Tuesday, January 19, 2021

Heart Care Foundation of India writes to PMO, Ministry of Health and State Health Departments on Tobacco Harm Reduction & Vaping

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New Delhi, 29th March 2019.

Heart Care Foundation of India has written to the Prime Minister’s Office, Ministry of Health and State Health Departments on policies and regulations of vaping products, including e-cigarettes, based on a consensus statement signed by leading medical practitioners, which is scheduled to be published in the April edition of Indian Journal of Clinical Practice.

The consensus statement shared on the Indian Journal of Clinical Practice website highlights the need for a regulatory framework for vaping products, which allow adults to access quality-controlled products in their efforts to stop the use of combustible smoking with the objective to reduce harm. Further, the letter also urges the Government of India to ensure that the policy for vaping products addresses:

  • Marketing & Advertisement
  • Youth access; such products should only be available to smokers above the age of 21
  • Safeguarding pregnant women from initiation and use through awareness campaigns
  • Labelling
  • Quality control over manufacturing
  • Standards for contaminants

Commenting on the letter, Dr. KK Aggarwal, President, Heart Care Foundation of India (HCFI) said, “Despite efforts to reduce tobacco burden in India by means of taxation, stringent labelling requirements, etc., cigarette volumes have not witnessed any significant decline. HCFI and all the signatories of the letter including some eminent medical practitioners such as PK Julka, TS Kler and Ashok Seth have always supported smokers in their efforts to quit smoking, regardless of the approach, giving their health and well-being paramount importance. Therefore, to help smokers quit, we recommend that clinicians should advise their patients to use available smoking cessation products coupled with behavioural counselling. Further, in cases where the aforementioned methods fail to work, reduced harm alternatives such as vaping devices should be considered”

“In our letter, we have also recommended that the Government of India should allocate funds for independent and continued research on the health effects of vaping products and guide their policies from time to time basis such evidence. There should be consistent guidance from regulatory authorities on product and ingredient standards with a view to further reduce toxicity and addictiveness of any tobacco product and related harm reduction products” said, Dr. Anoop Misra, Consultant Diabetologist, Fortis Centre for Diabetes, Obesity and Cholesterol (Fortis C-DOC Hospital).

Further, the consensus statement also strongly echoes the view that it is ideal for people to refrain from initiation of consumption of any tobacco product and related harm reduction product. However, transitioning to a related harm reduction product presents an important and critical public health opportunity for existing smokers and must be encouraged through appropriate regulations and support from clinicians.

Amongst the signatories to the statement, are several acclaimed global experts. Commenting on statement, Prof. David Sweanor, Adjunct Professor, Faculty of Law-University of Ottawa, and signatory to the statement said, “Cigarettes are significantly more detrimental to public health than non-combustible nicotine products, such as e-cigarettes, which deliver nicotine without the by-products of smoke and tar. We hope that the Governments and public health experts will recognise that bans on less harmful alternatives would only benefit the tobacco industry and not the public at large. Instead, there is a need for policies that aim to reduce harm and help wean people off cigarettes through behavioural support and access to less risky alternatives”

Prof. Lion Shahab, Associate Professor Behavioural Science and Health Institute of Epidemiology and Health, University College London, an expert who has studied both the behavioural aspects of tobacco use as well as the role of smoking-related biomarkers in smoking cessation, stated that “Scientific evidence shows that by switching to e-cigarettes, users are exposed to nearly 95 per cent lower levels of carcinogens compared to long-term cigarette smokers. Nicotine dependence can be reduced using a combination of behaviour therapy and less harmful alternatives, such as NRTs, e-cigarettes or pharmacological options. However, e-cigarettes, by lieu of being behaviourally similar to cigarettes, have seen greater success in aiding smoking cessation. Policies that aim to reduce tobacco harm should take into account these new-age products, as they are not only less harmful but also pave the way to cessation.”

“While complete smoking cessation would be ideal from a public health standpoint, it is not always feasible and in such cases, e-cigarettes or other non-combustible alternatives would pose less risk to the user and should be recommended as an option. I strongly support the cause taken up by Heart Care Foundation of India and other signatories of this letter, and would urge governments across the world including India, to make regulatory frameworks in alignment the relative risk of such products, with an objective to reduce overall harm to people” said, Dr. Riccardo Polosa, Director, Institute for Internal Medicine and Clinical Immunology- University of Catania. Dr. Polosa and his team have led several clinical trials on the health impacts of e-cigarettes.

The consensus statement includes a summary of existing scientific evidence in favour of promoting vaping products as a reduced harm alternative to combustible cigarettes. Based on currently available evidence, using current generation vaping products is less harmful than smoking cigarettes and going forward, it is important to continue research on the health effects of long-term use. The Heart Care Foundation of India (HCFI) and the signatory medical practitioners stated that they recognize the irresponsibility to continue monitoring and evaluation of emerging scientific evidence in relation to vaping products and will always strive to promptly inform policy makers, public and medical practitioners of these findings.

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