New Delhi: A call by two oncologist-researchers at the All India Institute of Medical Sciences (AIIMS), Delhi to review India’s policy on e-cigarettes has prompted the institute to distance itself from their opinion saying it opposes all forms of tobacco and nicotine use.
E-cigarettes, or Electronic Nicotine Delivery Systems (ENDS), are devices which work on batteries to simulate features of conventional tobacco smoking. In 2019, India banned their sale, storage and manufacture—but not its usage—by enacting the Prohibition of Electronic Cigarettes Act (PECA).
These devices were previously banned by 18 states under The Drugs and Cosmetics Act, before being taken on a pan-India level on the basis of a white paper by the Indian Council of Medical Research (ICMR), said Dr Rakesh Gupta, president of the Chandigarh-based Strategic Institute for Public Health Education and Research.
In an opinion piece published last week in JCO Global Oncology, oncologists Dr Vaibhav Sahni and Dr Abhishek Shankar wrote that “it seems timely to examine the effects of this ban in light of current evidence which has evolved significantly since the ban, and it might be considered unfortunate that an evolution in policy has not accompanied this”.
The journal by the American Society of Clinical Oncology is among the most prestigious publications on cancers worldwide.
Why the controversy
Proponents of e-cigarettes who pitch these devices as a tobacco cessation tool often cite it as being 95 percent less dangerous than conventional cigarettes, but specialists say these claims are not backed by scientific evidence.
The World Health Organisation (WHO) says that while long-term health effects are not fully understood, e-cigarettes generate toxic substances—some of which are known to cause cancer and some that increase the risk of heart and lung disorders.
Use of e-cigarettes can affect brain development and lead to learning disorders for young people, according to the UN health research body.
Children of 13–15-years old are using e-cigarettes at rates higher than adults in all its regions, it said. In Canada, the rates of e-cigarette use among 16–19-year-olds has doubled between 2017–2022, while the number of young users tripled between 2019 and 2022 in the UK.
“Even brief exposure to e-cigarette content on social media can be associated with increased intention to use these products, as well as more positive attitudes toward e-cigarettes,” it said.
Studies consistently, the UN body added, show that young people using e-cigarettes are almost three times more likely to use cigarettes later.
Yet, the AIIMS oncologists contended, e-cigarettes are available for sale at shops and through online platforms, which may not even verify the purchaser’s age and even offer home delivery.
“.. a complete ban on such products can (and has) routed demand towards illicit marketing,” they wrote in the article titled, ‘Impact of Banning Electronic Nicotine Delivery Systems in India.’
The oncologists also opined that e-cigarettes have been demonstrated to help people quit smoking as evidenced by data supporting elevated quit rates and that there is also evidence of moderate certainty that cigarettes with nicotine have greater quit rates in comparison with those without nicotine.
“E-cigarettes with nicotine when compared with no treatment/usual care has also been evidenced to be of benefit albeit with risk of bias,” they wrote.
In a statement Sunday, the AIIMS reiterated its “clear and long-standing position opposing any form of tobacco and nicotine use, including e-cigarettes”.
“The Institute clarifies that individual opinions and their conclusions are solely the responsibility of the respective principal investigators and research teams, and do not represent the official stance or endorsement of AIIMS as an Institution.
“The Institute reaffirms its commitment to rigorous scientific standards, emphasizing that only studies reviewed and formally adopted by its expert committees or management are considered its official position,” the public health research institute said
It, the AIIMS added, supports data-driven, evidence-based medical practice and policy and notes that any interpretation or communication of unapproved should not be attributed to the institute as a whole.
Cessation tool?
Dr Ravi Mehrotra, a cancer researcher associated with the WHO’s International Agency for Research on Cancer (WHO-IARC), underlined that even the manufacturers don’t claim that ENDS are cessation devices.
While the WHO agrees that long-term effects are not known, Indian health bodies have expressed concern that the use of e-cigarettes could lead to nicotine addiction in non-smokers, particularly the young, and act as a gateway to conventional tobacco use.
The often quoted 95 percent less dangerous number is without solid medical evidence, Mehrotra, who has previously headed the ICMR- National Institute of Cancer Prevention and Research, told ThePrint.
“Doctors have compared vaping to jumping from the sixth floor versus the tenth floor of a building, if smoking cigarettes,” he explained, adding that there were no strategies to help addicts of vaping.
The WHO says that the tobacco industry profits from destroying health and is using these newer products to get a seat at the policy-making table with governments to lobby against health policies.
The industry funds and promotes false evidence to argue that these products reduce harm, while at the same time heavily promoting these products to children and non-smokers and continuing to sell billions of cigarettes, the international health agency adds.
Dr Arjun Singh, scientist and head surgeon at Mumbai-based Tata Medical Centre, said India’s e-cigarette ban must remain, as no amount of “harm reduction” rhetoric can obscure the growing body of evidence showing that these devices inflict serious and potentially irreversible damage.
E-cigarettes expose users—not only to ultrafine particulates but also to carcinogens like formaldehyde and acrolein—known to induce DNA damage, increase cancer risk, and impair cardiovascular health, he said.
Alarmingly, long term vaping has been linked to permanent lung scarring and diminished respiratory function, and studies reveal cellular alterations in the mouth akin to those found in smokers—raising serious cancer concerns.
Worse still, e-cigarettes are not only ineffective in curbing nicotine dependency—they may in fact perpetuate it.
Most users continue smoking alongside vaping, with dual use offering no reduction in harm, Dr Singh said, adding that at the population level, cessation outcomes are mixed at best: one major review concluded there’s no clear improvement in quit rates or relapse prevention, while WHO has repeatedly asserted that e cigarette products are not proven cessation aids and may generate adverse population health outcomes.
According to him, the gravest danger lies in youth uptake. Young people are being actively enticed by flavored and glamorized vaping products, resulting in soaring initiation rates—even among those who never smoked before.
The trajectory of the “gateway effect” is unmistakable: e-cigarette use has been directly linked to progression toward combustible cigarettes and even other substances like cannabis and opioids, he pointed out, adding that this is neither hypothetical nor distant—it threatens to reverse decades of hard won tobacco control progress.
The concern, stressed the clinician scientist, that a ban fuels illicit trade is not a sufficient reason to legalize harmful products.
“Stronger customs checks, stricter penalties, and better enforcement can curb illegal supply without normalizing use. The analogy to liquor bans is also flawed—alcohol has deep social and historical integration, whereas e-cigarettes are a recent, avoidable public health threat,” he said.
India is still suffering the most from the so called “harm reduction” from smokeless tobacco and areca nut and this is just another ploy, Dr Singh maintained.
(Edited by Tony Rai)
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