Huff and e-puff

In a recent hearing on a public interest litigation in the Delhi High Court, the Delhi government said it was planning to ban e-cigarettes. If it follows through, the NCT will join States such as Karnataka and Maharashtra in the ban. The Union Ministry of Health and Family Welfare has taken a stand against e-cigarettes. But is a ban the right approach to regulate this technology, given that combustible cigarettes are freely available across India? The controversy exists partly because it is a new and rapidly evolving technology. This makes it hard for researchers to study the health effects. Still, the evidence so far indicates that e-cigarettes are safer than combustible cigarettes. Because they heat a liquid to generate a nicotine-containing aerosol, instead of burning tobacco, they do not produce toxic tars. That doesn’t mean they are completely safe. At high temperatures, e-cigarettes produce carcinogens such as formaldehyde, although these are fewer in number compared to regular cigarettes. They also increase the odds of lung disease and myocardial infarction, but to a lesser extent than normal cigarettes do.

In the AmericanAnnual Review of Public Health , in January 2018 a group of researchers argued that e-cigarettes must be viewed from a “harm minimisation” perspective. Given that combustible cigarettes are more noxious than electronic ones, switching from the former to the latter can only help addicts, they argued. Writing in the same journal issue, however, another group of researchers advocated the precautionary principle. Given that e-cigarettes are a young technology, they said, it will take time to uncover their ill-effects. Already we know some carcinogens in e-cigarettes have a non-linear effect on cancer. This means even the low doses in e-cigarette aerosols can be carcinogenic if inhaled for years. Recent surveys also show that e-cigarettes can act as a gateway drug for young people. A 2011 study of Korean adolescents found that e-cigarette users were more likely to turn into regular smokers eventually. Plus, 2004-2014 data from the U.S. National Youth Tobacco Surveys suggest that young people at low risk of taking up smoking are turning to e-cigarettes. Against this background, India must tread carefully. Completely banning the technology, while selling normal cigarettes, could take away a promising smoking-cessation aid. A more pragmatic option would be to regulate e-cigarettes tightly, by creating standards for the aerosols and banning underage and public use. This would leave smokers with a therapeutic alternative, while protecting youngsters from a gateway drug. Either way, conflicting evidence makes it a tough call for policymakers.