2023-11-17 16:13:01
“Based on data published in November 2022, which shows the response more than six months after abandoning traditional cigarettes, we can see that those who use e-cigarettes to quit smoking are 60% more likely to give up permanently smoking compared to those undergoing nicotine replacement therapy (NRT), i.e. treatments based on the use of nicotine products as alternatives to cigarettes”. Thus Peter Hajek, director of the health and lifestyle research unit of the Wolfstor Institute of Public Health at Queen Mary University of London, on the occasion of the 2023 edition of the ‘E-cigarette summit UK – Science, Regulation and Public Health’, a conference created with the aim of facilitating dialogue and thoughtful analysis of the scientific evidence regarding the use of electronic cigarettes (e-cigs) as an alternative to traditional cigarettes and as a possible useful tool for quitting to smoke.
In the presentation ‘Is vaping a safe and effective aid in quitting smoking? The Cochrane review on e-cigarettes for smoking cessation, Hajek notes that “the side effects most commonly reported by those who use nicotine-containing e-cigarettes are: irritation of the throat or mouth, headache, cough and nausea that reduce over time. Not very different – he adds – from those complained of by those who use nicotine replacement therapies. In conclusion, there is no clear evidence of harm deriving from the use of electronic cigarettes but it must be considered that the studies included in the Cochrane review so far have a maximum follow-up of two years”.
The data updated to October 2023 from the Cochrane analysis have yet to be published “but it can be said – underlines Hajek – that the conclusions remain unchanged. Despite the evidence, however, in recent years the idea that vaping is as risky as smoking, if not even more, has spread among the general population and among smokers themselves. This belief is also the result of bad information, as in the ‘Evali case’. Clinicians can reassure smokers of traditional cigarettes who want to quit smoking, but changing the general perception created in the last period remains a challenge”.
Also speaking at the meeting was Clive Bates, director of Counterfactual Consulting Ltd, who focused on the importance of providing correct information for adult smokers. “If we want to aim for an end to smoking-related deaths and illnesses,” he states, “we must focus first and foremost on adult smokers, who in Great Britain are 16 times more numerous than young smokers. In fact, it is the adult population that smokes traditional cigarettes that represents a public health problem.”
Nonetheless, “the discussion on the topic of harm reduction – continues Bates – is often focused on the younger population who, as American data show, in most cases vapes and has never smoked traditional cigarettes. Aiming for the end of combustion does not necessarily mean aiming for the end of tobacco or nicotine. In fact – he clarifies – the discussion shifts to nicotine, we must understand that, for people, the demand for nicotine is much more important than the way in which it is taken. And the demand for nicotine can be explained by the fact that this substance has positive effects on those who take it: for example, it helps to control anxiety and stress and reduces appetite, ‘promoting’ weight control. It also has an anti-inflammatory and neuroprotective action. Caffeine, alcohol and other psychoactive substances – Bates summarizes – are considered harmless and accepted. The same reasoning could apply to nicotine. It is important to underline that a false or altered perception of risk leads to bad regulatory policies”.
Tikki Pang, former director of the Research, Policy & Cooperation area of the World Health Organization (WHO), speaking on the same panel as Bates, also underlined that in Southeast Asia “there is strong opposition to reducing tobacco harm and regulatory policies are inconsistent and disproportionate to the risk.” As Pang highlighted, “127 million smokers” live in the region, practically 10% of all smokers worldwide, “1.25 billion” people. “In Myanmar and Vietnam – he explains – cigarette substitute products for reducing tobacco damage are allowed. In Indonesia, Malaysia and the Philippines they are allowed but with some restrictions dictated by regulatory policies while in Thailand, Cambodia, Laos, Singapore and Brunei they are banned”.
According to the Indonesian professor, “the OMA’s approach to reducing tobacco harm is hostile and this attitude also influences the positions of South-East Asian countries. In the absence of capable and prepared leaders and policy makers – he reflects – these States have chosen to adopt the same line as the WHO, without considering other evidence. In conclusion, I believe that there are non-aligned points of view between the communities that promote the reduction of tobacco harm and those that regulate tobacco – summarizes Pang – The former aim to reduce smoking-related diseases while the latter want society free from nicotine. I believe that countries such as the United Kingdom, Japan and New Zealand, whose policies on alternative products to traditional cigarettes I believe are enviable, should push for the WHO to change its position on reducing tobacco harm and I also think that in countries South-East Asia, quality local scientific research must be promoted – he concludes – which offers evidence on these key themes”.
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