Expert to DoH: Don’t ignore evidence on e-cigarettes

Expert to DoH: Don’t ignore evidence on e-cigarettes


An expert on tobacco harm reduction urged the Department of Health (DOH) to stop ignoring the growing body of evidence supporting e-cigarettes as a significantly less harmful alternative to conventional cigarettes and viable smoking cessation aid.

“No one has the right to ignore scientific evidence. Anyone can have an opinion, but scientific evidence is objective—it’s not opinion,” said Dr. Konstantinos E. Farsalinos during the 1st Philippine Harm Reduction Forum held on May 23, 2019 at the Holiday Inn & Suites in Makati City.

Farsalinos is a research fellow at the Onassis Cardiac Surgery Center, University of Patras, and National School of Public Health in Greece. He has been conducting research on e-cigarettes as principal investigator since 2011. His research findings were among the references used by the European Union in drafting the EU regulatory framework on e-cigarettes.

“The DOH may have had a valid argument five years ago when there was limited evidence on the safety and efficacy of e-cigarettes,” Farsalinos explained. “But since 2015 and especially in 2018, many respected health organizations and research institutes have released official reports stating their evidence-based conclusions and recommendations on e-cigarettes.”

Experts support tobacco harm reduction

A 2015 review by Public Health England (PHE) and a 2016 report by the Royal College of Physicians (RCP) both concluded that e-cigarettes are at least 95 percent less harmful than smoking and that e-cigarettes may be contributing to falling smoking rates among adults and young people in the UK. Composed mostly of scientists, researchers and public health professionals, PHE is an operationally autonomous executive agency of the UK Department of Health. The RCP is the leading professional membership body for physicians in the UK and internationally.

A 2018 review by the US National Academies of Sciences, Engineering, and Medicine concluded that, “compared to combustible tobacco cigarettes, e-cigarettes contain fewer toxicants; can deliver nicotine in a similar manner and might be useful as a cessation aid in smokers who use e-cigarettes exclusively.”

In its 2018 position statement on e-cigarettes, the American Cancer Society (ACS) concluded that, “Based on currently available evidence, using current generation e-cigarettes is less harmful than smoking cigarettes.” The ACS also stated that despite firm doctor’s advice some smokers will not attempt to quit smoking cigarettes and will not use Food and Drug Administration (FDA) approved smoking cessation medications, and “switching to the exclusive use of e-cigarettes is preferable to continuing to smoke combustible [tobacco] products.”

According to Farsalinos, quitting without any smoking cessation aid (“quitting cold turkey”) only has a 5% success rate. At least 8 out of 10 smokers fail to quit with currently approved smoking cessation methods such as nicotine replacement therapy; moreover, many smokers do not want to take medications. “If you are to believe the WHO, smokers have only two choices: quit or die. Tobacco harm reduction offers a third option: switch to a less harmful alternative such as e-cigarettes.”

Farsalinos cited a 2014 position statement from the American Heart Association which recommended that, “If a patient has failed initial treatment, has been intolerant to or refuses to use conventional smoking cessation medication, and wishes to use e-cigarettes to aid quitting, it is reasonable to support the attempt.”

Nicotine not the problem

Farsalinos underscored the distinction between the great risk posed by smoking and the low health risks of nicotine. He quoted Professor Michael Russell who said, “People smoke for nicotine but die from the tar.”

In January 2018, the U.S. FDA released its Strategic Policy Roadmap, which declared that, “nicotine…is not directly responsible for the cancer, lung disease, and heart disease that kill hundreds of thousands of Americans each year. It is the other chemical compounds in tobacco, and in the smoke created by setting tobacco on fire, that directly and primarily cause the illness and death – not the nicotine.”