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Smoke or vape: The growing public health debate

By Ndubuisi Kalu
15 March 2020   |   3:43 am
Sir: As the debate rages globally over cigarette smoking and the much-touted smoke-free alternatives, such as e-cigarettes, which are being presented by tobacco companies...

Sir: As the debate rages globally over cigarette smoking and the much-touted smoke-free alternatives, such as e-cigarettes, which are being presented by tobacco companies as safer options for smokers, truth sometimes get killed in the stampede and falsehood often ascends the throne.

Meanwhile, there has been no conclusive study disputing the safety of smoke-free devices. The closest was the research by University of California’s scientists Stanton Glantz and Dharma Bhatta, published in the Journal of American Heart Association, JAHA, which concluded that conventional cigarettes and vapers carried similar risk, with increased likelihood of a heart attack when both are used. The study was originally published on June 5, 2019 and concluded that the use of conventional and electronic cigarettes carried similar risks while doing both at the same time was an even more dangerous option that could increase the likelihood of having a heart attack.

This conclusion then called into question the assertion by the tobacco industry that the new smoke-free devices were an alternative with potentials to reduce the damage caused by consuming cigarettes for the more than 1 billion smokers in the world.

However, after much criticism and after eight months of pressure from the scientific community, the editors of the magazine accepted their error and retracted. They stated that the study could have been based on misleading data, concluding that it did not take into account certain information from a population assessment survey on tobacco and health, very relevant to the research.

By modifying its position, JAHA confirmed the fact that these conclusions were “unreliable.” Much of the information shared in the report did not have adequate scientific methodologies, internationally recognised practices and validated scientific teams.

There are different ways of smoking now. There are electronic cigarettes, which are battery-powered devices, do not contain tobacco but vaporise a liquid solution (e-liquid or e-juice) with different amounts of nicotine and / or flavors. On the other, vaporisers, a type of electronic cigarette that may or may not contain liquid nicotine, in addition to other substances such as marijuana oils or flavorings. And finally, heated tobacco products, which contain natural tobacco and nicotine and produce steam instead of smoke.

In this sense, it is very important that information based on science, is always put out about alternatives to cigarettes and products that, although not risk-free, are significantly less harmful to health than smoking tobacco.

It is interesting, once again, that the Glantz and Bhatta research report was retracted by the Journal of American Heart Association, where it had been published, on account of ‘misleading data’ that did not consider some information on tobacco and health from a relevant population assessment survey.

The journal was emphatic in its retraction, saying, “the editors are concerned that the study’s conclusion is unreliable.”

Jamie Hartmann-Boyce, a senior researcher on health behaviours, at University of Oxford seized upon the retraction to declare: “We can try to learn from this, and it takes several forms. For researchers and the people who fund and publish research, it means not just doing more research, but doing good research, subject to rigorous, critical review.

It also means doing open research; it is possible that if the initial data was publicly available, the flawed analysis may not have made it to publication in the first place. It means being aware of ‘hot stuff bias,’ where topics that get a lot of media attention attract more bad science than those that are less on the radar.”

Meanwhile, as far as the safety of e-cigarettes is concerned, WHO says that while it is still too early to understand long-term effects of use or exposure, non-smoking consumers who use them have double chance of smoking conventional cigarettes.

Tobacco manufacturers, of course, disagree, insisting that whatever decision is taken should not only be based on sound science that stresses harm reduction, but also be based on the people’s preferences. If this sounds self-serving, they are at least correct in one respect: smokers’ decisions need to be guided by absolutely correct information.

“The best choice is to quit altogether, but every adult smoker in the world who does not, should have access to accurate information on significantly less harmful alternatives,” says Dr. Gilchrist, Philip Morris International’s Vice President of Strategic and Scientific Communications, admitting that smoke-free products are not entirely risk-free, since they contain nicotine, which is addictive but is not the primary cause of smoking-related disease.

As this debate rages, in many countries in Africa, including Nigeria, there are many deaths from preventable diseases.

The real duty before the governments is to invest heavily in the welfare of the people, especially in nutrition and health-care delivery.

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