22 August 2017:
The debate on electronic cigarettes took a turn for the worse this week, when raw numbers were used to suggest that current interventions to reduce smoking may not be working — and therefore e-cigarettes need to be part of the solution.
There was no scientific merit to either of these claims. To use them together to push an evidence-free barrow on e-cigarettes is not only flawed but dangerous.
Yes, reliable estimates show the total number of smokers in Australia increased by 21,000 between 2013 and 2016. But that is explained mainly, and easily, by migration.
According to the Australian Bureau of Statistics, Australia’s net population grew by 589,000 from migration between 2013 and 2015. On that basis, a growth in total smoker numbers of 21,000 is remarkably low, at only 3.5 per cent of that population growth.
Smoking take-up among other Australians, and particularly in younger age groups, is at an all-time low, thanks to decades of effective tobacco control policy. Claims that tobacco tax and plain packaging are “not working” are simply wrong.
This is population health 101, and it is the reason that percentages, rather than aggregate or total figures, are used to evaluate the effectiveness of interventions.
At a time when other nations with poor tobacco control policies and terrible tobacco health harms are looking to Australia’s success for guidance, not to recognise these facts and principles of science is not just wrong, but also potentially dangerous.
Smoking prevalence in Australia has more than halved in the past 25 years. This is a remarkable achievement in the face of unrelenting opposition from tobacco companies, who now support e-cigarettes under the guise of public health policy. This is just another dubious attempt to cast themselves as part of the solution to a problem they created — and one that will rack up 1 billion global deaths this century since the mass-marketing of cigarettes began a century ago.
One quarter of all reduced prevalence from 2012 to 2014 can be attributed to plain packaging alone. This is extraordinary, given that plain packaging was intended to prevent people starting smoking, rather than to encourage people to quit.
Yes, the decline in Australia’s smoking prevalence has since slowed in relative terms — but this is after what was the greatest relative decrease on record, between 2010 and 2013. The slowing down also coincides with a big fall in Federal government funding for hard-hitting, mass media advertising campaigns emphasising the harms of smoking.
We don’t hear anything from the e-cigarette entrepreneurs about the outstanding success of Australia’s media campaigns, going back to the late 1990s with the Every Cigarette is Doing You Damage initiative. But why would we, when it’s difficult to separate e-cigarette entrepreneurs from the tobacco industry?
The evidence in favour of e-cigarettes does not stack up when the potential risks and benefits to the whole population are assessed. Australia’s Therapeutic Goods Administration and National Health and Medical Research Council, and the Australian Medical Association, have all come to this conclusion based on the current evidence.
This is Australia, after all, where we are blessed to have strong and independent health authorities to advise government on policies. Australia is also the nation where a phenomenal 98 per cent of teenagers do not smoke — an unimaginable percentage a generation ago. This is an achievement we will protect fiercely, in the face of studies showing young people initially exposed to nicotine from e-cigarettes are more than three times as likely as those who do not use e-cigarettes to become tobacco smokers.
There are also studies that show e-cigarettes may have a benefit. We need to look at all the evidence and would support the availability of e-cigarettes under appropriate controls if such evidence were conclusive. But it isn’t, especially in the Australian context.
The World Health Organisation has warned that countries with a good record in tobacco control — and yes, that’s us — need to be particularly cautious about the risks of e-cigarettes. And these risks are not only about the gateway to smoking.
Does any parent want their kids inhaling toxic vapour laced with highly addictive nicotine directly into their lungs, from products blatantly designed to appeal to youth — with fruit and energy drink flavours, and gimmicky marketing?
Let’s continue to do what works to get Australia’s smoking rate down below 10 per cent in the next five years. Revving up our mass media campaigns is the missing piece, as the evidence shows.
Smokers are paying their tobacco tax. We would only need a fraction of that revenue to fund effective campaigns that would prompt people to quit in even bigger numbers. We just need to see through the tobacco industry’s smokescreen.