In an open letter to the British Queen, Mumbai-based anti-tobacco warrior Dr Pankaj Chaturvedi highlights how Public Health England accepted flimsy references to claim e-cigarettes were 95% safer than cigarettes. This statement helped the sales of e-cigarettes across the world

Your Majesty Queen Elizabeth ,

(Copy to – Mr Boris Johnson , Honorable Prime Minister, the United Kingdom)

As a cancer specialist in India’s premier cancer facility in Mumbai, I daily witness death, disease and devastation caused by tobacco. I am hence prompted to write this open letter to draw your attention to a “medical inaccuracy” that emerged in your nation and is harmful for not only 2.5 million vapers in the UK but has also misguided the public in India.

I am hopeful you will take cognisance of this letter because you had once said, “I cannot lead you into battle. I do not give you laws or administer justice but I can do something else – I can give my heart and my devotion to these old islands and to all the peoples of our brotherhood of nations.”

To begin with a historical perspective: In 1910, a British-owned cigarette company was registered in the then Calcutta as Imperial Tobacco Company of India Limited. It formalized tobacco cultivation in 1912 in India because the cigarette industry needed huge amounts of raw tobacco for its European market. This British company established the first cigarette factory of India in 1913. As per an estimate, the cigarette industry is responsible for the premature deaths of 23 million Indians in the last 100 years. The British American Tobacco Company continues to be a major investor in ITC Ltd, India’s leading cigarette manufacturer.

This unflattering legacy of Britain apart, India has recently been bombarded by yet another British reference in a tobacco-related matter. The Indian government recently banned e-cigarettes or Electronic Nicotine Delivery System (ENDS) based on irrefutable scientific evidence. Indian prime minister Narendra Modi said, “E-cigarette have been banned so that this new form of intoxication does not destroy our demographically young country. It does not trample on the dreams of a family and waste the lives of our children. This scourge and this obnoxious habit should not become rooted in our society.” To date, over 20 countries, mostly in South America, the Middle East and South-East Asia, have banned the sale of e-cigarette products. Government and public health specialists in these countries are at logger-heads with the tobacco lobby which is the prime investor in ENDS. The ENDS’ lobby claims to be a victim of the cigarette lobby, but this is a smoke screen because both are great pals.

The main argument of the ENDS a.k.a. the tobacco lobby is that the “Public Health England (PHE) has said that e-cigarette are 95% safer than cigarette”. Even the Royal College of Physicians has been extensively quoted as being supportive of ENDS. Such things are unimaginable from the land of Dorothy Hodgkin, Isaac Newton, Alexander Fleming, Rosalind Franklin etc.

This magic figure of 95% is being constantly exploited by the tobacco lobby to market yet another deadly addiction in the developing world, including India. The authors of this figure assumed that the absence of harmful smoking- related chemicals made ENDS safer. They ignored the fact that nicotine in its purest form is toxic, with 30 mg being a lethal dose for adults. This distorted evidence had contributors from the reputed institutions of London such as the King's College, Queen Mary University, etc.

It is shocking that this conclusion was derived from two grossly flimsy references and not a robust research. The first reference was a briefing report to the UK All-Party Parliamentary Group on Pharmacy. The other reference was an article published in the European Addiction Research. In 2013, the authors of this paper hosted a two-day workshop of experts to discuss on “relative importance of different types of harm related to the use of nicotine-containing products”. The experts scored the products on their health effects, and weightings were given to the results. Cigarettes were ranked as the most harmful with a score of 99·6 and e-cigarettes received a harm-score of 4%. Moreover, many experts in this workshop had conflict of interest that was not revealed in the publication. For reasons not known so far, PHE immediately acted on this recommendation, misleading (perhaps inadvertently) the whole world and paving way for ENDS’s entry. I am dismayed that PHE did not caution the readers about either the conflict of Interest or the poor quality of evidence. PHE failed in its mandate to “protect and improve the nation's health and wellbeing”.

The entire narrative of ENDS’s safety over traditional cigarette now stands shattered. The US is in the grips of an epidemic of adolescent vaping . It has already caused 12 deaths and over 800 serious lung injuries in US in just three months. Let me quote you once again: “When life seems hard, the courageous do not lie down and accept defeat; instead, they are all the more determined to struggle for a better future.”

It is wrong to say that the entry of e-cigarettes led to a decline in cigarette consumption in the UK because the drop would have occurred happened regardless. Look at other countries which banned ENDS but yet show a steeper decline in cigarette consumption than the UK. As per the Global Adult Tobacco Survey 2016, India has demonstrated 17 % relative decrease in tobacco consumption in just five years, steepest in the world, without promoting any alternative nicotine delivery system.

There is no conclusive evidence to suggest that ENDS is a superior form of quitting over currently approved ones. On the contrary, as per current evidence, one-fourth use ENDS along with cigarettes and three-fourth remain addicted to ENDS even after quitting cigarettes. This deprives the smokers of a nicotine-free or risk-free life. Ironically, to my knowledge, the ENDS lobby itself has never claimed ``quitting’’ benefits and applied to drug regulators as a cessation tool. If ENDS could eliminate smoking, cigarette companies would not invest in their own death.

The ENDS industry isn’t interested in smokers, their main aim is to convert innocent kids into Vapers by luring them with 1,500 flavours, including bubble gum and candy floss.

In the background of reports of fatalities from the US, PHE has emerged as the messiah for the ENDS lobby. We cannot have snake in our backyard and believe that it will only bite others. There are millions of children in the UK who are exposed to ENDS and need to be protected immediately. As per Public Health England data, around one in six children aged between 11 and 18 years have tried e-cigarettes.

We sincerely request you to correct the monumental mistake before it causes further harm to your own population and world citizens. Former UK prime minister Tony Blair had apologised for believing in a false evidence that was used as a pretext to invade Iraq. UK's views on ENDS have invigorated the cigarette (true weapon of mass destruction) industry that was on the verge of collapse. You had said, “Family does not necessarily mean blood relatives but often a description of a community, organization or nation.” I sincerely request you to protect our family.

I sincerely hope my email is taken in the right spirit. The depressing sight of young people dying miserably every day motivates me to take this battle to its logical end. With you on our side, we shall win.

Most humbly yours,

Pankaj

(Dr Pankaj Chaturvedi is Professor and Surgeon (department of head neck surgery) and Deputy Director of Tata Memorial Center, Parel, Mumbai)

