E-cig policy needs implementation
What to do about e-cigarettes is currently an extremely controversial issue in the areas of public health and addictions policy.
There is no doubt that Action on Smoking and Health Australia (ASH) and some tobacco control advocates, who were remarkably effective in reducing smoking in Australia, have been deeply traumatised by Big Tobacco’s unscrupulous behaviour.
Although ASH Australia, a national health group established in 1994 to reduce diseases, disabilities and premature deaths caused by tobacco products, closed in 2013, it continues to rally support through its website.
In May this year, Celeste Poulton, Project Officer at The George Institute for Global Health, reported on the ASH website that “The rise in the popularity of electronic cigarettes and non-cigarette tobacco products can be attributed to their endorsement by Big Tobacco, the lack of robust and long-term research and the common perception that they are safer than traditional tobacco products. A thorough review of the current scientific literature surrounding electronic cigarettes has revealed that they cause short-term harmful effects and have the potential to alter tobacco smoking, depending on model and usage patterns.
This contrasts starkly with the expert independent evidence review published in August 2015 by the UK governmentsÃ¢â‚¬â„¢ Public Health England (PHE). It concludes that e-cigarettes are “significantly less harmful to health than tobacco and have the potential to help smokers quit smoking. Key findings of the PHE review are that e-cigarettes are around 95% less harmful than smoking; nearly half the population (44.8%) don’t realise e-cigarettes are much less harmful than smoking; and that “there is no evidence so far that e-cigarettes are acting as a route into smoking for children or non-smokers. The review, commissioned by PHE and led by Professor Ann McNeill (King’s College London) and Professor Peter Hajek (Queen Mary University of London), suggests, “e-cigarettes may be contributing to falling smoking rates among adults and young people.
However expectations that the PHE report would be heavily criticised rapidly bore fruit in a commentary in Ã¢â‚¬ËœThe LancetÃ¢â‚¬â„¢ of 29 August 2015 entitled Ã¢â‚¬ËœE-cigarettes: Public Health England’s evidence-based confusionÃ¢â‚¬â„¢.
This in turn has provoked an attack on the editorial in Ã¢â‚¬ËœThe Lancet.Ã¢â‚¬â„¢
While all this academic wrangling is occurring, some tobacco control experts, who clearly have the ear of State and Federal governments, maintain that we should promote the “cult of the perfect in which, no matter what the cost to public health and well-being, Australian’s must be protected absolutely from the demons of nicotine and Big Tobacco. This philosophy contrasts with the “cult of the imperfect. A good example of the latter is Robert Watson-Watt who did not wait for 100% efficiency before he delivered early warning radar in time for the Royal Air Force to defeat the Luftwaffe in the Battle of Britain.
For ASH supporters, 95% less harm is not enough and the possibility that e-cigarettes may be contributing to falling smoking rates among adults and young people is a heresy requiring researchers and their evidence to be pilloried.
For the record, Ann McNeill is a Professor of Tobacco Addiction in the National Addiction Centre. She is Deputy Director of the UK Centre for Tobacco & Alcohol Studies (UKCTAS) — an international consortium of 13 universities. UKCTAS does not accept any funding, hospitality or gifts from the tobacco or alcohol industry or associated entities. Peter Hajek is Director of Tobacco Dependence Research Unit, at the Wolfson Institute of Preventive Medicine and a world leader in the development of smoking cessation treatments. His research is also free from tobacco industry funding.
The primary role of Public Health England is to support evidence-based public health policy rather than to encourage policy based on trauma and speculative myths. It will follow up the expert independent evidence review by “continuing to monitor the evidence on the uptake of e-cigarettes, their health impact at individual and population levels, and their effectiveness for smoking cessation as products and technologies develop.
PHE will also provide the public with accurate information on the relative harm of nicotine, e-cigarettes and smoked tobacco. It will commission the National Centre for Smoking Cessation and Training to “provide training and support to Stop Smoking practitioners to improve their skills and confidence in advising clients on the use of e-cigarettes.
Like Professors McNeill and Hajek, PHE is no friend of Big Tobacco. Hence it will “monitor tobacco industry involvement in the evolving e-cigarettes market and exercise continuing vigilance to protect public health policy from commercial and other vested interests of the tobacco industry.
Professors McNeill and Hajek and the PHE, unlike ASH supporters and current Australian governments, are not blind to the health needs of those who cannot or do not want to stop smoking and to the impact that this smoking may have on the non-smokers with whom they share our planet.
It is well established that rates of smoking are higher among older Australians and more disadvantaged Australians, including indigenous people. The negative impacts of smoking bans in prisons are already in the headlines but much overlooked groups are senior citizens in care homes and people confined to palliative care hospices in the last months of their lives.
The expert independent evidence review commissioned and published by PHE shows minimal and non-significant secondary smoking effects from e-cigarettes. The evidence is clear that e-cigarettes do not pose a significant health threat to prison warders or to care staff. This is important, not least because it means that, by encouraging and supporting aged and dying smokers to switch to e-cigarettes, it opens the door for them to benefit from aged-care and palliative-care support without the need to quit the use of nicotine.
Here in Australia it is time for our Federal Minister for Health, Sussan Ley, to sit down with the Federal Opposition Shadow Health Minister, Catherine King and calmly and thoughtfully digest the PHE expert independent evidence review. Having done so, the next step is for them is to attend a COAG Health MinistersÃ¢â‚¬â„¢ meeting where evidence-based policy on e-cigarettes can be agreed and implemented nation wide.
Australian’s are not well served by governments that are afraid of the big bad wolf, even when that wolf is Big Tobacco. Australian’s expect and deserve an evidence-based health policy that extends dignity, freedom and choice to all, while at the same time reducing harm.
Professor Ross Fitzgerald is an Australian academic and political commentator. He is the author of 37 books.
The Weekend Australian, September 19-20, 2015, Inquirer, p 26