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An Australian vaping revolution: a talk to Dr. Colin Mendelsohn

Feb 3, 2020

Last week, the Royal Australian College of General Practitioners published new smoking cessation guidelines which now underlines the importance of suggesting ecig in smoking cessation programmes.

Millions of smokers around the world usually talks to general practioners when they get the intention to quit smoking for good. And it happens everywhere. Vaping has the potential to help rejuvenate smoking cessation in Australia and improve public health if smokers are allowed easier and legal access to appropriately regulated products.

Now things have changed and new guidelines have been published. We have talked to DR. Colin Mendelsohn, Associate Professor in the School of Public Health and Community Medicine at the University of New South Wales, Sydney, Australia and a Tobacco Treatment Specialist.

He is a member of the committee that develops the Royal Australian College of General Practitioners national smoking cessation guidelines and is the Founding Chairman of the Australian Tobacco Harm Reduction Association, a health promotion charity.

What has been the evolution of smoking cessation programmes in Australia? What are the current rates and statistic about smoking in Australia?

Australia has been a world leader for many years in tobacco control and has strict regulations, plain packaging and the highest cigarette prices in the world. A pack of 20 Marlboro costs $30AUD in Australia and about $9AUD in Italy. Smoking rates declined by half from 1991 to 2013.

However, since 2013, smoking prevalence has changed very little. The latest adult (18+) smoking rate is 15.2%. Smoking is still the leading preventable cause of death and illness in Australia, killing 21,000 smokers per year.

The traditional tobacco control strategies are now not working as well as previously and innovative and effective treatments are needed to supplement conventional methods.

Vaping is effectively banned in Australia. It is a criminal offence to possess nicotine liquid without a prescription and vaping rates are very low – 1.2% of adults are ‘current vapers’.

Smoking rates are falling much faster in other countries where vaping is available and it is likely that vaping will help many Australian smokers quit, according to our recent study published in Drug and Alcohol Review.

Another area in which Australia has underperformed has been in providing professional smoking cessation services. Very little funding is allocated to helping smokers quit in spite of it being one of the most cost-effective health interventions.

How did you develop the ecig guidelines despite the hostility towards vaping shown multiple times?

The Royal Australian College of General Practitioners develops the national smoking cessation guidelines which are an evidence-based guide for health professionals on how to help smokers quit.

The latest update was developed by a diverse range of experts who reviewed the evidence. A meta-analysis was performed to determine the effectiveness of vaping. Finally members of the committee voted on the various recommendations.

The final outcome was that the guidelines support the use of vaping for smokers who are unable to quit with approved treatments who ask their health professional about them. Informed consent is vital and smokers need to be told that the products are not regulated, that long-term risks are unknown and to avoid dual use.

The final recommendation was a surprise to many people as there is almost universal opposition in Australia to vaping from health departments, health charities and medical associations. The new guidelines are a big step forward in the battle to legalise vaping in Australia.

What are the necessary steps to fight the smoking phenomenon?

Strategies to reduce smoking are well known and are clearly outlined in the Framework Convention on Tobacco Control. Essentially this involves

  • strategies to reduce the demand for tobacco products (increasing taxes, mass media  campaigns, banning advertising, smoke-free zones, graphic health warnings, readily available treatments to help smokers quit) 
  • Strategies to reduce the supply of tobacco products (reducing the number of retailers, restricting access to young people)
  • Tobacco harm reduction: strategies to reduce the harm to continuing smokers, such as with safer nicotine products like vaping, snus and heated tobacco products

What is your opinion about the latest statements from OMS about ecig?

The World Health Organisation recently published a Q&A on vaping. This was a disgraceful document full of false and misleading information which reflects the bias of WHO and its determination to undermine vaping, in spite of the evidence.

Clive Bates has done a wonderful analysis of this shameful document here. Experts from the UK has also harshly criticised it at the Science Media Centre here.

WHO’s anti-vaping bias has been clear for some time, but now it has lost all credibility on vaping.

Read the Italian version here.

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