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Use science to inform public policy in matter of e-cigarettes, heat-not-burn devices

Use science to inform public policy in matter of e-cigarettes, heat-not-burn devices

In his commentary, “Singapore should aim to be smoke-free, not just smoke-lite” (Oct 5), Dr Chia Kee Seng said that “emerging tobacco products such as e-cigarettes and heat-not-burn cigarettes… are no less harmful than cigarettes”.

There are now credible, rigorous, published, peer-reviewed scientific studies that indicate that heat-not-burn devices (HNBs) and e-cigarettes are materially safer than cigarettes.

Notably, there are no credible published studies that conclude that HNBs and e-cigarettes are as damaging as cigarettes.

This is not surprising. In the case of HNBs, they heat specially formulated tobacco and release the nicotine, but they do not burn it.

Most of the toxins are in the tobacco smoke, such as tar and carbon monoxide — and, of course, smoke only comes from burning.

In the case of e-cigarettes, there is no tobacco, just vapours that either have been engineered to remove toxins, or can be mandated to be safe through regulation.

Certainly, scientific debate remains. It is not known exactly how much safer HNBs and e-cigarettes are compared to cigarettes — is it 60, 90 or 95 per cent safer?

There is concern that HNBs and e-cigarettes will produce “gateway” effects, encouraging smoking among youth who would not have smoked otherwise, but this is contested by scientists, and studies that show that only 1 or 2 per cent of e-cigarette and HNB users are non-smokers.

Furthermore, we cannot predict how many Singaporeans will substantially reduce or give up smoking, or how many potential smokers will not start smoking, as a result of the promoting and selling HNBs here.

It has also been claimed that HNBs are new, so there is no long-term evidence of their safety. Yet, I believe that this has never really been the yardstick used in Singapore (or in any other developed nation) to introduce new pharmaceuticals, medical devices or therapeutic practices.

The accepted protocol is to scientifically and rigorously examine whether they work, whether they are safe and what the side effects are.

Waiting 20 years to review health outcomes is not part of that protocol. This makes good sense. Otherwise, we would all be stuck with using 20-year-old medical technology.

The research teams under the Health Ministry must examine all the available published scientific evidence and ongoing research on new products. New healthcare products have an element of risk, and there should be public debate as well as scrutiny from the authorities.

In the case of HNB devices, this process has not yet begun. Let’s use science to inform public health policies.