In 2013, two-year-old Naomi Elbaz in Israel died after drinking a liquid refill for electronic cigarette. The doctors were unable to revive her despite all efforts. She was being watched over by her grandparents, when she sneaked into her grandfather's room and downed the fatal dose. A few minutes later she collapsed. She was hospitalised but succumbed a few hours later.
In 2013, two-year-old Naomi Elbaz in Israel died after drinking a liquid refill for electronic cigarette. The doctors were unable to revive her despite all efforts. She was being watched over by her grandparents, when she sneaked into her grandfather's room and downed the fatal dose. A few minutes later she collapsed. She was hospitalised but succumbed a few hours later.
In spite of evidence that e-cigarettes can cause death and poisoning, at a press briefing last month in American Association of Advancement of Sciences (AAAS), a three-member panel consisting of Wilson Compton, deputy director of National Institute of Drug Abuse, US Department of Health and Human Services; Deborah Arnott, chief executive, Action on Smoking and Health; and Dr Kevin Bridgman, CMO and director, Nicovations, stirred a hornet's nest by endorsing e-cigarettes as being useful in possible de-addiction techniques.
On further questioning, Compton later told dna that there was little regulation over open availability of liquid refill vials in the US. Also, they are freely available online to be ordered anywhere around the world.
“There have been reported deaths due to consumption of nicotine vials, which are freely available in the mom and pop shops of the US. They are pre-loaded cartridges which if downed can cause death or poisoning,” he agreed.
E-cigarettes are not regulated under the Control of Tobacco and other Products Act in India. They do not fall under the regulation of US Food and Drug Administration (US-FDA) either. “It has been taking the US-FDA a while to form laws that can bring e-cigarettes under its control. Processes have been moving very slowly,” observed Compton.
But health experts in India are critical of US' approach and attitude towards e-cigarettes.
“Certain group of doctors and scientists have always been in support of smokers switching from cigarettes to ENDS. The issue, however, is what happens when those who have never smoked also get hooked to ENDS and become addicts,” said Dr PC Gupta, director, Healis Sekhsaria Institute of Public Health, Navi Mumbai.
“The figures of adolescents getting hooked to ENDS compiled by the US are the worst of their kind. This is because e-cigarettes are marketed to youths just like normal cigarettes. Images of sports, glamour, fashion and sex are linked to ENDS to boost its Internet sales. Even though, the US has banned TV advertisements of ENDS, in a recent survey, 200 YouTube videos of ENDS were screened and it was noticed that 95% were in favour of e-cigarettes as opposed to 5% that were against it or neutral. In this light, the stand taken by the panel at AAAS is very worrisome.”
Arnott, however, said, “There are 1.4 million smokers in the UK, we would like them to switch completely to e-cigarettes. I'd rather they experiment with e-cigarettes than smoke.”
The problem before public health officials is minimising availability of products for adolescents and maximising its usage for smokers. “This is a challenging issue, but 6 million tobacco-related deaths occur globally.
Cigarette smoke contains 5,000 chemicals, 65 carcinogens, and carbon monoxide, which is a byproduct of tobacco combustion. How do we provide smokers the nicotine they crave? I would not support taking them off the market currently,” argued Compton.
There has also been a debate on whether prescribing e-cigarettes as medicine for de-addiction be considered and that they only be sold in pharmacies on presentation of a proper prescription, but there has been no headway in this regard.
Most e-cigarette companies do not fully list the ingredients that may potentially be poisonous. “We should ensure that they contain pharma-grade nicotine and exclude those chemical flavours that cause cancer. But as of now, this is not being practised,” said Bridgman.
While India has little data to understand the usage of e-cigarettes in the population, the US conducted Monitoring the Future Study in 2014 to gauge use of ENDS in schoolgoing children. The findings were alarming.
The study indicated that non-smoking adolescents may get addicted to nicotine through e-cigarettes, which in turn could lead to the use of regular cigarettes, 8% of eighth graders, 16% of tenth graders, and 17% of 12th graders had used e-cigarettes in the past month before the study was conducted. The students were more likely to have used e-cigarettes than regular cigarettes, revealed Compton.
Indian researchers say the irony of the West is that in spite of glaring data on huge popularity of ENDS in the population, little is being done to control the use of e-cigarettes.
Around the world
Canada: E-cigarettes can be used for personal consumption but cannot be sold in the market.
Korea: They are legally taxed like tobacco products.
India: They are sold in paan shops but in certain states are banned by the state-run FDA, including Maharashtra. India is contemplating a ban.
In Brazil, China and Hong Kong, e-cigarettes are illegal.
Europe has regulated e-cigarettes under the Tobacco Products Directive; their advertising is prohibited in the media, but they are openly sold in shops.
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