WHO revises its previous proposal (and plans) to ban electronic cigarettes

 

By Dr Farsalinos

The World Health Organization (WHO) released today their official position about electronic cigarettes. They maintain an overcautious approach and present one-sided evidence in many parts of the statement. However, they indirectly acknowledge that e-cigarettes may have the potential to reduce the burden of smoking and related disease. This is a major (but not extensive enough) revision from previous statements and proposals which basically called for a ban on electronic cigarettes. A major drawback of the report is their proposal to ban flavors until evidence shows they do not attract youngsters. Additionally, they believe that the best regulatory framework would, most likely, be a two-pronged strategy: regulating electronic cigarettes as tobacco and medicinal products.

The statement starts with one-sided presentation of evidence, with selective citation and mis-presentation of science. For example, they continue to suggest that micro and nanoparticles pose a risk to bystanders, while no such evidence exists because the composition of the particles is different from environmental pollution or cigarette smoke. However, in many parts of the statement, they indirectly accept the lower risk of electronic cigarette use compared to smoking. They do not dismiss the potential for public health benefit conferred by electronic cigarettes. In their regulatory proposals, they call for restrictions (but not ban) on advertising and marketing, with the main purpose of not promoting their use in non-smokers and youth. They suggest prohibition of any health claims unless there is evidence from clinical trials (in reality, this means medicinal regulation). Finally, they support the ban in public places and the adoption of electronic cigarettes in smoke-free air laws (similarly to what AHA suggested yesterday).

A major problem with this statement is the proposal to ban flavours. They apply the precautionary principle in an exaggerated way, and fail to acknowledge evidence showing that flavors are a necessary part of the vaping experience. Finally, they suggest application of tobacco and medicinal regulation, which is similar to what the EU suggested through the TPD. Overall, they have softened their “quit or die” approach, but not to the extent of realizing and acknowledging the large amount of evidence supporting the use of electronic cigarettes as smoking substitutes.

 

I think that WHO has reconsidered and changed its initial position, which was much more strict and restrictive for electronic cigarettes. Of course, there is a lot of ground for improvements. WHO officials continue to ignore the interests of smokers and the huge potential for health benefits from switching to electronic cigarette use. They do not realize that currently-available smoking cessation methods fail in most smokers, while the majority of them do not even want to try them. Despite the improvement over previous statements, there is still a long battle ahead in order to convince regulators about the life-saving potential of electronic cigarettes. It is of crucial importance to intensify our research efforts and provide stronger and more consistent evidence about the beneficial role of electronic cigarettes for smokers.

 

 

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