AIIMS-Delhi researchers call for relook at ban on e-cigarettes
New Delhi, Aug 10 (PTI): AIIMS-Delhi researchers have called for a relook at the ban on electronic nicotine delivery systems in India, contending that e-cigarettes with nicotine, when compared with no treatment or usual care, have been evidenced to be of benefit, albeit with a risk of bias.
Electronic Nicotine Delivery Systems (ENDS), commonly known as e-cigarettes, are powered by batteries to simulate features of conventional tobacco smoking. In 2019, India banned the sale, storage and manufacture of such devices by bringing in the Prohibition of Electronic Cigarettes Act (PECA).
Examining the effects of this ban in light of current evidence, oncologists Dr Abhishek Shankar and Dr Vaibhav Sahni from AIIMS-Delhi, in a commentary published in the JCO Global Oncology this month, said a complete ban on such products "can (and has) routed demand towards illicit marketing".
They stated that the harms of following the abstinence approach in policy can be observed in the e-cigarette and vaping-associated lung injury outbreak in the United States, which was attributed to harmful ingredients in ENDS obtained from informal sources.
They stated that the United Kingdom, backed by Public Health England, followed a more pragmatic policy based on harm reduction, thereby adopting e-cigarettes as smoking cessation tools based on evidence.
Policy differences may be attributed to regulatory measures such as those on advertising, packaging, labelling, and lowering nicotine levels in e-fluids, the researchers said.
In their 2022 evidence update, the Public Health England found vaping to be associated with a minor fraction of conventional smoking risk in the short to medium term, while acknowledging the fact that vaping is not devoid of risks, especially for "never smokers".
The researchers said that India has seen some catastrophic results with a complete ban on liquor in some states, which has led to illicit commerce and deaths caused by consuming spurious products.
A complete ban on products may cause revenue loss to the administration as well, the doctors said, underlining that despite the ban, ENDS are available for sale at local shops and through online platforms, which may not even verify the purchaser's age before making the sale and even offer home delivery.
E-cigarettes, the AIIMS-Delho doctors stated, have been demonstrated to help people quit smoking, as evidenced by data supporting elevated quit rates. There is also evidence of moderate certainty that e-cigarettes with nicotine have greater quit rates in comparison with those without nicotine.
They also said e-cigarettes with nicotine, when compared with no treatment or usual care, have also been evidenced to be of benefit, albeit with risk of bias.
"There certainly appears to be a need for advocating at least a relook into the complete abstinence policy pertaining to ENDS as is being followed by the Government of India, which is guided by evidence.
"This will ensure that public health practices remain current and well-informed and people in need of appropriate cessation aids receive the help they need within the confines of a proper regulatory framework," the doctors recommended.
Talking to PTI, Dr Shankar, an assistant professor in the Department of Radiation Oncology at AIIMS-Delhi, said that available evidence conveys that the complete ENDS ban policy in India needs a relook.
"ENDS are a form of harm reduction and in a scenario where proven carcinogens such as alcohol and tobacco are not banned and ENDS are being illicitly marketed to never-smoking kids, certainly something like ENDS can be looked at for their cessation benefits with strict legislation and caution," he said.
Dr Vaibhav Sahni, a scientist in the Department of Radiation Oncology at AIIMS-Delhi, explained, "Since the ban was instituted, evidence has accrued to the extent that a relook into the ENDS policy is warranted."
"It is prudent practice to examine evidence in medicine from time to time in order to evaluate whether policy is still on the right TRACK," he told
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Separate nodal officer in all districts to prevent female foeticides in Karnataka: Minister
Belagavi (PTI): Accepting that the female foeticide has not stopped in the state, Karnataka Health Minister Dinesh Gundu Rao on Tuesday said that the government is taking strict measures to prevent it.
The minister said the government is appointing separate nodal officers in all districts and tightening measures to prevent foeticide, which he called a "social evil".
He also assured that the government will consider strengthening legislation to control such activities.
The minister was responding to a question by BJP MLC C T Ravi in the Legislative Council.
"Female foeticides have certainly not stopped. If you look at the sex ratio, there is a lot of difference. I accept that this is happening," Rao said.
"Foeticides are not happening under pressure; voluntarily, it is happening, for not wanting a girl child. These things are happening based on the sex determination of the foetus at some hospitals. Sex determination is illegal, but with the advancement in technology, portable ultrasound machines have been developed, which can be easily carried anywhere, and scans and tests can be done. This needs to be controlled. We will bring it to the notice of the central government," he said.
In some districts and in a few hospitals, a higher number of male child births is happening. It is found with the help of intelligence input, the minister said.
"Information is being gathered on the taluk in which the male-female ratio is worsening, what is happening in which hospital, and appropriate action is being taken to crack down on such a network, after proper evaluation."
Decoy operations have been done at seven places in the last two years, to identify those involved in illegal activities linked to female foeticides, and actions have been taken against officials and hospitals involved, he said, adding that more needs to be done on priority.
Responding to a question by Ravi about whether any stringent legislation is being brought, Rao said, the government will consider strengthening the legislation and making it stricter to control this.
"Some amendments have been made to the existing laws in the last two years....advanced technology and the internet is being used to carry out such things, also oral medicines for abortions are available over the counter.
We need to look into bringing legislation to control them. The Food and Drug Administration has issued instructions to pharmacists that the sale of such drugs should be documented."
The minister also said that measures are also being taken for the effective implementation of the Pre-Conception and Pre-Natal Diagnostic Techniques (PC & PNDT) Act, and awareness is being created against the identification of female foetuses and female foeticide.
