Israel’s smoking rate, after a decade of decline, increased from 19.7% of Israelis in 2015 to 22.5% in 2016. But instead of reversing this deadly trend, Israel’s Ministry of Health will make matters worse with a proposed ban on a new type of e-cigarette.
According to Leah Rosen, who heads Tel Aviv University’s Health Promotion Department: “This is unheard of in the developed world. There’s an epidemiological curve of tobacco use, and as people start to get sick from smoking, the [smoking] rate starts going down, and it never goes back up. We have now broken that trend.”
Ironically this smoking surge parallels increased spending on a wide variety of smoking-cessation efforts ranging from Quit lines to nicotine patches to drugs that curb nicotine dependence.
E-cigarettes deliver nicotine in a vaporized form – the process is called vaping. Millions of people around the world have abandoned smoking in favor of vaping. Juul, a new type of e-cigarette that has captured nearly half of the vaping market in the US, is now available in Israel – as is an e-cigarette produced by Philip Morris called Iqos. The ministry is curiously seeking to ban Juul while allowing Iqos to remain on the market, using claims that they are neither scientific nor evidence-based.
First, the ministry has claimed Juul contains too much tobacco. In fact, Juul contains no tobacco and doesn’t even heat up or convert tobacco to vapor. Rather, as addiction expert Dr. Sally Satel notes, it delivers high concentrations of nicotine that “mimic a regular cigarette’s blood absorption pattern marked by a sharp peak and steep drop-off of nicotine levels. This pharmacological profile holds special appeal for smokers.”
The ministry also claims that vaping is as dangerous as inhaling tobacco smoke. Several long term studies of millions of smokers, including one published last year, have found that vaping does not have cancer promoting agents. Similar studies carried out previously – namely the one carried out by Public Health England and the one by BAT – had found that vaping is safer than smoking.
In line with these studies, data obtained from this latest research found that cigarette smoke has cancer-promoting agents, while e-cigarette vapor does not, hence confirming that e-cigarettes are a safer alternative to their combustible counterparts. Nor do e-cigarettes cause long term respiratory or cardiovascular damage. On the contrary, their use is associated with an improvement in such organ function.
FACED WITH such scientific evidence, the ministry and Israeli public-health activists claim that Juul is as addictive as cigarettes. But this statement is misleading. To be sure, nicotine is a drug that can induce dependence leading to outright physical or psychological addiction that makes quitting smoking or any tobacco use so challenging. On the one hand, that means e-cigarettes can allow smokers to get the same pharmacological response without the harmful effects of lighting up. On the other hand, there appears to be limited evidence of people using e-cigarettes as a stepping stone to smoking precisely because of that equipoise.
Finally, opponents have demanded banning e-cigarettes because they are a gateway to smoking. The Population Assessment of Tobacco and Health (PATH) Study – a national US longitudinal study of tobacco use and how it affects the health of people in the United States conducted by the FDA and the US Centers for Disease Control and Prevention – shows conclusively that E-cigarettes were and are used primarily by current smokers and recent former smokers. In fact, the CDC says that fewer than 4% people who had never tried traditional cigarettes have ever tried using a vaporizer.
The most reliable gateway to cigarette use are other smokers. In particular, military personnel are twice as likely to become smokers and stay smoking as civilians. As Rachel Widome, a researcher who tracks smoking patterns in the US military, has noted: “It is a stress reliever, something to do when you are bored, a way to socialize with other people and a way to take breaks.”
Because military service in Israel is mandatory, that means it is also the biggest gateway for smoking in the Jewish state. Indeed, a recent study of smoking rates in the IDF found that cigarette use increased by 39.4% during military service. About 8,000 Israelis die from smoking associated diseases each year, costing the nation about NIS 4 billion. A significant number of the dead are members of the IDF who survived combat only to fall to lung cancer, stroke and respiratory failure.
The ministry and e-cigarette companies could study if and how such cigarettes can reduce the deadly impact of smoking in the IDF. That would be in keeping with Israel’s relentless use of technological innovations to make the world safer and more sustainable.
The writer is Vice President of the Center for Medicine in the Public Interest.