E-Cigarettes: Are They Really The Alternative To Smoking?

Bihar recently became the eighth Indian state to ban them. The jury is still out on whether they are relatively harmless or a gateway drug. Play it safe and use patches or gum instead, doctors say

Delhi-based businessman Rahul Sainani, 32, has been vaping for almost a year and says he is ‘almost 99% off cigarettes’.

He used to smoke a pack a day. “Apart from a drag here and there, I have nearly stopped. I cut down almost as soon as I started getting my fix in another form,” Sainani adds. He’s not sure about getting over the vaping, though.

Sainani started smoking when he was in Class 11. He developed respiratory issues last year and his doctor calculated he had smoked close to 65,000 cigarettes in all.

“That kind of scared me. I realized I needed to do something about this habit,” he says. That something is working for now, but it’s still delivering a toxic substance to his bloodstream and he’s not sure he can give up his e-cigarettes at all.

“I plan to gradually reduce the nicotine content in my vaping liquid. Even if I am never able to stop, it’s still better than smoking a cigarette,” he says.

This is a common refrain, and it’s cause for concern, doctors say. In just 14 years since the e-cigarette was invented by a Chinese pharmacist, it has already spread around the world. By 2023, its adoption rate is expected to outstrip that of cigarettes.

The reason it has caught on so rapidly is the same reason it is so hard to give up — vaping (incidentally, Oxford Dictionaries’ Word of the Year in 2014) mimics the smoker’s ritualistic behaviour of holding a cigarette, puffing, and delivers a hit of the addictive nicotine too.

E-cigs are certainly less damaging to the lungs and respiratory system, but the jury is still out on how safe they inherently are.

And because of the misconception that they are relatively harmless, they are proving to be a gateway drug for nicotine addiction among the young — including teens who may not have taken up smoking at all.

Amid the concern, Bihar recently became the eighth Indian state to ban e-cigarettes, after Punjab, Maharashtra, Kerala, Karnataka, Mizoram, Jammu & Kashmir and Uttar Pradesh.

“The government is examining how to tackle the consumption of electronic smoking on the basis of the reports of three panels formed by the health ministry to study different aspects of the issue,” union health minister JP Nadda said in the winter session of Parliament.

There is no arguing with the fact that Nicotine Replacement Therapy (NRT) is the best way to get smokers to quit. But nicotine patches, gum and lozenges are all less addictive than e-cigarettes in this role, doctors say.

Apoorv Pandit, a 37-year-old entrepreneur from Mumbai, started smoking in 2003 and smoked about a pack a day for the next decade. E-cigarettes seemed like a lesser evil, so he switched in 2013.

“It was a step towards quitting, but still an addiction,” he says.

Because the ritual of puffing persists, there’s arguably a higher risk of returning to cigarettes, as Pandit did in three months. Since last July, he has gone cold turkey. “E-cigarettes helped but I realised that smoking both electronic and real ones are addictions making my lifespan shorter. If I was going to quit, I had to just quit,” he says.

For those who don’t give it up, long-term side-effects of vaping include insomnia, anxiety, a heightened risk of hypertension, cardiovascular disease, complications in pregnancy and low sperm count.

“As a rule, we recommend patches over e-cigarettes because patches are external; the nicotine doesn’t go into the bloodstream directly,” says Dr Jaishree Bankira, consulting oncophysician at Mumbai’s SRV

Mamata Hospital. “As a result, patches also don’t have the kinds of severe side-effects one risks with e-cigarettes,” she adds.

A World Health Organisation (WHO) report released in 2014 on Electronic Nicotine Delivery Systems or ENDS had this to say about nicotine in the bloodstream: “Although nicotine itself is not a carcinogen, it may function as a tumour promoter. Nicotine seems involved in fundamental aspects of the biology of malignant diseases, as well as of neurodegeneration. The evidence is sufficient to caution children and adolescents, pregnant women, and women of reproductive age about ENDS use because of the potential for fetal and adolescent nicotine exposure to have long-term consequences for brain development. Given the relatively recent entry of ENDS into the market and the lengthy lag time for onset of many diseases of interest, such as cancer, conclusive evidence about the association of ENDS use with such diseases will not be available for years or even decades.”

E-cigarettes cause population level harm, one or two people may benefit but overall it seems more like a gateway product to smoking cigarettes, especially among kids, says Dr SK Khandelwal, former head of psychiatry at the All India Institute of Medical Sciences.

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