Riccardo Polosa heads up the Centre for Tobacco Research at University of Catania, Italy. He is the author of more than 250 peer reviewed articles and books, covering respiratory medicine, clinical immunology, and tobacco addiction. He is also the chief scientific advisor for Lega Italiana Anti Fumo (LIAF), the Italian Anti-Smoking League. As one of Europe’s top expert on e-cigarettes, he shares his views on the issues surrounding the regulation of such novel products.
What are your views on e-cigarettes and their influence on smoking so far?
As a scientist and expert on alternative methods for smoking cessation, I believe the e-cigarette is the most promising tool to assist smokers to quit or reduce smoking. Besides many clinical studies and research surveys, our daily personal experience in a busy smoking cessation center indicates that e-cigarettes are more efficient than nicotine replacement therapies (NRTs) and other antismoking drugs. We believe that the reason for their success is that for many smokers the e-cigarettes—which also replace many of the rituals associated with smoking—appears to facilitate a change in behaviour: from smoking to vaping. For smokers, switching from combustible tobacco products to much less harmful nicotine vaporisers is one of the best health investments.
My research group recently showed that asthmatic smokers who switched to regular e-cigarette use have benefited from it. Not only have they stopped smoking or substantially reduced the number of cigarettes, but they have also reported a substantial improvement in respiratory symptoms and pulmonary function.
How do you view Europe’s approach to e-cigarettes in terms of research and regulation?
Unfortunately, I have not seen any serious effort at EU level to advance our current knowledge about e-cigarettes. No money has been invested to fund independent research. But great effort has been spent to sabotage e-cigarette’s positive potential for public health instead. On one hand, the EU has been concerned about the lack of independent scientific evidence on e-cigarettes efficacy and safety. However, on the other hand, the EU has underestimated, misrepresented or even selectively ignored the already existent scientific evidence.
The EU’s approach, from a regulatory point of view, reflects the unethical and unprofessional attitude that has characterised their demonising campaign against these products. Indeed, the EU Tobacco Product Directive calls for restrictions on production, sale and advertising that are disproportionate and unjustified for a product that does not contain tobacco. A legal restriction in e-cigarettes innovation and diffusion is the true purpose of the EU Tobacco Product Directive.
It has been suggested that the US has dealt with this issue better especially in terms of taking a strategic approach and funding research questions?
I agree, but only to a certain extent. The Food and Drug Administration (FDA) appears to be taking a more strategic approach. It seems to recognise—better than other regulatory agencies—the value of informed discussion with experts, industry and consumers. Moreover, 273 million of dollars will be spent over the next five years by an ongoing inter-agency partnership between the FDA, the National Institute of Health (NIH) and the National Institute on Drug Abuse (NIDA) to fund research questions about tobacco-related research including e-cigarette specific issues.
This may seem good. But the evidence for informing future regulation will become so vast and disparate that the regulatory process will be paralysed by scientific overload. And it will be reduced to best identifying which research aligns with the political agenda. This risk is real given that many of those who have just received these funds have already made clear statements as to where they stand in relation to e-cigarettes research questions.
How would you describe the Italian approach to the regulation of e-cigarettes?
I could define Italian Government approach to e-cigarette legislation as “schizophrenic”. In a few months, our politicians moved from a ban to a tax, from the abolition of the ban to a reconsideration of the abolition. The Law 99/2013, art.18, is detrimental for the vapers, because the tax measures contained in the law would at least double the sale price of electronic cigarettes and accessories, thus conversely promoting the competitiveness and dominance of conventional cigarettes, with the obvious negative consequences for public health.
Ironically, this war against e-cigarette in Italy has not produced the desired reduction of tobacco consumption, but its revival instead. I hope that the timid opening shown in recent months by our politicians towards a revision of the e-cigarette legislation is not just a mirage. But that it shows a real awareness of the unintended consequences that disproportionate regulation might have for thousands of smokers and vapers.