In 2019, prior to the COVID pandemic, I supported an advocacy favoring Electronic Nicotine Delivery Systems (ENDS) over regular cigarettes. ENDS include electronic cigarettes and vape, which are electronic atomizers that simulate cigarette smoking. I supported ENDS mainly for its potential as a nicotine replacement therapy (NRT), specifically to help people quit smoking.
I read available data, did some research, and came to the early conclusion that ENDS might help cigarette smokers switch to what I believed then to be a better option. Of course, this was not realizing at the time how vape could be even more addicting than cigarettes, and even more attractive to the youth. And that ENDS might be regulated differently than regular cigarettes.
Since then, I have changed my mind about ENDS with respect to it getting regulatory advantages over tobacco given its use as NRT. Considering what it is, a cigarette alternative, I have since been advocating that ENDS and regular cigarettes should be treated the same in terms of taxation, regulation by the Food and Drug Administration, sales and marketing restriction, and distribution. In short, both should be made expensive and difficult to access particularly by the young.
But a study that recently came to my attention seems to be a sort of light at the end of the ENDS tunnel. It is the first study I have read that tracked over a period of three years a sample of cigarette smokers who switched to ENDS, and the impact of that “switch” on their health. To ENDS’ credit, according to the abstract of the study results, it appears to have positive attributes.
I managed to secure only an abstract, as there are still restrictions on the distribution of the study. The abstract was available online on Nicotine & Tobacco Research (N&TR), a journal that is sponsored by the Society for Research on Nicotine and Tobacco. The study I am referring to was released to the journal only this month as an “accepted manuscript,” and was authored by Saul Shiffman, PhD, Douglas R. Oliveri, PhD, Nicholas I. Goldenson, PhD, Qiwei Liang, PhD, Ryan A. Black, PhD, and Snigdha Mishra, PhD.
The study “assessed adults who had smoked ≥10 cigarettes/day for ≥10 years, comparing 124 continuing cigarette smokers (Smokers) to 140 former smokers who switched to JUUL-brand ENDS exclusively for ≥6 months (Switchers). Assessments included biomarkers of exposure (BOEs) to select harmful and potentially harmful constituents (HPHCs), biomarkers of potential harm (BOPHs) related to smoking-related diseases, psychometric assessments of dependence on cigarettes and ENDS, respectively, and respiratory symptoms.”
According to the abstract of study results published in N&TR, “nicotine levels were significantly higher in Switchers (median time switched = three years), who were unusually heavy users of JUUL. All other BOEs… were significantly lower in Switchers than Smokers. Most BOPHs (sICAM-1 [primary], and e.g., white blood cell count, MCP1, HbA1c) were significantly lower in Switchers than Smokers; HDL was significantly higher. Switchers reported significantly lower dependence on JUUL than Smokers did on cigarettes, and respiratory symptom scores were significantly lower among Switchers than Smokers.”
With these results, the abstract concluded that “compared to continuing smokers, smokers who switched to JUUL had substantially lower exposures to multiple HPHCs, favorable differences in markers of inflammation, endothelial function, oxidative stress, and cardiovascular risk, and less respiratory symptoms.” Simply put, the abstract noted, “these findings suggest that switching from cigarettes to JUUL likely reduces smokers’ health risks.”
And this I believe to be some form of light at the end of the tunnel for ENDS. It appears there is still hope even for long-time cigarette smokers shifting or intending to shift to ENDS exclusively, assuming any health “damage” done by their years of cigarette smoking are still reversible. In this line, I can support ENDS but only as an alternative for long-time smokers, and not something that should even be started by nonsmokers.
The abstract added, “short-term confinement studies and randomized clinical trials demonstrate that adult smokers who switch completely to ENDS experience substantial reductions in exposure to many smoking-related toxicants. This study extends those findings to longer periods of switching to JUUL-brand ENDS (almost three years on average) under naturalistic use conditions in real-world settings, and found that switching to JUUL resulted in favorable differences in BOPHs more proximally related to smoking-induced disease, as well as in respiratory symptoms. Smokers who switch to ENDS reduce their exposure to toxicants, likely reducing their disease risk.”
Moving forward, I foresee things getting trickier for governments. After all, with ENDS perhaps showing some positive attributes, some quarters might spin the narrative that ENDS are better and “healthier” than cigarettes and should thus be restricted less. After all, if the aim is to make cigarette smokers shift to ENDS, then ENDS should be more accessible to them.
The problem with this argument is that less stringent regulation can also make ENDS more accessible to nonsmokers, particularly the young who never smoked cigarettes but are now influenced by peers or social media to take up vaping or the use of electronic cigarettes. It is not as if ENDS are prescription medicine that can be prescribed only for smokers who wish to quit.
I still believe in parity. Regular cigarettes and ENDS should be treated the same, taxed in the same way, and regulated and restricted in the same way. More important, the government should strictly enforce regulations at points of sale, particularly their distance to schools, and regulate if not ban the use of “flavors” that make cigarettes and ENDS products appeal to the young.
Marvin Tort is a former managing editor of BusinessWorld, and a former chairman of the Philippine Press Council
