E-cigarette regulation through pharmacy?


man choosing between smoking cigarettes and e-cigarettes

As the Senate Economics References Committee conducts its public hearing on e-cigarettes, stakeholders have put the case for them forward – but one public health expert told the AJP that ‘vaping’ needs regulation, perhaps with access through pharmacy

Fairfax reports today that Terry Barnes, former health advisor to Tony Abbott and designer of the GP co-payment, says policy on issues such as lockout laws, bike helmets and e-cigarettes containing nicotine are “arse over tit”.

Slamming “nanny state” regulations, Barnes says Australia has adopted a “ban first, ask questions later approach” instead of giving e-cigarettes the benefit of the doubt.

And Dr. Stephen Jenkins, director regulatory and medical affairs, Nicoventures Asia Pacific, said in a statement to the media that he believes the ban on e-cigarettes is making it difficult for Australian smokers to reduce and cease their tobacco consumption.

He says e-cigarettes are 95% less harmful than smoking and are “proven to be the most successful smoking cessation tool, 50% better than traditional gums and patches”.

But public health expert Professor Simon Chapman told the AJP that while evidence on smoking cessation with e-cigarettes is being gathered, their availability should be regulated, perhaps through community pharmacy.

“There are indications both from England and the US—where the FDA and National Institute of Health have just put out preliminary results from a very large national sample of 46,000—and they’re finding the number of smokers who are using e-cigarettes on a daily basis is very low indeed,” Prof Chapman told the AJP.

“If you read between the lines, most are dual using. So they continue to smoke, and they’re occasionally using e-cigarettes. And a lot of the data, especially the British data, also indicates that around 70% of even daily vapers continue to smoke cigarettes.

“The central platform of their appeal is that by using e-cigarettes you’re likely to quit smoking, but that’s far from the case.

“What we know so far is they tend to use both, and so the real concern, from a public health perspective, is that e-cigarettes may have a net effect in populations of keeping people in smoking, rather than pulling out.”

Prof Chapman says that many smokers also use vaping to cut down on smoking traditional cigarettes, thus believing they are significantly reducing their risk of smoking-related illness. However, the effects of cutting down, rather than quitting altogether, is limited to non-existent, according to large-cohort studies.

He compared the advent of e-cigarettes to “two large experiments over the last few decades with harm reduction and tobacco, which were failures”.

“The first was filters, which were heralded as greatly reducing the risk; that was a total failure. People just suck deeper, and tar is still pulled into the lungs.

“The second was ‘lights’ and ‘milds,’ and around 80% of smokers switched to the so-called lights and mild cigarettes. In 2005 the ACCC had to intervene and tell consumers that these labels were deceptive, and not delivering appreciably less harmful constituents. They fined manufacturers and those descriptions are now banned in Australia.

“My attitude to e-cigarettes is that it would be wonderful if they did what their advocates say they promise to do, but there’s precious little evidence to say they do,” Prof Chapman says.

“The prudent thing to do would be to regulate them as pharmaceutical products, and create maybe some way of getting hold of e-cigarettes through a pharmacy, whether on prescription or with some other form of restriction, as with pseudoephedrine.

“Just allowing the law to continue as is and watching what happens is a national health experiment.

“I think pharmacists have the training and counselling knowledge that the girl at the supermarket desk or petrol station attendant doesn’t, so I think it would be appropriate, if we are to let e-cigarettes in, that they ought to be regulated in this way.

“There’s a tsunami of highly motivated material out there about e-cigarettes that is, naturally, saying they’re the best thing since sliced bread; there’s a commercial agenda behind a lot of it and pharmacists need to be highly circumspect.”

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10 Comments

  1. John Abbate
    10/03/2016

    E-cigarettes provide an alternative source of nicotine without combustion or tobacco. If Professor Chapman doesn’t understand how this differs from “filters and lights”, then someone needs to explain to me why his opinion is sought for these articles.

    • sharon
      11/03/2016

      I thought the same thing, how can vaping be compared to the filters and light cigs when people were still inhaling smoke from these things. He also claims most vapers are dual using by “reading between the lines”, but if he would stop insulting and dissing vapers and engage with them for a change (no hope of that), he might actually realise that all the, what he calls “anecdotal” stories of vapers quitting smokes is far beyond an occasional vaper. Most smokers feel trapped and want to quit, so where do these “experts” get the right to tell people how they must do that? If all smokers quit, who would tc treat like garbage? they get off on denigrating smokers

  2. Rudy Thompson
    10/03/2016

    John, to understand the argument, you might need to first appreciate the difference between literal and metaphorical..? Prof Chapman referred to ‘filters and lights’ because they were hailed as a ‘safe’ or ‘better’ alternative. Subsequent study (not available at the time each device or marketing ploy was released) showed that neither the provided filters, nor the reduction in nicotine content (lights) provided any noticeable benefit to the consumer – the public. The connection is that all academically backed information available currently shows precisely none of the benefits claimed by the manufacturers/distributors of these products.

    The ingredients of the products are unregulated.

    The fact that their delivery method for nicotine is non-combustive is irrelevant if there is no information on Any additional chemicals delivered in the process. He also points out that the ONLY information published currently shows that vapourisers are used IN ADDITION to cigarettes.
    He refers to the relative lack of information available and believes that in the absence of that information we might not want to believe the claims of the manufacturers…

    The Professor’s opinion might be in the article as he has a PhD in Medicine, has published 500+ peer reviewed articles, and has an entire career of expertise in the effects of tobacco on public health. Terry Barnes on the other hand has a Bachelor of Arts in History/Politics, and a career based in political advice and policy.
    As far as credible arguments on the effect vapourisers have on health go, would you believe the Political Advisor? or the PhD qualified Medical Professional?

    • John Abbate
      10/03/2016

      The suggestion that there is no good “academically backed” evidence for the effectiveness of vaping as harm reduction and smoking cessation is false. I would point you to the comprehensive report by Public Health England, which took into account over 180 studies looking at all facets of these devices and their public health impact. The evidence continues to mount confirming PHE’s findings. A survey released just yesterday for No Smoking Day found that 65% of Welsh vapers have quit smoking completely: http://www.southwalesargus.co.uk/news/gwentnews/14330767.Poll_shows_two_thirds_of_e_cigarette_users_quit_smoking_in_Wales/?ref=twtrec

      E-cigarettes are already regulated as consumer goods. It would take little effort to regulate the ingredients and packaging of e-liquid for additional safety and quality, were there the will to do so. I suspect most people would welcome sensible regulation.

      The professor’s opinion is not backed by a degree in medicine per se, but by a sociology thesis on tobacco industry messaging, overseen by a medical department. This is apparent in his various, consistent contributions to this debate, which have less to do with health, and more to do with square-pegging the narrative until it conforms with something he already understands: a tobacco industry plot to keep people smoking and hook the next generation of addicts. This naturally happens to justify the centrality of his own voice in the debate. It is as self-serving as it is inaccurate.

      I don’t generally read Terry Barnes. I prefer to paraphrase a question posed by David Sweanour: has the introduction of a new, safer, cheaper technology ever led people to use more of the older product? That is the argument being made here (that vaping will somehow lead to more smoking); it is the one argument that really matters.

      • sharon
        11/03/2016

        And for tc to claim that not enough research has been done and there are too many unknowns is also false. Interested researchers have done quite a bit of research in recent years, and nothing has come out that shows vaping to be anywhere near as dangerous as smoking. It has people in tc scared, if a product comes along that could quickly replace smoking where does that leave them? They are suddenly irrelevant, they don’t want that, that want to keep banging on the anti smoking drum for years to come, so they can continue to be experts in social manipulation and collect their pensions. They certainly don’t want to become redundant so soon.

    • sharon
      11/03/2016

      “The Professor’s opinion might be in the article as he has a PhD in
      Medicine, has published 500+ peer reviewed articles, and has an entire
      career of expertise in the effects of tobacco on public health.”

      He’s a sociologist, iow, his expertise is in manipulating behaviour at a population level. The effects of tobacco on health has nothing to do with vaping, vaping does not involve tobacco use.

      People are now wising up to the supposed claims of tobacco control too. Even Mckee was recently outed as the expert who anonymously published the article in a medical journal claiming that vaping is 95% safer than smoking was a tobacco company construct, which proved to be completely made up and was designed to cast aspersion on vaping by an anti tobacco relic. Anti tobacco have been manipulating the truth for decades but they can’t get away from it now and are just making themselves look foolish and corrupt when they lie.

  3. bakerb
    10/03/2016

    “most are dual using”

    Yes, that’s true, but fail to mention (strangely enough) 6 million Europeans that have stepped away from tobacco due to vaping with many millions more in US.

    It doesn’t matter if 90% of people were dual-using. It matters that its helped the 10%. Its all about having a variety of options for smokers to choose if they want to improve their health.

    “may have a net effect in populations of keeping people in smoking, rather than pulling out”

    This is made up, no data can prove this and is purely subjective opinion to accentuate a negative slant on something that should be an option for smokers in Australia NOW.

    “thus believing they are significantly reducing their risk of smoking-related illness”

    No smokers don’t think this. After being bombarded with anti-smoking messages for decades I doubt anybody really thinks this. This is a mechanism to make smokers appear to be the victims of ‘evil’ e-cigarette companies and so the demonisation begins.

    Comparing harm reduction potential of vaping to low tar cigarettes is deceptive to say the least. There is no smoke or tar in vaping so they are completely different things. A mechanism to manufacture a link between tobacco companies and vaping, further demonisation and misrepresentation.

    “regulate them as pharmaceutical products”

    No. One of the oldest and largest markets for vaping is in the UK and I doubt very much that they would have achieved 1.1 million ex-smokers due to vaping if they had been medicalised and made as unattractive as possible. Smokers are not ill, they don’t need medicine, they just need a safer options to be there if they want them.

    “Just allowing the law to continue as is and watching what happens is a national health experiment.”

    The law as it is is a disgrace. Many people can’t access this option because of its de-facto illegality and because they can’t go into a vape shop and get set up properly as nic liquid is illegal. You need to be internet savvy to order over the internet and to actually have knowledge of what you need to get set up.

    “there’s a commercial agenda behind a lot of it”

    Oh how terrible, somebody wants to make some money to pay off their ridiculously large mortgage. How awful. Must be so comfortable to always be fed via public money, such an altruistic state. Those evil cafes, drug pushing caffeine dealers, shut them down. A lot of small business vape shop owners are ex-smokers due to vaping and are actually passionate about what they do. Having a commercial agenda doesn’t automatically brand you as ‘evil’ besides nobody is recruiting kids to be vapers as you can see by the UK stats showing an infinitesimally small amount of young never smokers vaping habitually.

    Its another indicator of the much less than progressive nature of the quit services in this country when they don’t support another option being there for smokers. At least one of the main ones in the UK is

    http://www.ncsct.co.uk/usr/pub/Electronic%20cigarettes.%20A%20briefing%20for%20stop%20smoking%20services.pdf

    Again and again in these articles there’s never a strong enough argument to continue the prohibition of tobacco harm reduction in this country, only punitive bans, failed pharma ‘solutions’ and bullying.

  4. hugeonreddit
    10/03/2016

    The data shows smoking rates in Australia are at historical lows, the idea that e-cigarettes might encourage or keep people smoking who may have otherwise quit is weak at best, if anything the opposite is more likely to be true. Regulation should focus on safety not efficacy. It makes little sense for these products to be controlled by the pharmaceutical industry when you can pick up a packet of cigarettes or nicotine candy at every other corner store, the latter without even any age restriction.

  5. Deb Downes
    15/03/2016

    Firstly, Chapman is an expert in sociology, not a scientist, and he has amply demonstrated his inability to analyse data without his own prejudices influencing his determinations. In the EU/UK and US, it is legal to purchase e-liquid which contains nicotine – from a SHOP, not a community pharmacy, whatever that might be.

    The Nicorette Inhaler(NI) contains the same ingredients as e- liquid, plus a few more, like Hydrochloric Acid. The NI can be freely purchased, e-liquid cannot. Why?

    Why do TC people in Australia choose to ignore the substantial research that has emerged from the UK, and elsewhere, where e-liquid containing nicotine is legal? I wouldn’t expect them to immediately fall into line, but I would certainly expect a better response that what is occurring in OZ. Or, are these OZ “professionals” calling their UK peers liars?

    How many people from the tobacco control, public health and anti cancer industries in Australia receive funding from Pharmaceutical Companies? Because, the Pharmaceutical companies are the ones who stand to lose the most if Australians have better access to e-liquid which contains LEGAL nicotine.

    Lastly, it’s disappointing that journalists continue to be lazy and do no investigative research. They allow so called “experts” to say whatever they wish, and don’t check the veracity of the information. The above information from Chapman regarding e-cig use is not true. He has a long history of both being abused by vapers, and abusing them back. He’s blocked so many vaping advocates, he wouldn’t know a vaper if he fell over one and is hardly qualified to discuss the issue.

  6. Maisha Shayne
    16/03/2016

    If you want to know why is it so difficult to quit smoking we must to locate the bad: Nicotine. And also the fact that this substance is easy to get at through the cigarette does not mean it’s harmless, it’s actually probably one of the most addictive substances out there, and like every addiction, at try to eliminate their consumption occur both real and psychic symptoms known as abstinence syndrome.

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    You actually realize how to bring a problem to light and make it important. More and more people really need to read this and understand this side of your story.

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