Vaping theology: 3 Australia’s prescribed vaping model “privileges Big Tobacco”

Robert Beaglehole is a veteran public health leader from New Zealand. He was professor of public health at the University of Auckland between 1988-1999, before joining the World Health Organisation in Geneva in 2000, heading its chronic disease prevention and health promotion division until 2007. He started New Zealand’s Action on Smoking and Health in 1982 and chairs its board today.

I’ve known and admired Robert’s work for many years, and have spent some very pleasant time in his company.

But lately, he has become an advocate for vaping and is showing signs of having drunk the movement’s kool aid rather deeply.

One of the most persistent memes in vaping advocates’ creed is the profoundly silly argument that anyone who expresses any scepticism about any of the pillars of the case for vaping is helping Big Tobacco. I explored this argument in an earlier blog here.

Recently, Beaglehole was interviewed for a short video produced by CAPHRA (the Coalition of Asia Pacific Harm Reduction Advocates).

Australia’s Therapeutic Goods Administration has ruled that from October 1, 2021 anyone wanting to import or purchase nicotine for vaping will be required to have a doctor’s prescription – see here. This is in effect a quasi “license to vape”, that has some of the reasoning in common with that I set out in a paper in 2012 on the idea of a “smokers’ licence”, later adapted by Coral Gartner and Wayne Hall in a paper on a “vaping licence”. The prescription route is now causing apoplexy among those who want to see e-cigarettes containing nicotine sold in almost every conceivable retail outlet (I’ve not yet seen this include crèches, tuck shops or back-to-school sections of stationery shops … but nothing would surprise me here).

Asked to comment on this recent decision to implement what the interviewer calls “a medical model” for vapouriser access, Beaglehole says at 2m35s:

Well, basically going that route privileges the tobacco industry. By making vaping less accessible and more difficult for smokers who smoke cigarettes and want to quit, making it more difficult for them to access nicotine is privileging Big Tobacco. That’s the last thing we want to do. We should be treating nicotine as a consumer product. Let the market innovate. Let people make their own choices as to what they do.

So, what do the main tobacco companies selling tobacco in Australia and hoping to be able to sell their vapourised and heated nicotine products here have to say about their impending “privileged” position said to arise from prescribed access?

Imperial Tobacco told the 2020 Australian Senate enquiry into harm reduction:

We are discouraged by recent moves from the Department of Health to ban the import of nicotine containing EVPs [electronic vaping products]… We believe NGPs [next generation products] are more likely to succeed at transitioning adult smokers if they aren’t perceived to be medical treatments for smoking, unlike NRTs [nicotine replacement therapies].

And what about British American Tobacco Australia?

A practical and regulated solution that allows Australian smokers ready access to nicotine containing e-liquids (along with other potentially reduced risk alternative products to cigarettes) without the need for a prescription, is urgently required.

And Philip Morris International? PMI applied unsuccessfully to have the poisons schedule amended to allow its IQoS heated tobacco product to be openly sold in Australia. But has not submitted an application to the Therapeutic Goods Administration to have it scheduled as a therapeutic good (as has long been the case with nicotine replacement therapy). So it too, does apparently not share Beaglehole’s understanding of how prescribed access would privilege it.

So all three Big Tobacco companies operating in Australia, which are all hoping to market their so-called harm reduced products here, are not exactly popping champagne corks at the thought of how privileged they will become in 2021. In fact just the opposite: they are all implacably opposed to access via a doctor’s prescription.

And what should that tell us?

It tells us that they all know that the “consumer product” classification that Robert Beaglehole supports will see the companies able to avoid any of the controls that therapeutic regulation would bring. For example, very, very few doctors would be willing to issue a nicotine vaping license to a child, while 45% of US vaping retailers and 39% of English shops operating under a “consumer product” model sell to underage customers. In New Zealand, vaping by kids is booming. And no tobacco company would ever want to see that happen …

Source: Youth19 survey 2019 of 7891 young people. Funded by Health Research Council of New Zealand

Quite amazingly, at 7m26s into the video, Beaglehole picks up two nicotine delivery systems strategically placed on a coffee table in front of him. One at a time, he carefully inspects them, with the brand names clearly visible. Irony of ironies, the two brands are BAT’s Vype and PMI’s IQoS: the two flagship new generation nicotine products of two of the biggest Big Tobacco companies in the world. You know, the ones that he thinks it’s a bad idea to “privilege”.

He also says that access via prescription will make it “more difficult” for smokers wanting to get vapable nicotine than if these products were sold in shops with open access.

And how enormously difficult is it in Australia for people to access prescribed medications? In 2018-19, in a population of some 25 million, 205.1 million prescriptions for 900 subsidised drugs in 5,455 brands were dispensed via Australia’s Pharmaceutical Benefits Scheme. There can be few people in Australia who, in any year, are never handed a prescription by a doctor.

“All of it is incorrect”

Beaglehole also has some choice words about those who have drawn attention to emerging evidence about harms of vaping. At one point he refers to “the supposed harm of nicotine and vaping”, theatrically gesturing quotation marks around “supposed harm”. He then says “A lot of that information is incorrect. All of it is incorrect. And based on very poor science and vested interests.” (my emphasis)

All of it is incorrect? All of it? So any published evidence that has concluded that there are any concerns about vaping being harmful or not very effective in helping smokers quit is all wrong? In our submission to the 2020 Senate enquiry, we referenced 11 expert reports and meta-analyses of smoking cessation via vaping published since 2017 which all concluded there was weak evidence that e–cigarettes are useful ways of quitting smoking. We also listed (on pp 23-24 of our submission) a small selection from many recent papers on harms from vaping.

Such categorically dismissive language from a person with a seriously impressive public health background is quite remarkable.

He continues “The misinformation which is coming from a rather limited number of people with strong vested interests in traditional tobacco control approaches”.

A limited number of people? With “traditional tobacco control approaches?” Perhaps by this Robert means those approaches which no less than 188 nations have signed to support the World Health Organization’s Framework Convention on Tobacco Control – a blueprint for reducing smoking. The only nations that have not signed are Andorra, Dominican Republic, Eritrea, Indonesia, Liechtenstein, Malawi, Monaco, Somalia and South Sudan. Here’s a 2019 blog from me showing a very long list of national and international health agencies who have expressed strong reservations about e-cigarettes.

Speaking for myself, I plead not guilty, m’lud, to slavish adherence to the “traditional” suite of tobacco control policies and practices. I have been persistently critical since 1985 of the very limited impact of stop smoking clinics (see here at p154) and NRT and smoking cessation drugs on reducing smoking prevalence (and am several months into writing a book on these quit smoking “weapons of mass distraction”); of banning smoking in wide-open outdoor areas; of employers refusing to hire smokers; and of R-classifications for movies depicting smoking.

My scepticism of the turbo-hyped claims for vaping is shared by many of the world’s peak health agencies. Here’s how Australian agencies line-up. Notice a pattern?

If there is anyone helping Big Tobacco in the vaping policy debate, it is of course all those who are doing all they can to enable its ambitions to see a repeat with vaping of the disastrous historical failure to regulate tobacco and cigarettes. I’ve never met anyone in health or medicine who thinks it is wonderful for public health that cigarettes can be sold anywhere. Australia’s decision to require a prescription will put a significant barrier between kids and vapes, but will not constitute a barrier for adults who smoke to access vapourised nicotine under the care of a GP.

Update 20 Feb 2021: two excellent investigative pieces published this morning in the Australian Financial Review, on how two tobacco companies (BATA and Philip Morris) have been lobbying to stop the “prescription” regulatory model.

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