By Erda Khursyiah Basir
SEOUL: The use of electronic cigarettes (e-cigarettes) or vaping has become an issue and has triggered polemics around the world, including in Malaysia.
One reason for this may be the report by United States authorities about 33 deaths and 1,479 confirmed and probable cases from a ‘mysterious’ respiratory illness linked to vaping.
There is global concern that the use of e-cigarettes or vaping among youths, especially school children, can cause a decline in the morals of the younger generation and create more social problems.
Calls for ban
As such, many people are urging governments to impose a total ban on vaping.
In Malaysia recently, 50 associations and NGOs around the country signed a memorandum urging the government to immediately impose a total ban on the use of electronic cigarettes.
Some people have called for stern action against those who sell e-cigarettes and other products to children under the age of 18.
Malaysia’s neighbours Singapore and Thailand have banned vaping. South Korea has advised its citizens to stop using liquid e-cigarettes due to growing health concerns and has vowed to speed up an investigation into whether to ban sales, a move likely to hit major producers.
The Malaysian health ministry has said that it has not found any evidence or study indicating that the use e-cigarettes is safe to treat addiction to smoking.
Need for harm reduction
It is in this scenario that Seoul recently hosted the 3rd Asia Harm Reduction Forum (AHRF).
Several experts shared their views on tobacco alternatives, such as e-cigarettes and heat-not-burn devices, at the forum, noting that it is difficult for the majority of smokers to quit the habit.
It has been reported that over 1.1 billion people smoked tobacco in 2015 and eight million premature deaths are recorded annually due to smoking.
According to the World Bank, the smoking rate among males is high in Asian countries. Indonesian men rank the world’s top smokers with 76 per cent, next is Laos (57 per cent), then South Korea (50 per cent), China (48 per cent), Vietnam (47 per cent), Cambodia (44 per cent) and Malaysia (43 per cent).
Dr Konstantinos Farsalinos, a cardiologist and researcher at Onassis Cardiac Surgery Center, University of Patras and National School of Public Health in Greece, said tobacco harm reduction was a necessity and should be considered in curbing the smoking habit.
“While drugs and alcohol are perceived as harmful and may affect an individual’s health, even disturbing others’ lives, a harm reduction initiative which involves treatment for cessation, intervention to reduce consumption, and psychological and social support may help to lower the risk and have benefits on a personal and population level.
“In fact, we apply the harm-reduction approach in our daily life. For example, the consumption of medicine to treat diseases is a harm-reduction approach of reducing health consequences, symptoms and inability through the use of medications or medical procedures which are not risk-free.
“The use of a helmet while riding, buckling up the seat belt while driving, even the use of condoms are also among the many different harm-reduction approaches that we apply in our daily life to minimise risk.
“We don’t simply jump to the conclusion that we should not ride, drive or have sex at all because of the risk that we may face. However, we are trying to figure out the feasible measures that we can take to solve these matters. Hence, this should be done for smoking too,” he told Bernama.
Dr Farsalinos cautioned that illegal products bought in the black market and on the streets can be “very dangerous”.
“These illegal products are not available in the (normal) market as they contain high quantities of marijuana oils and probably some solvents which are not supposed to be vaped and may cause poisoning and other side-effects.
“Some people, especially those who are probably curious to try marijuana or anything else (illegal products), will buy them from the black market. These have nothing to do with the products you buy from vape shops. People who want to use marijuana oils are just using a battery device to evaporate and inhale illegal narcotics and some other chemicals in the liquid form,” he said.
Dr Farsalinos advised the media to avoid using the term ‘mysterious illness’ when talking about so-called vape-related ailments, saying that this could confuse the public.
“It is not a mysterious disease; it is basically acute poisoning, in the same way that you get poisoned when eating contaminated food. Using illegal products to vape means you have no assurance about the safety or product quality,” he said.
He said there was nothing absolutely harmless or absolutely safe when it came to “inhaling something” and added that the most important thing was how the risk and harmful effects could be reduced by switching from tobacco cigarette smoking to less harmful products.
Telling the truth
Dr Farsalinos admitted that he had never heard any scientist claim e-cigarettes to be safe.
“But I strongly support the need for the public to know the truth — that e-cigarettes are by far less harmful than smoking.
“Of course, we do not want non-smokers, especially teenagers, to try these products; but I think it is a huge mistake to lie to the people simply because we don’t want them to use e-cigarettes.
“If you tell them that e-cigarettes are as harmful as smoking, then they may very well choose to smoke because it is the same thing. If you tell people who are already smoking that e-cigarettes and tobacco cigarettes are the same, then why would they try to make the switch? That is why we cannot lie to the public. I find it completely irresponsible and inappropriate,” he said.
Prof David Sweanor, Adjunct Professor at the Faculty of Law, University of Ottawa, who sits on the Advisory Board of the Centre for Health Law, Policy and Ethics, said much of the harm from cigarettes was due to the inhalation of smoke, not the nicotine.
He said this was something already known in scientific circles since the work of the famous professor, Michael Russell, in the United Kingdom in the 1970s.
“There are 20,000 deaths globally per day from inhaling cigarette smoke.
“People smoke to get nicotine but they die from the smoke. This insight gives us the ability to prevent many millions of premature annual deaths by distinguishing between the substance people seek and the way they get it,” he said.
Sweanor said public health policies typically sought to reduce risks in pragmatic ways, and some groups at the same time try to empower people to make better health decisions.
“This has been done in efforts to reduce risks (in terms) of foods, pharmaceuticals, air travel, automobiles and a long list of other goods, services and activities. In this case, we simply need to apply such successful policies to reduce the harm caused by people who smoke combustible tobacco cigarettes,” he said.
Prof Tikki Pang (Pangestu), visiting professor at the Lee Kuan Yew School of Public Policy, National University of Singapore, said among the challenges to harm reduction in Asia were misinformed and misguided policy makers, political and economic drivers, the fear among potential beneficiaries and affordability of electronic nicotine delivery systems (ENDS) including e-cigarettes, vape and heat-not-burn devices.
Therefore, he said, there was a necessity to continually inform and educate the public that e-cigarettes were about 90 to 95 per cent less harmful than combustible cigarettes and have been shown to help people quit smoking.
“ENDS should carefully and clearly define this in the legislation in order for the countries to regulate it effectively. Conclusive evidence is lacking that ENDS products may serve as a gateway for conventional smoking among young people,” he said. – Bernama