No conclusive evidence that demonstrates effectiveness of e-cigarettes

TODAY, 2 July 2013

Perhaps it’s time to look at legalising e-cigarettes?

The Health Sciences Authority (HSA) website cites several reasons why e-cigarettes are banned in Singapore, one of which is that the World Health Organization has not endorsed it.

What it negates to mention is that this product is already legal in several countries like the United Kingdom and the Netherlands, with some like Denmark even classifying them as medicinal products.

I agree that there is more research to be done regarding the safety of the chemicals in e-cigarettes and also its efficacy to curb smoking, but the HSA’s approach has one contradiction.

While more work needs to be done on the effects of e-cigarettes, the banning of such a product due to its “unknowns” flies in the face of the legalisation of cigarettes — of which, its evils are well proven.

I urge the HSA to study e-cigarettes seriously as a possible way to help smokers quit, or even to deter would-be smokers from picking up the habit in the first place.

Danny Tan

TODAY, 3 July 2013

E-cigarettes can easily be abused

Smoking remains a common vice, even though the deleterious effects of a smoking habit are well-known and widely publicised. Smoke damages the respiratory systems of smokers and the people unfortunate enough to be within their vicinity. This imposes significant costs on society; general air quality declines along with the health of the populace, with an attendant increase in healthcare costs. Cigarette butts irresponsibly discarded also contribute to unsightly litter and pose public hygiene problems.

In light of these ills brought upon society by the conventional cigarette, the e-cigarette appears to be an attractive alternative (“Perhaps it’s time to look at legalising e-cigarettes?”, July 2). First, e-cigarettes minimise or eliminate second-hand smoke, such that any harmful effects of smoking are borne by the smoker alone. Second, e-cigarettes do not generate smoke because they do not involve combustion. This arguably reduces damage to the smoker’s lungs as well. Third, e-cigarettes are a “greener” option, being reusable.

Several countries have legalised their use, but prudence ought to be exercised, particularly where narcotics are concerned. Aside from largely hypothetical concerns about e-cigarettes being marketed to children or serving as a “gateway drug”, there is a real risk of illegal adulteration of e-cigarette liquid.

E-cigarettes function by vaporising liquid solutions containing nicotine, allowing the smoker to inhale the nicotine vapour. It is possible for smokers to tamper with the liquid solution; it is even possible for smokers to create “DIY” concoctions. Smokers may be able to increase the concentration of nicotine in the solution to dangerous levels. They may also be able to adulterate their liquid solutions to induce a stronger “high”.

Legalising e-cigarettes without appropriate control measures is akin to legalising a particular form of drug paraphernalia. This is because of its unique delivery mechanism — namely, vaporisation — which may be open to abuse. Hence, the wiser option may be to stay our hand for the moment, and observe developments in other jurisdictions before coming to a better-informed decision.

Benjamin Wong Yong Quan

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JOINT MOH-HPB-HSA REPLY TO TODAY VOICES, 19 July 2013

We thank Mr Danny Tan (“Perhaps it’s time to look at legalising e-cigarettes?”, 2 July 2013) and Mr Benjamin Wong Yong Quan (“E-cigarettes can easily be abused”, 3 July 2013) for sharing their views on e-cigarettes.

          The Ministry of Health (MOH) and the Health Sciences Authority (HSA) share the UK's concern about the safety of electronic cigarettes (e-cigarettes) and their effects on long-term health. As Mr Wong has rightly pointed out, prudence ought to be exercised when it comes to e-cigarettes. We are aware that e-cigarettes have been marketed as a safer alternative to standard cigarettes or as an effective smoking cessation device. We remain cautious as there is no conclusive scientific evidence to demonstrate the effectiveness of e-cigarettes in helping smokers quit tobacco use. E-cigarettes could potentially be a gateway to developing a smoking habit, particularly among the young. Smoking is known to increase the risks of chronic diseases and other health conditions, and is a major preventable cause of death.

          In addition, we note the British Medical Journal’s report on 14 June 2013 that the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA) accepted the findings of the Commission on Human Medicines, that e-cigarettes currently in the market do not meet appropriate standards of safety, quality and efficacy. The MHRA has recommended that people do not use e-cigarettes currently in the market as their safety and quality are not assured. A study conducted by the HSA in 2011 also found poor correlation between actual nicotine content and the stated amount labelled among the different e-cigarette products. Smokers seeking to quit smoking with the assistance of pharmacotherapy should use a regulated and licensed nicotine replacement therapy (NRT) product or other non-nicotine medications under proper medical supervision. NRTs, when used in conjunction with counselling, could be effective in helping smokers quit smoking in the long run.

        The National Tobacco Control Programme will continue its multi-pronged efforts to curb the supply and demand of tobacco products that are already entrenched in Singapore. At the same time, MOH and HSA urge the public to refrain from using e-cigarettes and discard any e-cigarettes they have in their possession.

Dr Lyn James
Director
Epidemiology & Disease Control
Ministry of Health

Dr Chris Cheah
Deputy Director (Substance Abuse)
Adult Health Division
Health Promotion Board

Norman Chong
Acting Director
Tobacco Regulation Branch
Health Products Regulation Group
Health Sciences Authority