Preliminary findings of studies conducted by two universities in the Philippines and Indonesia show that vaping or the use of electronic cigarettes is less harmful than smoking.
Harm reduction advocates, including doctors, scientists and lawmakers, said the results of such clinical research should convince health authorities, including the Department of Health in the Philippines, to consider the use of e-cigarette as an effective harm reduction tool or as a way to quit smoking.
“Tobacco harm reduction is currently not maximized and implemented as a policy. There is much work to be done in encouraging society and legislators to adopt harm reduction in public policy,” Coop-Nattco Party-list Rep. and House minority leader Anthony Bravo said in a keynote speech during the 2nd Asia Harm Reduction Forum at Dusit Thani Manila Hotel in Makati City.
Prof. Ron Christian Sison, a medical technologist and lead convenor of Harm Reduction Alliance of the Philippines, said results of a pioneering clinical study conducted by his research team at the University of Santo Tomas, found that vapers have lower biomarkers of polycyclic aromatic hydrocarbons in their bloodstream, which are associated with the development of lung cancer, compared to those of cigarette smokers.
“The said biomarkers are said to be relatively and statistically significant and high among those who are smoking and relatively low among those who are having e-cigarettes,” Sison said in news briefing.
Sison said his team presented the preliminary results of the study before a technical working group of the Senate committee on health and demography. The Senate plans to come up with a regulatory policy on e-cigarettes, which are also known as electronic nicotine delivery systems.
“When I presented this, I also had a chance to meet all those public health specialists in the Philippines and initiated the establishment of Harm Reduction Alliance in the Philippines. We started with tobacco harm reduction and we are targeting expanding, to cover not only tobacco harm reduction but also other aspects such as occupational health, HIV, road safety and air pollution,” Sison said.
Tobacco harm reduction advocates gathered in Manila for the 2nd Asia Harm Reduction Forum to push for the harm reduction approach to address the global smoking scourge. More than half of the world’s 1.1 billion smokers are reportedly in Asia, and harm reduction advocates claim that the best way to save smokers from serious illnesses is to provide them with less harmful alternatives such as e-cigarettes, heath-not-burn products, and Swedish snus which, unlike nicotine patches and other nicotine replacement therapies, still provide the sensation or pleasure of consuming nicotine.
The 2015 Global Adult Tobacco Survey showed that 23.8 percent Filipino adults were smokers. The smoking rate among Filipino women (5.8 percent) was among the highest in Southeast Asia. On average, Filipino smokers start at the age of 17.8 years. Meanwhile, Indonesia has the world’s highest smoking rate at 76.2 percent among males aged 15 and older.
In India, one million people die each year because of smoking-related illnesses, according to Samrat Chowdery of Association of Vapers India. Fortunately, he said, “despite government bans and restrictive policies, awareness on tobacco harm reduction is increasing and more smokers are switching to reduced harm products.”
Smoking, which produces the toxic tar, is linked to many illnesses, with studies showing that it can shorten the lifespan of an individual by an average of 10 years.
Prof. Jay Jazul of the University of Santo Tomas Faculty of Pharmacy, who is also a co-convenor of Harap, said a genotoxicity assessment on groups of smokers, non-smokers and e-cigarette users showed different results. The research team conducted a mammalian erythrocyte micronucleus assay to determine the cadmium and lead levels among the three groups.
Results pointed to an interaction effect of different treatments. E-cigs are not without risks, but the findings showed they are less harmful than cigarettes.This is because the cadmium and lead levels are significantly higher among conventional smokers than among users of e-cigs, said Jazul.
A perception study among 220 respondents in Metro Manila also checked the efficacy of vape among users where 67.7 percent revealed that they did not experience any side effects in using e-cigs. There were also positive changes in terms of smell and physical endurance, they said. Respondents also stated that ECs are safer than cigarettes.
Jazul, however, cited the need to conduct a more comprehensive study with a larger number of participants to validate the results of the initial research.
Meanwhile Dr. drg. Amaliya of University of Padjajaran (Indonesia), said her team conducted a study called “Electronic Cigarette: Findings on Oral Mucosal Cells” to evaluate the prevalence of cellular changes among smokers, non-smokers and e-cigarette users in the light of recent studies showing that tobacco and alcohol play a great role in oral carcinogens. In fact, smokers are known to have a 3.4-percent risk of oral cancers.
In the micronucleus assay test, findings showed significant differences in micronucleated cells among the three groups. Results indicate that the oral mucosal cells of e-cigarette users represent no changes that could be associated with malignancy, she said.
Dr. Amaliya said that in terms of oral health, there was no instability discovered among e-cig users, unlike smokers.
“Evidence shows that tobacco harm reduction products are at least 95 percent less harmful than cigarettes. Switching completely from smoking to vaping provides substantial health benefits,” said Prof. Tikki Pangestu of Lee Kuan Yew School of Public Policy at the National University of Singapore.
Co-organized by Harap and Yayasan Pemerhati Kesehatan Publik Indonesia (YPKP- Indonesian Public Health Observer Foundation), the regional forum builds on the success of the First Asia Harm Reduction Forum in Jakarta last year.
Participants said that despite strict government regulation, high taxes, and extensive public awareness campaigns, smoking remains a major public health issue in Asia, with over half of the world’s smokers living in the region.
The forum aims to educate society on harm reduction through better alternative products and to promote and advocate for practical solutions that can contribute to the improvement of overall public health.
“There are currently about 16 million Filipino smokers. Only a small percentage of them want to quit smoking, and an even smaller number will actually succeed in quitting smoking. Harm reduction must be integrated into public health policies to help reduce smoking-related illnesses and deaths in the country,” said Sison.
Experts from India, Indonesia, Singapore, and Sweden called on governments to develop appropriate regulation of alternative products in order to advance tobacco harm reduction.
“In Japan and South Korea where alternative tobacco products are widely available, smoking prevalence rates have dropped sharply. In Singapore and Australia which have banned e-cigarettes, smoking prevalence rates have remained unchanged,” said Andrew Da Roza of Promises Healthcare (Singapore).
He said there was no evidence supporting concerns that young people who use alternative nicotine products go on to become tobacco smokers. “Global data show that smoking prevalence rates have decreased among youths who use alternative products such as e-cigarettes,” he said.
Da Roza lauded Congressman Bravo and other local legislators who have introduced bills advocating e-cigarettes as harm reduction tools. “Please support Congressman Bravo and his colleagues in their advocacy to advance tobacco harm reduction in the Philippine Congress,” he said.
Prof. Helen Redmond of New York University said while the overall smoking prevalence has declined in the United States, the rate among vulnerable groups―the homeless, those with mental health issues and those taking illegal drugs, has not moved.
Tobacco harm reduction is about saving lives and helping people make the switch. Current alternatives such as nicotine patches and gums do not have high success rates, she said.
On the other hand, vaping, electronic cigarette products, heat-not-burn, and snus emerged as game-changing revolutionary products and that are considered the future.
“We have to get these products into the hands of people who need them the most and we have the opportunity to help the people switch and live. It is about life and death. We need to do everything we can to make these products accessible to the people,” she said.
“We will never live in a nicotine-free world as nicotine is here to stay,” Redmond said.
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