The chapter objectively points out: for the merits and demerits of e-cigarette, we should compare the positive and negative evidence, so as to provide fair opportunities for all parties in the dispute to compete, rather than taking only part of the evidence that supports the harm of e-cigarette.
The article also wrote that the iteration of technology upgrading of e-cigarettes is very fast, so the discussion of e-cigarettes should also use the latest evidence to evaluate the latest e-cigarettes. The first three generations of e-cigarettes discussed in the "China report on the health hazards of smoking 2020" may be in the past.
In addition, the author also advocates that the supervision of e-cigarettes should be based on scientific evidence to make decisions, rather than negate e-cigarettes in an all-round way. He said the latest e-cigarettes products can significantly reduce health hazards to users and second-hand tobacco exposed people and help guide people to quit smoking gradually.
The report describes the prevalence of smoking and secondhand smoke exposure in China, and summarizes the four chronic diseases, such as respiratory diseases, malignant tumors, cardiovascular diseases, diabetes, and public health problems caused by second-hand smoke. It is worth noting that, for the first time, a chapter has been added to the report, compared with the report issued eight years ago, devoted to the health hazards of e-cigarettes.
Smokeless business has a long way to go
The report shows that, with the per capita cigarette consumption in most countries declining continuously, China's per capita tobacco consumption has not decreased significantly, but has an upward trend in recent years. According to the national survey of smoking epidemiology, the total smoking rate is declining, but the decline is low. The total smoking rate in 2002 was 28.5 per cent, 28.1 per cent in 2010, 27.7 per cent in 2015, and 26.6 per cent in 2018.
From the point of view of the decline rate of total smoking rate, the annual average decline from 2002 to 2010 is 0.05%, that of 2010-2015 is 0.08%, and that in 2015-2018 is 0.37%. The decline rate in each survey period is increasing《“ The 2030 program of Health China proposes that the total smoking rate will be reduced to less than 20% by 2030, so it will take 0.55% reduction every year from 2018 to 2030 to achieve the goal. Therefore, it is possible that it is difficult to reach this grand goal to continue to seek the current policy of tobacco control.
According to the data of the World Health Organization, the total smoking rate in 2017 was 19.2%, while that of the United States, Australia and other countries has dropped to about 15%. According to the data of smoking rate in China in the past 20 years, the campaign has achieved some results, but it has little effect compared with other countries and regions around the world.
The report takes a lot of space to list a series of health hazards caused by smoking and second-hand smoke exposure, but the scientific evidence and health knowledge are not used to reduce the public smoking rate significantly. Why is it difficult to reduce the total smoking rate in China? How can we maximize the implementation of smoke control policies?
In 2012, Li Cheng, a Chinese political researcher at the Brookings society of the United States, issued a report entitled "political map and tobacco control movement of China's tobacco industry". His research shows that there is a great deal of connection between China tobacco industry and governments at all levels, which makes the tobacco control policy difficult to achieve the expected effect.
Tobacco monopoly system makes government departments get huge tax revenue, and the decrease of tax revenue caused by tobacco control makes the enthusiasm of tobacco control in different regions not high. For example, many countries and regions around the world have printed skull and other warning signs on cigarette boxes or are not allowed to display cigarettes in commodity windows in order to eliminate the desire to attract people.
However, during the "two sessions" of the National People's Congress in 2016, duantieli, deputy director of the National People's Congress and deputy director of Tobacco Monopoly Bureau, said that this approach is not in line with Chinese cultural traditions and does not intend to add similar warning icons.
Is electronic smoke just unsafe?
In recent years, the electronic cigarette industry has developed rapidly, and Chinese related enterprises have become the leader of the global e-cigarette industry. The report points out that the use rate of e-cigarettes is on the rise, and the use rate of people aged 15 and above has increased from 0.5% in 2015 to 0.9% in 2018; The highest use rate of young people was 1.5% in the 15-24 age group.
"There is sufficient evidence that electronic smoke is unsafe and can be harmful to health," the report said The report suggests that for teenagers, e-cigarettes can have adverse effects on their physical and mental health and growth, and at the same time they can induce them to use cigarettes.
Not long ago, Ministry of industry and information technology and the State Tobacco Monopoly Bureau proposed to regulate electronic tobacco by reference to tobacco monopoly system. As soon as the draft of the policy was issued, the share price of e-cigarettes related enterprises fell. The report also made e-cigarette related companies' share prices experience roller coaster like a sharp drop. So, is electronic smoke really useless?
Evidence based decision requires that the government should support the policy with scientific evidence, and emphasize that the scientific evidence on which policy decisions are based is comprehensive, effective and up-to-date. For the policy of tobacco control, all relevant scientific evidence should be considered comprehensively, and transparent and impartial measures should be taken to make decisions based on evidence.
We should compare the positive and negative evidence to provide fair opportunities for all parties to compete for the merits of e-cigarettes, rather than relying on the evidence that supports the harmful effects of e-cigarettes.
On the one hand, there is a lot of evidence that the smoke liquid, aerosol, additive and smoke of electronic smoke will bring many health hazards, and may induce teenagers to use cigarettes. On the other hand, there is also a lot of evidence that electronic smoke has advantages in guiding smokers to quit smoking and reducing health hazards. Science means that all evidence should be evaluated comprehensively, not a certain point of view is identified and only the evidence consistent with it is accepted.
The technology upgrading of e-cigarettes products is very fast, so the discussion of e-cigarettes should also use the latest evidence to evaluate the latest electronic smoke. In other words, the cigarettes discussed in the report are still the original ones, but the first three generations of e-cigarettes discussed may have been past. The technological progress of e-cigarettes means that we are still full of unknown information about it. Let the bullet fly for a while may be a more inclusive and prudent regulatory posture.
The effectiveness of scientific evidence depends on the research methods and observation time, and the influence of electronic smoke is not only the quantity and quality of relevant evidence, but also the sustainability of the research needs to be improved. Therefore, it seems that the electronic cigarette is negated in an all-round way, which seems to be based on a large number of evidence, which is contrary to the basic principle of evidence-based decision-making focusing on the effectiveness of evidence.
Smoke free: from ideal to reality
Smoking can bring smoke, but the evidence should not be smoky. Just as our understanding of cigarettes will change with the accumulation of scientific evidence, the evidence in smoke needs to be clarified to guide the policy of tobacco control correctly. In the early 20th century, the theory of smoking harmlessness and even smoking benefit was rampant. However, with more and more evidence pointing to the harm of smoking, the theory of smoking harmful can truly stand firm and promote the great reversal of tobacco policy.
Similarly, the supervision of electronic smoke also needs to be based on scientific evidence to make decisions, through the fog of evidence, and to promote the smokeless cause through evidence-based decision-making. E-cigarettes are not healthy, but compared with cigarettes, the latest e-cigarettes products can significantly reduce the health hazards to users and second-hand cigarette exposed people, and help guide people to quit smoking gradually.
We know that the absolute harmless brought by smoke-free is the best choice, but in the short term, when it is impossible to achieve harmless, we should compare the differences of different hazards, which is called "the right of two harm to take the light of it". Smoke free is ideal, but smoking prohibition, smoking control, smoking cessation and smoking reduction are the realistic road. Idealistic smoke-free policy stands on the moral high ground, but it can not actually promote the claimed smokeless cause.
Therefore, instead of advocating the ideal of smoke-free which is difficult to achieve in a short time, it is better to promote the smokers to reduce the health hazards caused by smoking and second-hand smoke exposure by replacing the smoke and reducing the smoke.