The West Australian AMA (Australian Medical Association) recently distributed a letter about vaping to West Australian federal MPs. Although well intentioned, ATHRA believes this advice is misinformed and will lead to additional premature deaths among West Australian smokers unless it is corrected.

This has occurred at a time when adult smoking rates have not fallen in WA since 2014. We should be doing everything we can to help smokers quit.

Health and Wellbeing of Adults in Western Australia. Health.wa.gov.au. 2012-2017

Safer nicotine alternatives such as vaping allow smokers who cannot quit to have an enjoyable but much less harmful experience similar to smoking, while spending less money.

Here we provide responses to some of the more egregious errors in the AMA letter:

'e-cigarettes … could pose a serious risk to public health'

• Vaping is not risk-free, but there is overwhelming scientific agreement that it is far less harmful than smoking. Long-term vaping has less than 5% of the risk of smoking according to several expert bodies.
• Vaping is the most popular quitting method in the UK, US and EU and is helping millions of smokers quit.
• Several high-quality modelling studies have compared the potential benefits and risks and have estimated a substantial positive net public health benefit from vaping (here here and here).

'there is evidence of a gateway effect for young people to tobacco smoking'

• Young people who vape are more likely to go on to smoke (and drink alcohol, use drugs etc), but there is no evidence that vaping CAUSES smoking.
• Most vaping by teens is experimental and short lived. Regular vaping is almost exclusively confined to current or past smokers.
• If there is a 'gateway' effect, it is insignificant and more than offset by the diversion of youth away from smoking.

'an "epidemic" of youth e-cigarette use that threatens to create a new generation of nicotine addicts'

• Since vaping became widely available in the US and UK in 2014, the rate of decline in smoking in high schoolers has TRIPLED compared to the long-term trend and youth smoking is at record lows in both countries.
• The rate of regular vaping (≥20 days p month) in the US by high school students is now 5.7% (National Youth Tobacco Survey 2018)  This is not an epidemic. Most are smokers or ex-smokers.

'Our tobacco control is the envy of the rest of the world'

• This is no longer the case. The national smoking rate has not declined since 2013. However, smoking rates are falling faster than ever in the UK and US  where vaping is available.

‘The vast majority of Australian government and non-government health organisations have taken a joint precautionary position on electronic cigarettes’

• Australian governments and health organisations are misusing the precautionary principle (#7). The precautionary principle states that an innovation should be banned if there are residual uncertainties and potential risk. This also requires an assessment of the potential harms of inaction. The known and substantial harms from smoking far exceed the small potential risks from vaping. Smoking kills two in three long-term users.
•  While more research is needed, there is no justification for withholding a far lower-risk product from existing smokers while further data is collected.

The Big Tobacco conspiracy theory

• Big Tobacco owns less than 20% of the vaping market globally and sells no products in Australia. Vaping is a grass-roots, consumer-led movement by addicted adult smokers wishing to reduce their harm from combustible tobacco. Tobacco companies arrived late in the vaping market and have been playing catch-up ever since to avoid their Kodak moment.

E-cigarettes a public health risk. Western Australia AMA 5 October 2018

Posted by Colin Mendelsohn, colin@athra.org.au

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