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AUSTRALIAN MEDICAL ASSOCIATION (WA)
While we may celebrate victories in reducing smoking and its harms, Big Tobacco has been waiting (im)patiently for its big comeback.
As is typical with giant global corporations, their tactics evolve and they re-emerge in fresh guises with a renewed focus.
The 2018 Global Forum on Nicotine (GFN), touted as “the only place where science and policy meet” was held in Warsaw from 14-16 June. Move over, World Health Organisation!
The theme for this year’s forum was “rethinking nicotine”, focusing on “harm reduction, especially the rapid development and availability of new safer ways for the consumption of nicotine”.
Naturally, the International Symposium on Nicotine Technology (ISoNTech) ran alongside GFN 18. This public event is a “show and tell” for developers and manufacturers of new nicotine devices and products to demonstrate and discuss the science and technology behind them.
The conference website states that it “is funded by registration fees and does not receive any sponsorship from manufacturers, distributors or retailers of nicotine products including pharmaceutical, electronic cigarette and tobacco companies”.
However, there was a fascinating pricing structure for participants. Conference and registration fees were £99 for “local and reduced” participants, £235 for “academic/public sector/NGOs”, £315 for “small and medium enterprises” and £610 for “industry and consultants”.
Speakers during the forum included representatives from Japan Tobacco, Philip Morris, British American Tobacco, Altria and Reynolds. Following the tobacco industry and associated speakers was WA’s own Dr Joe Kosterich. Dr Kosterich delivered the keynote oration, his lecture titled “Rethinking Nicotine: New nicotine products, the media and the medical profession”.
Fostering a link between the medical profession and industry, particularly such a powerful industry of harmful commodities, is deeply concerning.
Dr Kosterich’s “interest in e-cigarettes has come from listening to the experience of patients…both those struggling to quit smoking and those whose success has come from vaping”.
This is not an isolated stance among doctors. At the 2018 AMA National Conference, a motion was brought to members that the Association support e-cigarettes as a harm minimisation measure.
While the motion was rejected with a two-thirds majority, it was alarming that one third of doctors supported the notion of e-cigarettes as a solution to patients’ addiction.
Ironically, this support is building at a time when the evidence supporting caution on e-cigarettes gets stronger and stronger. With regard to e-cigarettes as a quitting aid, the evidence is scant and does not indicate an advantage over presently available Nicotine Replacement Therapy.
This can be contrasted with the many, as-yet unquantified, risks associated with the introduction of a new method of nicotine consumption.
Concerns that e-cigarettes normalise the behaviour of smoking and that they do not encourage people to break the habit are also valid and difficult to dispute. The promotion of miracle cessation methods isn’t new, let alone novel tobacco industry products that enable companies to seek a role in health discourse and policy.
However, the focus on e-cigarettes, particularly the media citing a surge in support for e-cigarettes, is unprecedented. Some of this is from well-meaning health professionals, but also from organisations and individuals who have previously supported tobacco industry lobbying, opposed action against the industry’s interests or simply been absent from campaigns to reduce smoking.
I do not doubt the intentions of those doctors seeking a solution to smoking, which still causes 19,000 deaths in Australia each year. I believe that most doctors as high-achieving and empathetic individuals are deeply frustrated when they see patients struggling with a problem that seems irremediable.
However, not all clinicians have a population-level mindset, the skills to interrogate evidence presented to them, or the time to consider the unintended consequences of legislation.
Would it be possible to legislate the introduction of e-cigarettes only as a “medicine”, prescribed by doctors to patients as a quitting aid and thereby tightly regulated? I don’t know. What is apparent is that the tobacco industry’s strategies have been evolving to respond to the probabilities.
Make no mistake: this is Big Tobacco 2.0. E-cigarette companies are seeking to position themselves as part of the tobacco solution, thereby gaining a seat around the policy table and exploiting well-meaning physicians and leaders who desperately want to improve the health of their patients.
These e-cigarette companies do not want people to quit. Their sole responsibility is to their shareholders, not to the health of the Australian public.
At the same time as the tobacco industry promotes e-cigarettes as a cessation method, they are shamelessly promoting their products in ways that would be eerily familiar to those who recall the battle with Big Tobacco.
Reminiscent of cigarette ads, the images on e-cigarette promotions are overly sexualised and glamorous, clearly targeting young people. The packaging and appearance of vaping devices are sleek, modern and elegant.
Nicotine flavours on offer include chocolate, Coca-Cola and “gummy bear”. The packaging and appearance of vaping devices are sleek, modern and elegant. Some promotions go so far as to ask: “Why quit? Switch to Blu”.
The GFN also comes as the Federal AMA revises the Guidelines on Doctors’ Relationships with Industry. As well as recommendations that doctors pay particular attention to independent, authoritative sources of evidence and critically appraise the information provided at industry-organised meetings, it outlines why doctors are such a target for industry.
The medical profession is uniquely trusted and influential in health, and often the only way of industry reaching patients.
It seems Dr Kosterich, among others, has fallen into this trap.
Tobacco companies simultaneously work to promote cigarette smoking and undermine tobacco control globally. Doctors should think carefully about both the conflicts of interest and ethics of endorsing these products – and stub it out.