It's only fair to share…

Recently I had the great privilege of being part of the Australian launch of the Global State of Tobacco Harm Reduction (GSTHR). In the 50 years to 2013, smoking rates in Australia fell sharply. In the 1980’s we led the world. However, a sense of “we know best” has seen smoking rates become static since 2013. This is in spite of having the highest cigarette prices in the world and plain packaging.

Regular readers will know that I am a supporter of vaping as tobacco harm reduction. New Zealand expert Professor Marewa Glover presented the views of a judge in NZ who had heard the case against vaping brought by the Ministry of Health seeking to ban the importation of vaping and heat devices.

The judge threw the case out on the basis that tobacco control legislation had the intent of reducing harm and that to ban a less harmful option to smoking was totally contrary to the reason the law existed!

This is worth repeating. The reason countries have tobacco control laws is to reduce harm. Vaping has consistently shown to be significantly (upwards of 95%) less harmful than smoking. Thus, the judge correctly ruled that banning the less harmful product was totally at odds with why any such legislation exists.

In Australia we cling to methods which have gone as far as they can. Tax increases are no longer working. They simply provide fodder for a black market or people buy cigarettes rather than feed their children. Quit messages run on prime time TV are failing to reach those groups (e.g. Indigenous, people with mental health problems, homeless) were smoking rates are highest.

Put simply Australia is failing its most disadvantaged and those most vulnerable to smoking related illness.

The international data and research is impressive. Vaping has been consistently shown to be at least 95% less harmful than smoking. A study released last month by Queen Mary University of London found people are almost twice as likely to succeed in quitting smoking if they use e-cigarettes than if they rely on nicotine replacement patches and gums.

Where vaping and e-cigarettes are legal, smoking rates are falling faster than where it is not. Youth smoking rates are also declining where vaping is legal. At the same time, Australia’s smoking rates have stalled, despite having the highest cigarettes prices in the world, plain packaging and strict tobacco control laws. The latest data from the ABS shows that daily smoking rates have plateaued.

19000 Australians die of smoking related illness each year. We know that on average smokers die 10 years younger than non-smokers. We know that there are numerous diseases including many cancers related to smoking.  These number matter but are impersonal.

However, it is the stories from patients that is the human side of the data. People report being able to finally throw away the packet. They report breathing easier, being better able to play with children or grandchildren. They enjoy not smelling like an ashtray to family and friends.

Politicians and policy makers rely on the advice of public health.  To quote Richard Horton from  The Lancet  last year “public health science needed to pay more attention to the lived experiences of people in societies”.

What is disappointing is the attitude of some in officialdom to the lived experience. Horton concludes, “Public health today is crudely reductionist, often ignoring or denying the lives of those it purports to defend. Public health has evolved into an elitist endeavour, more concerned with its own power, reputation and survival”.

As a doctor my concern is the health and wellbeing of the person sitting with me. To presume that their experience is invalid is both wrong and insulting to that person. Doctors learn the most by listening to patients. Policy makers and politicians would be well served to do likewise.

Australian tobacco control laws are meant to serve the same purpose as in N.Z. Those opposed to helping smokers have lost the scientific argument. Their opposition is increasingly shrill and ideological. Victory for smokers wanting to reduce harm may not be yet at hand but we are getting closer.