To regulate or kill?


  • Nation
  • Sunday, 04 Oct 2015

Growing trend : The attractive flavours and stylish e-cigs are making people vape openly in restaurants and public places. — AZMAN GHANI/The Star

ELECTRONIC nicotine delivery systems (ENDS), or e-cigs, hailed as an effective cessation tool for smokers, are a booming industry here. Estimated to be worth half a billion ringgit, the industry’s future depends on the Government’s policy stand, set to be announced soon.

E-cig users, or vapers, want the industry to be regulated while health experts and non-govern­mental organisations are divided in their opinion on whether to have the devices legalised.

Greek cardiologist Dr Konstantinos Farsalinos, who was in town recently, feels that e-cigs are not tobacco products and should not be as strictly regulated. Regulations should, instead, give e-cigs a competitive advantage against cigarettes because they are “less harmful”.

Any regulation should not give the impression that vaping is another form of smoking, he says.

And, subjecting e-cigs to health regulations will be a disaster because it does not fall under the medicine category.

“Unlike e-cigs, medication or nicotine inhalers don’t give pleasure. You can’t prescribe the number of e-cig puffs either. And the liquids used in e-cigs are made from common food additives. So, e-cigs cannot be regulated the way medication is. Otherwise, e-cigs will become too expensive and out of smokers’ reach.”

Interview with Dr Konstantinos Farsalinos on e-cigs.SAMUEL ONG / THE STAR, 1ST OCTOBER 2015.
Differing views: Dr Farsalinos (above) feels that e-cigs are not tobacco products and should not be as strictly regulated, while Subbarow (below) finds the trend worrying because it could lead to smoking and drugs.

Instead, he recommends that liquids comply with food safety standards and proper labelling requirements be introduced.

Promote it among smokers. Stress that it’s not for non-smokers, he suggests.

The researcher at the University of Patras’ Onassis Cardiac Surgery Center in Greece, and the University Hospital Gathuisberg’s Medical Imaging Research Center in Belgium, has been studying e-cigs since 2011. He performed a global survey of almost 20,000 vapers and conducted the first study on the cytotoxic effects of e-cig vapour on cultured cells and its effects on cardiac function and coronary circulation.

Asked if there’s a conflict of interest as some studies were funded by e-cig companies, he justifies: “Most of my work has been through crowd funding. I don’t have any direct affi­liation with any pharmaceutical or tobacco company. E-cig companies gave a grant to cover costs for two recent studies on the impact of smoking and vaping on the arteries but they have no say in how the research is done.”

He challenges sceptics to conduct their own studies to rebut his findings “if you are suspicious that something is wrong.”

Dismissing talk that tobacco companies are behind e-cigs, he explains that they only entered the market recently.

CAP education officer N.V. Subbarow

“The stricter the regulation against e-cigs, the better it is for tobacco companies involved in the market because only the big boys can afford to comply. The result is a monopoly that will suppress the evolution of e-cigs while ensuring that the tobacco industry continues to grow.”

On the possibility of tobacco extract being used for vaping, he says it can only be used in minimal quantities – not as a concentrate, for flavouring. Otherwise, the liquid would be impossible to vape. There would be no vapour and no one would want it, he thinks.

“I’ve tested tobacco-flavoured liquid and though the toxin content is slightly more than other liquids, it’s very much lower than regular cigarettes.”

The ex-smoker who stopped after he began vaping almost four years ago, admits that the ideal is to quit cold turkey without e-cigs but it’s not a realistic aim.

“People smoke for nicotine but die from tobacco tar. Quitting is diffi­cult because of the nicotine. And tobacco products are the worst source of nicotine. I’d prefer to have a nicotine-free world but my duty as a researcher isn’t to judge. It’s to scientifically suggest a safer alternative – e-cigs.”

Asked about the long-term safety of e-cigs, he explains that the technology is too new to expect a 10- to 15-year study.

But, he stresses, compared to regular cigarettes, it’s safer.

Imperial College London Emeritus Professor Gerry Stimson, who sits on the British Standards Institution group on e-cigarette standards, says it’s time for good regulation.

In Malaysia, nicotine is a class C poison under the Poisons Act, he points out. So, the sale of e-cigs containing nicotine is illegal.

A de-facto ban on e-cigs has the perverse effect of protecting regular cigarettes from competition, he says in an e-mail interview.

A ban also means that the government abrogates responsibility for ensuring safety and quality of e-cigs.

Removing a ban provides opportunity for good regulation that offers Malaysia’s smokers a viable exit from smoking.

He suggests regulating e-cigs as consumer goods, providing advertising guidelines.

“Within a year, all European countries will have a process for approving e-cigs onto the market, and an international standard is set to follow,” he says.

Last month, Deputy Health Minister Datuk Seri Dr Hilmi Yahaya said the Government was looking at amending the Control of Tobacco Products Regulations under the Food Act to regulate the use of items such as tobacco and e-cigarettes.

In August, Health Minister Datuk Seri Dr S. Subramaniam and National Fatwa Council chairman Tan Sri Prof Abdul Shukor Husin urged the public to stop vaping until comprehensive findings on the risks were released.

Six local non-governmental organisations, including the Consumers Association of Penang (CAP), however, want a strict ban.

CAP education officer N.V. Subbarow says a meeting was held with representatives from the Health Ministry two months ago where the demand was made.

“Vaping is a very serious problem. We know because we are working with people on the ground, including teachers. Just recently, six boys as young as 12 were caught vaping in a school in Penang. It’s very common among children, even the girls.”

The trend is worrying, he warns, because it could lead to smoking and drugs.

Our neighbours like Singapore, Brunei, and Thailand have banned e-cigs. Why are we dragging our feet? he asks.

“People are vaping openly in restaurants and public places. The attractive flavours, easy accessibility and stylish e-cigs are luring young kids. We need to act now.”

Dr Farsalinos, who is planning a survey of Malaysian vapers with the Malaysian Organisation of Vape Entity (MOVE) and regional consumer advocacy group factasia.org, disagrees.

He says only a very small group of non-smokers vape, adding that in the European Union, only 0.09% of non-smokers vape nicotine daily.

Dismissing the dangers of second-hand vapour in public spaces, he says the nicotine content in vapour exhaled is miniscule.

In August, Sunday Star front paged the issue on the unregulated vape industry here. Worth half-a-billion-ringgit, it’s the second largest in the world after the American market.

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Health , Dr Konstantinos Farsalinos , vape , e-cigs

   

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