Tapping technology for enhanced public health
The quest for a smoke-free Philippines was boosted last year after President Rodrigo R. Duterte’s issuance of Executive Order (EO) 26 that banned smoking in public places and conveyances, except in designated areas.
EO 26 aims to push the country into attaining smoke-free air, defined by the World Health Organization (WHO) as “air in which tobacco smoke cannot be seen, smelled, sensed, or measured.” The eightpage EO defines smoking as “being in possession or control of a lit tobacco product regardless of whether the smoke is actively inhaled or exhaled.”
Electronic cigarettes or e-cigarettes are not covered by both definitions nor by EO 26 itself, the latter due to the absence of information and recommendation from WHO, according to former Health Secretary Paulyn Ubial.
An e-cigarette is a handheld, batteryoperated electronic device that vaporizes a flavored liquid. The e-cigarette user inhales the resulting vapor, which is colloquially known as vape. Since vaping is legal in the Philippines, many Filipino smokers have shifted to e-cigarettes way before EO 26 was issued.
Edward Gatchalian, president of the Philippine E-liquids Manufacturers Association (PEMA), explained that “nicotine is the chemical in cigarettes that hooks people to smoking, but it is the toxic gases in cigarette tar that kills smokers.” He said e-cigarettes are products of new technologies designed to provide nicotine without the harmful substances contained in cigarette smoke. Unlike conventional cigarettes, e- cigarettes have zero tar and do not emit first- and second-hand smoke.
American public health policy experts led by Dr. David Abrams of New York University (NYU) supported Mr. Gatchalian’s position. In their position paper published by the Annual Review of Public Health, a respected medical journal, they recommended the implementation of an effective tobacco “harm minimization” strategy anchored on a balanced regulatory framework for alternative nicotine delivery systems such as e-cigarettes.
Dr. Abrams and his co-authors described harm minimization as a pragmatic, evidence-based approach that can complement proven tobacco control efforts of prevention and cessation, with the primary goal of moving smokers to the exclusive use of much safer products as quickly as possible. They believe that if prudently regulated, e-cigarettes could disrupt the global pandemic of smokingrelated diseases.
“This opportunity depends on encouraging increased technological innovation and finding the appropriate balance between product safety, consumer appeal, and regulations targeted specifically to decrease the use of conventional, combusted tobacco products,” the authors stated. They underscored the importance of appropriate regulation in harnessing the potential of new technology and product innovation to enable smokers to quit combustible tobacco and avoid relapse. Vapers Philippines President Tom Pinlac called on the Department of Health to craft an appropriate regulatory framework for e-cigarettes that would help millions of Filipinos cut down or even quit smoking and ultimately save their lives.
Meanwhile, Filipino vapers hailed the recently published strategic policy road map of the US Food and Drug Administration (FDA) categorically stating that nicotine, although not totally risk-free, is not directly responsible for fatal heart and lung diseases. ”It is the other chemical compounds in tobacco and in the smoke created by setting tobacco on fire that directly and primarily cause illness and death — not the nicotine,” the FDA paper said.
Mr. Pinlac thinks that by following the scientific evidence and adopting this new FDA policy direction, the US joins a growing number of governments that are adopting the use of less harmful nicotine products such as e-cigarettes as part of their national tobacco control programs. Science-based findings have shown that it is not the nicotine but the smoke that is harmful.
Our national government must therefore pursue a harm reduction strategy with regard to smokers who opt not to quit, while public health authorities should regulate e- cigarettes instead of banning them outright. After all, they are considered the safer technological alternative to cigarette smoking.