS vapour delivers nicotine to a user with significantly reduced quantum of exposure to these toxins. Quitting smoking is ideal and remains the most desired outcome of any public health effort. Many smokers do so on their own while many others require help. The latter category involves behavioural support and nicotine replacement therapy (NRT) such as nicotine patches, nicotine gum and inhalers approved by the World Health Organisation (WHO). However, the global patterns of tobacco cessation, including that in India, show that a significantly large population has failed to achieve even partial tobacco cessation with the help of such aid. If alternatives can be used to support existing tobacco control and harm reduction measures, it would significantly help India in meeting its public health objectives at a much faster pace.
Both e-cigarettes and cigarettes contain nicotine, which is an addictive component. Some experts also say nicotine could be toxic. What are the findings of your study in this regard?
Although addictive, nicotine has not been proved to be a human carcinogen and carries little risk by itself when delivered without tar and other by-products of combustion. Most of the harm caused by smoking arises from other components of tobacco smoke and tar. There are roughly 6,000 chemicals in cigarette smoke and tar. Our study found that toxic chemicals such as Class-1 carcinogens and carcinogenic metal ions, which were found to be present in significantly higher quantities in conventional cigarette smoke/tar, were present in negligible amounts in the vapour of ENDS.
What would you recommend to reduce tobacco harm while also ensuring that the youth and non-smokers do not take up ENDS?
While dependence on any addictive substance is not desirable, it is important to note that there are over 106 million smokers in India today. There is potential to supplement existing tobacco control measures with ENDS as a less harmful substitute to combustible cigarettes for those smokers who are unable to quit otherwise. However, it is desirable to do so under appropriate regulations to ensure that ENDS is available as an alternative, and not to promote vaping among never-smokers and the youth. It is to be recognised that ENDS is an effective aid for smokers, who are otherwise unable to quit, in their efforts to quit smoking. Hence it is a tool of tobacco harm reduction.
