As the government intensifies its collection of cigarette taxes in the Philippines, a Greek visitor in Manila reminds authorities that saving millions of Filipino smokers from premature death is a campaign that deserves a greater attention.
“Smoking is an epidemic worldwide. We have over 1.1 billion smokers in the world, or about 23 percent of the adult population. The World Health Organization predicts that within the 21st Century alone, we are going to have 1 billion premature deaths due to smoking. In the Philippines, the smoking prevalence is about 20 percent. Of these 20 million smokers, 10 million of them are going to die prematurely by smoking-related diseases. The average life expectancy of a smoker is 10 years less than a non-smoker. It is a huge cost in lives and in economy,” says Dr. Konstantinos Farsalinos, a researcher at Onassis Cardiac Surgery Centre in Athens and University of Paltras in Paltras, Greece.
Farsalinos, a former smoker, says millions of Filipino smokers have an opportunity to quit the vice by switching to a less harmful product—electronic cigarette. He considers vaping or the use of e-cigarette as a harm reduction tool, because it is 95-percent less harmful than the traditional burning of cigarettes.
He says, however, that vaping should never be endorsed to non-smokers and minors and should be promoted only to smokers as a tool to help them quit smoking.
Farsalinos explains that it is not nicotine that is responsible for diseases related to smoking, but the burning process of cigarettes. “We know for more than 40 years, or since 1976, that people smoke for nicotine, but die from the tar. Tar is the combustion product from burning of material. Nicotine itself has not killed any smoker. All the diseases caused by smoking are not caused by nicotine present in the smoke, but by the combustion product, the burning of the cigarette tip at more than 800 degree Celsius that creates a lot of toxins consequently inhaled by the smoker,” he says in an interview at Holiday Inn Hotel in Makati City.
Vaping is the act of inhaling and exhaling the vapor produced by an electronic cigarette, a battery-operated device which vaporizes a flavored liquid made of nicotine, propylene glycol, glycerine and flavorings.
A cigarette industry executive in the Philippines, however, says vaping does not give the same satisfaction as smoking. He predicts that smoking will continue to thrive in the coming years.
Farsalinos, who has done 50 scientific studies on electronic cigarettes, says while WHO does not support the use of e-cigarettes, individual countries such as the Philippines should develop regulations on the growing vaping sector. “WHO is making a big mistake,” says Farsalino, referring to the organization’s quit-or-die approach.
“Worldwide, six million people die every year prematurely because of smoking. That is going to go up to 10 million per year by 2025. Any delay is costing lives. With 1.1 billion smokers, we have a lot of deaths per year. We don’t have time to wait for 20 or 30 years. We are going to lose one generation of smokers,” he says.
Farsalinos says while the best solution remain a complete stop to smoking or smoking cessation medication, e-cigarettes proved to be most successful in making a large number of smokers quit the vice.
“E-cigarettes help smokers quit,” says Fersalinos, citing the results of a May 2016 study by Action on Smoking and Health UK.
He says that a 2014 study in the European Union shows that 6.1 million Europeans quit smoking and another 9.2 million reduced consumption of cigarettes after they had tried e-cigarettes. This means that 67.3 percent of Europeans who had tried e-cigarettes either quit or reduced smoking.
“In Europe, there were about 9 million established regular users in 2014. I am sure that number now is much higher. But the biggest market is the US,” he says.
He says in Asia, the Philippines and Malaysia are two countries with large population of e-cigarette users. “Here in the Philippines and Malaysia, they created the industry by themselves, the local people. They are not imported products. They are products made locally. Many entrepreneurs got engaged into that, and that’s how it grew here. The regulation should be done in such a way that vaping will be promoted to smokers only. That’s why we need rules,” he says.
“I am seeing that over the years, WHO is changing its position. But it is going on slowly,” he says. “We have a lot of data. There are more than 1,000 studies. I myself have done 50 studies on e-cigarettes.”
“I am a former smoker who has tried every smoking cessation medication in the past. I have tried gums, I have tried oral smoking cessation, I have tried psychological therapy. I managed to be smoke free for a maximum of five months. I was successful repeatedly because I repeatedly relapsed,” he says.
“After I did my first study on e-cigarettes, at that time I was still a smoker and seeing the results, I decided to try it. I managed to quit on day one. I kept a pack of cigarettes at home for one week. After a week, I threw it away together with the lighter. And I am now smoke-free for five years and one month. Now, I never feel the need to get a cigarette. That’s why I am saying the relapse is probably gonna be much smaller with e-cigarettes compared to quitting with other methods,” he says.
Farsalinos says it is important that the Philippines develop a regulatory framework for e-cigarettes in such as way that vaping will be promoted to smokers only as a harm reduction tool.
“You need to have rules and ensure that everyone in the industry complies with the rules,” he says.
Farsalinos says while there is a need to ensure the safety and quality of e-cigarette devices, it is also important that the industry does not fall under the control of big tobacco companies. “If you create a very expensive and very restrictive regulation, who is going to afford this regulation? Only the big tobacco companies. A very strict regulation is basically providing the whole industry to the hands of the big tobacco and we don’t want that. We want to have competition and innovation. It was not a product made by big tobacco and we don’t want now to deliver it to big tobacco. We need to have small and medium-sized independent players because we will have competitive, creative, innovative environment and this helps in developing much better products,” he says.
Heneage Mitchell, founder of not-for-profit, consumer-oriented think tank Fact Asia Consultants Ltd., says e-cigarette is something that consumers enjoy and which can be improved and enhanced. “This is the only invention that has come up ever that has shown that promise [to quit smoking],” he says.
Mitchell says the current strategies against smoking such as the imposition of higher excise taxes which have been in place for 20 years now are not working. “They are just feeding the illicit trade and the criminal syndicates who are selling counterfeit and illicit cigarettes all over the world,” he says.
“E-cigarettes have been successful in getting millions of smokers in the EU to quit smoking. It is a personal choice, a consumer choice, a product that consumers have chosen and they deserve to have a regulatory framework that protects their interest, their health and to ensure that the products they are buying are manufactured safely,” says Mitchell.
“E-cigarettes have the proven capacity to save millions upon millions of lives, not just in the Philippines, but worldwide,” he says.
Mitchell says a ban on e-cigarettes would be disastrous. “More people are going to die because they are not given an opportunity to switch, from a dangerous product, and surely it is the government’s duty to protect the lives of its citizens and to ensure they are given access to products that will help them improve their lives and to be around with their families longer and to be more productive,” he says.
“On behalf of millions of Filipino smokers whose lives are impacted by tobacco, this is a way forward. We have an opportunity here to save millions of Filipino lives. If the government does not act and regulate the products, and make them available to smokers, I am sorry, but they will be responsible for the death of millions of Filipino smokers. They need to make the right decision. Filipino smokers and their families deserve to have access to these life-saving, game-changing products,” says Mitchell.