E-cigarettes, ENDS devices good or bad? Experts differ from ICMR suggestion

A section of experts has said banning Electronic Nicotine Delivery Systems (ENDS), including e-cigarettes, without proper research will reduce the options of viable alternatives for smokers who want to quit tobacco. The reaction comes in the wake of apex research body - Indian Council of Medical Research (ICMR) recommending a "complete" ban on ENDS, saying their use can initiate nicotine addiction among non-smokers.

ENDS are devices that heat a solution to create an aerosol, which also frequently contains flavours, usually dissolved into propylene glycol and glycerin. There are various types of ENDS devices like e-cigarettes, heat-not-burn devices, vape, e-sheesha, e-nicotine flavoured hookah among others.

Riccardo Polosa, Director, Institute for Internal Medicine and Clinical Immunology of the University of Catania said the ICMR recommendation only further intensifies the debate on the merits and de-merits of ENDS. "The conclusions drawn by ICMR as well as the Ministry of Health do not take into account that it is incumbent upon a welfare-oriented government to work together with the scientific community to better protect the millions of Indian smokers by adopting a harm reduction strategy rather than banning possible options," he said.

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. Sameer Kaul, a nationally acknowledged voice on cancer prevention and treatment and Founder President of The Cancer Foundation, said evidence-based practices seem to have been given a go away.

As far as scientific data is concerned, not a single shred of evidence exists anywhere in the world pointing towards carcinogenic potential of any of this device's ingredients or components, he claimed. "On the contrary, clear indications of declining smoking rates in the US and Europe undeniably place ENDS as the most novel anti-tobacco smoking strategy till date," Kaul said.

Commenting on the ICMR white paper, Anoop Misra, Consultant–Diabetologist, Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, stressed on the importance of developing public health strategies that rely on innovation to reduce harm.

He said the UK and the US are promoting substitution for combustible tobacco with less harmful non-combustible sources of nicotine like ENDS. "These should be available as harm reduction strategy for chronic cigarette smokers, but similar to tobacco, should be restricted to underage population," Mishra said.

Experts said studies undertaken by Public Health England say while vaping is not risk-free, it is at least 95 per cent less harmful than smoking and can provide a useful aid for those who are trying to quit smoking.

Lion Shahab, Associate Professor, University College London (UCL) said combustion releases more harmful chemicals, but e-cigarettes do not have combustion so it is safe to assume that they are much safer than normal cigarettes. In a white paper released on World No Tobacco Day, the ICMR had said e-cigarettes adversely affect the cardiovascular system, impair respiratory immune cell function and airways in a way similar to cigarette smoking and are responsible for severe respiratory disease.

The ICMR officials and scientists after studying over 250 research papers on nicotine delivery devices stated that e-cigarettes are also harmful to non-users and have adverse health impacts even when people are exposed to second-hand vapours. 

(With inputs from agencies.)