New Delhi : More than 1000 doctors from 24 states and three union territories of India have written to Prime Minister Shri Narendra Modi to enforce the ban Electronic Nicotine Delivery Systems (ENDS) which includes e-cigarettes, e-hookah, etc. before it becomes an epidemic in India, especially among youth. These 1061 doctors are extremely concerned that on a public health matter, trade and industry organizations’ are pitching for promotion of e-cigarettes.

E-cigarettes, also called “e-cigs,” “vapes,” “e-hookahs,” “vape pens,” are “electronic nicotine delivery systems (ENDS).” Some e-cigarettes look like regular cigarettes, cigars, or pipes. Some look like USB flash drives, pens and other everyday items.

The doctors were concerned about a media report that 30 organisations had written to the Ministry of IT to prevent the ban on promotion of ENDS on the internet. They wrote that this is a public health matter and commercial interests should not be entertained.

On 28th August 2018, the Ministry of Health & Family Welfare (MoHFW) had issued an advisory to all states/UTs to ban ENDS. This March 2019, a panel of health experts appointed by MoHFW submitted a report in which 251 research studies on ENDS were analysed. The Panel concluded that ENDS is as bad as any other tobacco product and is definitely not safe.

Dr Pankaj Chaturvedi, Deputy Director, Prof Head & Neck Surgical Oncology Tata Memorial Hospital said, “It will not be an exaggeration if nicotine is considered as poison. It is sad that the ENDS lobby has assembled a group of physicians who are sharing misleading, distorted information to suit the ENDS industry. I applaud the Government of India that in line with their goal of universal healthcare, it took a tough stand against nicotine delivery devices. They must now ensure that this does not get diluted”

He further said E-cigarettes should not be promoted as a safe alternative. The only way is to completely quit smoking and not initiate use of any tobacco product. Tobacco companies want to hook a new generation on nicotine under the allure of safe smoking.

The doctors network writing to the Prime Minister is associated with the Voice of Tobacco Victims (VoTV) campaign and they are distressed that some of their own fraternity are falling prey to the ENDS lobby. One group of such physicians with vested interests are taking words from reports of highly respected international health associations out of context. For instance, they say that that the American Heart Association (AHA) has said that e-cigarettes are “an opportunity for harm reduction” whereas AHA on their website clearly states that “E-cigarettes have dangerous highly addictive chemical, as well as toxins, metals and contaminants. Not only users but non-users around the ones vaping also may be exposed to these harmful chemicals through the exhaled vapour”. The Association further warns everyone not to be fooled when these newer nicotine products are marketed as being safer than smoking. It adds that these products should not be promoted as a safe alternative to smoking.

The letter to the Prime Minister quotes a report by the US Food & Drug Administration (FDA) which stated that e-cigarette use in one year from 2017 to 2018, has increased to 78% among high school students and 48% among middle school students. The FDA reported that In the US, traditional smoking has been falling for years among teens. That trend continues as, according to the Centers for Disease Control (CDC), high school smoking fell from 15.8% to 7.6% between 2011 and 2017. However, ENDS popularity among teens has outstripped the reductions in traditional cigarettes as e-cigarette usage has risen from 1.5% to 11.7% over the same period. Thus, ENDS significantly offset the progress made in the fight against teen smoking, especially because these teens will also take up regular cigarettes over time. Number of studies and reports from CDC, US Surgeon General Report 2016, World Health Organization (WHO) have also stated that ENDS are not safe for youth, young adults, pregnant women or adults who do not currently use tobacco products.

Dr Shiv Choudhary, Head of Cardio-Thoracic Vascular Surgery (CTVS) AIIMS Delhi, said, “Research has proven that ENDS are not safe or alternatives to cessation. Nicotine dependence is a major health threat. As a doctor, I will never recommend any nicotine product usage without medical supervision, it being a highly addictive chemical. These products should be banned in India.”

The American Cancer Society (ACS) and The National Academies of Sciences Engineering Medicine (NASEM) are both of the view that Young people who begin with e-cigarettes are more likely to transit to regular cigarette use and become smokers.

Ashima Sarin, Director, Voice of Tobacco Victims (VoTV) said, “As per the Global Adult Tobacco Survey (2017), there are 100 million smokers in India, which is a potentially a large market for makers of ENDS. The ENDS lobby is spending lot of money on trying to get an entry into India. Youth who have not tried regular cigarettes are initiating with vaping and end up smoking regular cigarettes or both. Prestigious Associations such as The American Cancer Society, The American Heart Association have said it all.”