Wednesday, February 27, 2019

Reaching for objects while driving may cause 7-fold increase in risk of teen car crashes

Teenagers who reach for objects, such as food or makeup, while driving increase their risk of crashing nearly seven times, according to National Institutes of Health (NIH) in a study published in the American Journal of Preventative Medicine, online Feb. 21, 2019. Also, manually dialing, texting or browsing the web on a phone while driving doubled the risk of vehicle crash.

The current study is the first to use real-time driving data to quantify the extent to which visual inattention — the amount of time a teen’s eyes shift from the road to various distractions — contributes to the risk of a crash.

Researchers followed 82 newly licensed teen drivers in Virginia over a one-year period, equipping their vehicles with cameras and GPS technology to track the driver’s activity and environment.

After one year, 43 of the drivers did not experience a crash, while 25 had one crash and 14 had two or more crashes.

Using six-second videos of driver behavior prior to a crash, researchers calculated that for every second that a teen’s eyes were off the road, the risk of a crash increased by 28% regardless of the type of distraction.

In addition to documenting a driver’s dialing, texting, browsing or reaching for a phone, researchers assessed numerous “secondary tasks,” including dancing to music, attending to personal hygiene, and eating or drinking. The greatest crash risks were found to be from visual distractions related to using cell phones and reaching for objects.

·         Teens manually using a cell phone doubled their odds of crashing.
·         Teens who were reaching for something while driving increased their risk nearly 7-fold, which researchers attributed to a combination of distractions, including taking their eyes off the road and their hands off the wheel.

In India, fatal road accident victims largely constitute young people in the productive age groups. Young adults in the age group of 18-45 years accounted for 72.1% of victims during 2017.

Several factors like inexperience, distracted driving, reckless driving, impaired driving, driving with other teen passengers put the young driver at greater risk of vehicle accidents.

The study authors suggest that teenage drivers may benefit from technological and behavioral interventions that will keep their eyes on the road at all times and discourage engagement in distracting secondary tasks.

 (Source: NIH, Feb. 25, 2019)

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

Wrong diagnosis does not amount to medical negligence: Supreme Court

We have sympathy for the appellant, but sympathy cannot translate into a legal remedy”

Dr K K Aggarwal

“We appreciate the pain of the appellant, but then, that by itself cannot be a cause for awarding damages for the passing away of his wife. We have sympathy for the appellant, but sympathy cannot translate into a legal remedy

The Supreme Court dismissed an appeal filed by a man against order of National Consumer Disputes Redressal Commission which dismissed his complaint alleging medical negligence on the part of a hospital in the death of his wife in the matter of Vinod Jain vs Santokba Durlabhji Memorial Hospital & Anr (Civil Appeal No. 2024 of 2019 Arising out of SLP(C) No.32721/2017, dated February 25, 2019).

The bench comprising of Justice L. Nageswara Rao and Justice Sanjay Kishan Kaul upheld the NCDRC order which had held that the case “would at best be a case of wrong diagnosis, but not medical negligence”.

The state commission had allowed his complaint and ordered a compensation of Rs.15 lakh, the national commission had set it aside.

The Apex Court discussed all the legal principles Bolam Test, Kusum Sharma & Ors. v. Batra Hospital & Medical Research Centre and Jacob Mathew v. State of Punjab while deciding the case.


In the early hours on 16.10.2011, the IV cannula stopped functioning and instead of re-cannulating the patient, oral and not IV administration of the antibiotic Cefpodoxime was done, which amounts to medical negligence.


The bench agreed with NCDRC approach and said:

“The explanation offered by respondent No.2-Doctor was that when he attended the patient at 11:00 a.m. on 16.10.2011, he found that the drip had been disconnected, on account of all peripheral veins being blocked due to past chemotherapies, and that the drip had been stopped, the night before itself, at the instance of the appellant. Taking into consideration the fact that the patient was normal, afebrile, well-hydrated and displayed normal vitals, the oral administration of the tablet was prescribed. This, according to the NCDRC was the professional and medical assessment by respondent No.2-Doctor, arrived at on the basis of a medical condition of the patient, and could not constitute medical negligence.”

“We see no reason to differ from the view expressed by the NCDRC, keeping in mind the test enunciated aforesaid Respondent No.2-Doctor, who was expected to bring a reasonable degree of skill, knowledge and care, based on his assessment of the patient, prescribed oral administration of the antibiotic in that scenario, especially on account of the past medical treatments of the wife of the appellant, because of which the veins for administration of IV could not be located. Her physical condition was found to be one where the oral administration of the drug was possible.”

“The appellant has also sought to make out a case that the blood culture report required his wife to be kept in the hospital. This was again a judgment best arrived at by respondent No.2-Doctor, based on her other stable conditions, with only the WBC count being higher, which, as per the views of the respondent No.2-Doctor, could be treated by administration of the antibiotic drug orally, which was prescribed for 5 days, and as per the appellant, was so administered. In the perception of the doctor, the increase in lymphocytes in the blood count was the result of the patient displaying an improved immune response to the infection. It is in this context that the NCDRC opined that at best, it could be categorised as a possible case of wrong diagnosis.”

Apex Court ruling

The apex court ruled that “In our opinion the approach adopted by the NCDRC cannot be said to be faulty, while dealing with the role of the State Commission, which granted damages on a premise that respondent No.2-Doctor could have pursued an alternative mode of treatment. Such a course of action, as a super-appellate medical authority, could not have been performed by the State Commission. There was no evidence to show any unexplained deviation from standard protocol. It is also relevant to note that the deceased was medically compromised by the reason of her past illnesses………….”  (Source Live law)

Some quotes from the judgment

In para 89 of the judgment in Kusum Sharma & Ors the test had been laid down as under:

“89. On scrutiny of the leading cases of medical negligence both in our country and other countries specially the United Kingdom, some basic principles emerge in dealing with the cases of medical negligence. While deciding whether the medical professional is guilty of medical negligence following well known principles must be kept in view:

     I.        Negligence is the breach of a duty exercised by omission to do something which a reasonable man, guided by those considerations which ordinarily regulate the conduct of human affairs, would do, or doing something which a prudent and reasonable man would not do.
    II.        Negligence is an essential ingredient of the offence. The negligence to be established by the prosecution must be culpable or gross and not the negligence merely based upon an error of judgment.
  III.        The medical professional is expected to bring a reasonable degree of skill and knowledge and must exercise 4 (1968) 118 New LJ 469 5 (supra) a reasonable degree of care. Neither the very highest nor a very low degree of care and competence judged in the light of the particular circumstances of each case is what the law requires.
   IV.        A medical practitioner would be liable only where his conduct fell below that of the standard so far reasonably competent practitioner in his field.
    V.        In the realm of diagnosis and treatment there is scope for genuine difference of opinion and one professional doctor is clearly not negligent merely because his conclusion differs from that of other professional doctor.
   VI.        The medical professional is often called upon to adopt a procedure which involves higher element of risk, but which he honestly believes as providing greater chances of success for the patient rather than a procedure involving lesser risk but higher chances of failure. Just because a professional looking to the gravity of illness has taken higher element of risk to redeem the patient out of his/her suffering which did not yield the desired result may not amount to negligence.
 VII.        Negligence cannot be attributed to a doctor so long as he performs his duties with reasonable skill and competence. Merely because the doctor chooses one course of action in preference to the other one available, he would not be liable if the course of action chosen by him was acceptable to the medical profession.
VIII.        It would not be conducive to the efficiency of the medical profession if no doctor could administer medicine without a halter round his neck.
   IX.        It is our bounden duty and obligation of the civil society to ensure that the medical professionals are not unnecessarily harassed or humiliated so that they can perform their professional duties without fear and apprehension.
    X.        The medical practitioners at times also have to be saved from such a class of complainants who use criminal process as a tool for pressurizing the medical professionals/hospitals particularly private hospitals or clinics for extracting uncalled for compensation. Such malicious proceedings deserve to be discarded against the medical practitioners.
   XI.        The medical professionals are entitled to get protection so long as they perform their duties with reasonable skill and competence and in the interest of the patients. The interest and welfare of the patients have to be paramount for the medical professionals.”

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

Tuesday, February 26, 2019

Vaccine travel advice: It’s time to have a National Vaccine Travel Advisory

The CDC regularly updates its Travel Health Notices and issues Travel Advisories, which inform American travelers about current health situations to specific international destinations on its website.

India is home to large variety of infectious diseases, which are endemic in different parts of the country.

So, when Americans and other international travelers are advised by their national public health bodies to take certain vaccines when traveling to India, why do we not have a National travel advisory for vaccines in place for interstate travel or when we travel from urban India to rural India?

We have attempted to draw up such a list and welcome your additions and suggestions on the same.

You should be up to date on routine vaccinations while traveling to any destination in India. Routine vaccines include: MMR, DPT, polio vaccine, hepatitis B, yearly flu and pneumonia.

Some additional vaccines may also be required for travel.

·         Hepatitis A: The infection may be acquired through contaminated food or water in India, regardless of where you are eating or staying.
·         Typhoid: One can get typhoid by eating or drinking contaminated food or water in India. If you are staying with friends or relatives, visiting smaller cities or rural areas, or if you are an adventurous eater.
·         Cholera: This vaccine is recommended for adults who are traveling to areas of active cholera transmission.
·         Malaria: Opt for malaria prophylaxis when traveling to any part of India, especially if traveling to areas of high endemicity; also if you are visiting low-altitude areas except none in areas >2,000 m (6,562 ft) in Himachal Pradesh, Jammu and Kashmir and Sikkim.
·         Japanese encephalitis: Consider JE vaccine, if your trip will last more than a month in areas with JE or rural areas or you will be spending a lot of time outdoors, even for trips shorter than a month.
·         Rabies: Rabies can be found in dogs, bats, and other mammals in India. Therefore, the following groups should take pre-exposure rabies vaccination. All travelers involved in outdoor and other activities (such as camping, hiking, biking, adventure travel, and caving) that put them at risk for animal bites or people who will be working with or around animals (such as veterinarians, wildlife professionals, and researchers) or people who are taking long trips and children, because they tend to play with animals, might not report bites and are more likely to have animal bites on their head and neck.
·         Yellow fever: There is no risk of yellow fever in India.
·         Deworming: All should take deworming tablet twice a year: 10th February (National Deworming Day) and 10th August (2nd round of National Deworming Day)
·         Meningococcal meningitis: People who travel to attend fairs and festivals, should take a single dose of bivalent vaccine 10-14 days before the scheduled visit. 

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

Medical Negligence: A Cross to Bear

Do surgeries where swabs and instruments are left inside the body of a patient fall under the ambit of criminal negligence and how have courts adjudicated in such matters?

By Dr KK Aggarwal

Recently, two doctors at Nizam’s Institute of Medical Sciences in Hyderabad were booked under Sections 336 and 337 of the Indian Penal Code for alleged medical negligence after surgical forceps were found in the abdomen of a woman who had undergone surgery last year. The forceps were surgically re­moved. Such cases where swabs and scissors are left behind after an operation are often reported in the media. Is this willful negligence or carelessness?

A retained surgical instrument is any item inadvertently left behind in a patient’s body in the course of surgery. As a preventable medical error, it occurs more frequently than “wrong site” surgery and it incidence has a reported rate of 0.01-0.001 percent. Of these, swabs make up 70 percent of the cases and the remainder, surgical instruments. The consequences of retained surgical tools include injury, repeated surgery, excess monetary costs, loss of hospital credibility and in some cases, death of the patient.

These errors are more common after an emergency surgery, an unplanned intra-operative change of procedure, changes in theatre staff and failure to count swabs in and out. An operation by a single surgeon carries a greater risk than when a team is involved. Other situations are obesity and a sudden change during surgical procedure (such as a change of surgeon). Whatever be the situation, the occurrence of a retained swab should not happen, and is classified by the National Patient Safety Agency as a “never event” and are classed as medical negligence in court judgments.

It is preventable by performing more than one in and out swab count (double checking and reporting to ensure that all swabs have been removed); having an adequate number of experienced staff; replacing small swabs by laparotomy pads and thoroughly searching the abdomen before closure of the wound. In one study of successfully litigated cases, a correct count of swabs had been noted in 88 percent of cases. This led to a call for bar-coded swabs which can be scanned on entry and exit to avoid human errors which are clearly still too prevalent.

Why are there fewer convictions?

Despite medical negligence being widely prevalent, why are there few convictions? For criminal negligence, one has to prove either a wrong intent or knowledge on the part of the doctor that a particular action is likely to cause harm and was still done without consent. Informed consent in most cases is the bridge between a wrong act and an untoward event.

Any adverse event or non-criminal medical negligence will attract compensation under the law of torts or the Consumer Protection Act. Today, compensation is awarded in upto 5-10 percent of consumer cases, which is a significant number. The indemnity insurance by national insurance companies also acknowledges medical negligence as acceptable for compensation. To err is human and no treatment is risk-free.

However, criminal negligence is a different matter altogether. In 2005, the Supreme Court in the Jacob Mathew case said: “Negligence in the context of medical profession necessarily calls for a treatment with a difference. To infer rashness or negligence on the part of a professional, in particular a doctor, additional considerations apply. A case of occupational negligence is different from one of professional negligence. A simple lack of care, an error of judgment or an accident, is not proof of negligence on the part of a medical professional. So long as a doctor follows a practice acceptable to the medical profession of that day, he cannot be held liable for negligence merely because a better alternative course or method of treatment was also available or simply because a more skilled doctor would not have chosen to follow or resort to that practice or procedure which the accused followed. When it comes to the failure of taking precautions what has to be seen is whether those precautions were taken which the ordinary experience of men has found to be sufficient; a failure to use special or extraordinary precautions which might have prevented the particular happening cannot be the standard for judging the alleged negligence. So also, the standard of care, while assessing the practice as adopted, is judged in the light of knowledge available at the time of the incident, and not at the date of trial. Similarly, when the charge of negligence arises out of failure to use some particular equipment, the charge would fail if the equipment was not generally available at that particular time at which it is suggested it should have been used.

“The jurisprudential concept of negligence differs in civil and criminal law. What may be negligence in civil law may not necessarily be negligence in criminal law. For negligence to amount to an offence, the element of mens rea must be shown to exist. For an act to amount to criminal negligence, the degree of negligence should be much higher i.e. gross or of a very high degree. Negligence which is neither gross nor of a higher degree may provide a ground for action in civil law but cannot form the basis for prosecution.”
—By Dr KK Aggarwal

Let us understand “never” events: These are situations where deficiency of service and/or negligence is presumed, and no trial of expert’s evidence is necessary (IMA vs VP Shantha and Spring Meadows Hospital v. Harjol Ahluwalia). Such cases can be speedily disposed of (Nizam Institute vs P S Dhananka). In another apex court judgment, decided on January 16, 2012, in Jaswinder Singh vs Santokh Nursing Home, the Court endorsed the National Consumer Disputes Redressal Commission judgment that “in such a surgical procedure, the surgeon is assisted by other Doctor and para medical staff like nurses, etc. who also owe a duty to count the mops used during the surgical procedure to ensure that all the mops/swabs so used had been retrieved before the operated organ is sutured. However, the surgeon cannot abjure of his/her overall responsibility even in that behalf and cannot be allowed to take the plea that it was not his/her concern to ensure that no mop/swab was left in the abdomen”.

In Achutrao Haribhau Khodwa vs State of Maharashtra on February 20, 1996, the apex court observed: “In cases where the doctors act carelessly and in a manner which is not expected of a medical practitioner, then in such a case an action in torts would be maintainable.” A tort is a civil wrong which unfairly causes someone else to suffer loss or harm resulting in legal liability for the person who commits the tortious act, called a tortfeasor. Although crimes may be torts, the cause of legal action is not necessarily a crime.

The victim of the harm can recover his loss as damages in a lawsuit. In order to prevail, the plaintiff in the lawsuit must show that the actions or lack of action was the legally recognisable cause of the harm. Tort law is different from criminal law in that torts may be created due to negligent, but not intentional and criminal actions. Tort lawsuits have a lower burden of proof.

When can such negligence be criminal negligence? Four IPC Sections can be applicable in such cases:

Section 304A, IPC: Causing death by negligence—whoever causes the death of any person by doing any rash or negligent act not amounting to culpable homicide shall be punished with imprisonment of either description for a term which may extend to two years, or with a fine, or both.

Section 336: An act endangering life or personal safety of others—whoever does any act so rashly or negligently as to endanger human life or the personal safety of others, shall be punished with imprisonment of either description for a term which may extend to three months, or with fine which may extend to Rs 250, or both.

Section 337: Causing hurt by an act endangering life or personal safety of others—whoever causes hurt to any person by doing any act so rashly or negligently as to endanger human life, or the personal safety of others, shall be punished with imprisonment of either des­cription for a term which may extend to six months, or with a fine which may extend to Rs 500, or with both.

Section 338: Causing grievous hurt by act endangering life or personal safety of others—whoever causes grievous hurt to any person by doing any act so rashly or negligently as to endanger human life, or the personal safety of others, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine which may extend to Rs 1,000 or both.

In Dr. R.R. Rana vs State on May 31, 2012, the Delhi High Court upheld the trial court framing charges under Section 338 IPC on the grounds that “in the instant case, the nature of injuries suffered by the wife of the complainant is grievous. While treating a patient for medical termination of pregnancy, the nature of injuries which the wife of complainant allegedly suffered (perforation of uterus and bowel) at the hands of the petitioner are such that no professional or skilled person in his ordinary senses and prudence could have caused. It appears that the petitioner did not have even the ordinary skill to perform the MTP”.

For any criminal liability, it needs to be shown that it was a gross case of reckless negligence. A private complaint is not supposed to be entertained by the police unless the complainant has produced prima facie evidence before the court in the form of a credible opinion given by another competent doctor to support the charge of negligence on the part of the accused doctor. The investigating officer should also proceed against the accused doctor by obtaining an independent and competent medical opinion, preferably from a doctor in government service qualified in that branch of medical practice who can normally be expected to give an impartial and unbiased opinion regarding the facts collected in the investigation.

It is obvious that such cases are not easy to tackle and unravel.

(This article dated February 24, 2019 has been reproduced from India Legal available at:

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

Monday, February 25, 2019

Chronic wasting disease detected in wild deer in the US: Could this be another emerging zoonosis?

Chronic wasting disease (CWD has been detected in wild deer, elk or moose in 24 states in the United States. It is a fatal progressive neurodegenerative illness, which was first identified in the 1960s and has been found in the US and Canada, Norway and South Korea.

·         It is a prion disease belonging to the same family as Creutzfeldt-Jakob disease, the human prion disease.
·         The incubation period is more than one year and some animals may be asymptomatic for years.
·         Symptoms when develop include drastic weight loss (wasting), stumbling (lack of coordination), listlessness and other neurologic symptoms. It can make them more aggressive and less afraid of human contact, according to the CDC.
·         An animal with chronic wasting disease can spread prions to other animals through direct or indirect contact with bodily fluids such as feces, saliva, blood, or urine.
·         There are no treatments or vaccines available for the disease.

The CDC has warned hunters to take precautions around potentially infected animals.

Since 1997, the World Health Organization has recommended that it is important to keep the agents of all known prion diseases from entering the human food chain.

The CDC has advised people not to handle or eat meat from deer and elk that seem sick or have been found dead. It says latex or rubber gloves should be worn when handling the meat and contact kept to a minimum, especially when handling organs such as the brain or spinal cord.

No cases of CWD have been reported in humans so far, but experimental studies have suggested a possible risk to humans and may emerge as a zoonotic disease in the future.

Wildlife disease surveillance may provide information of domestic and wild animal morbidity and mortality, identify changes in patterns of disease occurrence over time, and assist in early detection of disease outbreaks, including those linked to emerging diseases (World Organisation for Animal Health [OIE]).

Surveillance of disease in wild animals is challenging and not easy compared to surveillance in domestic animals. And, not many countries have animal health information systems and surveillance systems for animal diseases.

India has the largest number of deer species in the world. Hunting of all wild animals is banned in India under the Wildlife (Protection) Act of 1972, poaching or illegal hunting, killing or capturing of wild animals is still prevalent.

Wild animals serve as major reservoirs for transmission of zoonotic agents to domestic animals and humans.

So, it is important to be aware about the disease and prevent human exposure.

Like Nipah and Zika,  could this be another outbreak waiting to happen?

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

Can vaping be the answer for cancer prevention?

Emirates also has lifted the ban on the sale of vaping products

Earlier this week, the Emirates Authority for Standardisation and Metrology (ESMA) announced the lifting of a ban on the sale of e-cigarettes.  For the first time now, e-cigarettes and vaping devices will be legally sold in the UAE under new regulations, known as UAE.S 5030, which allow the sale of electronic cigarettes, electronic pipes, electronic shisha devices plus the liquid refills.

Under the new standards, Esma will regulate all nicotine components used in e-cigarettes including other details such as technical specifications, weight, list of ingredients, import, packaging, and labeling, among others.

Manufacturers will be allowed to sell the battery-powered products as long as they meet new standards and carry health warnings. E-cigarettes are expected to be available in stores from mid-April this year.

This carefully considered decision was made with the sole aim of protecting public health.

Until now it has been against the law for retailers to sell e-cigarette products, although it is not an offence to own or use one and they are widely available online. Legalizing these businesses will allow the relevant authorities to oversee the quality of products they sell and to enforce the prominent display of appropriate health warnings.

In recent years, there has been a significant cultural shift from traditional cigarettes to vaping. In some countries, electronic cigarettes are promoted as an effective way to quit smoking.

Is vaping safer than smoking?

Use of e-cigarettes or “vaping” has always been looked upon with suspicion. This is despite accumulating evidence, which shows them to be safer than the conventional combustible cigarettes.

Although generally perceived to be considerably similar, vaping and smoking are not alike. It therefore becomes important to understand the distinction between vaping and smoking.

Smoking is a practice in which a substance (tobacco) is burned and smoke is produced, which is inhaled into the lungs and is absorbed into the blood. When combustion occurs, new chemicals are formed via the process of oxidation. Hence, smoke contains thousands of new chemicals different from those initially burned.

E-cigarettes do not produce tobacco smoke, but an aerosol, which is commonly termed as “vapor”. Vaping is the act of inhaling and exhaling a vapor or an aerosol. Unlike smoke, when vapor is produced, no new chemicals are formed. The chemicals that are in vapor are the same as those found in the vaporized substance.

Therefore, the major and the most important difference between smoke and vapor is the presence of toxic tar and carbon monoxide in smoke. “People smoke for the nicotine, but they die from the tar” (BMJ. 1976) as it is the tar, which contains most of the mutagenic and carcinogenic agents in tobacco smoke.

An evidence review of e-cigarettes and heated tobacco products published in 2018 by the Public Health England has said “vaping is at least 95% less harmful than smoking.” “An advantage of e-cigarettes is that particular constituents can be removed or minimised in a way that is not feasible with tobacco cigarettes.”

As vaping does not involve combustion, no tar is produced and the resultant vapor has no carcinogens that are normally found in the cigarette smoke.

Long-term NRT-only and e-cigarette–only use, but not dual use of NRTs or e-cigarettes with combustible cigarettes, is associated with substantially reduced levels of measured carcinogens and toxins relative to smoking only combustible cigarettes, concluded a study reported in Annals of Internal Medicine in 2017.

According to a study published in Tobacco Control in 2017. “e-cigarette emissions have much less carcinogenic potency than tobacco smoke”.

In a report by its Tobacco Advisory Group titled “Nicotine without smoke. Tobacco harm reduction” and published in April 2016, the Royal College of Physicians has said, “Although it is not possible to precisely quantify the long-term health risks associated with e-cigarettes, the available data suggest that they are unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower than this figure.”

Do e-cigarettes help smokers to quit?

A key observation of the Public Health England report (2018) was that “in the first half of 2017, quit success rates in England were at their highest rates so far observed and for the first time, parity across different socio-economic groups was observed. It is plausible that e-cigarettes have contributed to this.”

The RCP further says, “Large-scale substitution of e-cigarettes, or other non-tobacco nicotine products, for tobacco smoking has the potential to prevent almost all the harm from smoking in society. Promoting e-cigarettes, NRT and other non-tobacco nicotine products as widely as possible, as a substitute for smoking, is therefore likely to generate significant health gains in the UK.”

A study reported as recently as January 2019 in the New England Journal of Medicine found that e-cigarettes were nearly twice as effective as conventional nicotine replacement products, like patches and gum, for quitting smoking. The success rate was 18% among the e-cigarette group as compared to 9.9% among those using traditional nicotine replacement therapy. 

Can vaping be the answer for lung cancer

Lung cancer is number one cancer in males in urban India and is linked to tobacco smoking. In one of the harm reduction conference organised by us it was concluded that there is no evidence that nicotine causes lung cancer. In a country like India amongst smokers to prevent lung cancer either they should quit or shift to less harmful non-tobacco inhalation products.  

e-cigarettes cut exposure to carcinogens (HT)

A recent study sponsored by JUUL Labs and conducted by Deletion Labs, and independent global research facility found that electronic cigarettes reduce harmful exposure to addictive nicotine and chemicals known to cause cancer and present a safe alternative to smoking. The study presented before the Society for Research on Nicotine & Tobacco 2019 annual meeting in San Francisco on Saturday has found that some advanced e-cigarettes reduce the exposure to carcinogens.
The study found that electronic nicotine delivery systems reduce harmful exposure to chemicals known to cause cancer and present a safe alternative to smoking. The study was based on a clinical analysis of biomarkers of smokers, non-smokers and people who vaped (used electronic cigarettes) using a closed nicotine-salt pod system (NSPS).
The study ‘e-cigarettes cut exposure to carcinogens (HT) Changes in Biomarkers of Exposure Associated with Switching for 5 Days from Combusted Cigarettes to Nicotine Salt Pod System’ by Joanna Jay et all explored whether switching from cigarettes to ENDS may potentially reduce exposure to key toxicants. 
Data was presented from a randomized, open-label, parallel-group, inpatient study of adult smokers that examined changes in primary urine and blood biomarkers of exposure (BOEs), relative to baseline, following a 5-day exclusive use period of the nicotine salt pod system (“NSPS”, JUUL Labs, Inc.) with one of four flavors at 5% nicotine strength (Virginia Tobacco, Mint, Mango, Crème), abstinence, or continued use of usual brand combustible cigarettes.
In the study ninety subjects were randomized into one of six cohorts: use of JUUL system (n=15 for each of the four flavors), use of usual cigarette (n=15), or abstinence (n=15).  Total nicotine equivalents, and the following biomarkers were measured in 24-hour urine collections: NNN, NNAL, 3-HPMA, MHBMA, S-PMA, HMPMA, CEMA, and 1-OHP. COHb was measured in blood. 
All subjects randomized to the use of NSPS (n=60 ITT) and usual cigarettes (n=15) completed the study; four subjects from the abstinence arm terminated early (n=11; 73% completion rate in-arm). Over the course of 5 days, mean total nicotine equivalents increased by 9% in the pooled NSPS group vs. 26% in the usual cigarette group (p>0.05).
Decreases in the mean levels of all non-nicotine BOEs were observed in the abstinence group and all four NSPS groups at Day 5 compared to baseline (Day -1); the cigarette group demonstrated increases in all BOEs except for 1-OHP and HPMA. The eight non-nicotine urine BOEs were reduced by an aggregate 85.3% in the abstinence group and 85.0% in the pooled NSPS group (99.6% relative reduction in aggregate biomarkers; p>0.05).
Similar reductions were seen in the pooled NSPS and abstinence groups for each individual BOE (p>0.05 for each analyte). In the usual cigarette group, these BOEs increased by an aggregate of 14.4% (pooled NSPS vs. usual cigarette; p<0.001 for each analyte). COHb was likewise reduced by 71.8% in the pooled switching group vs. 69.1% in the abstinence group (p>0.05), while increasing by 13.3% in the usual cigarette group (p<0.001).
These results support the hypothesis that complete switching from cigarettes to the NSPS may lead to meaningful reductions in multiple key, short-term biomarkers of exposure observed with combustible use. 
Incomplete switching from cigarettes to NSPS (dual-use) was not studied.
Main points
1.      The urine biomarkers for adult smokers who used NSPS for five days and those who didn’t smoke were almost at par, with the NSPS group reporting an aggregate mean reduction of 99.6% relative to the reduction associated with five days of abstention.
2.       The subjects were all healthy smokers between the ages of 22 and 62 years, with a minimum 12-month history of smoking 10 or more king-size manufactured, combustible cigarettes each day.
3.       The study found equivalent reductions in select short-term biomarkers of exposure between adult smokers who exclusively switched to JUUL products and those who abstained from smoking over a five-day period. (Source Hindustan Times)

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA