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29 May 2018

Transcript:   AMA President, Dr Tony Bartone, 3AW, Morning with Neil Mitchell,
Tuesday 29 May 2018

Subject:  E-cigarettes


NEIL MITCHELL:   I want to check on this e-cigarettes thing. A report in The Australian newspaper today that the incoming President of the Australian Medical Association has made his view clear that he doesn't want- they will not change their policy on e-cigarettes. They are opposed to them. Now, e-cigarettes, it's been argued, can help you get off the real cigarettes. The Cancer Council, in fact, says it's as indisputably less dangerous than real cigarettes, even if you are ingesting nicotine, because I don't think nicotine itself is carcinogenic, but it is addictive, no question about that. A lot of people are saying it's the way we should go. There's been federal committees looking at it, federal Parliamentary committees, all manner of things. The e-cigarettes, you ingest the nicotine through them, but you can't actually legally get the nicotine, you've got to order it offshore and there are all sorts of complications to it.

Dr Tony Bartone, good morning.

TONY BARTONE:   Good morning, Neil.

NEIL MITCHELL:   Why not?

TONY BARTONE:   Look, there's a number of reasons around it, and essentially it deals with the evidence around the efficacy to be used as a cessation aid for coming off smoking. In fact, a lot of the evidence coming through now is showing that actually all it does is defer or delay or even actually- the decision to actually come off cigarettes, and a lot of people go back to cigarettes while coming down to it. So, there's still a lot of work to be done on whether they really do help people get off smoking in the meantime. But yes, we don't deny that it is less dangerous than smoking the actual real cigarettes, but it's about normalising the whole behaviour.

NEIL MITCHELL:   So, if I'm going to smoke something, I'm better off smoking one of these than tobacco?

TONY BARTONE:   But I'd rather you weren't smoking at all, Neil.

NEIL MITCHELL:   No, of course, of course and I agree with you.

TONY BARTONE:   And it's about the message. This also encourages- it encourages- it sort of glamorises the actual act of smoking, and it acts as an attraction to young teenagers coming through. We've had a really successful campaign to reduce the level of smoking in this country. We're down to almost 12 per cent or just under and that's from, you know, 20 per cent plus a couple of decades ago.

NEIL MITCHELL:   So you're saying that the e-cigarettes legitimise smoking?

TONY BARTONE:   Yeah, it normalises the act of smoking and almost glamorises it to the young population coming through. And really that's the message. It's as much a message of: we don't know what the harms are of smoking the vapour, inhaling the vapour. We don't know whether it works as a cessation aid fully, and we don't- also, the subliminal messages, the appearance of actually smoking and glamorising the whole behaviour of lighting up. So really, there's a number of reasons and we say: let's see the evidence, let's see the proof. When and if that comes through, yeah, obviously- all our Position Statements predicated on research, and the best reliable research available at the time.

NEIL MITCHELL:   Is that research being done anywhere?

TONY BARTONE:   Look, it's been published all around. I don't have anything specifically to hand at the moment [indistinct].

NEIL MITCHELL:   [Interrupts] No, no, but you need more. You say you need more research.

TONY BARTONE:   Yes. What we do need to see- I know that there’ve been some papers written to say that it does work, but they're really questionable trials or questionable- you know, the power, or the depth, or the- you know, the efficacy of those trials. We just need to see more data about there be no long-term effects from the use of e-cigarettes. We need to see more data that people don't keep flipping back to the process of smoking. We want to see people come off. So, we reckon try- you know, we know it's difficult to come off cigarettes. A lot of my patients take a couple of goes, but, with your doctor, keep trying, keep trying. We've got a number of cessation aids and products available that are proven to work and they have been authorised and legitimised by the TGA.

NEIL MITCHELL:   [Talks over] So, what works?

TONY BARTONE:   So, nicotine patches might work. There's medications that'll work. There's Quitline. There's programs to support. There's counselling, there's hypnosis. There's different things for different people and your GP will be the best person to guide you through that.

NEIL MITCHELL:  The vaping is out there. It's happening, isn't it?

TONY BARTONE:   Absolutely.

NEIL MITCHELL:   In fact, it seems to be becoming more and more common.

TONY BARTONE:   Absolutely. You don't need to look far, especially around the traps or in the trendy suburbs or hipster areas. You'll see that all around the place, you're right, Neil.

NEIL MITCHELL:   Did- have you seen any research out of the UK? I think the College of Physicians, they've published something recently.

TONY BARTONE:   Yes. And look, you know, that goes to the accumulating body of evidence that needs to be understood and fully verified and replicated. We don't usually go with just the one trial. We need to see more data because at the end of the day, Neil, it's about- we don't want to advocate for something that ultimately may cause harm and until it's proven, until it's proven to cause no harm, the default position is we're saying [indistinct] smoking cigarettes is bad, e-cigarettes are not proven yet. Come off both. Come off either and let's get you back into a fit and healthy lifestyle.

NEIL MITCHELL:   Is there a comparison with beer? I want to drink beer and you'd rather I drank light beer than heavy beer, I assume.

TONY BARTONE:   Look, it's not- you're right. In a limited way there is a connection because we know that there is, from various studies, there is no acceptable safe level of alcohol intake. However, we do, as guidelines recommend, there are a minimum- a maximum of no more than one to two drinks daily and with a couple of days of abstinence a week. That's the recommended guidelines on alcohol intake. So, insofar as that, there is- we know that the really- it's after you go beyond those levels that you really start to get a kickup in the terms of risk factors for the various conditions and cancers.

NEIL MITCHELL:   Well, thanks for speaking to us. Congratulations on your appointment. I'll talk to you again.

TONY BARTONE:   Absolutely, thank you very much, Neil.

NEIL MITCHELL:   Dr Tony Bartone, the incoming President of the Australian Medical Association.


29 May 2018

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Published: 29 May 2018