Investigative Journalism: The never-ending “smokeless” health confusion over e-cigarettes

The “healthier” option as a form of business innovation 

E-cigarettes being branded as a healthier alternative to traditional smoking products.

The very same can be said for food products. Look at coke diet, low fat yoghurt/cereals, skim milk, vegetarian salads etc., and the list can go on and on. We are in a current era where there is a growing market of health or eco-conscious customers. As such, it has become a strategic move for businesses to profit on this market shift towards health-friendly or sustainable products.

Companies have to constantly innovate, develop, and think of new ideas to retain the customer’s interest, so as to maintain business profits. E.g. If handphone brands did not  come up with newer models year after year, how would they be able to meet the consumer’s materialistic desire for novelty, versatility, and increased or improved phone functions, as well upkeep the evolving needs of our changing generations?

Are e-cigarettes targeted only at existing smokers? 

What makes e-cigarettes attractive to the consumer market? Different reasons -the diversification element (a novel product in the smoking market which will make it trendy). The “healthier option” factor. The versatility aspects (different flavors of e-liquids – which means smokers can customize the nicotine strengths and taste).

Who do you think these cigarette companies are targeting their e-cigarettes at? Existing smokers so that they can become healthier smokers? It it is not as straightforward as that. The cigarette industry most probably wants to also attract our youths – non-smokers or smokers to experiment with, and become hooked to this “fresh” product where you can customise the e-liquid flavours.

Ultimately, e-cigarettes are most likely viewed by some from the 21st century cigarette industry as a permanent gateway to replace traditional cigarettes in the decades down the road, just like how our current iPods have replaced our MP3s and Walkman etc.

Public consultation for the government’s preset decisions proposals

MOH and HSA mentioned they would hold a 12-week public consultation to seek views from the public on tobacco control measures that Singapore could potentially introduce, held from Dec 29, 2015 to Mar 29, 2016 on the various issues:

  1. Introducing standardised tobacco packaging to reduce the appeal of tobacco products
  2. Enhancing graphic health warnings
  3. Restricting the sale of flavoured tobacco products
  4. Increasing the minimum legal age for the purchase, possession and use of tobacco in Singapore from 18 to 21 years old.

Government’s rationale:

.. potential tobacco control measures that Singapore could potentially introduce to more effectively discourage Singaporeans from picking up smoking, and encourage smokers to kick the habit. 

 
 

Other tobacco revisions not in the list for public consultation:

Government’s rationale:

.. to protect non-smokers – particularly our young – from the promotional effect of point-of-sale displays and to create a better environment for smokers who are trying to quit, we also want to work with tobacco retailers to try and help them reduce the inconveniences caused to businesses.

Government’s rationale:

Second Minister for the Environment and Water Resources Grace Fu said the Government is mulling over its “next steps” even as it eventually moves toward a smoke-free Singapore. However, she said policies must be balanced between smoking’s impact on non-smokers and accommodating the needs of smokers. (2015)

Government’s rationale:

“The ban is aimed at ensuring that the targeted emerging tobacco products do not gain a foothold or become entrenched in the Singapore market,” said the Ministry in its statement. It is also intended to prevent such products from becoming “gateway” or “starter” products for non-smokers. (2015)

 ..could stimulate demand for and increase the prevalence of tobacco consumption (2015)

Weighing the pros and cons of legalising e-cigarettes 

  • Regulation and taxation of e-cigarette products feasible?

If the government allow e-cigarettes, it means they might have to allow Shisha and all the other emerging or already banned or emerging smoking products back in too, as people might raise the question of why one product is legalised, while others are banned.

If non-traditional cigarettes are legalised and regulated, taxation and packaging of the diverse range of these products might be another complex process which the government have to tackle. Even for an e-cigarette itself, it has different components. E.g. How are we going to go about taxing the e-liquids?

  • Are e-cigarettes indeed healthier than traditional cigarettes?

I myself do not even know the answer. There have been many contrary research on whether e-cigarettes are indeed a healthier alternative (*you can find them easily find online).

As such, I think we will need a few more years of research experiments and collection, and also have a credible and independent scientific team (free from any biasness in intended objective) to do a comprehensive and objective research on the matter.

Being able to customise the nicotine strengths could also lead to abuse by users, if they take in a much higher dose than normal traditional cigarettes.

  • Will banning of e-cigarettes result in a lower smoking population?

To look at it from the government’s point of view, they hope to reduce youths from even picking up the habit of smoking, and to encourage current smokers to quit – with the overarching goal of lowering our current 13.3% smoking rate in Singapore to a further 12 per cent by 2020.

E-cigarettes would be “trendy” and “novel” for youths to experiment with, adding on to the fact that they can customise the candy flavoured e-liquids.

As such, the e-cigarette ban and potential tobacco measures would align to the end objective the government had set forth from the start.

However, it is good to note that the illicit e-cigarette trade in Singapore will most likely thrive too – as the flow of demand (*from our younger generation of smokers) and supply is still ever present, even though the product is banned. Thus, the smoking rate might end up remaining status quo.

  • A more affordable alternative to traditional smoking?

I was at 7-eleven and decided to take a look at the traditional cigarettes displayed at the payment counter – $10-$13 was the price range. I did not know smoking could be so costly.

Quoted from Straits Times (2014):

Singapore’s 71% tobacco tax is not as high compared with at least 50 countries. At least 50 countries, many in Europe, impose even higher taxes. And that is the correct thing to do, according to the World Health Organisation (WHO). In its release marking World No Tobacco Day today, it says: “Research shows that higher taxes are especially effective in reducing tobacco use among lower-income groups and in preventing young people from starting to smoke.”

Quoted from CEO of a “reduced-risk” smoking product company:

“…new products will continue to cost roughly double the price of making and selling the same capacity of traditional cigarettes”

Quoted from Danny Vinik:

“it would take about 51 days before an e-cigarette smoker recouped his initial investment (as compared to purchasing a traditional tobacco)”

Quoted from Ethan Wolff-Mann:

“Vaping Is..40% Cheaper Than Smoking”

From here, there are three totally different accounts on the cost of non-traditional cigarettes compared to traditional ones. One CEO of a cigarette company stated that their future “reduced-risk” smoking products will cost double so as to align to it’s increased production fees. Another writer said that it would take almost 2 months for an e-cigarette smoker to even out the cost with that of purchasing a traditional cigarette. While the last writer said that e-cigarettes are a cheaper alternative to traditional smoking products.

If these non-traditional products could possibly go up to twice the price like what the CEO of a tobacco company stated, imagine how much it will cost after including Singapore’s 71% tobacco tax (*though e-cigraettes contains no tobacco)?

  • Battery explosions

There have also been cases of battery explosions in e-cigarettes. Quoted from U.S. Fire administration:

  1. More than 2.5 million Americans are using electronic cigarettes (e-cigs or e-cigarettes), and this number is growing rapidly.
  2. Fires or explosions caused by e-cigarettes are rare.
  3. Twenty-five separate incidents of explosion and fire involving an e-cigarette were reported in the United States media between 2009 and August 2014.
  4. Nine injuries and no deaths were associated with these 25 incidents. Two of the injuries were serious burns.
  5. Most of the incidents occurred while the battery was charging.

I have also checked online and found at least 13 news incidents of such happenings in western countries. A few e-cigarette users had serious eye injuries, fractures, second hand degree burns, one was almost paralyzed , another was left in a coma.

Government’s view on e-cigarettes

Get the Facts Right! Learn More about Tobacco Products (HPB)

Adverse health effects of e-cigarettes (MOH)

Most of the current government’s response are one-sided – focuses mainly on why e-cigarettes are harmful, instead of showing a more balanced comparison across overseas research findings.

Regulatory body and clinical trials for e-cigarettes products 

Questions: 

1) Are there any present regulatory body for emerging tobacco products e.g. Tobacco Regulation Branch of the Health Sciences Authority?

1) If there are, have they conducted clinical trials on the impact of e-cigaettes e.g. risk assessments and safety evaluation – in the past, or as of now?

2) And, do they carry out regulatory checks on existing clinical trials done by e-cigarette companies for risk assessments and safety evaluation of the product itself?

3) If not, would they start to look into existing clinical trials done by e-cigarette companies, or carry out future clinical trials on the impact of e-cigarettes?

And alongside all these questions, I’m wondering first and foremost – whether there was in-depth discussion and consultation done by the local authorities with medical, public health, and scientific professionals or research teams. policy experts and advisors, (be it in Singapore and overseas e.g. global e-cigaerette conferences) – both independent, and related to the tobacco industry, before the ban on emerging tobacco products came about?

Because, there would be statistics and factual data which Ministry of Health (MOH) and the Health Sciences Authority (HSA) could possibly benefit from, and gain a better and more comprehensive understanding of the product e.g. safety, and it’s health impact on users.

All these research findings would scientifically and medically validate the health impact of e-cigarettes, which acts as essential backing evidence to support the reason for the ban of e-cigarettes in Singapore, and reduce queries on the effectiveness and rationale behind the ban of emerging tobacco products that was announced to citizens swiftly through the mainstream media.

Possible outcomes if e-cigarettes are found to be healthier 

Let’s say if e-cigarettes are indeed found to be a healthier alternative many years down the road, the truth is – legalizing and regulating the e-cigarettes might not reduce smoking, it only encourages “healthier” smokers, benefit cigraette companies who have invested significantly to the e-cigarette products, and might even attract new or non-smokers to this form of non-traditional traditional products.

So, the question for the government would be then…

(Legalising e-cigarettes)

Do you want e-cigarettes to replace traditional cigarettes as a healthier option for our smoking population in the long run? Though it might be perceived as normalizing the act of smoking to the public in the short run, since the government would be giving autonomy for more alternative smoking choices which could lead to healthier, but at the cost of a higher smoking population, which means it does not align to their end goal of reducing the smoking population.

OR

(Not legalising e-cigarettes)

Do you want to stick with traditional cigarettes, which removes possible health benefits of e-cigarettes for our smoking population in the long run, but still maintain the government’s stand towards smoking as being undesirable? Which would be aligned to their direction of decreasing our smoking population, though it might backfire as the illicit trade could thrive with more curious and experimental smokers wanting to try out contraband cigarettes, just like the underground drug scene in Singapore. Thus, the smoking population could go many directions.

State restriction for the long term benefits of non smokers? Or long term health benefits for future and existing smokers? A lot of factors to consider – government’s moral ideology, social, physical health, economic, legal, healthcare costs, autonomy in making lifestyle choices etc.

Current lacking loophole?

But before we can even reflect on this dilemma, we have to first find out whether e-cigarettes are indeed – a healthier alternative. This is something that experts from the e-cigarette industry, as well as medical and scientific professionals, policy experts, and tobacco regulatory boards in Singapore can come together to at the very least – form an exchange of views and debate, inform the Singapore public of their collated discussions, even if there are no ultimate mutual conclusion.

More holistic and in-depth information could be then shared on our governmental and mainstream media platforms for citizens to gain a comprehensive perspective of the health impacts of using e-cigarettes.

Afterthoughts

Once we tackle this loophole, it will lead to not only a stronger validation for our current or future e-cigarette law proposals/revisions, but also create a more informed society towards both sides of the coin of the of e-cigarette issue.

If not, the issue of whether e-cigarettes are as healthy as it is claimed to be will remain merely as a “smokeless” confusion with no end.

Look forward to our post next week on the – raising of the legal smoking age to 21 and tobacco media control. 

To check out our other posts on e-cigarettes:

[Investigative Journalism] Legalizing the electronic puff

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Will increasing the smoking age to 21 & tobacco media control be a “smokeless” difference?

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Written by: Cass

Picture taken from: ScienceNews

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3 thoughts on “Investigative Journalism: The never-ending “smokeless” health confusion over e-cigarettes

  1. All electronic cigarettes are different and have variable settings. As a rule of thumb, it’s best to start low and adjust to higher temperature as you go in order to hone in on the perfect flavor of e cig juices to vapor ratio. Before you begin, make sure your settings are on the lowest setting (for your first time) to ensure a tasty first experience instead of a gross one.

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