Don’t market e-cigarettes as cessation aids: AMA


The AMA has called for e-cigarettes to remain subject to “strong regulation” in Australia

Commenting on its submission to an inquiry into the devices, the AMA says it believes that there is currently no compelling evidence that e-cigarettes are successful in helping people to stop smoking.

In the submission, to the Standing Committee on Health, Aged Care and Sport Inquiry into the Use and Marketing of Electronic Cigarettes and Personal Vaporisers in Australia, the AMA says that the tobacco industry is aggressively pursuing the potential of new products, including e-cigarettes, which can either maintain or establish a nicotine addiction in users.

AMA President Dr Michael Gannon says that the growth in e-cigarette products internationally has provided sections of the tobacco industry with the opportunity to rebrand themselves as part of the effort to reduce smoking – but there is no evidence that e-cigarettes work as a deterrent.

“E-cigarettes must not be allowed to be marketed with claims that they are a smoking cessation aid,” Dr Gannon says. “There is no such evidence.

“Australian authorities have not been able to establish any proof that e-cigarettes are safe or effective in stopping people smoking.

“Australia is a world leader in tobacco control, and we must remain a world leader in stopping people smoking or taking up smoking for the first time.

“We must not allow e-cigarettes to become a socially acceptable alternative to smoking.”

Dr Gannon says that e-cigarettes essentially mimic or normalise the act of smoking.

“They can result in some smokers delaying their decision to quit, and they can send signals to children and young people that it is okay to smoke,” he says.

He called for e-cigarettes and related products to be only available to people aged over 18, and says that marketing and advertising of e-cigarettes should be subject to the same restrictions as cigarettes.

Dr Gannon said that longitudinal research being conducted by the National Health and Medical Research Council into the safety or otherwise of e-cigarettes is ongoing and will take time.

“Until we see comprehensive clinical reports from the NHMRC on the safety or non-safety of e-cigarettes, we must continue to treat these products with extreme caution,” Dr Gannon says.

The AMA’s submission points out that while many online e-cigarette retailers claim the products are recognised cessation aids, they have not been approved by the TGA in this capacity.

In March this year, the TGA made a final decision on nicotine for use in the devices, which was to maintain the ban on the substance for use in e-cigarettes.

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40 Comments

  1. dodderer1
    11/07/2017

    I don’t know whether evidence on effectiveness from UK will be considered valid but here are population level facts

    1)prevalence was 20.9% in 2007(the year of our indoor smoking ban),20.4% in 2012 and 16.1% in 2016
    2)we also run a monthly survey measuring(among other things) quit attempts.Of the total annual attempts,ecigs accounted for 6% in 2012,24% in 2013,30% in 2014 and 36% in 2015
    3)we introduced a big shops display ban in 2012 which was assessed to have had a marginal positive impact
    4)numbers using our Stop Smoking Service(free behavioural support + meds) more than halved between 2012 and 2016
    5)spending on mass media campaigns was cut from ~£20m pa in the period up to 2010 to ~£5m pa thereafter
    6)tax & duty increases have generally been inflation plus a few % points throughout

    The uptake of ecigs is the best explanation of the rapid fall in prevalence after 2012 – critics need to provide a better explanation if they are to dismiss these figures

    • Ronky
      13/07/2017

      Coincidence is not causation. The Australian smoking prevalence rates have also fallen steeply, in fact to a level 30% lower than in the UK.

      • dodderer1
        13/07/2017

        “Coincidence is not causation” is,of course,true and our existing TC policies have undoubtedly incentivised many smokers to quit via ecigs – most,like me, after having failed to quit via the recommended methods.

        I merely share the hopefully undisputed data from the UK & suggest that ecigs are the most likely explanation for the recent rapid fall.It is not incontrovertible evidence but very little in this area truly is-it relies on interpretation in much the same way as all falls in prevalence are attributed to various policies.

        Given Australia is such a small market in the global context,I doubt TI is furious – they were late to the ecig ‘party’ and are trying to catch up and take their share-and not for public health purposes.Still,the UK evidence is that smokers prefer ecigs for quitting and if TI profit from this,so be it.Public health is more important than who delivers it.

        The downside of traditional TC policies is the impoverishment,stigmatisation & isolation of those who can’t/won’t quit – not an issue for a non-smoker but very real for those who try & fail with NRT etc etc

      • G. Karl Snae MD
        14/07/2017

        Absolutely wrong on the smoking prevalences, Swedens daily smoking prev 5% (Eubarometer 2017), Iceland a little above that, if above, and…….. Australia not near that, sorry.
        Haven´t noticed Big Tob to be furious about that either. There is no Gateway from vaping -> smoking, but there is more likely EXIT from cigarettes –> vaping (e-cigarettes). But it is true that Big Tob are increasing their stake in e-cig market, but that´s a tot different story, last time I checked on that was around 20% e-cigs but mostly the 1st generation e-cigarettes and less effective as switching alternative from smoking than the newer generations of e-cigarettes.

      • G. Karl Snae MD
        14/07/2017

        Absolutely wrong on the smoking prevalences, Swedens daily smoking prev 5% (Eurobarometer 2017, EB458), next in the row is Iceland a little above that, (if above anymore because last year 2016-2017 cig sales plummeted 10% and the years before that around 20%), and…….. Australia not near that level, sorry, but smoking prevalence in AU has levelled off (stalled) in the last years from 2013 (ca 13%) at the same time most countries in the dev world see their smoking prevs plummeting.

        Haven´t noticed Big Tob to be furious about that either, rather on the contrary, f ex marketing their HnB product (IQOS, PMI/Altria) and BAT with theirs as a harm reduction products! There is also no Gateway from vaping -> smoking, but there is more likely EXIT from cigarettes –> vaping (e-cigarettes). So, ergo, nobody should be too afraid of increased use of e-cigs and switching from cigarettes, rather invite the competition like the Scandinavian, UK and more countries are doing and by that are almost eliminating smoking on that route with snus and e-cigarettes.

        But it is true that Big Tob are increasing their stake in e-cig market, but that´s a tot different story, last time I checked on that was around 20% e-cigs but mostly the 1st generation e-cigarettes and less effective as switching alternative from smoking than the newer generations of e-cigarettes.

        • Andrew
          14/07/2017

          >>>Swedens daily smoking prev 5%

          Smoking is low, snus is high. It’s a bit of a misleading stat.

          • Robert Fairrington
            14/07/2017

            But shouldn’t the health consequences of such stats be the absolute most important? Yes, the Sweeds use snus. But if smoking didn’t cause adverse health issues, would anyone care as much?

          • Andrew
            14/07/2017

            Is that implying that snus is harmless? I think that’s a long bow.

          • Robert Fairrington
            14/07/2017

            Is anything harmless? The dose makes the poison as they say, but if you want to compare stats of smoking/snus related illness and deaths across Europe, I think Sweden is far ahead of the game. Why has so much effort and money been put to stop smoking, is it ideological or because of the adverse health effects of smoking?

          • G. Karl Snae MD
            14/07/2017

            Not totally harmless of course 🙂 nothing is, but in comparison or relative risk from cigarettes you could almost say so, or maybe around 98% less harmful than smoking. Would that be a long or a short bow?

          • G. Karl Snae MD
            14/07/2017

            That´s true, smoking prev is low and total use of Tobacco with snus is almost unchanged through the years. Not misleading stats. But, smoking related diseases, lung cancer, COPD etc, are way below other countries and in fact below half of what other countries live and die with. That´s what it´s all about, decreasing diseases for the population and fewer deaths by smoking. Is there anything else that is more important? No.

        • Ronky
          14/07/2017

          See https://en.wikipedia.org/wiki/Prevalence_of_tobacco_consumption
          Just as I said, Australia’s smoking prevalence is 30% less than the UK, it’s also 33% less than Sweden and 9% less than Iceland (which had a low rate before e-cigs were invented). The lowest in the developed world. You sir are absolutely wrong so please stop insulting our intelligence by using cooked up statistics to market your probably useless and harmful product.

          • G. Karl Snae MD
            14/07/2017

            Please sir check data on Wikipedia before presenting that as facts, unreliable 🙂 and if facts insults your intelligence or not then you have do deal with that yourself without my or others involvement, sorry about that 🙂 but use your words carefully even if you have your own opinion about things, but, which does not change facts or science.

            Look up f ex this: Eurobarometer 458, May 2017:
            http://www.drugsandalcohol.ie/27368/1/Eurobarometer_Attitudes_towards_tobacco_and_electronic_cigarettes.pdf

            ….and this gives a good graphics of the data above:
            https://gfn.net.co/downloads/Presentations_2017_/Dr%20Lars%20Ramstrom.pdf

            ….and OECD Health Statistics 2015: http://dx.doi.org/10.1787/health-data-en
            or
            http://dx.doi.org/10.1787/888933280827

            I´m sure you are able to look up more recent stats from your own country (I have them too) and as I said before they have mostly levelled off or stalled since 2013. Sorry about that but stay with facts not your own private opinions or views about things.

          • Ronky
            16/07/2017

            Independent evaluations have found Wikipedia is just as if not more reliable than any other source. You will find the original sources for all of the stats at the end of the page, all fully referenced.

            If you really are a medical doctor as you imply, why don’t you spend your time promoting health instead of trying to sell this rubbish. Or if you insist on selling it, provide the health authorities with the “evidence” which you repeatedly claim you have.

  2. charlie
    11/07/2017

    First he says there’s no evidence that vaping helps people stop smoking then he makes a bunch of claims to support his desire to ban vaping for which he has even less evidence. Conflicted, emotion driven, self interested, no science anywhere to be found. Vaping got me off smoking in 6 weeks nearly 3 years ago. There’s no doubt it wouldn’t have happened any other way. This guy cares about something but the health of smokers is not one of them.

  3. bakerb
    11/07/2017

    Australia is falling behind in its support for tobacco harm reduction and looking like fools. At least NZ has seen sense and legalised it.

  4. melawyth
    12/07/2017

    Too bad the Australian AMA is more interested in protecting its record in tobacco control than in the actual health of people who are trapped in a smoking addiction. Australia may think itself the world leader in the field (the useless plain-packaging fiasco notwithstanding), but vaping is now a world-wide movement of common people in a mood to stage a revolution against these know-nothing “experts” who haven’t even done research.

  5. Kenneth Burkhardt
    12/07/2017

    In reality they are speaking the truth, it just needs translating. “We at the AMA recommend that you use our approved methods” Translated – Keep smoking, we want to protect our funding sources (Pharma) nevermind that their products don’t work. I made the switch to vapor products over 4 years ago, in one day, because I had a near fatal heart attack and could not quit. I have never used a product made by Big Tobacco since making the switch. I advocate for smokers to get all of the choices available based on real honest science not influenced by ideology.

  6. Jim McDonald
    12/07/2017

    Whether e-cigarettes “work for cessation” — meaning are proven through extensive clinical trials to have a <8% effectiveness rate in cessation, like NRT products — doesn't matter. The AMA is advocating for this massively less-dangerous product to be banned, while the most harmful nicotine product of all is widely available across the country.

    Abstinence doesn't work. They KNOW it doesn't work, but they're willing to let many smokers keep smoking — and dying — to maintain their indefensible anti-addiction purity. What kind of ugly, miserable people make that choice?

  7. Ron Batagol
    12/07/2017

    Despite anecdotal experiences here and elsewhere, the following outcome of a court case is worth reading:

    ARTICLE FROM ABC NEWS HEADED:
    “Three vaping retailers
    slapped with $175,000 in court fines over misleading advertising”

    Link is:http://www.abc.net.au/news/2017-05-08/three-vaping-retailers-slapped-with-175k-in-court-fines/8506500

    • Ronky
      13/07/2017

      Interesting that 2 months after the Federal Court found the ads proven to be making false claims that the products didn’t contain carcinogens, the picture caption on the story on the ABC site is still describing the ads as “allegedly” misleading.

  8. G. Karl Snae MD
    12/07/2017

    This conclusion from AMA AU does not tally with what the actual data show, if science is of any interest for them. It is simply not true that e-cigarettes are a tobacco product or that vaping lures children to smoking or that it creates dependence in non-smokers. Neither does it normalise smoking nor has it been marketed anywhere as a cessation aid to smoking. Simply not true.

    That in light of the fact we have seen 6.1 million Europeans that have quit smoking by vaping and other 9.2 million still in double use. Total of more than 15 million people vaping in Europe with double use often seen as an interim stage in the quitting process of many. That also seen in the light of massive propaganda and skewed opinion about vaping of the general population. Think what could be accomplished to get people to quit smoking if the general message would be like that from Public Health England and Royal College of Physicians promoting vaping instead of smoking.

    Statement from Dr Michael Gannon on behalf of AMA AU is therefore total nonsense and has no science base to support their views or opinions. Views it is because it has nothing to do with scientific facts, because science is just one wherever we are situated on the globe.

    The facts are that prevalence of smoking among young people is at an all-time low and regular use of nicotine containing e-cigarettes among never-smokers is extremely rare (0-0.02%) and so far e-cigs have acted as a gateway away from smoking, for adults and adolescents alike. You AMA colleagues just have to take your heads up from down under the sand and look at our science today that´s for everyone to see and easily grasped for everyone who so wants.

    AMA AU president Dr Gannon says “….that e-cigarettes essentially mimic or normalise the act of smoking”. Yes, it does and that´s why it is working magics and enabling the smokers to quit smoking easier than anything else in our smoking history. That´s one of the wonders, if not the most important, of e-cigs that makes it almost a miracle in the working for people to an easier and less harmful way to quit smoking, which is by the way the real killer. But still an EXIT Gateway from smoking, not the other way around as implied.

    By ignoring todays science and the huge benefits of vaping for adults as well as smoking adolescents, and trying to limit their access to this so much risky option of vaping, it surely contributes to keeping smokers smoking and smoking-related disease and death going at the current rate.

    The agenda of AMA AU may be well-meant, but absolutely not to be seen as any excuse though of their actions and consequences. No consideration is given to their likely unintended consequences with the most likely results of contributing to keeping smokers smoking and continued unnecessary smoking-related diseases and deaths. No excuse for blindingly contributing to killing people by recommending deadly policies. In view of todays statistics that shows 15.0000 people dying each year in AU from smoking related diseases. Enough is enough, this deadly approach as from AMA AU has to end.

    This is not what public health and medicine are supposed to be about. If continued agenda from AMA AU I urge my medical colleagues in Australia, who still are members of AMA AU, to resign from it ASAP. Such an approach like AMA AU equates to nothing but cruel intent and said in a more common wording it is just plain evil and should nowhere be accepted or tolerated.

    With my best …… from the other side of the globe, the most northern country of Europe, a voice of silence or “down-under” from AU perspective.

    G. Karl Snæ MD
    Iceland

  9. G. Karl Snae MD
    14/07/2017

    This conclusion from AMA AU does not tally with what the actual data show, if science is of any interest for them. It is simply not true that e-cigarettes are a tobacco product or that vaping lures children to smoking or that it creates dependence in non-smokers. Neither does it normalise smoking nor has it been marketed anywhere as a cessation aid to smoking. Simply not true.

    That in light of the fact we have seen 6.1 million Europeans that have quit smoking by vaping and other 9.2 million still in double use. Total of more than 15 million people vaping in Europe with double use often seen as an interim stage in the quitting process of many. That also seen in the light of massive propaganda and skewed opinion about vaping of the general population. Think what could be accomplished to get people to quit smoking if the general message would be like that from Public Health England and Royal College of Physicians promoting vaping instead of smoking.

    Statement from Dr Michael Gannon on behalf of AMA AU is therefore total nonsense and has no science base to support their views or opinions. Views it is because it has nothing to do with scientific facts, because science is just one wherever we are situated on the globe, not special for Australia or any other country, but everyones.

    The facts are that prevalence of smoking among young people is at an all-time low and regular use of nicotine containing e-cigarettes among never-smokers is extremely rare (0-0.02%) and so far e-cigs have acted as a gateway away from smoking, for adults and adolescents alike. You AMA colleagues just have to take your heads up from down under the sand and look at our science today that´s for everyone to see and easily grasped for everyone who so wants.

    AMA AU president Dr Gannon says “….that e-cigarettes essentially mimic or normalise the act of smoking”. Yes, it does “mimic” the act of smoking in many ways and that´s why it is working magics and enabling the smokers to quit smoking easier than anything else in our smoking history. That´s one of the wonders, if not the most important, of e-cigs that makes it almost a miracle in the working for people to an easier and less harmful way to quit smoking, which is by the way the real killer. But still an EXIT Gateway from smoking, not the other way around as implied.

    By ignoring todays science and the huge benefits of vaping for adults as well as smoking adolescents, and trying to limit their access to this so much less risky option of vaping, it surely contributes to keeping smokers smoking and smoking-related disease and death going at the current rate.

    The agenda of AMA AU may be well-meant, but absolutely not to be seen as any excuse though of their actions and consequences or of later saying “we really did not know then”. Not acceptable in light of science facts today.

    No consideration is given to their likely unintended consequences with the most likely results of contributing to keeping smokers smoking and continued unnecessary smoking-related diseases and deaths. No excuse for blindingly contributing to killing people by recommending deadly policies. In view of todays statistics that shows 15.0000 people dying each year in AU from smoking related diseases. Enough is enough, this deadly approach as from AMA AU has to end.

    This is not what public health and medicine are supposed to be about. If continued unchanged agenda from AMA AU I urge my medical colleagues in Australia, who still are members of AMA AU, to resign from it ASAP. Such an approach like AMA AU equates to nothing but cruel intent and said in a more common wording it is just plain evil and should nowhere be accepted or tolerated.

    With my best …… from the other side of our globe, the most northern country of Europe, a voice of silence or “down-under” from AU perspective.

    G. Karl Snæ MD
    Iceland/Sweden

  10. G. Karl Snae MD
    14/07/2017

    This conclusion from AMA AU does not tally with what the actual data show, if science is of any interest for them. It is simply not true that e-cigarettes are a tobacco product or that vaping lures children to smoking or that it creates dependence in non-smokers. Neither does it normalise smoking nor has it been marketed anywhere as a cessation aid to smoking. Simply not true.

    That in light of the fact we have seen 6.1 million Europeans that have quit smoking by vaping and other 9.2 million still in double use. Total of more than 15 million people vaping in Europe with double use often seen as an interim stage in the quitting process of many. That also seen in the light of massive propaganda and skewed opinion about vaping of the general population. Think what could be accomplished to get people to quit smoking if the general message would be like that from Public Health England and Royal College of Physicians promoting vaping instead of smoking.

    Statement from Dr Michael Gannon on behalf of AMA AU is therefore total nonsense and has no science base to support their views or opinions. Views it is because it has nothing to do with scientific facts, because science is just one wherever we are situated on the globe, not special for Australia or any other country, but everyones.

    The facts are that prevalence of smoking among young people is at an all-time low and regular use of nicotine containing e-cigarettes among never-smokers is extremely rare (0-0.02%) and so far e-cigs have acted as a gateway away from smoking, for adults and adolescents alike. You AMA colleagues just have to take your heads up from down under the sand and look at our science today that´s for everyone to see and easily grasped for everyone who so wants.

    AMA AU president Dr Gannon says “….that e-cigarettes essentially mimic or normalise the act of smoking”. Yes, it does “mimic” the act of smoking in many ways and that´s why it is working magics and enabling the smokers to quit smoking easier than anything else in our smoking history. That´s one of the wonders, if not the most important, of e-cigs that makes it almost a miracle in the working for people to an easier and less harmful way to quit smoking, which is by the way the real killer. But still an EXIT Gateway from smoking, not the other way around as implied.

    By ignoring todays science and the huge benefits of vaping for adults as well as smoking adolescents, and trying to limit their access to this so much less risky option of vaping, it surely contributes to keeping smokers smoking and smoking-related disease and death going at the current rate.

    The agenda of AMA AU may be well-meant, but absolutely not to be seen as any excuse though of their actions and consequences or of later saying “we really did not know then”. Not acceptable in light of science facts today.

    No consideration is given to their likely unintended consequences with the most likely results of contributing to keeping smokers smoking and continued unnecessary smoking-related diseases and deaths. No excuse for blindingly contributing to killing people by recommending deadly policies. In view of todays statistics that shows 15.000 people dying each year in AU from smoking related diseases. Enough is enough, this deadly approach as from AMA AU has to end.

    This is not what public health and medicine are supposed to be about. If continued unchanged agenda from AMA AU I urge my medical colleagues in Australia, who still are members of AMA AU, to resign from it ASAP. Such an approach like AMA AU equates to nothing but cruel intent and said in a more common wording it is just plain evil and should nowhere be accepted or tolerated.

    With my best …… from the other side of our globe, the most northern country of Europe, a voice of silence or “down-under” from AU perspective.

    G. Karl Snæ MD
    Iceland/Sweden

    (not a spam 🙂

  11. Deb Downes
    14/07/2017

    Well, the AMA have published their submission, in complete defiance of the rules of the Inquiry. As a vaper, I complied with those rules, therefore I have written to the Inquiry Secretariat and asked for the AMA submission to be “struck off” – pun fully intended lol

    • G. Karl Snae MD
      15/07/2017

      Haha, that’s a beauty, let us know what the IS decides to do about that 🙂 Follows their own rules or not

  12. Jarrod McMaugh
    18/07/2017

    It’s very interesting reading some of the comments on here, especially with regards to claims of therapeutic benefit.

    First, Ronky is right in saying that it is not appropriate for people to say that these are usable to assist in quitting smoking on an Australian health website – while this may well be what is happening overseas, and is even accepted therapeutic practice in the UK, it is not approved for this use in Australia, and therefore it is not appropriate.

    As a result I’ll be removing any specific anecdotes from individuals who have posted here about how they quit smoking. It’s not appropriate in the context of this discussion.

    Second, I accept that there is a large amount of personal/social use of these devices, and there are (in my mind) two disctinct discussions to be had about these devices from the Australia perspective:
    1) Should they be usable for personal use
    2) Should they be recommended as a therapeutic device.

    Whether either or both of these things end up happening here, they should not be specificlly tied together… that is, if someone gets a licence to market nicotine-containing devices in Australia for social use, they should absolutely be banned from ever claiming or implying that they can be used to help quit smoking, since this is a claim of a therapeutic nature. If they are going to be used socially, they should only be marketed as a social product.

    Second, if anyone markets one of these products as a therapeutic device with all the red tape and evidential burden this requires, this should not impact on any decision (or precedent) to be used socially – that is, if they are available legally for social use, they still cannot claim therapeutic use, nor should their availability for social reasons be limited by the availability as a social product.

    In both cases, these should be based on legislation, not “disruption” ie entering an unregulated market and attempting to carve out a space.

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