Bruce Cran: Canadian MDs ill-prepared to talk to smokers about tobacco alternatives
Credit to Author: Gordon Clark| Date: Sat, 31 Aug 2019 01:00:48 +0000
Canadian physicians appear to be ill-prepared when it comes to discussing alternatives to help smokers quit, according to a survey conducted for the Consumers’ Association of Canada. Only 25 per cent of the 456 physicians surveyed recommended electronic nicotine delivery systems (ENDS), such as vaping devices and e-cigarettes, within the past year even though 63 per cent believe them to be less harmful than cigarettes.
Only 37 per cent have read research on ENDS within the past six months and discussed it with patients, 29 per cent more than six months ago, while 34 per cent have not read research. It’s a troubling statistic when we consider the number of people who credit these products with helping them become smoke-free.
Over the past year, only 25 per cent of physicians surveyed have recommended that patients who smoke use ENDS to help them reduce or quit their tobacco consumption.
Sixty-three per cent of the physicians believe ENDS represent a harm-reduction approach for patients who smoke traditional cigarettes, 26 per cent do not while 11 per cent are not sure.
Vaping products are the most common type of ENDS and are devices that do not burn or use tobacco leaves but instead heat up to vaporize a solution the user inhales. The number of smokers interested in the devices has likely increased since vaping products were legalized in 2018, but Canadian physicians are not up to speed on these products nor given any formal guidance by governments or medical associations that would help them to confidently recommend vaping as an alternative to smoking.
The picture is very different in other countries, particularly in England, where professional medical associations like the National Institute for Health Care Excellence and bodies such as the Public Health England offer evidence summaries and practical guidance to their members. In a guideline published in March 2018, the institute states that smokers should be told that many people have found e-cigarettes helpful aids to cessation and the evidence indicates that e-cigarettes are substantially less harmful to health than smoking, although not risk free.
Public Health England goes as far as to recommend that vaping products should be prescribed to smokers, in a report published in February 2018, and two hospitals in England now allow vape shops to support their move to become smoke free premises.
Although Health Canada has recognized on its website that ENDS deliver nicotine in a less harmful way than smoking and that it may help smokers quit, it offers no guidance to health-care practitioners who routinely have conversations with smokers.
The gap between the number of physicians who believe that vaping is less harmful than smoking with the number of physicians actually recommending these products to smokers demonstrates the need for Health Canada or a professional association to step up and provide some guidance on vaping products. There are various studies that show vaping is a less risky way to consume nicotine and the more smokers turn to vaping, the more the harms associated with smoking are reduced.
But there is also a great deal of negative information on vaping. Physicians should not be left to their own to sift through the research to form a medical opinion. Offering reliable, practical guidance to physicians will ensure that physicians, in turn, are able to fulfil their responsibility to make smokers fully aware of all options that are available.
Although vaping products are less harmful than cigarettes, they do contain nicotine and are not harmless. For that reason, the CAC supports government regulations to keep vaping products out of the hands of youth while allowing proper communication and access to information so adults can make informed choices.
Bruce Cran is president of the Consumers’ Association of Canada.
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