Does a cigarette that is not really a cigarette help?

In a country where smoking doesn't just kill you, your family and friends, but also any halfway decent movie watching experience (Woody Allen refused to bow to laws that require superimposition of anti-smoking ads in smoking scenes and did not release Blue Jasmine in India), it's a smart move to explore a few life-saving alternatives. The debates around the safety and efficacy of nicotine replacement therapies, or NRT, have been raging in the world for decades now, and only just making their way to India.  

The remedial administration of carefully monitored nicotine to the body by means other than inhalation of tobacco smoke depends on the hypothesis that a smoker is slowly weaned off tobacco while preventing cravings and other withdrawal symptoms. Nicotine gums, patches, lozenges, nasal sprays and electronic cigarettes, all fall under this umbrella term. Perhaps the most popular among them is the electronic cigarette. It is a battery-powered device that uses a heating element to vapourise a liquid solution made of propylene glycol, vegetable glycerine and added flavours in order to stimulate smoking. For heavy smokers used to smoking more than a pack a day, an e-cigarette offers a viable replacement to nicotine addiction and provides an outlet for oral fixation. 

E-cigs haven't really captivated the Indian market space as, say, in European and American markets, where they're selling in hundred different types and flavours at gourmet stores and mall kiosks. In India. those of the Chinese variety are readily available at the local panwari. Brands in the market include SteamLite, Health E Cigarettes, Vapours and Chinese alternatives that have drawn flak for lack of quality control. Imported European brands include XEO, Joytech, Pravog and Damfer. Prices for these range between Rs 600 and Rs 2,500.

Ajay Srivastava (name changed), a Delhi-based independent film maker who used to smoke a pack a day, has managed to cut down to one cigarette a day through "sheer will power and yoga". He says, "I believe electronic cigarettes are merely a passing fad."  KK Aggarwal, consultant for medicine and cardiology at Moolchand Hospital in Delhi, says all NRT options should strictly be tried out under medical supervision so that dosages can be monitored effectively. "E-cigs contain pure nicotine, an overdose of which can even precipitate a heart attack," says Aggarwal. "Moreover, they haven't been approved by either the Food and Drug Administration or World Health Organisation, and their safety and benefit claims are widely disputed."

A senior manager (who does not wish to be named) with Alchem Pharmaceutical, which manufactures nicotine solutions for e-cigs, says what makes them safer than regular cigarettes is the fact that there's no tar, no foul smell and the lack of carcinogenic impurities that arise from incomplete oxidation of tobacco.

However, Aggarwal cautions that since, as opposed to pharmaceutically manufactured gums and patches, the quantity of nicotine in e-cigarettes is unregulated and varied, it may lead to an addiction to the e-cigarette itself. Some products have even been known to contain harmful chemicals such as anti-freeze (used in car radiators) and various other contaminants.

Sajeela Maini, president of the Tobacco Control Foundation of India, corroborates Aggarwal's opinion, "I'm a strong advocate of NRT, but e-cigs are not an effective model of nicotine cessation and are considered mere hogwash within the medical community. I have personally seen high rates of success with combination therapy of nicotine gum plus patch, and psychotherapy."

With many people's New Years' resolutions hanging in the balance and the e-cig proving not such a miracle cure as it was thought to be, the important thing for smokers to remember is that the best way forward is to seek help from family, friends and, most importantly, medical health professionals. In the last half century, smoking rates have been dropping steadily in developed countries and climbing in developing countries. At the end of the day, it's all about breaking (the) bad (habit).