Doctors urged to recommend e-cigarettes to help smokers quit habit

The AMA says research had found the concentration of nicotine varied widely in e-cigarette solutions.

SIAN POWELL
April 6, 2018
The Australian

The battle over e-cigarettes has flared again with a scientific paper declaring doctors have an ethical obligation to consider recommending them for patients who cannot stop smoking.

Written by University of NSW conjoint associate professor Colin Mendelsohn, and published today in the Internal Medicine Journal of the Royal Australian College of Physicians, the paper cites research that found smokers who switched to e-cigarettes had significant health improvements, including improvements in asthma, chronic obstructive pulmonary disease, blood pressure, cardiovascular health, lung function and pneumonia risk.

It also noted that recent studies in the US and Britain, where ­­e-cigarettes are legal, found the new models of e-cigarettes, particularly, were associated with higher success rates in quitting smoking.

However, Professor Mendelsohn’s position is contrary to the stand of the Australian Medical Association, the Thoracic Society and the Australian government, all of which have said smokers should give up smoking, but have shied away from endorsing e-­cigarettes as a useful temporary option for hard-core smokers.

An Australian parliamentary committee concluded last week that the ban on e-cigarettes should remain, saying “current regulatory arrangements for nicotine e-cigarettes remain appropriate” and “further research into the health impacts is needed”.

However, a minority report found e-cigarettes could help smokers who had tried and failed to quit. E-cigarettes, the report said, “could save many thousands of lives” and they should be available “as a consumer good to Australians”.

In its submission to the parliamentary inquiry, the AMA said “e-cigarettes should not be seen as a socially acceptable alternative to smoking, and their safety and usefulness as quit-smoking aids had not been established”.

The AMA also said research had found the concentration of nicotine varied widely in e-cigarette solutions, and nicotine had been found in solutions that were claimed to be nicotine-free.

Professor Mendelsohn said the line taken by the AMA and others was a matter of “group think”, and represented a failure to understand the broader principles of harm minimisation, a failure that hampered the establish­ment of Sydney’s medically supervised injecting room in 2001, and even the introduction of seatbelts, which some early nay-sayers thought would encourage speeding.

“Some people simply can’t stop smoking”, he said, adding that the policy of “stop smoking or die” was not helpful, given the high numbers of Australians who actually were dying from smoking. About three million Australians smoked, he said, and it was generally accepted that two in three of them would die prematurely from a smoking-related illness.

Smoking rates across Australia had stalled over the past three years, he added, despite very high prices for cigarettes and plain packaging.

“It’s a huge public-health issue,’’ he said. “I know it’s controversial, but other Western nations are moving forward on this, while Australia is falling behind.’’

E-cigarettes, battery-powered devices that heat and vaporise a liquid to ­deliver nicotine, do not have the tar, carbon monoxide and other chemicals of combustible cigarettes.

About 240,000 people in Australia use them, Professor Mendelsohn said, despite the fact that it was difficult to obtain them ­legally, requiring a doctor’s prescription.