Reposting our BMJ blog article

https://blogs.bmj.com/tc/2021/12/17/philippine-congress-set-to-reverse-protective-tobacco-control-measures-via-retrogressive-vape-bill/

Philippine Congress set to reverse protective tobacco control measures via retrogressive ‘Vape Bill’

Posted on December 17, 2021 by Karen Evans-Reeves

Anna Bueno and Ulysses Dorotheo

New laws often build upon and strengthen existing laws, but in the midst of a pandemic when health-protective measures should be prioritised, retrogressive bills seeking to loosen existing restrictions on heated tobacco products (HTPs) and electronic nicotine/non-nicotine delivery systems (ENDS/ENNDS) have advanced in Philippine Congress, despite firm objections from the country’s health and medical communities led by the Philippine Medical Association, Philippine College of Physicians, and Philippine Pediatric Society, as well as public interest lawyers and youth groups.

In 2019, Philippine Congress amended the National Internal Revenue Code to impose and raise tax rates on HTPs, and ENDS/ENNDS; however, because Republic Act (RA) 11346 and RA 11467 imposed much lower tax rates on HTPs and ENDS/ENNDS than on cigarettes, safeguards to protect public health, particularly youths, were included in these amendments: (a) prohibiting sales to non-smokers and anyone below 21 years of age; (b) restricting flavours to tobacco and plain menthol; (c) mandating the Food and Drug Administration (FDA) to regulate the manufacture, importation, sale, packaging, advertising, and distribution of these products; and (d) requiring graphic health warnings (GHW) on packages in line with the GHW Law (RA 10643) that was implemented in 2016 and  prescribes 12 images to be printed on a rotating basis on all product packages.

As a concession to the industry, these provisions will only come into force in May 2022, but instead of preparing to comply with the law, the industry got a court injunction to stop the Department of Health and FDA from implementing regulations on HTP and ENDS/ENNDS and has been aggressively lobbying for a more industry-friendly law to repeal and pre-empt those public health safeguards before they can even be implemented.

In May 2021, the day after the Lower House approved House Bill 9007 on third and final reading despite strong opposition from health advocates in the House, Senator Ralph Recto, a smoker turned vaper and known industry ally, sponsored the Senate version of this pro-industry bill (Senate Bill 2239), which was approved on second reading yesterday, 13 December 2021.

Completely disregarding the existing laws that already set a regulatory regime for these products and the repeated and pointed opposition of medical organizations, these bills seek to make HTPs and ENDS/ENNDS more widely available by lowering the minimum age of access from 21 years to 18 years, allowing sales to non-smokers, allowing online marketing and sales, allowing multiple flavours that are attractive to teens, replacing the FDA with the industry-friendly Department of Trade and Industry as the regulatory agency for these harmful products, and limiting the placement of GHW to a single message on nicotine as an addictive substance. As with cigarette regulation in the Tobacco Regulation Act of 2003 (RA 9211), we are seeing a replay of the industry tactic of agreeing to regulations that favour trade at the expense of public health.

Under the guise of balanced regulation, HB 9007 and SB 2239 proponents claim that regulation of HTPs and ENDS/ENNDS should not be stricter than that for reportedly much more harmful cigarettes, as stipulated in RA 9211. They completely ignore that RA 9211 is outdated and long overdue for amendment because it is non-compliant with the WHO Framework Convention on Tobacco Control (FCTC) and even violates it by including tobacco industry representatives in public health policymaking. Instead of amending RA 9211 to raise to 21 years the minimum age of access for cigarettes, as proposed by veteran tobacco control champion Sen. Pia Cayetano and recommended by the medical community (to prevent nicotine addiction and harm to the developing adolescent brain) or banning cigarette flavours, vaping proponents have chosen to lower the bar for HTP and ENDS/ENNDS.

As per the 2019 Philippine Global Youth Tobacco Survey, 14.1% of 13-to-15-year-olds are already current ENDS users, compared to 10%, who are current cigarette smokers. In addition, 24.6% have ever tried ENDS, more than double the 11.7% who had ever tried in 2015.

In stark contrast, neighbouring Singapore, whose smoking prevalence dropped to 10.1% in 2020, gradually increased its minimum age from 18 to 21 over the past 3 years, banned HTPs and ENDS as a preventive measure, maintains a comprehensive ban on online tobacco advertising, and enforced standardised tobacco packaging in 2020 under the helm of its Ministry of Health.

On its final reading on 16 December 2021, the bill was approved by a majority vote of the Senate and will now be harmonised with the House version by a Bicameral Committee before being sent to the President for his signature. The only thing that can stop e-cigarette and HTP laws from being relaxed now would be a Presidential veto.

Anna Bueno JD is a writer, researcher, and lawyer at Imagine Law in the Philippines.

Ulysses Dorotheo MD is Executive Director at the Southeast Asia Tobacco Control Alliance (SEATCA).

Conclusions of EU's scientists and others on whether e-cigarettes help smokers quit

The Physicians for a Smoke-Free Canada has an excellent compilation and analysis of the evidence on e-cigarettes. Full blog article here: Physicians for a Smoke-Free Canada: Conclusions from the EU's scientists and others on...

This week the European Union's scientific advisers issued their "Final Opinion on Electronic Cigarettes". This report strengthens concerns about the risks associated with e-cigarette use, while failing to find more than weak evidence that they help smokers quit. 

• evidence supporting e-cigarettes as an effective smoking cessation device was "weak". 
• evidence that second-hand exposure to e-cigarette vapour posed risks was "weak to moderate".
• evidence that e-cigarettes helped smokers cut down on the amount smoked was "weak to moderate".
• evidence that e-cigarettes could cause cancer in the respiratory tract was "weak to moderate".
• evidence that e-cigarettes posed risks for coronary disease was "moderate".
• evidence that e-cigarettes were a gateway to smoking for young people was "moderate"
• evidence that e-cigarettes with nicotine were addictive was "strong"
• evidence that flavours in these products contribute to initiation was "strong".

Why are teens smoking and vaping?

Everyone agrees how important it is that youths should not be smoking or vaping. 

Even tobacco companies have said so publicly for decades, although internal tobacco company documents clearly show that they:

- targeted teenagers with flavors,[1] 

- referred to 14-to-18-year-olds as “young adult smokers,” studied teen smoking patterns (differentiating between “presmokers”, “learners” and “confirmed smokers”), admitted that “the base of our business is the high school student,”[2] 

- recognized that “the renewal of the market stems almost entirely from 18-year-old smokers”[3] and that “today’s teenager is tomorrow’s potential regular customer,”[4] and 

- concluded that “the ability to attract new smokers and develop them into a young adult franchise is key to brand development.”[5] 

In order to survive and prosper over the long term, tobacco companies have seen the need to capture the youth market, developing new products and brands that appeal to youths, because “younger adult smokers are the only source of replacement smokers... If younger adults turn away from smoking, the industry must decline, just as a population which does not give birth will eventually dwindle."[6] 

References:

(1) Marketing Innovations. (1972). Youth cigarette - New concepts [memo to Brown & Williamson]. Bates No. 170042014 

(2) Achey TL. (1978). Memo from Lorillard sales manager Achey to CEO Curtis Judge about the "fantastic success" of Newport, August 30, 1978. Bates No. TINY0003062 

(3) R.J. Reynolds. (1984). Young adult smokers: Strategies and opportunities [report]. Bates No. 501928462-8550 

(4) Johnston ME. (1981). Young smokers prevalence, trends, implications, and related demographic trends [Philip Morris market research report, 31 March 1981]. Bates No. 1000390803 

(5) Philip Morris International. (1999). Worldwide Marlboro monitor: Five year trends, 1988-1992. Bates No. 2044895379- 484 

(6) R.J. Reynolds. (1984). Young adult smokers: Strategies and opportunities [report]. Bates No. 501928462-8550

Smoke-free air is aerosol-free. Don't be fooled.

Tobacco smoke is a chemical aerosol, composed of gaseous and particulate matter. It is also toxic and carcinogenic, and up to 70 carcinogens have been identified among its thousands of chemicals.

Electronic smoking devices (ESD) such as electronic nicotine delivery systems (ENDS) and heated tobacco products (HTP) also emit similar chemical aerosols. They do not emit simple water vapour.

In fact, ESDs emit many of the same toxic chemicals in tobacco smoke (as well as new ones); albeit studies seem to show a lesser concentration of these toxicants and carcinogens.

ESD proponents, including tobacco companies and their vociferous lap dogs, publicly claim that ESD use is less harmful (even "95% less harmful") than cigarette smoking, that cigarette smokers can "quit" smoking by switching to ESDs, and that smokers have a right to access these "safer" alternatives to cigarettes.

The "95% less harmful" factoid has been debunked for years, but even if it were true, is there such a thing as a "less harmful" poison or cancer? Is it okay to jump from the 5th floor rather than the 100th floor of a building?

The truth is that none of the manufacturers of these ESDs can or will claim that their products are safe or harmless, and so far, none of them have registered their products as smoking cessation devices in any country in the world. Doesn't that make you wonder why?

In its application to the US FDA, Philip Morris even gave an "important warning" - "It has not been demostrated that switching to the IQOS system reduces the risk of developing tobacco-related diseases compared to smoking cigarettes."

Source: FDA does not rule that IQOS reduces tobacco-related harm, yet PMI still claims victory
https://exposetobacco.org/wp-content/uploads/STP054_FDA_IQOS_Brief_v3.pdf

So remember:

Read more about Electronic Smoking Devices and Secondhand Aerosol here.

WHO's statement on heated tobacco products and the US FDA decision regarding IQOS is spot on

The full statement is reproduced below and also available on the WHO website: https://www.who.int/news-room/detail/27-07-2020-who-statement-on-heated-tobacco-products-and-the-us-fda-decision-regarding-iqos

WHO statement on heated tobacco products and the US FDA decision regarding IQOS

27 July 2020

WHO takes this opportunity to remind Member States that are Parties to the WHO Framework Convention of Tobacco Control (FCTC) of their obligations under the Convention. Heated tobacco products are tobacco products, meaning that the WHO FCTC fully applies to these products. (Decision FCTC/COP8(22)) Specifically, Article 13.4(a) obliges Parties, to prohibit "all forms of tobacco advertising, promotion and sponsorship that promote a tobacco product by any means that are false, misleading or deceptive or likely to create an erroneous impression about its characteristics, health effects, hazards or emissions."

WHO reiterates that reducing exposure to harmful chemicals in Heated Tobacco Products (HTPs) does not render them harmless, nor does it translate to reduced risk to human health. Indeed, some toxins are present at higher levels in HTP aerosols than in conventional cigarette smoke, and there are some additional toxins present in HTP aerosols that are not present in conventional cigarette smoke. The health implications of exposure to these are unknown.

On 7 July 2020, the US FDA authorized the marketing of a heated tobacco product, the IQOS Tobacco Heating System, under the Federal Food, Drug and Cosmetic Act. This Act requires pre-market authorization of new tobacco products before they can be placed on the US market.

The US FDA statement noted that, “Even with this action, these products are not safe nor “FDA approved“. The exposure modification orders also do not permit the company to make any other modified risk claims or any express or implied statements that convey or could mislead consumers into believing that the products are endorsed or approved by the FDA, or that the FDA deems the products to be safe for use by consumers.”

The US FDA authorization rejected claims that the use of the product is less harmful than another tobacco product or reduces risks to health. The FDA orders also require the company to monitor youth awareness and use of the products to help ensure that the marketing of the MRTPs does not have unintended consequences for youth use. The company must also keep the FDA apprised of efforts to prevent youth access and exposure.

Given that health may be affected by exposure to additional toxins when using HTPs, claims that HTPS reduce exposure to harmful chemicals relative to conventional cigarettes may be misleading.

Moreover, the relevant orders grant a temporary market authorization within the US and are based on factors specific to the US, which is not a Party to the WHO Framework Convention on Tobacco Control (WHO FCTC).

All tobacco products pose risks to health and WHO urges full implementation of the WHO FCTC. Rigorous implementation will support quit attempts and reduce initiation by non-users of tobacco products, especially the young. WHO recommends cessation of all tobacco use with interventions, such as brief advice from health professionals, national toll-free quit lines, nicotine replacement therapies and cessation interventions delivered via mobile text messaging.

Heated Tobacco Products (HTPs) are not safer alternatives to smoking

What utter rubbish!

According to a South China Morning Post article on 28 October 2019, Philip Morris’s president for East Asia and Australia, Paul Riley "pointed out that heated tobacco products were not the same as e-cigarettes, which have been linked to more than one thousand cases of illnesses and 34 deaths in the US. While in e-cigarettes, a cartridge of solution that usually contains nicotine, propylene glycol, glycerine, flavourings and other chemicals are heated up, in heated tobacco products, only a tobacco stick is involved."

Riley is trying to emphasize the distinction between heated tobacco products (HTP) and liquid-based e-cigarettes in order to distance HTPs from the "more than one thousand cases of illnesses and 34 deaths in the US linked to e-cigarettes," but:

1. Aerosols (not vapor) emitted by HTPs also contain nicotine, propylene glycol, glycerine, flavorings, and various other toxicants and chemicals.

2. He fails to mention that Altria (Philip Morris in the US) owns 35% of Juul, which is an e-cigarette company that uses nicotine salts in its e-cigarettes and holds over 70% of the US e-cigarette market. 

3. He also fails to mention that Philip Morris also makes its own e-cigarettes branded as IQOS MESH, and aside from Juul, Philip Morris has another nicotine salt e-cigarette called STEEM.

4. Some HTPs heat up a cartridge of liquid, whose aerosol is then passed through a tobacco plug/capsule.


5. There is no evidence that proves that HTPs are less harmful than cigarettes. Even if some toxicants appear to be less than those in cigarettes, there are more of some other toxicants.

6. The US FDA's tobacco advisory panel rejected PMI's claim that IQOS is safer than conventional cigarettes. Even if allowed for sale in the US, the FDA prohibits Philip Morris form making any claims of reduced harm or modified risk.