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Korea Electronic Cigarette News

Time: 2022-06-19

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Korea Herald: E-cigarette health risks and loose regulations spark controversy in South Korea

South Korea's anti-smoking fight has had some success, according to South Korean media outlet The Korea Herald.

When the first nationwide smoking prevalence survey was conducted in Korea in 1998, more than 35 out of every 100 Korean adults were smokers.

However, a closer look at the data reveals some troubling trends: E-cigarettes and unconventional tobacco products are gaining a strong foothold here, while tobacco use among teens and women is also on the rise.

The country's latest anti-smoking campaign, unveiled on May 31, shows the front lines of its tobacco control policy. The campaign's tagline says there is no safer cigarette.

The problem is that authorities and regulations are lagging behind the growing alternative tobacco industry. In fact, some new products are not even classified as tobacco products by local laws, meaning they are not subject to strict tobacco-related regulations.

When Koreans say e-cigarettes, they tend not to distinguish between different types. For Koreans, e-cigarettes refer to actual products that generate an aerosol by heating a liquid containing nicotine, as well as heated tobacco products (HTPs) that heat treat tobacco leaves and allow users to inhale nicotine.

The legal status of e-cigarettes and HTPs in the country has also been ambiguous, to say the least. Some are not technically or even legally classified as cigarettes under the Tobacco Commerce Act.

The Act defines tobacco as a product of which leaf tobacco is the raw material, in whole or in any part, used for chewing, smelling, smoking, sucking or inhaling. The key term here is tobacco leaf, which means that cigarettes made using other parts of the tobacco plant (such as stems or roots) or synthetic nicotine are not regulated by the Act.

This is in line with the WHO Framework Convention on Tobacco Control, an international treaty ratified by 180 countries around the world, which also defines tobacco products as products made from tobacco leaves.

Most tobacco products in the country use nicotine extracted from tobacco leaves, which fall under the legal category of tobacco, but some use nicotine derived from other parts of the tobacco plant.

Lawmakers and activists in the country have been calling for changes to the law to include ingredients derived from all parts of the tobacco plant, not just the leaves.

In 2019, then-lawmaker Kim Seung-hee (currently President Yoon Seok-yeol's candidate for welfare minister) proposed such a revision, calling the attention of all lawmakers and policymakers due to the COVID-19 pandemic. The National Assembly is currently awaiting a similar amendment to the law.

Lee Sung-gyu, director of the Korea Tobacco Control Research and Education Center, said it was necessary to expand the definition of the World Health Organization's Framework Convention on Tobacco Control and the country's laws.

"Legal blind spots are one thing, but basically there is no way to regulate the entry of new tobacco products into the Korean market," he said.

Another regulatory-related issue concerns flavored materials, especially those widely used in e-cigarettes.

In the U.S., youth vaping has been described as an epidemic as thousands of children's flavors drive the popularity of e-cigarettes among young adults.

The country passed the Family Smoking Prevention and Tobacco Control Act in 2009, which banned the use of flavored cigarettes other than menthol or tobacco, and other countries, including Canada, Brazil and several countries in the European Union, have implemented bans to varying degrees.

In South Korea, which currently has no regulation on flavored tobacco, its sales have grown from 270 million packs in 2011 to 1.38 billion in 2020, while overall cigarette sales fell from 4.4 billion to 3.59 billion in the same period.

The only legal restriction related to flavor additives is Article 9-3 of the National Health Promotion Act, which states that any flavor added to tobacco shall not be identified in the form of text, pictures or photographs on the packaging or advertising of the product.

How dangerous are they?

The modern concept of electronic cigarettes was first proposed by a Chinese pharmacist. For nearly 20 years, a question that has haunted everyone's mind is how harmful e-cigarettes are to your health compared to regular cigarettes.

In January 2018, the National Academies of Sciences, Engineering, and Medicine released a consensus report of 800 different studies that concluded that e-cigarettes contain and release many potentially toxic substances.

The study focused on e-cigarettes that use e-liquids -- liquefied products used in nicotine-containing e-cigarettes -- and the aerosols they produce, acknowledging the biological plausibility that long-term exposure to e-cigarette aerosols may increase cancer risk and adverse reproductive outcomes risks of.

While not many would say aerosols from e-cigarettes or HTPs are harmless, researchers are divided on how harmful they are to humans.

Philip Morris Korea, one of the leaders in the HTP market in South Korea, insists that the aerosols in its products contain far fewer harmful chemicals than regular cigarettes.

The U.S. Food and Drug Administration approved an exposure reduction claim for the company's Iqos 3 system stand and charger in March, allowing it to market the product in the U.S. with the following exposure information: The Iqos system heats tobacco but doesn't burn it.... ..this significantly reduces the production of harmful and potentially harmful chemicals...Scientific studies show that switching completely from traditional cigarettes to the Iqos system can significantly reduce your body's exposure to harmful or potentially harmful chemicals.

The FDA emphasizes that authorization does not mean the product is safe or FDA-approved.

But explanations for this vary. Following Philip Morris International's first application in 2016, researchers in the UCSF Department of Clinical Pharmacology investigated it and found that the company reported 93 harmful and potentially harmful ingredients in the FDA's list of harmful and potentially harmful ingredients. There are only 40 levels. Potentially Hazardous Constituents (HPHC) in Iqos Mainstream Aerosols.

"The data (from Philip Morris International) appear to support PMI's claim that Iqos reduces exposure to HPHC. However, the PMI data also shows that several substances the FDA does not recognize as HPHC are in the The levels in Iqos emissions are significantly higher than in combustible cigarette smoke," the researchers concluded in their study.

In a 2020 report, Dr. Cho Hong-jun of the Department of Family Medicine at Asan Medical Center noted that PMI's preliminary report did not disclose the exact levels of harmful substances that may be present in HTP other than combustible (regular) cigarettes. "This suggests that HTP may cause diseases other than those caused by combustible cigarettes," he wrote.

Cho continued that the lower levels of HPHC in e-cigarettes and HTPs as defined by the FDA do not directly translate into health benefits compared to regular cigarettes. This is because the relationship between exposure and effect is nonlinear for cardiovascular disease. "Duration of exposure is more important than exposure level in determining lung cancer mortality," he added.

"Therefore, tobacco control measures should be the same for e-cigarettes, HTPs and combustible cigarettes," he concluded.

KT&G -- the country's leading tobacco company that recently took the top spot in the HTP market -- has avoided commenting publicly on the issue in the past. However, it has recently changed its stance. "HTP is an alternative product (cigarettes) and we (KT&G) believe they should be regulated differently than cigarettes," the company told the Korea Herald.

Besides steam, another possible health risk lies in the device itself.

Before the world was taken over by COVID-19, there was an outbreak of vaping or e-cigarette use-related lung injury (EVALI) between mid-2019 and early 2020. Vitamin E acetate -- an additive in some THC-containing e-cigarettes -- is responsible for the disease, but other chemicals have not been ruled out.

The patients, nearly all Americans, were found to have been using unregulated marijuana vaping products.

Some countries, such as Canada, regulate vaping devices under the Canadian Consumer Product Safety Act, but this is not the case in South Korea. Under current law, e-cigarette devices are not considered tobacco products and are not regulated by the Tobacco Commerce Act.

There have been calls for a comprehensive government effort to tackle e-cigarettes and HTP. In addition, there are calls for revealing exactly how well they affect health and how much they should be regulated. The South Korean government established a pan-governmental task force on the health risks of e-cigarettes and HTP following the EVALI outbreak, but its activities were restricted by the ensuing COVID-19 pandemic.

Since cigarette-related issues involve multiple social sectors including public health, industry and law, Lee, head of the Korea Tobacco Control Research and Education Center, said pan-government efforts are needed to solve the problem. He also stressed the importance of raising public awareness of the potential health hazards of e-cigarettes.

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