We need smart regulations and e-cigs to stub out harmby Derek Yach, September 03 2015, 06:32
E-cigs and a wider portfolio of reduced-risk nicotine products are emerging from laboratories of small start-ups and large tobacco companies. Picture: REUTERS/MARK BLINCH
FOR a decade, a range of new, reduced-risk nicotine products have appeared. Millions of smokers now use them and many of them have completely ditched their regular cigarettes.
This is happening in the absence of a well-developed regulatory regime. The regulatory gap is being filled by the experiences of smokers who seek to quit using a product that gives them a similar experience to regular products but without the cancer, heart and lung disease, and stained teeth and fingers.
But the gap is also being filled by tobacco control leaders and doctors who fear that the new products will be as bad as regular ones or who simply do not believe that tobacco companies can innovate their way out of having killer products.
In SA, the minister of health has announced his intention to legislate e-cigarettes in the Tobacco Products Control Amendment Act.
I can understand their views.
For decades I led tobacco control efforts in SA, then globally through the World Health Organisation. While at the WHO, in 1998, I invited tobacco companies to present their progress on what have since become "reduced-risk nicotine products" in a scientific setting. We were unimpressed.
But times have changed. E-cigs and now a wider portfolio of reduced-risk nicotine products are emerging from laboratories of small start-ups and large tobacco companies. All have a common aim: give smokers a product that removes the harmful and deadly components of tobacco products (the tar), but provides the nicotine in a dose and with the full experience they have as a smoker.
Some companies are now investing billions of dollars in doing this and hope that they can maintain a market for their products without killing their consumers.
The evidence and science underpinning these products is maturing and today suggests that newer products do reduce the harms caused by tobacco products by maybe 95% or more. This has led several major public health groups in the UK to recommend that smokers who seek to quit should switch to these products. Last month, Public Health England, a government agency, published an independent review concluding that e-cigs are 95% less harmful than smoking and have the potential to help smokers quit smoking.
Professor Ann McNeill of Kings College London and independent author of the review, said "e-cigarettes could be a game changer in public health in particular by reducing the enormous health inequalities caused by smoking".
Recall that it was the London-based Royal College of Physicians Report of 1962 that started current approaches to tobacco control. They too have joined calls for smokers to be encouraged to use new reduced-risk products — including e-cigs.
Media trends over the past few years show that e-cigs have eclipsed tobacco and cigarettes in stories about smoking and its effects.
...
AND most of the e-cig articles never highlight the differences in risk between them and regular cigs, but focus on scary stories: exploding e-cigs, kids overdosing on nicotine fluid, even citing doctors and medical associations’ concerns about e-cigs being as harmful as or worse than regular cigarettes.
These distorted media stories have led many e-cig users to move back to their old products. The health consequences are clear.
What we need is a smarter regulatory path. One that encourages smokers to shift to reduced-harm products and that tightens up on regulatory actions aimed at cigarettes. Until recently, leading policy makers in academia have avoided spelling out what this might look like.
Over the past month, a few signs of hope have emerged.
Leading health economists and lawyers Ken Warner, Frank Chaloupka and David Sweanor, writing in the New England Journal of Medicine, called for tobacco excise taxes to be set proportionate to the harm the product causes.
These three played a key role over the past 20 years in placing excise tax and pricing at the core of WHO, World Bank and government actions taken to curb use. Having worked with them, I know that their voice is taken seriously by finance ministers. Those who have applied their prescription have seen declines in tobacco use.
My view is that we do need to build a significant gap between the actual prices to smokers of regular versus reduced-risk products.
That starts by increasing the tax on all regular tobacco products and not favouring local brands — a practice followed in many developing countries.
Governments should keep the tax on reduced-risk products very low for at least two decades or until they command 75% of total sales of nicotine products.
Careful attention should be paid to raising excise taxes on regular products as their use declines, with the goal of maintaining total government revenues.
The broader regulatory framework needs to follow a similar principle — something Larry Gostin, O’Neill professor of global health and law at Georgetown University, has started writing about.
...
HE HAS had a substantial effect on many aspects of global health law so when he tackles a major public health issue, regulators tend to listen with respect and interest. There will be a need to ensure that companies can market their products to smokers and to have their products labelled carefully to distinguish between them and regular products.
The regulatory framework matters. But what has historically mattered even more is the advocacy of doctors.
I have witnessed in meetings in the UK, US and SA how their knowledge of the difference between the health effects of nicotine and tar remains rudimentary. They dominate the policy space and in the past, it was their leadership that led to effective policies and actions that have reduced smoking rates to near 20% in many countries.
That is not good enough. In SA, one in four adults still smokes. Almost 40,000 die from tobacco-related disease every year.
We need to act faster to adopt smarter regulations aimed at accelerating the transition out of harmful products. For the first time, we have a range of products that will help smokers do this.
SA will host the next World Conference on Tobacco and Health in 2018. If we all worked together, by then SA could be a shining example of how tobacco’s harms can be rapidly reduced.
• Yach is chief health officer at Vitality, Discovery Holdings
source: http://www.bdlive.co.za/opinion/2015/09/03/we-need-smart-regulations-and-e-cigs-to-stub-out-harm
