Oncology experts have spoken out against the Centre’s proposed ban on e-cigarettes and other electronic nicotine delivery systems (ENDS), criticising the Indian Council of Medical Research (ICMR) white paper advocating for it.
The ICMR has advocated for prohibiting production, sale, and imports of the devices on the grounds that they pose a danger to public health. In particular, the body asserts that e-cigarette use can be linked to “DNA damage; carcinogenic, cellular, molecular and immunological toxicity; respiratory, cardiovascular and neurological disorders; and adverse impact on [foetal] development and pregnancy.” They also claim that the devices could potentially pose a risk to get young people hooked on tobacco through a gateway effect, as a result of e-cigarettes addicting them to nicotine.
These claims have been disputed by experts. 62 specialists wrote to the ICMR protesting the proposed ban, claiming its paper on the matter was influenced by selective evidence and overlooks the potential value of ENDS as a tool to help people quit smoking. The ICMR has disputed this notion in the past, claiming that “there is…evidence that there is risk of people continuing to use both them as well as tobacco products.”
The group of oncology experts concurs, claiming that the ICMR’s research indicates “a high probability of bias”. Dr Sameer Kaul, a senior surgical oncology and robotics consultant at the Apollo Cancer Institute, asserted that ENDS have “proven social, economic and health benefits over combustible cigarettes” and that they “present an excellent opportunity for India to accelerate a decline in smoking rates.”
“Adult smokers who want to quit but may be unable to, have the right to be able to access harm reduction alternatives such as ENDS,” added Dr Kaul, who is also the founder and president of BCBPF – The Cancer Foundation. He contributed to the letter to the ICMR criticising its white paper on ENDS.
The experts do not advocate for the absence of research into ENDS. Rather, as put by Dr Riccardo Polosa of the University of Cantina’s Department of Clinical and Experimental Medicine, “a detailed, critical appraisal of all existing evidence on ENDS” is needed in the hope that the ICMR will reconsider its stance. Polosa described the ICMR’s research as “an uncritical evaluation of evidence gathered from poor-quality studies.”
The Centre directed state governments to ban ENDS last year. A number have done so, both before and after the Centre’s directive. Whilst the Delhi High Court stayed the directive earlier this year, the Drugs and Technical Advisory Board (DTAB) have reclassified ENDS as a drug under the Drugs and Cosmetics Act – thereby giving the Centre the authority to ban them. Recent reports indicate this is on the cards.
ENDS should not be free from scrutiny and scientific investigation into potential adverse effects. However, there is an emerging consensus that they can have value to public health by reducing rates of tobacco use. One wonders then if it is a misplaced priority to move to ban them, especially in a country which loses one life to the effects of tobacco use every eight seconds.