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Distinct, risk-proportionate health advisory

Sometimes, it’s easier living the lie. – Catch Me If You Can

One size-fits-all is simply not feasible.

Indeed, even straightjackets are not viable solutions to address mayhem in a madhouse.

That’s why most cure-all remedies are even counterproductive.

True, there’s no stopping the ambulant snake-oil sales(con)man from plying his illicit trade in communities where regulators seldom tread.

Bur in jurisdictions where state public safety enforcement is tough, such ersatz, esoteric products cannot land on the shelves of shops, stores, and stalls.

Needless to say, consumer products are need-specific – they are manufactured to satisfy a particular craving or want.

Or to comply with a health or dietary requirement.

Consider caffeine-free coffee, non-dairy creamer, textured vegetable protein, low-sodium canned goods, diet soft drinks, and lately “Light” alcoholic beverages.

These products are specially formulated and custom-made for a particular, specific segment of the market.

Therefore, the mandatory “product information” declares the specific content to guide the consumer.

If so, why should “health risk warnings” have universal application over a range/variation of non-food consumer items?

For instance, health warnings for smoke-free products such as e-cigarettes or vapes and heated tobacco products should be proportionate to their risk as compared to combustible cigarettes.

This was the key message of Prof. Tikki Pangestu in his keynote speech during the 2nd Philippine Harm Reduction Online Forum on December 4.

“Health warnings on combustible cigarette packs should not be the same as those on the packaging of e-cigarettes and HTPs. This is because e-cigarettes and HTPs have been shown to be 90 percent to 95 percent less harmful than combustible cigarettes,” said Pangestu, visiting professor at the Yong Loo Lin School of Medicine at the National University of Singapore and former Director for Research Policy & Cooperation of the World Health Organization.

The implementing rules and regulations as prescribed by Republic Act 11346 and RA 11467 mandate the Department of Health to issue graphic health warning templates for the packaging of HTPs and vapor products including “inserts, and onserts, outside packaging, outside packaging and labeling, and any other wrapping” withdrawn from the manufacturing facilities, or imported into the Philippine customs territory.

“By all means, health warnings should be placed on e-cigarettes and HTPs as the laws and regulations mandate, but these should be proportionate to the risk of these smoke-free products,” stressed the WHO official.

For example, health warnings could state that smoke-free products are not completely free from harm but are significantly less harmful than combustible cigarettes which contain tar and carbon monoxide. The health warnings could also indicate that smoke-free products are for adults only and should not be used by the youth, he added.

The global picture on regulations for smoke-free products remains very mixed, with many countries still struggling with developing appropriate regulations, according to the academic.

“There are many factors to be considered in developing regulations, but in my view, such regulations must, in the first instance, be based on the science and evidence around smoke-free products.”

He noted that the Philippines and his native country of Indonesia look to the WHO for guidance on smoke-free products.

“Unfortunately, at this point in time, the WHO position on smoke-free products is quite negative, and even recommends banning some of these products in several countries.”

There are public health experts who strongly support the WHO position, but there are others, particularly those from NGOs, who advocate keeping an open mind on the potential of smoke-free products in helping people to quit smoking, he explained.

“But at the end of the day, the WHO cannot tell a country what to do and the final decision is up to the country,” the professor explained.

Ultimately, he continued, the policymakers, the Ministry of Health, and the regulatory agencies of individual countries must decide on their own based on various factors.

“For example, in the Philippines and Indonesia where there are a huge number of smokers, one factor to be considered could be the cost of smoking-related diseases to the healthcare system. The health risks of smoking in the context of noncommunicable diseases – heart disease, lung cancer, diabetes, stroke – are considerable in terms of economic costs and costs to the healthcare system.”

Pangestu said that he has participated in several congressional hearings on vapor products and HTPs conducted by the Philippine House of Representatives.

“I believe that the Philippine government is quite open to hear opinions and views from different [stakeholders], but at the end of the day the government has to make the decision. And a lot of these decisions are based not only on scientific evidence, and are influenced by a variety of factors such as political, economic, and socio-cultural.”

“The evidence available to date suggests that switching completely to smoke-free products has the potential to reduce the adverse effects of smoking on oral health. Based on the evidence at hand, I can recommend to my patients who are smokers to switch to e-cigarettes, which I consider as a harm reduction alternative to conventional cigarettes,” said Dr. Arleen Reyes, past president and former executive vice president and treasurer of the Philippine Dental Association, and currently the auditor of Asia Pacific Dental Federation.

“To date, there are no reported cases of periodontal diseases in persons who use e-cigarettes or HTPs,” . Reyes revealed. “At the end of the day, the best recommendation is still to quit smoking. But if the smoker cannot quit, he or she should at least shift to a less harmful alternative.”

The 2nd Philippine Harm Reduction Online Forum was organized by the Harm Reduction Alliance of the Philippines. HARAP is a national peer-run advocacy and capacity-building association that aims to promote harm reduction as part of the country’s public health policy, for the benefit of every individual’s right to well-being.

“Harm reduction refers to a range of practical strategies aimed at lessening the negative social and physical consequences associated with particularly risky human behaviors. Harm reduction policies or programs are supported by 84 countries worldwide, with 74 countries having explicit supportive reference to harm reduction in national policy documents. HARAP is hopeful that the Philippines will follow suit,” said Prof. Ron Christian Sison, HARAP lead convenor.

HARAP’s member organizations advocate for harm reduction in terms of HIV/AIDS control, road safety, air quality, dental public health, bio risk and bio security.

Its work is driven by its commitment to ensuring that individuals are made aware about and educated on harm reduction, its applications, and practices in their daily lives. The organization also stands for the social inclusion of marginalized communities, which oftentimes are the main beneficiaries of harm reduction practices.

Behold God’s glory and seek His mercy.

Pause and pray, people.

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