‘As the only pharmacist in this place…’

Canberra Parliament House

Pharmacist politician Emma McBride has waded into the e-cigarettes debate, saying there is no evidence they are safe or less harmful than combustible cigarettes

On Monday, Labor MP Mike Freelander moved that the House of Representatives acknowledge the recent Standing Committee inquiry into e-cigarettes and the fact that it did not find e-cigarettes or personal vaporisers to be health products or a universally-accepted smoking cessation tool – and could be a “gateway” into tobacco and nicotine for non-smokers.

“There is a rotten smell in this building and it smells like big tobacco,” he said, saying that the tobacco industry has pressured the Senate into recommending “yet another” inquiry into e-cigarettes.

There has been significant debate about the regulatory status of nicotine liquids for vaping, with the TGA’s Adjunct Professor John Skerritt recently outlining three potential regulatory paths for the products – two of which would be through bricks-and-mortar or online Australian pharmacies.

Emma McBride rose in response to Mr Freelander’s motion to call vaping a “Trojan horse” for the marketing of tobacco products.

“As the only pharmacist in this place and someone trained in nicotine addiction and smoking cessation, I thought it was important to bring the debate about e-cigarettes back to where it should be and to examine some of the key facts,” the former hospital pharmacist said.

“First, no brand of e-cigarette has been approved by the TGA for assisting people to quit smoking.

“Systematic evidence and quality trials have found no conclusive evidence that e-cigarettes are an effective quit aid or that they are more effective than approved, established methods for quitting smoking.

“According to NHMRC reports, e-cigarette use in nonsmokers is associated with future uptake of tobacco cigarette smoking, countering claims that e-cigarette use is mainly by long-term smokers to help them quit.

“The market for e-cigarettes is clearly young people and the tobacco industry’s profit drivers to addict a new generation. Current use of e-cigarettes among Australian teenagers aged 14 to 17 is 17.5%, second only to 18- to 24-year-olds, with the highest usage rate, of 18.7%.

“As leading respiratory physician Professor Matthew Peters points out, documentary evidence suggests kids who use vaping are three to four times more likely to go from e-cigarettes to smoking.

“Vaping is what the Public Health Association of Australia has called a Trojan Horse to effectively market tobacco products. Australia has an outstanding record of protecting young people from the harms of tobacco and nicotine, which we must protect.”

She asked decision-makers to “call out false claims by lobbyists that reductions in smoking prevalence have stalled or slowed as a means of aggressively promoting e-cigarettes as a quit method”.

“Let’s debunk a myth: the claim that e-cigarettes are safe or less harmful than smoke cigarettes,” Ms McBride told Parliament.

“There is no scientific basis for this claim. The health impacts from exposure to foreign substances—for instance, asbestos—can take decades to appear, and there is growing evidence to suggest that long-term inhalation of e-cigarette liquids or vapours is likely to pose health risks.

“Worldwide, millions of young people, who on previous trends were otherwise at no risk of harm from smoking or e-cigarettes, are using e-cigarettes, and many are now smoking because of e-cigarettes.”

She noted that the ingredients in liquids for vaping are unknown.

“Labelling of e-cigarettes and e-liquids has been found to be incomplete or inaccurate,” she said.

“Products have been found to contain chemicals that were not listed on the label, or the label has stated incorrectly that they didn’t contain potentially toxic chemicals despite analysis confirming their presence.

“There might also be wide variations between the levels of nicotine stated on packaging and the amount contained in e-liquid. One study comparing identical models of e-cigarettes found nicotine content varied by up to 12% within batches and up to 20% between batches.

“What we do know is that e-cigarette liquids or vapours might also contain potentially harmful chemicals that are not present in smoke from tobacco cigarettes, that e-cigarettes might expose users to metals such as aluminium, arsenic, chromium, copper, lead, nickel and tin, that the rise in popularity of e-cigarette use has corresponded with an increasing number of reported nicotine poisonings due to exposure to ingestion of e-liquids, and that e-cigarette use exposes both users and bystanders to particulate matter that might worsen existing illness or increase the risk of developing cardiovascular or respiratory disease.”

She cited comments by expert Professor Matthew Peters, who has said that the long-term effects of vaping are still unknown – but that short-term effects include “onset of pneumonia and other lung diseases”.

“Australia has done fantastically well to reduce smoking rates,” Ms McBride said.

“Current rates for people in the 14-to-17 age bracket are between three and four per cent. These figures are the envy of the world, and there is a desperate need to avoid introducing a product that risks increasing rates.

“We must protect young people from this scourge of nicotine.”

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  1. Ron Batagol

    Key points well summarised by Emma!!!

  2. A M

    Does vaping cause cancer?

    • CathyWotiff

      Carcinogenic compounds, and carcinogenic metabolites are demonstrated to be present in e-cigarette users and arise through e-cigarette use in animal studies, however, due to the short time frames that e-cigarettes have been in use the risk of developing cancer is not yet clear.

      • A M

        You would recommend smoking over vaping then?

        • CathyWotiff

          I would recommend quitting all smoking and vaping products

          • Zach Evans

            And those who can’t quit smoking? You wouldn’t recommend they switch to a safer alternative that’s at least 95% safer than smoking? Anyone reading this please don’t listen to the nonsense from Cathy. Trust the world renowned Royal College of Physicians who maintain vaping is no more than 5% as harmful as smoking and likely closer to 1%.

          • CathyWotiff

            I refer you to the Lancet’s debunking of the ‘95% safer’ figure- v386, issue 9996, p829, August 29, 2015. They advise that this figure was estimated by a committee with no prespecified expertise in tobacco control and was based on an absence of evidence of harm at the time.

          • Zach Evans

            You need to keep up with the current research. Health organisations around the world maintain that e-cigarettes are at least 95% safer than smoking and that is a conservative estimate. Likely 99% safer. The estimate is based on reviews of all the currently available evidence. Not just from a committee. How do we know it’s safer? It’s based on toxicology studies of vapour vs smoke and human bio markers looking for harm in humans. Vaping is orders of magnitude safer than tobacco smoking. They also are at least twice as effective as NRT at helping people quit smoking. Smoking rates plummet When vaping is available and recommended for smokers.

          • CathyWotiff

            So which tobacco company do you work for Zach?

          • Zach Evans

            I don’t and never have. I’m a former smoker who quit smoking overnight using an e-cigarette. Been smoke free now for almost 8 years. My lungs are clear. My blood pressure is great and I’ve barely had a cold in 8 years. I’m one of millions around the world.

            The vast majority of the vaping industry has nothing to do with tobacco companies. In Australia there are currently zero vaping companies or products owned by big tobacco. I’m clearly against smoking so your attempts to smear me look rather pathetic.

          • CathyWotiff

            To be fair, your responses are right out of the Big Tobacco Copybook-

            1. Dispute public health information
            2. Disseminate misleading research and information (noting that you have provided no references for your assertions)

            90% of e-cigarette products sold globally are made in China and the vast majority of e-cigarettes are imported to Australia so stating that no Australian e-cigarettes are owned by tobacco companies is irrelevant.
            The major international tobacco companies have invested heavily in e-cigarettes in recent years, and tobacco companies now own many of the top e-cigarette brands. See Mathers, A., Hawkins, B., & Lee, K. (2019). Transnational Tobacco Companies and New Nicotine Delivery Systems. American journal of public health, 109(2), 227–235. https://doi.org/10.2105/AJPH.2018.304813

          • Zach Evans

            E-cigarettes are at least 95% safer than smoking. Straight from U.K. public health and government.

            Also from world renowned royal college of physicians.

            Smokers who switch to vaping could soon ‘have healthier hearts’

          • CathyWotiff

            Ah, yes, thank you, notably all UK based sources. One from 2015, one from 2016 and the third from 2019 but citing a tiny study of 115 smokers.
            The UK committed itself to supporting the use of e-cigarettes far too early and is now doggedly sticking to its guns, despite mounting evidence.

            Here are a few more recent references for very large studies /meta-analyses that you may find helpful:

            1. Electronic Cigarette Use and Incident Respiratory Conditions Among US Adults (https://jamanetwork.com/article.aspx?doi=10.1001/jamanetworkopen.2020.20816&utm_campaign=articlePDF%26utm_medium=articlePDFlink%26utm_source=articlePDF%26utm_content=jamanetworkopen.2020.20816)

            Finds that e-cigarette use is associated with an increased risk of developing respiratory disease independent of cigarette smoking

            2. European Union Scientific Committee on Health, Environmental and Emerging Risks (SCHEER) Preliminary Opinion on Electronic cigarettes (2020) (https://ec.europa.eu/health/sites/health/files/scientific_committees/scheer/docs/scheer_o_017.pdf)

            Finds weak evidence for the support of electronic cigarettes’ effectiveness in helping smokers to quit and that the overall weight of evidence for risks of long-term systemic effects on the cardiovascular system is strong.

            3. American Journal of Epidemiology: E-Cigarette Use to Aid Long-Term Smoking Cessation in the US: Prospective Evidence from the PATH Cohort Study (2020) (https://pubmed.ncbi.nlm.nih.gov/32715314/)

            Results suggest that e-cigarettes may not be an effective cessation aid for adult smokers, and instead may contribute to continuing nicotine dependence

            4. Role of e-cigarettes and pharmacotherapy during attempts to quit cigarette smoking: The PATH Study 2013-16 (2020) (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467279/)

            Among US daily smokers who quit cigarettes in 2014–15, use of e-cigarettes in that attempt compared to approved cessation aids or no products showed similar abstinence rates 1–2 years later.

          • Zach Evans

            None of your links are working and besides none of this changes the scientific fact that vaping is vastly safer than smoking. The U.K. are seen as world leaders in this field. The reduction in smoking rates in the U.K. speak for themselves. It has been a great success and will only get better as devices improve and deliberately harmful and misleading stories from the US and Australia are put into perspective. So far there are no identified harms resulting from the use of e-cigs in the 15 years they’ve been available. Millions have quit smoking by using them.

            The scientific evidence in favour of nicotine vaping gets stronger. Not weaker. PHE latest review of the evidence in 2020 maintain the 95% safer figure. As do various health groups around the world. It took many years for the world to wake up to the RCP 1960’s report about the dangers of smoking. Turns out they were right all along and the same is true regarding their findings about vaping. Study after study confirm that e-cigs are the most effective smoking cessation aid. Most recently a comprehensive cochrane review found e-cigs more effective than NRT.

            Your studies have been debunked as flawed and some have even been retracted by the journals that published them. Some countries seem to like tobacco taxes more than saving lives and preventing disease caused by smoking. America even have sick incentives (MSA payments) that insure states keep many people smoking so the $$$ keep rolling in. There is very little accurate information coming from the US. It’s no surprise that the U.K. is the country with the least big tobacco influence. No wonder all the harmful anti vaping stories all originate from the US or Australia. Places that have the most to gain by keeping people smoking. They lie about e-cigs because they are such a huge threat to beloved taxes and MSA payments.

            If you are anti vaping you are pro smoking and I’m sure the governments and tobacco companies thank you for your efforts.

      • bakerb

        Carcinogenic compounds, and carcinogenic metabolites are present in vegetables, just not enough to do harm Dose makes the poison. You are stirring up irrational fear.

        • CathyWotiff

          This is directly cited from CSIRO’s literature review ‘E-Cigarettes, Smoking and Health’. The evidence of likely harm from e-cigarettes is also supported by a growing number of credible sources, including the EU Scientific Committee on Health, Environmental and Emerging Risks and the WHO Brief on Electronic Nicotine and non nicotine delivery systems.

  3. Jarrod McMaugh

    A reminder to all people who are responding to this article that if you’re comments become unprofessional or are not constructive, I will close comments on this article and delete or modify comments to remove those comments that are directed at other commenters.

    Discussion on this topic should be encouraged, and cover all opinions and perspectives, but if the tone is aggressive; if commenters imply that other respondents are uneducated or biased, then the actions I describe above will be applied.

    If you want to conduct your conversation that way, take it to twitter instead.

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