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Smoke and mirrors: Health experts try to navigate the fog on vaping

Should e-cigarettes be added to the arsenal of anti-tobacco weaponry? Or are they just a potentially dangerous diversion? An Australian parliamentary committee has spent the past year investigating. Danielle O’Neal reports. 

Words and Pictures by Danielle O’Neal
 
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If you’re confused about the pros and cons of vaping, you are not alone.

The Australian parliamentary committee which shapes our national health policy has spent the best part of the past year trying to determine whether electronic cigarettes (or e-cigarettes) should be enlisted into the war on tobacco smoking.

After weighing the arguments, evidence and submissions of numerous experts, the committee’s just-released conclusion is, narrowly, to recommend that the use of liquid nicotine in vaping devices remain illegal in Australia (see breakout below), while calling for further research into the health impacts of electronic cigarettes. The research should be reviewed every two years, it said, acknowledging that with 2.4 million Australians still using tobacco daily, more needed to be done.

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“Some of the long-term health impacts of nicotine e-cigarettes may not be known for a decade or more but their impact on smoking rates should become clear much sooner,” the inquiry report concluded.

“If e-cigarettes can be shown to reduce the number of smokers, then the potential benefits this may bring could strengthen the case for the legalisation of e-cigarettes.”

Leading public health advocates such as the Australian Medical Association, the Public Health Association, Cancer Council Australia and Heart Foundation commended the inquiry’s decision, which is in line with the recommendations of the National Health and Medical Research Council (NHMRC) and the Therapeutic Goods Administration.

But it was a tight call by the bipartisan committee, which has historically managed to overcome political and philosophical hurdles to deliver consensus reports on other health issues. In this instance, it split on party lines, with the committee chairman, Liberal MP Trent Zimmerman, arguing that maintaining restrictions on vaping was the wrong move.

He laid out his arguments in his foreword to the committee report, and in his own dissenting report – one of two dissenting submissions from Liberals on the committee.

“While the evidence base regarding e-cigarettes is still emerging, there are clear indications that e-cigarettes are significantly less harmful to human health than smoking tobacco cigarettes,” Mr Zimmerman wrote.

“If long term smokers who have been unable to quit smoking tobacco cigarettes switch to e-cigarettes, thousands of lives could be saved.”

The use of e-cigarettes, also known as “vaping”, is a relatively niche, but growing, subculture in Australia and around the globe.

One in every hundred Australians aged 14 years and above now uses e-cigarettes, according to the National Drug Strategy Household Survey. That might seem a fairly low number, but it comes out of a zero base just a decade ago.

The core question the parliamentary inquiry set out to investigate was whether vaping provides a useful, non-harmful strategy for helping smokers quit the hard stuff.

Decades of strong tobacco control policies in Australia – smoking bans, plain packaging, advertising blackouts, mass media campaigns explicitly spelling out the risks – have succeeded in bringing smoking rates down to 12.2 per cent of the population aged 14 and older. But it’s proved tough persuading remaining hardcore smokers to butt out.

If Australia is to reach the target of reducing smoking to 10 per cent of the population this year, “it needs another weapon in the arsenal”, argued Mr Zimmerman.

“One medical researcher whom the committee met in New Zealand put the choice starkly. If a patient has earnestly tried existing ways of quitting but failed, then knowing the consequences of that patient continuing to smoke, how could a medical practitioner morally and ethically not recommend they consider e-cigarettes?”

One prominent Australian expert who argues in favor of vaping is Professor Ronald Borland. He is the Nigel Grey Distinguished Fellow for the Cancer Council Victoria, and has been working in tobacco control policy and smoking cessation research for over 30 years.

Professor Borland says that “although electronic cigarettes may not be entirely harmless, they are almost certainly, significantly less harmful than traditional, combustible cigarettes”.

People smoke for the nicotine “hit”, he said, but it is the toxins released by the combustion of tobacco that cause lung cancer and other smoking related disease.

“Cigarettes are the formula one delivery system for the nicotine because the nicotine gets to your brain really quickly. That hit of nicotine many people find exquisitely attractive and they’re prepared to die for it. Nicotine itself is relatively benign.”

Professor Borland is currently involved in a large, relapse prevention study looking at the impact nicotine products – including vaping devices with liquid nicotine – have in helping people quit smoking.

He recently published a research paper in the American Journal of Preventive Medicine, demonstrating that people who use nicotine medication to quit are more likely to be successful over the first three months of their quit attempt.

“The big question for me is, are these products good enough to actually phase out smoking? On a level playing field, they’re probably not,” he says.

“But, can we tilt the playing field by making these products more available, a cheaper price, allowing some degree of promotion, perhaps not having dark green standardised packaging, not having health warnings, so making it clear that these are not as harmful? I think we probably can.”

Professor Borland’s views are out of step with the majority position of Australia’s public health community, which remains resistant to the idea of making nicotine e-cigarettes legally available.

The core concerns are two-fold:  unknowns around the health consequences of long term use of liquid nicotine, and the potential the vaping habit may provide as a gateway into tobacco smoking.

The Royal Australasian College of Physicians (RACP) stated in its submission to the parliamentary inquiry that the long term effects of e-cigarettes were still unclear. “To date, there is little conclusive evidence available about the product safety and quality of e-cigarettes. The flavoring chemicals used are a particular concern,” the RACP stated.

“At present there is no evidence that the large number and wide-ranging additives in e-cigarettes are safe when heated, vapourised and repeatedly inhaled deep into the lungs.”

The Queensland Government Department of Health also noted “the risk of electronic cigarettes influencing youth smoking uptake and maintaining tobacco smoking through dual use” to be of particular concern.

There is a strong whiff of politics and other issues shaping the discussion. On one side, disdain for smoking as an act, and suspicion around the motives and agendas of Big Tobacco. Last year, Australia’s Health Minister Greg Hunt told ABC Triple J’s Hack program, he had a “strong, clear, categorical view” that the commercial supply of nicotine for use in e-cigarettes should not be legalised in Australia.

“It’s Big Tobacco which is arguing the case for these e-cigarettes and they’re only doing it because it’s in their interests,” Mr Hunt said.

Tobacco giants Philip Morris sells e-cigarettes in some markets, and British American Tobacco also owns an e-cigarette company. The industry is spending billions to develop new products.

The other side raises questions of personal liberty and market freedom.

“There is also something obviously inconsistent about cigarettes being legally available while a less harmful nicotine product is not,” Mr Zimmerman wrote in his dissenting report.

 

 

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