Here's why the Union Health Ministry is considering a ban on e-cigarettes

When e-cigarettes came to market in 2007, they were packed with the promise that they could help some people quit smoking. However, the Ministry of Health and Family Welfare suspects they may have been doing the opposite all along - encouraging more people to take up smoking. According to a 22 August report by the news agency Reuters, the health ministry could soon ask the government of India (GoI) to ban the production and import of e-cigarettes altogether. The reason: the ministry fears e-cigarettes might be promoting an “epidemic” of nicotine-dependence among India’s teens. [caption id=“attachment_5202011” align=“alignleft” width=“380”]  Representative image.[/caption] Ranging from disposable to rechargeable and modular devices, e-cigarettes work as electronic nicotine delivery systems (ENDS)—they provide nicotine to users in the form of aerosols. GoI has time and again tried to ban all kinds of ENDS, including vapes, vape pens, e-hookah and shisha. Last year, the Ministry of Health and Family Welfare issued an advisory against using them. This year, with backing from the Indian Council of Medical Research (ICMR), GoI plans to pass an ordinance to ban all kinds of vapes. According to ICMR estimates, there are about 460 e-cigarette brands and more than 7,700 different flavours—with or without nicotine—available in India. With inadequate data on the number of e-cigarette users in the country, it is hard to gauge how this ban would affect the general population. But the controversy does beg the question: how do e-cigarettes work, and is there any science to support that they can help you quit smoking? Can an e-cigarette really help you quit smoking? E-cigarettes are not yet approved as smoking-cessation aids by the U.S. Food & Drug Administration -there is almost no evidence that they can even help people quit smoking. On 31 May 2019, on the occasion of World No Tobacco Day, the ICMR released a white paper in which it said that the small amounts of nicotine in e-cigarettes could get non-smokers addicted to nicotine. Scientist Joy Kumar Chakma in the division of non-communicable diseases, ICMR, clearly stated the immediate dangers of vaping devices in a paper published in the Indian Journal of Medical Research. He wrote: “E-cigarettes are increasingly becoming popular among the youth. Though when it comes to helping (people) quit smoking, vapes are estimated to be almost equal to—if not less than in efficiency than—nicotine patches. However, the variability of nicotine delivery with each puff and the amount of nicotine in various brands makes the former almost an unreliable option.” “Users who report of the positive effects of these devices have just moved on to vaping to get their nicotine fix,” Dr Chakma added. Dean E. Schraufnagel, a professor at the department of medicine, University of Illinois, U.S.,  explained the cultural effects of vaping in a forum of the International Respiratory Societies. He said that the popularity of vaping has promoted smoking behaviour in public places. If not checked in time, it may cultivate social acceptance towards nicotine-dependence and even conventional smoking. Health effects of e-cigarettes The white paper published in the Indian Journal of Medical Research labelled ENDS as potentially dangerous to human health, with impacts from “womb to tomb”. E-cigarette cartridges usually contain liquid-polypropylene glycol or glycerol, irrespective of whether or not they contain nicotine. Heating this cartridge creates an aerosol that vapers then inhale. Most brands of e-cigarettes have been found to contain toxic substances such as aldehydes, terpenes, heavy metals and silicate particles - these can affect almost every major system of the body, including the cardiovascular and immune system. What’s more, their effects can be quite similar to cigarette smoke, according to researchers. A peer-reviewed article published in the British Medical Journal talked about the negative effects of e-cigarette liquid (ECL) when combined with vaping. As per the findings of the Institute of Inflammation and Ageing, Birmingham, U.K., the condensation product of ECL is much more toxic to lungs than the liquid itself. It reduces the function of macrophages (a type of immune cells) and elicits an inflammatory reaction in alveoli—the air sacs present in lungs, making one prone to COPD (chronic obstructive pulmonary disease). In another study, the microparticles released from these vapes were found to be able to cross through the blood-air barrier, leading to DNA damage and increased cancer risk. Experts suggest that these health impacts are almost as severe in second-hand smokers, particularly pregnant women and people on cancer therapy. The counter-argument Despite the proven health risks of e-cigarettes, supporters argue that vaping is not as evil as it is made out to be. A review published in the Cochrane library provided evidence that it may help quit smoking in the long term. The review comprised a total of 24 studies including two random control trials and 21 cohort studies. Christine M. Bond, emeritus professor at the Centre of Academic Primary Care, University of Aberdeen Foresterhill, strongly opposed the negative portrayal of e-cigarettes in her article “Do the benefits of electronic cigarettes outweigh the risks”, published in the Canadian Journal of Hospital Pharmacy. “Every medicine has its own set of side-effects,” she wrote, “Whether to use or not use it should depend on its risks and benefits,” she added. The Public Health England, an executive agency that functions under the Department of Health and Social Care, Uk, also supports electronic smoking, saying it is less harmful than tobacco. Need for regulation Regardless of these pros, the manufacture and use of e-cigarettes needs to be regulated, if not completely banned - with strict rules for production, distribution, and use. Nicotine use is already regulated in India under the Food Safety and Standards (Prohibition and Restriction on Sale) Regulation, 2011. There are other regulations too that include e-cigarettes and ENDS. However, a ban may not be 100% successful in dissuading the use of ENDS. Instead, more awareness among the youth about its potential risks could help them make more informed choices. Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health. To know more on this topic, please visit https://www.myupchar.com/en/disease/smoking-addiction