The Ministry of Health (MOH) announced last year that it will ban emerging tobacco products via the Prohibited Tobacco Products Regulations made under Section 15 of the Tobacco (Control of Advertisements and Sale) Act.
The ban would take place via two phases. The first phase that has already taken place since 15 December 2015, is the ban on products such as e-cigarettes that are not available in Singapore. The second phase will take place from 1 August 2016, with existing products such as nasal snuff to be banned from sale.
MOH in an earlier statement asserted that the ban is being put into place to ensure that the products do not gain a foothold or become entrenched in the local market, which could spur demand for and increase the prevalence of tobacco consumption. It also said the vapour from e-cigarettes still contains cancer-causing agents, which pose a real risk to both users and bystanders.
A MOH spokesman also said that the ban on e-cigarettes in Singapore, “takes a high precautionary level of protection for the public’s health”.
But what is funny about the whole deal about banning e-cigarettes is that conventional cigarettes are still widely available for sale. Cigarettes that are proven to be harmful to health for smokers and third parties who happen to be around them when they smoke.
So apart from saying that there is no conclusive evidence on the health hazards that e-cigarette brings about, MOH seems to be saying, “since we are not sure about how exactly dangerous is e-cigarette, therefore everyone should continue to smoke conventional cigarettes that are tested and proven to be cancer causing.”
Does MOH believe that the health risk of smoking e-cigarettes is far significant than the risk of smoking burnt tobacco? Or is MOH adopting the saying, “better the devil you know than the devil you don’t.” in their policy on e-cigarettes?
Despite its concern on the matter of e-cigarettes, what scientific studies have the MOH, Health Science Authority (HSA), Health Promotion Board (HPB) conducted themselves on the subject matter?
Report findings by UK’s public health authority run contrary to MOH’s belief
On 19 August, United Kingdom (UK)’s public health jurisdiction, Public Health England (PHE) issued a report led by academics from King’s College London and Queen Mary University of London, saying that e-cigarettes are not only 95 per cent less harmful than regular cigarettes but also have the potential to help smokers quit.
“In a nutshell, best estimates show e-cigarettes are 95% less harmful to your health than normal cigarettes, and when supported by a smoking cessation service, help most smokers to quit tobacco altogether. We believe this review will prove a valuable resource, explaining the relative risks and benefits of e-cigarettes, in terms of harm reduction when compared with cigarettes and as an aid to quitting.” – Duncan Selbie, Chief Executive, PHE
The report highlights that smokers who cannot or do not want to stop smoking could be encouraged to switch to e-cigarette so as to help reduce chances of smoking-related disease, death and health inequalities.
On the gateway effect of e-cigarettes, the report stated that there is no evidence that the e-cigarettes are undermining the long-term decline in cigarette smoking among adults and youth, and may, in fact, be contributing to it. Despite some experimentation with e-cigarettes among never smokers, it is attracting very few people who have never smoked into regular e-cigarettes use.
When the report was brought to the attention of MOH, it along with HSA wrote a joint statement in response, ” 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 2014, HSA pointed to World Health Organisation (WHO)’s strongly worded statement of how it does not support e-cigarettes as a legitimate form of therapy to help smokers quit because the evidence available to date is insufficient to support the claim.
But if you look at the WHO’s report again in 2015, you can see that the stance taken by WHO has changed a fair bit and it has yet taken PHE’s report into consideration since the report was revised only in March 2015.
Promising that over 1 million have used e-cigarettes or replaced smoking, says UK Prime Minister
On 16 December last year, Mark Pawsey, Member of Parliament for Rugby in UK posed a question in its parliament.
He asked, “By the time the House next meets for questions, many people will have started their new year’s resolutions. For many, one resolution will be to give up smoking. Given that Public Health England recently stated that e-cigarettes are 95% safer than tobacco and half the population is unaware of that fact, will the Prime Minister join me in highlighting the role that e-cigarettes can play in helping people give up tobacco for good?”
In response to his query, UK’s Prime Minister, David Cameron replied, “Certainly, speaking as someone who has been through this battle a number of times, eventually relatively successfully, lots of people find different ways of doing it, and clearly for some people e-cigarettes are successful. We need to be guided by the experts, and we should look at the report from Public Health England, but it is promising that over 1 million people are estimated to have used e-cigarettes to help them quit or have replaced smoking with e-cigarettes completely. We should be making it clear that this a very legitimate path for many people to improve their health and therefore the health of the nation.”
The Director of Public Health for Hertfordshire, Prof Jim McManus said in his speech during the recent E-cigarette conference 2015, “Do we take a hermeneutic of suspicion or do we take a hermeneutic of generosity in a rapidly scientific world and I believe I need to take the latter otherwise I cannot do my job and serve the people who pay my wages.”, Before this, he professes that public health directors are more than often a jack of all trades and should listen to what the researchers have to say.
He added that Hertfordshire will become as e-cigarette friendly as it can be, in recognition that the public health gains from e-cigarettes significantly outweigh the risks. “at the time were people are still dying from tobacco-related illness, surely the priority is to stop death, misery from tobacco (consumption) and not get obsessed with nicotine.”
Given the scientific stance taken by United States, UK and other countries in the European Union to regulate the sale and consumption of e-cigarette as an alternative form of nicotine delivery. What should MOH’s stance on banning e-cigarette be based on? To disregard scientific findings in the face and maintain status quo, while possibly denying many smokers to a healthy alternative or an easier route to a smoke-free lifestyle?
Should Singapore have a healthy debate on whether a ban on such products is beneficial or counterintuitive in the combat against the unhealthy habit of smoking rather than a top-down approach in deciding that a ban is the best approach for the country and its people?
What if it is eventually proven beyond doubt that smokers who turn to e-cigarettes for an alternative form of tobacco intake are significantly healthy compared to burnt tobacco. What recourse can smokers take against the policy makers who denied them of an easier way to quit smoking or to minimise the damage to their body?
Till MOH relooks at its policy, smokers in Singapore are indirectly warned by the authorities. It is either you quit smoking or you die smoking.