Doctors still don’t understand tobacco harm reduction

Doctors and pharmacists appear to be giving ill-informed advice about reduced risk tobacco products, undermining public health efforts towards smoking cessation.

A new survey has revealed a serious lack of knowledge among healthcare professionals about e-cigarettes or heated tobacco products - making life harder for people who want to quit smoking.

International market research firm, ResearchNow, polled 500 UK GPs and pharmacists. They found that only 29% believe that e-cigarettes are very effective at helping a smoker to quit smoking. This is despite a substantial and growing body of evidence showing this to be the case (including a recent randomized control trial showing that they’re nearly twice as effective as nicotine replacement therapy).

Just 7% of healthcare professionals are aware of Public Health England’s February 2018 statement that e-cigarettes are at least 95% less harmful than normal cigarettes. Few are very familiar with NICE guidelines on smoking harm reduction, which are broadly positive towards e-cigarettes as a component of smoking cessation services. And most don’t even know that heat-not-burn tobacco products exist—nor are they aware of the emerging evidence of their relatively lower risk compared to cigarettes. Unsurprisingly, this means that the majority are unlikely to recommend them to patients who are looking to quit smoking.

This is likely linked to misconceptions about the harm caused by nicotine. Dr Roger Henderson put it best when he explained that “it may be nicotine that makes it hard for smokers to quit, but it is smoke and tar that puts them in the ground.”

Previous research has demonstrated widespread ignorance among healthcare professionals about the relative risk of nicotine compared to other constituents of cigarette smoke, and this new evidence is just as concerning: 34% of GPs and 25% of pharmacists surveyed believe that nicotine is very likely to contribute to the development of smoking-related diseases.

To their credit, our public health authorities have broadly accepted the case for liberal harm reduction policies for tobacco. But the message still hasn’t got through to healthcare professionals on the frontline, who are an important source of information for many people looking to quit smoking. Every effort should be made to provide GPs and pharmacists with accurate information on this new wave of smoking cessation technology. Leaving the EU could give us greater scope to reform advertising laws, spreading this information to even more smokers.

In the meantime, if you know someone who works in smoking cessation, link them to Public Health England’s evidence summary and the latest NICE guidelines. You might just save a life. And what’s more, you’d be doing so in a way that embraces liberalism and the fruits of free market innovation!