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In September 2019, the Indian government announced a complete ban on electronic nicotine delivery systems (ENDS), popularly referred to as electronic cigarettes or e-cigarettes, citing the potential health risks of e-cigarettes on the youth. Announcing the decision, Union Finance Minister Nirmala Sitharaman had stated that while vaping is meant to help people quit smoking, it has become an addiction in itself. However, this decision drew criticism from the e-cigarette industry and from some public health experts who argued that it deprived smokers in India of safer options. Speaking to the HealthSite, Dr. Nimesh Desai, director of IHBAS (Institute of Human Behaviour and Allied Sciences), Psychiatrist and public health professional, has also opined that India has missed a public health opportunity with the ban of ENDS. He also suggested that governments should consider policy-making backed by science and research with stronger regulations rather than bans. Following are excerpts from the exclusive email conversation with the expert.
Q1. Why did you say India miss a public health opportunity with the ban of ENDS or e-cigarettes?
It is largely a case of socio-cultural and philosophical reasons rather than medical science. There is an urgent requirement for policy makers to become pragmatic incorporating scientific research and insights behind regulations. Over the last 20 years, there is enough data which indicates the limited success of abstinence-oriented tobacco cessation methods or nicotine replacement therapies (NRTs) with many countries struggling to build a successful cessation category. It is unfortunate, most tobacco users and adult smokers even after best treatment attempts go back to limited or previous patterns of tobacco use.
It is also important to understand that there is no one formula which applies to all, every smoker has their biogenetics, their personality, their circumstances owing to which they cannot quit smoking. There is a need to consider different solutions for various groups and assess safer alternatives on a case-to-case basis. There is a need to provide consumers with varied and safer alternatives giving them the right to choose the best solution that works for them.
Q2. What are the scientific benefits of ENDS/Heated tobacco products in supporting countries in tobacco control?
There is plenty of evidence and scientific evidence on the vast potential of the tobacco harm reduction category and how it can benefit adult smokers. There are behavioral cues that matter the most. The tobacco harm reduction benefits should be considered and complemented to support country's tobacco control policies.
Q3 . How are other countries successfully leveraging ENDS/HTPs to reduce adult smokers?
There are many examples of countries which have successfully regulated reduced harm products. Governments should regulate it clinically, medically or legally not leaving it to free market. However, banning products is the worst form of regulation and should be avoided.
Many international countries around the world including UK, US, Japan, etc., are working towards their targets to reduce adult smoking rates by effectively complementing tobacco control measures along with allowing well-regulated, scientifically substantiated, less harmful alternatives to be available for the tens of millions of smokers who will otherwise continue to smoke for the foreseeable future.
Q4. Why is there a need for Govts to consider policy-making backed by science and research with stronger regulations rather than bans?
The trouble is omnipotence or the demi-god like aspects of medical fraternity in trying to succeed fully. There is enough and more evidence which proves the socio-cultural context and bio-chemical behaviors, all and none approach doesn't work. Innovations need to be viewed with pragmatism and need to evolve over time. Scientific research and health benefits even in part can be seen across categories including alcohol, opioids and tobacco.
In terms of public policy, Govt/we tend to take extreme stand owing to political discourse, socio-cultural issues or dogmatism of medical sciences which impact laws and progressive policies.
The current pandemic provides many learnings in terms of evolution of science and its impact on implementation of public health policies. Similarly, as science around tobacco harm reduction evolves, public health policies and cessation strategies need to advance keeping pace with it. As a society, we need to follow science rather than dogmatism, by investing in research and science and defining regulations which are progressive as well as benefits all stakeholders.
Q5. What are some of the emerging technologies around tobacco harm reduction that help provide users a safer choice?
In many age groups and states, half the issues are related to oral route rather than smoking, both in terms of product innovation and method of chewing. Most people with oral route of heavy or dependent tobacco use, may not benefit from ENDS or other strategies developed for smokers. So, in addition to NRT, we need to innovate on other harm reduction products and technologies for oral tobacco users.
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