Harm Reduction and IJCP Group |
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Harm Reduction and IJCP Group
Team IJCP Group,  08 February 2019
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e-cigarettes are not tobacco cigarettes

About IJCP

IJCP Group is a medical communication group established in 1990 and caters to the health awareness needs of more than 2 lakh doctors daily. It has journals, handbooks, online news, online CMEs, medical events, medico-legal section etc.

IJCP Group also works with medical and other health-care establishments, eminent doctors, its editors, contributors, writers, health care industry and government to achieve its objectives.

IJCP Group & Harm Reduction

Recently, the publication house has been working on the concept of ‘harm reduction’.

Harm reduction is a public health strategy, which aims to mitigate the dangers or harms associated with a behavior or condition with the ultimate goal of cessation of the said behavior. “In harm producing behaviors and clinical situations the aim should be to achieve a harm-free state but if the same is not possible, then one should try to achieve realistic goals using the principles of harm minimization incorporating reduction of the concerned risk or substituting it with available less harmful alternatives.”

Some examples of harm reduction are needle and syringe exchange program and opioid substitution therapy for intravenous drug users (IDUs) to reduce risk of transmission of blood-borne infections (HIV, Hepatitis B, Hepatitis C). A well-known example is tobacco harm reduction, which involves switching to non-tobacco nicotine containing products such as nicotine patch, nicotine gum. Use of seat belts in cars and helmets for motorbikes are everyday examples of harm reduction.

A common criticism for harm reduction as a concept has been that it allows people to continue to engage in harmful behavior. According to the National Health Care for the Homeless Council (2010), “Harm reduction is not at odds with abstinence; instead it includes it as one possible goal across a continuum of possibilities… Harm reduction neither condones nor condemns any behavior. Instead, it evaluates the consequences of behaviors and tries to reduce the harms that those behaviors pose for individuals, families and communities”.

Harm reduction has to be viewed vis-à-vis harm elimination. Preventive health  focuses on elimination of the risky behavior to gain health benefits. This is an idealistic but unrealistic approach.

The reality is that harm elimination is not always possible because some individuals are either reluctant to completely quit or find it difficult to quit risky health behaviors such as smoking, alcohol or substance abuse. This clearly suggests that harm elimination may not be feasible always and reducing the associated harm may be a better alternative for such individuals rather than compelling them to abide by total abstinence.

Tobacco Harm Reduction

With this belief, IJCP Group has recently taken up a campaign on “Tobacco Harm Reduction” with a clear-cut policy that we support total ban or complete cessation of use of tobacco products and till that goal is achieved, it should be medically replaced by safer nicotine-based products such as electronic cigarettes or e-cigarettes, as they are popularly called.

It is important to note here that the term “e-cigarettes” is a misnomer as they do not resemble conventional cigarettes and also do not contain tobacco.

Nicotine-based electronic delivery systems produces nicotine vapors (aerosols), which resembles smoke, but is not smoke, as no combustion has occurred with practically no tar, no carbon monoxide and other known carcinogens that are present in cigarette smoke. They are similar to NRTs, that can potentially help with smoking cessation.

Science on Vaping

“People smoke for the nicotine but they die from the tar”, said Michael Russell, a noted tobacco researcher in 1976 in the BMJ (Russell MA. Low-tar medium-nicotine cigarettes: a new approach to safer smoking. BMJ. 1976;1:1430-3).

In an evidence review of e-cigarettes and heated tobacco products published in February 2018, Public Health England, the largest UK public health agency said, “Vaping is a fraction of the risk of smoking, at least 95% less harmful, and of negligible risk to bystanders. ..."

A very recent study, published in January 2019 in the New England Journal of Medicine, found that e-cigarettes were nearly twice as effective as conventional nicotine replacement products, like patches and gum, for quitting smoking. The success rate was 18% among the e-cigarette group, compared to 9.9% among those using traditional nicotine replacement therapy.  The study was conducted in Britain and funded by the National Institute for Health Research and Cancer Research UK. For a year, it followed 886 smokers assigned randomly to use either e-cigarettes or traditional nicotine replacement therapies. Both groups also participated in at least four weekly counselling sessions, an element regarded as critical for success.

The available evidence suggests that using e-cigarettes is less harmful than smoking cigarettes though its long-term health effects are still unknown.

Our View 

In India, as of today, electronic nicotine delivery systems (ENDS) are neither classified as drugs  nor as tobacco products. They are not covered under Drugs and Cosmetic Act or COTPA and therefore it is important to develop an appropriate regulatory framework for the category.

IJCP Group is working with one of the vaping companies in compiling and advocating scientific evidence-based literature that addresses,inter alia, vaping vs smoking;vaping vs other NRTs; health effects of vaping..

Our legal team is of the view that in light of the doctrine of equality, one cannot allow a more harmful product like tobacco and not allow a less harmful product like vaping, which if allowed must be strictly regulated.

Based on the current scientific evidence, we believe there is an association between smoking cessation and vaping. We also believe that vaping is significantly less harmful than smoking. We encourage further research on the subject and its potential to reduce the burden of tobacco related chronic diseases in India.

Team IJCP Group

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