E-cigarettes: To ban or not to ban?
MANILA, Philippines – He had quit smoking after his college graduation, realizing its ill effects on his health.
His first puff came at age 15, after a game of DotA (Defense of the Ancients) with friends. Teddy (not his real name) has since been smoking 3 sticks a day, although sometimes he manages to go through a day without one.
Four years later, Teddy, who had quit cold turkey in March, was welcomed to a store that promised a habit “better” than the one he had abandoned.
“Kung mag-aalternative ka to smoking, e-cig na lang kasi yun yung healthier. Delikado ka sa throat cancer pag nag-smoke ka, unlike sa vaping,” the seller told him.
(If you’re looking for an alternative to smoking, choose an e-cigarette because it’s healthier. You can have throat cancer when you smoke, unlike in vaping.)
E-cigarettes or e-cigs are battery-run devices – puffed like regular tobacco cigarettes – emitting vapor into the air. It's done through the vaporization of what is commonly known as e-juice.
The e-juice may or may not contain nicotine, depending on the preference of the e-cigarette user. The juice also comes in different flavors.
The habit has been called “vaping” and enthusiasts call themselves “vapers.”
The Philippine Food and Drug Administration (FDA) is wary of the potential health risks of e-cigarettes, prompting a public hearing on the issue Wednesday, July 24.
Dr Kenneth Hartigan-Go, FDA Director, said the industry will have to go through the regular process – present efficacy papers based on a clinical trial – to back up its health claims.
There is currently a lack of scientific consensus globally – with studies contradicting each other and scientists rebutting each other’s claims – regarding the safety, benefits and harms of e-cigarettes.
Perhaps most cited by vapers, the "Efficiency and Safety of an Electronic Cigarette as Tobacco Cigarettes Substitute" or ECLAT concluded that e-cigerattes helped reduce tobacco use after a 12-month study of a group of smokers who were made to use the device.
The German Cancer Research Center in Heidelberg, however, negated the ECLAT conclusions, saying the product "cannot be rated as safe at the present time."
Concerned also over the lack of local data, if he had his way, Hartigan-Go would have preferred the product to be banned from the market while it is under study.
“If you use the precautionary principle, you wait till all the data is in,” he added.
Not approved for inhalation
E-cigarettes are composed of two primary materials – the battery-run unit and "e-juice." The e-juice refers to the liquid that is vaporized by the unit and which is inhaled by the vaper.
While the unit is likely to be regulated as a drug delivery device, there are questions on how to classify e-juice for purposes of regulation.
E-cigarette sellers insist that the e-juice contains substances like propylene glycol that is classified as Generally Regarded as Safe (GRAS).
The said e-juice substance, however, was approved by the FDA as GRAS only for its intended use – as a food additive.
“We didn’t know that it was going to be used for inhalation,” said Hartigan-Go, adding that while the substances may be safe as a food additive, they have not been proven to be safe when directed to the lungs.
Regulation of the vaping industry
The World Health Organization (WHO) has outlined a number of metal substances contained in the liquid used for Electronic Nicotine Delivery Devices (ENDS), among them e-cigarettes. These metal substances include, among others: sodium, iron, aluminum, and nickel.
“They may contain any of those, but the amounts are below toxic levels,” explained Mark Ong, co-vice president of the Philippine E-cigarette Industry Association (PECIA).
Hartigan-Go said, however, that while acceptable levels exist, the accumulation of toxins through the years of vaping poses health threats.
Registered with the Securities and Exchange Commission (SEC) in April 2013, PECIA is a non-stock corporation that groups about 95 e-cigarette sellers. It seeks to promote industry standards and a code of conduct among industry players, and etiquette among vapers.
According to its SEC papers, the group prohibits its members from asserting health, safety, and smoking cessation claims.
PECIA also prohibits its members from selling e-cigarettes to minors.
Rappler went to two e-cigarette shops – a PECIA-accredited and a non-accredited – whereas the PECIA shop probed of the buyer's age and smoking habit before explaining the product. A signage prominently posted in the store validated the rule.
Violators of its code of conduct are, however, faced with no other punitive measure besides being kicked out of the association.
The industry, however, is open to regulation. PECIA officers agree there should be approval and certification from an “independent testing body” for product safety.
"Huwag naman sanang i-ban," said PECIA co-vice president Joey Dulay, explaining it is well within the right of vapers and even smokers to choose. (I hope it won't be banned.)
Liberal regulators argue that an absolute ban can cause the underground market to flourish and become even harder to track.
“It’s not really a quit-smoking device. Harm reduction lang (only). We don’t market it as a smoking cessation device,” said Dulay.
Dulay became acquainted with the product after a friend concerned about his smoking habit gifted him with an e-cigarette. He eventually ventured into the business.
The marketing strategy – a “better alternative” to smoking but not a smoking cessation device – puts the product at an odd position in terms of regulation.
While on paper it is clear that health claims are disallowed during a sales pitch, the lines blur in practice when sellers explain why the product is better than a tobacco cigarette.
Expensive for adolescents
In a statement issued July 9, the World Health Organization (WHO) raised concerns over the sale of e-cigarettes to minors.
E-cigarettes, WHO said, “are offered in flavors that can be particularly attractive to adolescents.”
Sellers counter that the price range of each unit does not make e-cigarettes easily accessible to adolescents. Besides, PECIA prohibits sale to minors.
An e-cigarette unit is priced anywhere between P1,500 to P20,000.
Tobacco replacement potential
PECIA officers Mark Ong and Joey Dulay have had defining moments with tobacco use. They are passionate about selling e-cigarettes because their fathers died due to their smoking habits.
“Nakita ko yung mamamatay na siya, tinatago ko yosi niya, hindi kaya eh. He won’t stop hangang na dead bull,” Ong, who is a non-smoker, recalled. (When he was already dying, I was keeping his cigarettes because he couldn't take it. He wouldn't stop, eventually he died.)
Dulay is optimistic about the potential of e-cigarettes as tobacco replacement therapy. “May chance eh. Baka magkatotoo (There's a chance. It might come true),” he said.
Intending to regulate the product, the Department of Health will hear concerns from the industry and the health sector.
Dulay said he just wants government to “give the product a chance.” – Rappler.com
Woman inhaling e-cigarette image from Shutterstock
E-cigarette image from Shutterstock