Expert reaction:TGA announces ban on nicotine e-cigarettes to remain

Public Health

7 Feb 2017

Here’s what the experts had to say about the TGA’s decision to not lift the ban in nicotine e-cigarettes.

Professor Mike Daube is from the School of Health Sciences at Curtin University

“The TGA is Australia’s independent arbiter. Its decisions are based on evidence and the best science, not anecdote, lobbying and wishful thinking.

This is a sound and sensible decision based on the best available evidence.

Australia is already a world leader in reducing smoking – described by the tobacco industry as “the darkest tobacco market in the world”. We should keep doing the things we know work, that are already driving down smoking dramatically in both adults and children.”

Adjunct Associate Professor Renee Bittoun is a Tobacco Treatment Specialist (TTS) at The University of Sydney

“I am strongly opposed to the introduction of electronic cigarettes. I believe them to be the cigarettes of the 21st Century.

We have, over my career, been able to dramatically reduce the prevalence of smoking in Australia to one of the lowest in the world due to factors such as litigation, education, taxation and cessation initiatives. We do not need to introduce a new source of nicotine delivery device. This is a consumer issue as e cigarettes are addictive and promote the continuation and consumption of a tobacco product for life.”

Dr David Chapman is from the Translational Airways Group at the University of Technology Sydney. He is an active researcher in the field of e-cigarettes and human health

“In light of the recent decision from the TGA regarding maintaining nicotine on the dangerous poisons act list we thought we could add our perspective as active researchers in the field of e-cigarettes and human health.

E-cigarettes are considered a safer alternative to tobacco cigarettes because they do not require combustion and produce reduced levels of many toxic compounds. However, they still expose users to numerous toxic compounds and it is unknown whether a reduction in these compounds equates to improved health outcomes. Nicotine is a highly addictive compound and itself leads to detrimental health outcomes.

Additionally, the compounds used to provide the ‘smoke’ effect while vaping may contribute to the dangers of e-cigarette use.

Lastly, although flavour additives are safe for ingestion, they are likely toxic when heated and inhaled. Some flavour additives are already known to cause irreversible lung disease in factory workers who have been exposed to the fumes from heated flavouring compounds.

The role of e-cigarettes in reducing the health effects of tobacco smoking is not well understood. Initial research suggested that e-cigarettes had limited effectiveness in smoking cessation but there is now evidence from the UK that e-cigarette use has increased the success of quit attempts.

However, many tobacco smokers are simply smoking in conjunction with e-cigarette use and whether this dual use leads to positive or negative outcomes is not known.

Although evidence from the US suggests that adolescents who use e-cigarettes are more likely to become tobacco smokers, the majority of e-cigarette users at present appear to be former or current tobacco smokers. Therefore, it is unclear as to whether e-cigarettes will provide a new generation of smokers or reduce the current population of smokers.

I view the nicotine ban in e-cigarettes by the TGA as a good idea until more information is known. The downside of this decision is that e-cigarette users will still import nicotine containing e-cigarette fluids from the internet which may also contain other harmful products.

Simon Chapman is an Emeritus Professor at the Sydney School of Public Health, University of Sydney

“Australians have relied on the TGA scientific umpires to make decisions on the safety and effectiveness of drugs for decades. We have among the best drug regulation systems in the world and I’ve full confidence in the process.

In light of recent evidence, the WHO’s international Agency for Research in Cancer has named nicotine as high priority for carcinogenic assessment. The recent US Surgeon General’s report on e-cigarettes listed serious concerns about nicotine and adolescent brain development. Against that background, the TGA’s decision is commendable.

Australia has one of the lowest rates of smoking among adults and youth of any nation. It has been falling almost continually since the 1960s, and especially since the 1980s. This has been achieved without e-cigarettes.

The tobacco industry will unanimously condemn this decision. This is all anyone needs to know about why it should be welcomed.”

Dr Michael Keane is an anaesthetist and an adjunct associate professor at Swinburne’s Centre for Human Psychopharmacology

“In regards to the TGA decision, ideology has egregiously trumped science, reason and harm reduction. The decision of the TGA in effect reverse normalises conventional cigarettes and this will potentially kill many Australians.

The claim that e-cigarettes (which are much much less harmful) should be banned because they will normalise the much much more harmful conventional cigarettes is as absurd as claiming that the use of condoms to practice safer sex should be banned because they “normalise” unsafe sex. I’m glad the TGA was not responsible for the anti-AIDS campaign of the 1990’s. In this regard, the TGA will surely want to ban masturbation because it will normalize unsafe sex!

The TGA appears not to have undertaken an adequate critique of relevant studies regarding smoking uptake in teenagers after exposure to e cigarettes. It appears that some of the data has been accepted too readily, confirming an ideological position. Significantly more compelling information seems to have been dismissed.”

If people die because of the missed opportunity to allow this much safer product on the market, those responsible for this decision should be seen in the same light as the cigarette company CEOs of the 1980’s”

Conjoint Associate Professor Colin Mendelsohn is a Tobacco Treatment Specialist in the School of Public Health and Community Medicine at The University of New South Wales

“The TGA decision is a devastating blow to Australia’s 2.8 million smokers who have been denied access to a much safer alternative to smoking. The TGA has ignored the huge public health benefits of e-cigarettes in reducing smoking-related death and disease and has instead focused on potential but unproven risks.

 E-cigarettes, which are being used almost exclusively by smokers and ex-smokers to reduce the harm of smoking, and they have helped millions of smokers to quit. After ten years of overseas experience, there is no evidence that they act as a gateway to smoking in young people, in fact they appear to be replacing smoking in young people rather than encouraging it.

 International reviews have also found no evidence that e-cigarettes are undermining tobacco control. In fact, smoking rates are declining faster than ever in some countries as e-cigarette use increases.

 The TGA view of the risks of nicotine is also exaggerated. Fifty years of experience with snus, a high nicotine tobacco concentrate used in Sweden and Norway, and over 30 years of nicotine replacement therapy have not identified any serious concerns. According to Public Health England, the risk of poisoning from liquid nicotine appears to be comparable to ‘potentially poisonous household substances’.

 The TGA decision appears to be driven more by ideology than science and will cost the lives of thousands of Australian smokers.”

These quotes were collated by the Australian Science Media Centre. 

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