Posted on June 24, 2022 By Colin
THE NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL, Australia's peak medical body has released its latest guidelines on vaping. However, the guidelines are alarmist, seriously flawed, do not reflect the latest evidence on vaping and will harm public health.
Some of the key flaws in the guidelines are outlined below.
The review completely misunderstands the role of vaping nicotine for tobacco harm reduction. Vaping is a safer alternative for adult smokers who can't quit with other methods. The key question is how vaping risks compare to smoking, and this was completely ignored.
The NHMRC focusses on the small and potential the risks of vapPreview Changes (opens in a new tab)ing but ignores the overwhelming evidence that it is far safer than smoking.
The review refers to up to 200 chemicals in vapour, but neglects to mention that smoke contains 7,000 toxic chemicals and carcinogens at far higher doses.
Concerns are raised about the potential impacts on cancer, CVD, respiratory, mental health risks from vaping. However, there is growing evidence that the risk of these conditions is dramatically reduced when smokers switch to vaping.
The review links nicotine vaping to EVALI, a serious lung disease caused by vaping black market cannabis oils contaminated with Vitamin E Acetate. EVALI is not caused by nicotine vaping.
There is also no scientific evidence that vaping causes seizures. Seizures are a late side effect of nicotine overdose but would present with critical warning signs long before a seizure occurs.
Incredibly the report implies that diacetyl from vaping can cause 'popcorn lung' when there has never been a case from vaping or smoking, ever.
Some potential risks of vaping are greatly exaggerated. The review emphasises nicotine poisoning. However, almost all cases of nicotine overdose result in vomiting and most cases are mild and quickly resolve. Four children have died from nicotine poisoning in the last 15 years globally. While tragic, we need to remember that 8 million smokers are killed by smoking every year.
There have been two known cases of death globally from explosions from vaping devices, although this is presented as a common risk.
The review claims that taking up vaping leads people to smoking, when the evidence suggests the opposite.
The gateway theory has been debunked. Vaping more likely diverts young people away from smoking overall. Indeed, declines in youth and young adult smoking rates have accelerated from around the time vaping became popular in many countries. This population finding is the opposite of that predicted by the gateway theory,
It is simply incorrect that vaping is not a proven smoking cessation aid. It is well established that vaping is more effective than nicotine replacement therapy and is arguably the MOST effective quitting aid. (Thomas 2021)
The NHMRC encourages smokers to keep trying conventional treatments which have appalling quit rates. In clinical trials, only 6% of smokers using medication are still abstinent at 12 months. (Rosen 2019)
The NHMRC falsely claims that most users become dual users of smoking and vaping. This is completely incorrect. Dual use is a transition stage for most vapers as they move towards exclusive vaping. In the UK and US, dual use rates are 33-36% and falling each year and millions of smokers have gone on to complete cessation of both.
The NHMRC wants smokers to wait decades before switching to vaping. However, it is beyond reasonable doubt that vaping nicotine is far safer than smoking. The UK Royal College of Physicians and Public Health England estimate that it is at least 95% safer. Vapers are exposed to far fewer toxic chemicals after switching from smoking, have reduced toxins in their bodies (biomarkers) and have dramatic health improvements.
The NHMRC recommendations are irresponsible and deny the growing science that supports vaping. Unfortunately they will be referenced by anti-vaping groups and will guide Australian policy.
More smokers will be deterred from switching, some vapers may relapse to smoking and the cigarette trade will prosper. More people will die unnecessarily from smoking.
ABC News Radio | Interview with Colin Mendelsohn
Thu, 6/23 4:41PM • 8:34
Glen Bartholomew: Australia's peak body for medical research says e-cigarettes are not a proven safe and effective way to quit smoking, and the growing use could actually lead to an increase in smoking rates. The National Health and Medical Research Council today released new data on the health impacts of vaping. Associate Professor Becky Freeman from the University of Sydney was a member of the expert committee that reviewed the evidence for the statement, and she told News Radio the council's message is clear.
Becky Freeman: The key takeaway message that people need to focus on today is that e-cigarettes are not a safe product, that there is very limited evidence that they are helpful in helping people to quit, and that young people who use e-cigarettes are more likely to go on to smoke. If you use nicotine containing e-cigarettes, you're likely to have throat irritation headaches, a cough, we don't know a lot about is the long term health effects because I think a lot of people are really familiar with how deadly smoking is. We've been studying smoking for 50/60 years. And we have really solid data around cancer cardiovascular disease. And we don't have long term high quality human studies for that for e-cigarettes. But we do know that users are exposed to hundreds of different chemicals and toxins that have the potential to cause adverse health effects if they use vaping products and e-cigarettes
Glen Bartholomew: Associate Professor Becky Freeman from the University of Sydney. Well, Dr. Colin Mendelsohn has worked in tobacco treatment for over 35 years and sits on the Royal Australian College of GPs expert committee that develops Australia's national smoking cessation guidelines. Colin Mendelsohn, good afternoon.
Colin Mendelsohn: Good afternoon, Glen.
Glen Bartholomew: This advice states very clearly that the vapor from e-cigarette devices can be harmful and that there is limited advice that e-cigarettes are effective at helping smokers quit. Do you agree?
Colin Mendelsohn: Well, that is the position that the NHMRC is taking for some time. And this is the position of the Australian Government, although it's very much at odds with many other organisations, including the New Zealand's Ministry of Health and the UK Government, the Royal College of Physicians and many others. So yes, I have many concerns about some of the conclusions they’ve made.
Glen Bartholomew: How so?
Colin Mendelsohn: Well, the review completely misses the critical issue of the relative risk between vaping and smoking. So it's all about can we find risks with vaping? Of course you can. Vaping is not completely safe. Nothing is. Everything has risks. But vaping is a tool to help adult smokers reduce their harm from smoking. It's a harm reduction strategy. And the point is whether it's safer to make the switch to vaping than continue to be a smoker, and there's overwhelming scientific evidence that if you switch over to vaping, you'll have substantial reduction in exposure to toxins, and significant health improvements.
Glen Bartholomew: The NHMRC says this is based on the most current advice on health impacts of e-cigarettes. It's based on In Depth evidence reviews, the most up to date scientific research, and an extensive toxicology report. Tell us more specifically what your argument’s based on.
Colin Mendelsohn: Look, I think there are so many mistakes in this report to be frank. They say, for example, that vaping nicotine causes EVALI which was the serious lung disease in North America a couple of years ago. Look, we now know and it's quite clear that EVALI was not caused by nicotine vaping but they conflate nicotine vaping with the causes of EVALI which was black market cannabis oils and we now know that. They say it causes seizures. There's absolutely no evidence that vaping nicotine causes seizures. Yes, nicotine poisoning, in high doses, can lead eventually to seizures. But long before that you get very sick. So it's not an effect of vaping. I mean, the actual, the evidence, the Royal College of Physicians, for example, in the UK, who have reviewed all the evidence on a number of occasions, vaping is at least 95% safer than smoking. Of course there are potential unknown risks. They always are with any new treatment. But when you look at the fact that a vaping product has maybe 100, 200 chemicals at very low doses, and a cigarette has chemicals, at least 7000 chemicals at high doses, it's pretty obvious I think to most people, making the switch has got to be better for your health.
Glen Bartholomew: Better, I guess being perhaps the key wording relative. The NHMRC CEO Professor Anne Kelso says they know from data gathered nationally that the number of e-cigarette related calls to the Australian poisons Information Centers doubled between 2020 and 2021. Isn't that a concern?
Colin Mendelsohn: It's not really a concern in that the actual real number is actually very small. There were figures published from Western Australia yesterday and the number went up by four cases a year each year in the last few years. We're talking about reports we're not talking about poisoning, and most cases of nicotine ingestion result in vomiting and the outcome is mild and severe cases are actually very rare. There have been four children that have died in the world in the last 15 years from nicotine ingestion. One unfortunately in Australia. But I think that risk is exaggerated. I mean, many more people die from paracetamol and other household chemicals. And I think we need to keep it in perspective because smoking kills eight million people in the world each year. Yes, look, if there are risks, and there are small ones, I think we've got to weigh it up against a huge potential benefit to public health.
Glen Bartholomew: But isn’t it just as better to try and eliminate any of those potential adverse effects any way you can. I mean, the council says, as for smokers, the evidence remains unclear whether e-cigarettes help people quit. For example, it's common for smokers to become dual users of both e-cigarettes and tobacco products, instead. It says there are many proven quitting aids to try before considering any cigarettes.
Colin Mendelsohn: I've been working in this field for nearly 40 years. And I can tell you that most people try repeatedly and fail with the approved medical treatments. Yes we have long term studies and the safety data, but the reality is, the vast majority of the time, they don't work. What you then do with the people who have tried everything repeatedly and still can't quit. That's where vaping comes in. It's an alternative for people who just can't quit with other methods, which we know is much safer, which, for which there's very good evidence of effectiveness. A Cochrane Review shows convincing evidence of effectiveness. We know in large population studies when vaping rates rise, smoking rates fall. The UK Government and New Zealand are very clear about vaping being a very effective treatment, if not the most effective treatment. But in Australia, unfortunately, we haven't seen that.
Glen Bartholomew: The vaping is on the rise by about 2% on recent years. Beyond the debate about helping existing smokers quit, is the real concern the increasing uptake of the vaping habit by young people? Are we creating a new problem for a new generation? You can see that its use has never been more popular among kids and that the different flavors available serve to attract them to the product as well as its constant depiction from what I can see and things like television and movies.
Colin Mendelsohn: Yes, absolutely. There's no question that vaping is not for kids. It's like any other adult consumer product,
Glen Bartholomew: But you know, they're using it in large numbers.
Colin Mendelsohn: They are. And the way to deal with that is to regulate it properly, like we do any other adult product. This black market, that's arisen selling high nicotine disposable vapes to kids has arisen since the prescription model. So we made it so hard for people to get nicotine legally. The black market has got out of control and no one's enforcing or policing it. So the Border Force isn't stopping the container loads of black market products. No one's stopping the tobacconists and convenience stores from selling these products. But what we need to do we regulate sales. So these products are sold with proper age verification in licensed outlets, age of sale is strictly policed, and the black market will just go away. But we've taken this prescription model which no one's using, people do not get prescriptions. And it's just too hard. So people just go to the corner store and buy the illicit products. And of course, the black market heavily sells to children. That model is just not working.
Glen Bartholomew: Can be hard to police either way, I suspect. Well, Australia's Chief Medical Officer and Chief Health Officers from all states and territories say they support the NHMRC findings. They welcome the statement that will inform public health advice and policy decisions. So it sounds like they might be using it in determining their regulatory approach. Let's see what if anything changes. Doctor, thanks for joining us.
Colin Mendelsohn: Thanks, Glen.
Glen Bartholomew: Colin Mendelssohn joining us there. He sits on the Royal Australian College of GPS expert committee that develops Australia's national smoking cessation guidelines.