Global experts on tobacco control policy shared their insights on e-cigarettes and tobacco harm reduction with members of the Joint Trade and Health Committee of the House of Representatives during the committee hearing on Dec. 10.
The hearing tackled several bills that seek to regulate the manufacture, importation, packaging, use, sale, distribution and advertisement of e-cigarettes and heated tobacco products.
Clive Bates, a former director of the UK’s main anti-smoking organization Action on Smoking and Health and a longstanding advocate of rational tobacco control policies, sent his 31-page comments on e-cigarettes and tobacco harm reduction to joint committee chairs Rep. Weslie Gatchalian and Rep. Helen Tan via e-mail.
In his testimony before the joint committee, Dr. Konstantinos Farsalinos presented comprehensive evidence on e-cigarettes and recommended regulatory actions. He emphasized that a risk-proportionate and realistic regulatory framework will help maximize the use of electronic cigarettes (e-cigarettes or vapes) as an effective harm reduction and smoking cessation strategy for the promotion of public health.
Farsalinos is an adjunct professor at King Abdulaziz University and a researcher at Onassis Cardiac Surgery Center, University of Patras and National School of Public Health in Greece.
Addiction psychotherapist Andrew da Roza also appeared before the joint committee to share his expert insights. He said that new technologies give public health policy a unique opportunity to eliminate cigarettes in a single generation. He said that, “we can have a smoke-free world if we use heat-not-burn products and if we use e-cigarette products.”
Da Roza holds a Masters’s degree in counseling from Monash University in Australia and a Master of Science degree in addictions from King’s College, London University.
In his comments, Bates, who has no conflicts of interest with the tobacco, e-cigarette or pharmaceutical industries, said that “beyond any reasonable doubt, e-cigarettes are much less harmful than conventional cigarettes. Almost all the harm done by cigarettes arises from the smoke, and e-cigarettes do not produce smoke.”
He cited the US National Academies of Science Engineering and Mathematics, which concluded that e-cigarettes are “likely to be far less harmful” than conventional cigarettes. He also cited the evidence review of the Royal College of Physicians and Public Health England, which both concluded that vaping is at least 95-percent less harmful than smoking.
According to Bates, there are now four strands of evidence that suggest e-cigarettes are effective in helping people to quit smoking: evidence from randomized controlled trials; observational studies, which look at what happens when people use e-cigarettes; population data, which show unusually rapid reductions in smoking prevalence and cigarette sales in countries where e-cigarettes are available; and the testimonials of smokers who have struggled to quit using other methods but were able to quit after switching to e-cigarettes.
Bates said the concept of tobacco harm reduction aims to encourage consumers, on their initiative and at their own expense, to switch from high-risk combustible tobacco products like cigarettes to low-risk non-combustible products like e-cigarettes. Tobacco harm reduction works well because e-cigarettes are an attractive consumer alternative to smoking but at a small fraction of the risk. The appeal is important because it is what encourages smokers to switch, he said.
“E-cigarettes should be viewed as a disruptive and innovative technology capable of ending the grip of cigarettes and bring the 100-year epidemic of smoking-related disease to a rapid end,” Bates said. “Like many new and disruptive technologies, it has attracted instinctive opposition and hostility from many groups whose positions and interests are at risk, and this includes, unfortunately, some public health and tobacco control groups.”
He said the regulation of tobacco and nicotine products, including e-cigarettes, should be risk-proportionate. “Cigarettes are likely to be at least 20 times as harmful as e-cigarettes and e-cigarettes can help people quit smoking. The policy needs to take account of differences in risk and the potentially large benefits of e-cigarettes. The aim should be to encourage switching from cigarettes to e-cigarettes while controlling safety risks and preventing youth uptake of all tobacco and nicotine products.”
Bates said the controversy over e-cigarettes was often portrayed as a conflict between the e-cigarette businesses and public health”•between money and human life.
“This is not the case in reality. There are many eminent international experts in tobacco control and public health who see electronic nicotine delivery systems such as e-cigarettes as an important innovative pro-health technology breakthrough that will disrupt the cigarette trade and end the worldwide epidemic of smoking-related disease and premature death,” he said.