Do Doctors Understand Vaping?

The recent report by Public Health England (PHE) highlighted a problem with smokers holding misconceptions about vaping. While this is a barrier to them switching, you might be surprised to discover that a large number of doctors and nurses also believe things that aren't true about alternative nicotine products like ecigs. While the PHE report shared concerns about misunderstandings, it hasn't come as news as earlier in 2021 the British Lung Foundation (BLF) released a report( ¹ ) showing that members of the British medical community have a low level of training in and comprehension of vaping. This creates a huge problem when smokers receive quit advice from their GP or while in hospital. Only 2% of GPs said they had received adequate training in offering cessation advice. BLF estimated this mean almost seven million smokers are currently under the care of GPs who lack sufficient information. How has this misunderstanding about vaping come about? Firstly, it should be remembered that tobacco controllers have been attacking smoking for decades. There isn't a person on the planet who doesn't understand that using tobacco is a dangerous thing to do and most appreciate it leads to the largest preventable cause of death in the United Kingdom. As cigarettes and related products have been vilified, public conception of the dangers blurred between smoking and nicotine - the two became synonymous despite nicotine not being the reason for cancer and other related diseases. An example( ² ) from 2015 typifies the belief a lot of qualified doctors hold. Dr Frank Bures warned that the nicotine in eliquids could cause, " a big drop in blood pressure, slowing heart rate, central nervous system depression, muscle weakness and/or paralysis, difficult breathing, coma, respiratory failure/arrest and death ." "It is really impossible to say anything good about e-cigarettes," the doctor concludes. The issue of individual misunderstanding is then compounded when large organisations repeat inaccuracies. The UK Centre for Tobacco and Alcohol Studies attacked the World Health Organization ( ³ ) in 2016 for arguing that, " policy measures recommended to reduce tobacco use should be applied to e-cigarettes ". The Centre said: " The WHO report fails to accurately present what is already known about e-cigarettes. In particular, it: positions e-cigarettes as a threat rather than an opportunity to reduce smoking. " Doctors and nurses, as we've seen during the Covid pandemic, are incredibly busy. Without directed training, they will form opinions about vaping from announcements by the likes of the World Health Organization and from national media like the rest of the population. When newspapers carry stories about vaping, journalists frequently call on a select group of individuals to put over balancing opinions. One, Stanton Glantz, is on record( ⁴ ) as saying that misunderstanding the relative risk of vaping is " a good thing ". Professor Michael Siegel warned( ⁵ ): " Professor Glantz does not believe that accurate communication is the way to go. Apparently, inaccurate communication is better. This would almost be funny, were it not for the fact that many adults are going to die because of it ." By 2018, others from the select group took to the British Medical Journal , aimed at and read by clinicians, to write: " There is no reliable evidence to show that e-cigarettes are safe or that they did not provide a 'gateway' to smoking for youngsters ." This fed into attitudes revealed in a research report(6) by the National Cancer Research Institute and the New Nicotine Alliance charity(7). They discovered a stunning level of ignorance and fear within with cancer surgeons and cancer nurse specialists and concluded: " Training of health professionals and local adoption of e-cigarette advice are needed. " PHE picked up on this problem in 2019, in its document( ⁸ ) about what works for smoking cessation. It wrote: " Perhaps the greatest obstacle we face is the widespread misconception amongst smokers and health professionals that most of the harm of smoking comes from the nicotine. While nicotine is the addictive substance in cigarettes, it is relatively harmless. " It prompted many medical organisations to try to address the problem and speak directly to NHS staff. The British Medical Association provided answers to typical questions doctors should use( ⁹ ), telling them, " that using an e-cigarette is substantially safer than smoking tobacco ." The Royal College of GPs in conjunction with Cancer Research UK released a training video, podcast and written instructions( ¹⁰ ), and the National Centre for Smoking Cessation and Training produced a training module for professionals( ¹¹ ). Also, the Royal College of Physicians issued advice(12) on tobacco harm reduction, addressed the matter of budget cuts to smoking cessation services (impacting staff training), and calling for vaping to be allowed by all NHS Trusts on hospital grounds. Even PHE joined in, addressing misunderstanding on its blog(13) by raising and debunking the most common myths about e-cigarettes. Ultimately, all of these messages haven't had the desired impact according to PHE's recent evidence update(14), and more needs to be done as misunderstanding the dangers and risks of vaping persists. Clearly, more investment in training is needed as busy professionals don't seem to have the time to read all of the advice - but there is something we can do to change this: Advocacy organisations have been calling on vapers to talk about their success at quitting cigarettes or other tobacco products by switching to vaping when they visit their GP. John Newton, PHE's Director of Health Improvement, commented on the launch of the recent Vaping in England report that vaping helps fifty thousand smokers a year to stop smoking, but warned: "Thousands more could have quit except for unfounded safety fears about e-cigarettes." "For anyone who smokes, particularly those who have already tried other methods, we strongly recommend they try vaping and stop smoking - ideally with additional support from their local stop smoking service for the very best chance of quitting for good." In conclusion, the answer to our question as to whether doctors understand vaping is broadly 'No', but the more doctors hear about how their patients managed to successfully switch to vaping the more likely they will be to recommend it to smokers in the future. The links below will help you in those conversations. References:

1. A breath of fresh air: Research into the training needs of UK GPs on Very Brief Advice for smoking cessation - click here
2. Highly critical report: UK experts say WHO needs better understanding of the evidence on e-cigarettes to inform its international tobacco control treaty - click here
3. The Evidence of Electronic Cigarette Risks Is Catching Up With Public Perception - click here
4. Public Misunderstanding of Health Risks is 'a Good Thing' According to Some in the Tobacco Control Movement - click here
5. The New Nicotine Alliance - https://nnalliance.org
6. Health matters: stopping smoking - what works? - click here
7. E-cigarettes: balancing risks and opportunities - click here
8. RCGP and CRUK joint position statement on e-cigarettes - click here
9. E-cigarettes: a guide for healthcare professionals - click here
10. Hiding in plain sight: Treating tobacco dependency in the NHS - click here
11. Clearing up some myths around e-cigarettes - click here
12. Vaping in England: evidence update February 2021 click here