Malaysia: Ban alternative tobacco products to save lives

3 November 2020

Dr Mohamad Haniki Nik Mohamed, New StraitsTimes:

LETTER: I am responding to the letter, “The need for alternative products” by John Soosai (Nov 2, 2020), which presents a one-sided view with skewed arguments to promote tobacco and nicotine-containing products.

Firstly, while he claims to share findings from the conference he attended, he cherry-picked the information he shared, with some glaring omissions. For example, he does not let readers know that the conference was sponsored by large tobacco companies and others selling nicotine-based products.

The writer also failed to disclose that the Foundation for a Smoke-Free World, that he referred to, is 100 per cent funded by the world’s largest tobacco transnational corporation. These are vital omissions as the whole conference was geared towards being tobacco industry friendly.

Secondly, according to the World Health Organisation (WHO), “…all forms of tobacco are harmful”, including the so-called alternative products referred to by Soosai. The WHO states heated tobacco products (HTPs) contain tobacco and expose users to toxic emissions, many of which cause cancer and are harmful.

Electronic nicotine delivery systems (ENDS or e-cigarettes) do not contain tobacco, but a majority contain nicotine, making them still harmful to health and are undoubtedly unsafe. Furthermore, ENDS can be manipulated by the user, including by adding illicit substances.

The WHO has raised particular public health concern that children and adolescents are increasingly starting to use e-cigarettes. The Tobacco & E-Cigarette Survey among Malaysian Adolescents (TECMA) 2016 found the prevalence of current e-cigarette users among 10-19 year-olds was 9.1 per cent. Alarmingly, current e-cigarette usage among 13-15 year-olds was 11.3 per cent. 46.5 per cent of users tried their first e-cigarette before the age of 14 years.

About 10.6 per cent of our 10-19 year-olds reported being offered a free trial session of e-cigarettes, while 7.9 per cent were offered a free e-liquid. With the proliferation of e-cig promotions via social media, the internet, vape shops, etc., the number of adolescents hooked on nicotine in Malaysia can be even higher. Do we want to allow yet another menace in the form of HTPs to lure our adolescents into becoming lifelong nicotine addicts?

There are at least 20,000 flavours of e-liquids available in the market. Many of these can be purchased online and the government has no capacity to effectively regulate online promotions and sales of such alternative products.

The government is struggling to protect minors from cigarettes and other tobacco products, but Soosai wants to add many new nicotine and HTPs to the already huge problem. These products are not risk-free and we must not wait until the first established cancer case from HTPs before we decide to ban them.

Nicotine is a classified poison, but one of the tobacco companies which sponsored the conference Soosai attended even called for the Malaysian Poisons Act to be “updated” so that e-cigarettes can be more accessible. The fact is, what was classified a poison previously, remains a poison and should be treated as such.

The writer referenced the National Health and Morbidity Survey and freely comments on how the proposed tobacco control bill should not hinder the benefits posed by alternative products. This is remarkably similar to what the tobacco industry does – use public health data to propose policies that support its business.

It is perplexing why he would reference a Japanese cardiovascular surgeon and a Japanese school children’s survey on the use of alternative products when Japan lags far behind in tobacco control measures. Till now, Japan has no comprehensive ban on tobacco advertising and no pictorial health warnings on cigarette packs.

Our neighbours show far better examples to emulate. Smoking prevalence in both Singapore and Thailand are lower than that in Malaysia and both countries have banned e-cigarettes and NTPs as part of their comprehensive programme.

Like him, other individuals have emerged to express pro-industry proposals claiming to be for the good of tobacco control. In August, for example, David Lam from Kuala Lumpur, expressed positive views about a HTP approved for sale by the US FDA. He suggested these products should be regulated based on the level of risks they pose, i.e., less tax if less risky – a proposal that clearly benefits the tobacco industry.

Clearly, our adolescents must be protected from the predatory tobacco and nicotine industry, as well as their allies. Banning these so-called alternative tobacco products is the best way forward.