Over 1,000 doctors from 24 states and three union territories have urged Prime Minister Narendra Modi to enforce a ban on Electronic Nicotine Delivery Systems (ENDS), including e-cigarettes and flavoured hookah before it becomes an "epidemic in India", especially among the youth.
Expressing concern over media reports that 30 organisations have written to the IT Ministry to prevent the ban on promotion of ENDS, 1,061 doctors in a letter to the Prime Minister said this was a public health matter and commercial interests should not be entertained.
In August last year, the Health Ministry had issued an advisory to all states and UTs to stop the manufacture, sale and import of ENDS after the Delhi High Court took strong exception to the Centre for delay in coming up with appropriate measures to tackle the "new emerging threat" of e-cigarettes in the country.
In March, the Central Drug Regulator also directed all drug controllers in states and UTs to not allow the manufacture, sale, import and advertisement of ENDS, including e-cigarettes and flavoured hookah, in their jurisdictions.
ENDS are devices that heat a solution to create an aerosol, which also contains flavours, usually dissolved into propylene glycol and glycerin.
"It will not be an exaggeration if nicotine is considered as poison. It is sad that the ENDS lobby has assembled a group of physicians who are sharing misleading, distorted information to suit the ENDS industry.
"I applaud the government of India that in line with their goal of universal healthcare, it took a tough stand against nicotine delivery devices. They must now ensure that this does not get diluted," Dr Pankaj Chaturvedi, Deputy Director and Head and Neck Surgical Oncology Tata Memorial Hospital said.
He further said e-cigarettes should not be promoted as a safe alternative and the only way is to completely quit smoking and not initiate use of any tobacco product.
Tobacco companies want to hook a new generation on nicotine under the allure of safe smoking, he said. The letter of the doctors network is associated with the Voice of Tobacco Victims (VoTV) campaign.
The letter to the Prime Minister quotes a report by the US Food and Drug Administration (FDA) which stated that e-cigarette use in one year from 2017 to 2018, has increased to 78 per cent among high school students and 48 per cent among middle school students.
The FDA reported that in the US, traditional smoking has been falling for years among teens. That trend continues as, according to the Center for Disease Control (CDC), high school smoking fell from 15.8 to 7.6 pc between 2011 and 2017.
However, ENDS popularity among teens has outstripped the reductions in traditional cigarettes as e-cigarette usage has risen from 1.5 to 11.7 pc over the same period.
Thus, ENDS significantly offset the progress made in the fight against teen smoking, especially because these teens will also take up regular cigarettes over time, they said in the letter.
Dr Shiv Choudhary, Head of Cardio-Thoracic Vascular Surgery (CTVS) AIIMS Delhi, said, "Research has proven that ENDS are not safe or alternatives to cessation.
"Nicotine dependence is a major health threat. As a doctor, I will never recommend any nicotine product usage without medical supervision, it being a highly addictive chemical. These products should be banned in India."
The American Cancer Society (ACS) and The National Academies of Sciences Engineering Medicine (NASEM) are both of the view that young people who begin with e-cigarettes are more likely to transit to regular cigarette use and become smokers.
Ashima Sarin, Director, Voice of Tobacco Victims (VoTV) said, "As per the Global Adult Tobacco Survey (2017), there are 100 million smokers in India, which is potentially a large market for makers of ENDS.
"The ENDS lobby is spending a lot of money on trying to get an entry into India. Youth who have not tried regular cigarettes are initiating with vaping and end up smoking regular cigarettes or both. Prestigious associations such as The American Cancer Society, The American Heart Association have said it all."