We all know what a shitshow Tobacco Harm reduction is in America right now. From the misinformation being flung about to the quite frankly ridiculous regulations, the authorities want to make people frightened about vaping.
However there might be a bit of a breakthrough…
Harm Reduction
A position statement from the Physicians Research Institute (PRI) in the US has clarified their position on vaping and written a document hopefully to educate those in the medical professions of the facts about E-cigarettes.
I have to say it is a total breath of fresh air and a wonderful read for anyone hopeful that Vaping will become another acceptable method of smoking cessation.
PRI
I won’t pretend to know much about this organisation or about how much clout it has with the medical community.
What I do know is what is said on their “About” page.
Basically the PRI were established in 2016 as a not for profit organisation and has always been “Physician directed”.
I quote…
“From the beginning, the goal of PRI has been to provide direct assistance as well as carefully researched information to State Medical Societies. In most cases, the PRI direct assistance and information was helpful in either supporting or opposing legislative and regulatory proposals in a particular state.”
Author
The author of the statement is Cheryl K Olson Sc.D who holds a doctorate from the Harvard School of Public Health and was a member of the Harvard Medical School research faculty for over 15 years.
She has an extensive publication record and is a sought after lecturer on matters related to public health.
“The PRI Board decided that she would be an ideal person to report to PRI and its member State Medical Societies with respect to vaping and related issues.”
A grant from the Foundation for a Smoke-Free World Inc (FSFW) made this report possible.
Position Statement
Well this document does cover all areas of Harm Reduction and states facts about the issue of smoking.
I won’t bore you with all of the contents but a summary of key points is found at the top of the document which I quote below.
Over 30 million adult Americans still smoke.
Cigarettes take nearly half a million lives each year.
Today’s smokers have more disadvantages; quitting is harder.
Standard cessation treatments (nicotine replacement therapies and medications) usually fail.
Most physicians misperceive the risks of nicotine; the danger arises from combustion.
Electronic nicotine delivery systems (e-cigarettes) are a legal alternative.
Smoking is at least 20 times more harmful than vaping nicotine.
In randomised controlled trials and population surveys, e-cigarettes outperform nicotine replacement therapies. Even smokers not planning to quit do so with vaping.
Switching from smoking to vaping leads to rapid measurable reductions in biomarkers of harm.
NRT
The report says that NRT (Nicotine Replacement Therapy – such as Patches, chewing gum etc) are failing most smokers.
An Analysis in “Preventative Medicine” highlighted the limits of such products plus Varenicline (Champix) and Bupropion (Zyban). Using randomised controlled trials the analysis found that current cessation treatments in the US means only 2.3% of smokers would successfully quit.
“In other words, the available patches and pills barely budge the needle on real-world smoking levels.”
Misperceptions
The fact that the general public and medical community share misperceptions about the danger of nicotine is highlighted.
A 2021 survey round that 4 out of 5 physicians in the survey wrongly thought that nicotine caused Cancer, Cardiovascular Disease and COPD.
“This miscasting of nicotine as the primary health villain is concerning and dangerous. It may make doctors hesitate to recommend nicotine replacement therapies or reduced-risk nicotine products to smokers who seem unable to quit.”
Realistic Quitting
Obviously complete abstinence from tobacco / nicotine is the best case scenario – but this is not always realistic.
Thankfully there are more experts who realise that Harm Reduction is important, those who really are struggling or against quitting tobacco might benefit from alternative safer methods of obtaining nicotine – i.e. NRT, Vaping.
Vaping
Now we get to the groundbreaking part of this report.
The report discusses how e-cigarettes are likely to be a more effective means to reduce the deaths from smoking related conditions.
Also discussed is the negative propaganda shared by media outlets regarding vaping.
“Most media coverage of e-cigarettes, and many research articles, focus on vaping’s potential to addict teens. Fifteen past presidents of the Society for Research on Nicotine and Tobacco, writing in the American Journal of Public Health, state, “We believe the potential lifesaving benefits of e-cigarettes for adult smokers deserve attention equal to the risks to youths” (Balfour, 2021)”
The report then moves onto the FDA (US Food and Drug Administration) shambles where all nicotine products for sale must be “Approved” before they can legally be marketed. This process is called the PMTA (Premarket Tobacco Product Applications).
“No e-cigarettes have been approved as smoking cessation devices by the U.S. Food and Drug Administration.”
We all know what a mess this turned into, massive backlogs for applications, a costly and confusing method of applying and what seems to be an unfair refusal of the majority of applications.
Doctors
The statement below quoted from the report is quite damning…
“If you’re puzzled about e-cigarettes, and their potential risks and benefits, you are far from alone. A review from the University of Queensland (Erku, 2020) found 45 qualitative and quantitative studies internationally on physician beliefs and behaviors regarding e-cigarettes. Doctors were aware of vaping, but far from expert in its health effects and use for smoking cessation. Most of what they knew came from popular media stories or advertising, the internet, or patient reports. The authors note, “This lack of knowledge and feeling of being ‘uninformed’ was reported consistently by [health care professionals] across and within studies.””
Facts
The heading “what we know (and misbelieve) about e-cigarettes risks” tells you how this part of the report will pan out!
It quotes the Office for Health Improvement and Disparities (formerly Public Health England) stance…
““Vaping poses only a small fraction of the risk of smoking” says a comprehensive review by the U.K. Office for Health Improvement and Disparities (formerly known as Public Health England). To help the public and health professionals understand the magnitude of the difference in risk between vaping and smoking, these experts state: “Smoking is at least 20 times more harmful to users than vaping” (McNeill, 2022).”
Also the findings of the UK review relating to COPD and Cardiovascular issues are shared…
“Vaping generally leads to lower exposure to many of the carcinogens responsible for the health risks of smoking.”
“Based on the toxicant profile in vaping products and aerosols” the risk of vaping to cardiovascular health “is expected to be much less than that of cigarette smoking.”
For smokers, “switching to vaping is likely to slow down the development of respiratory diseases.”
A consensus study report “Public Health Consequences of E-cigarettes” from the National Academies of Sciences, Engineering and Medicine (2018) states…
““Laboratory tests of e-cigarette ingredients, in vitro toxicological tests, and short-term human studies suggest that e-cigarettes are likely to be far less harmful than combustible tobacco cigarettes.””
A link to the UK Health Security Agency website listing the myths and corrections has been included.
The report then links relevant surveys, clinical trials and systematic reviews with facts on vaping.
Resources
The document concludes with a list of suggested resources for anyone advising patients on smoking cessation.
“Just providing advice to smokers does little to help with quitting (Stead, 2013). And as shown above, cessation patches and pills have a poor track record. Weighing the risks and benefits, e-cigarettes are an option worth considering.
Surveys suggest that patients typically hear about e-cigarettes from the media, family or friends, and vape shops; few hear about them from physician offices. But most patients who had used e-cigarettes would like their primary care provider to talk with them about vaping (Doescher, 2018). “
Responses
As you can imagine the Twitter response to this has been very positive – some examples below!
We have progress!
To kick off 2023, The Physicians Research Institute has taken a positive stance on tobacco harm reduction.
They state: “smoking is at least 20 times more harmful than vaping nicotine.” https://t.co/mMZt5tf4QM @TheBMA @Domus_Medica @medicina_cfm
— Tobaccoharmreduction.net (@Tobaccoharmred1) January 13, 2023
A nice position statement on vaping from Physicians Research Institute with many useful links and references.https://t.co/r4qnnbPQuM
— Jukka Kelovuori (@jkelovuori) November 18, 2022
Physicians Research Institute
Key points
*30 million adult Americans still smoke
*Cigarettes take nearly 1/2 million lives/year
*Today’s smokers have more disadvantages; quitting is harder
*Standard cessation treatments (NRT & medications) usually fail
1/3
— Alex Wodak AM (@AlexWodak) January 12, 2023
*In RCTs & population surveys, vaping outperform NRT. Even smokers not planning to quit do so by vaping
*Switching from smoking to vaping leads to rapid measurable reductions biomarkers of harm
3/3https://t.co/fuKJ5ozGzI@ColinMendelsohn @TheRACP @RACGPPresident @amapresident
— Alex Wodak AM (@AlexWodak) January 12, 2023
