The National Medical Commission (NMC) recently issued a directive for medical professionals, possibly requested by Directorate General of Health Services (DGHS) and the Ministry of Health and Family Welfare (MoH). The letter instructed doctors to refrain from initiating or participating in any research activities related to e-cigarettes without obtaining prior approval from the DGHS and MoH. This directive is closely aligned with the World Health Organization’s (WHO) recommendation to ban e-cigarettes, marking a significant barrier for medical research practices on the subject in the country.
Research in India needs to be high quality, scientific and innovative to be able to propel the Prime Minister’s vision to make the country self-reliant and focus on converting their knowledge & bring about change in everyday life. This is only possible when primary research comes to the fore.
For instance, the government’s efforts on tobacco control can be more effective if insights it relies on are backed by facts. The comparison of data between smokers and e-cigarette users should be the base to understand the impact of new nicotine alternatives as opposed to a comparison of non-smokers and e-cigarette users. Such issues, where data is not compared pragmatically and realistically, concludes in restrictions & guardrails as the way forward.
UK & Sweden have adopted a tailored policy using nicotine alternatives. UK’s health department concluded that nicotine alternatives are at least 90% less harmful than traditional combustible tobacco, helping 2.5 million smokers switch & eventually quit tobacco. Sweden will soon be the first country to become smoke-free. Smoking prevalence has fallen from 15% to 5.6% in just 15 years with the help of new nicotine alternatives. Further, they witnessed a 41% lower incidence of cancer, lowest across the EU.
In the US, a recent CDC report highlights that while adult vaping rates have increased, they have not increased smoking rates in adults or teens, with both groups registering a decline in use. The report also indicates that teen vapers have reduced by 61% as against the number reported in 2019.
Documents released by the WHO recently recommend countries to ban or restrict and tax all tobacco products, clubbing them in the same health risk bracket despite scientific consensus that burning of tobacco causes much more harm as compared to heating it.
Contrary to this approach, The Cochrane Library concluded in November 2022 that “there is strong evidence that e-cigarettes with nicotine increase smoking quit rates compared to nicotine replacement therapy.” In countries with liberal regulation towards vaping, smoking has declined twice as fast as the global average.
Research is a lifeline to any kind of scientific revolution in the health space, especially when you consider the population size in a country like India. Proper standards, focus and impetuous will bring out analysis which will help in shaping progressive policy & way forward for the health sector. Every citizen will have the right to information if this approach is backed by logic. Given that research is such a poignant part, in case there are gaps in the research approach, it compromises the right to information for the govt machinery as well as citizens. Possibly closes out an option to save lives from tobacco harm.
In India’s case, the direction from DGHS has scope for improvement if the data it may rely on does not consider secondary research but granular and in-depth insights from credible product research. For instance, the comparison of e-cigarette users with non – smokers will not represent a complete analysis as against a comparison of cigarette smokers with e-cigarette users to study harm reduction. Many such builds which if done efficiently, with the right kind of focus that the Government of India has put in other areas like medical products and medicinal salts can lead to better policies. If tobacco control policies can use such research centric approach, they can rely on insights and reduce the harm from tobacco.
It becomes an urgent requirement for decision-makers to draft a tobacco control policy customized to solve public health issues. Research that can bring out effective policies has put us on the precipice of a public health revolution of historic significance. We can do what has worked so well for so long on so many other public health issues. It merely requires us to embrace science, reason, and humanism. Simply put, India needs to bring back the gold standard of research to help achieve our country’s full potential of ‘Viksit Bharat @2047’.
