Could Big Tobacco return to its old tricks with vapes?

Rarely has a plan been put on hold so sharply.
 
Details of a scheme to offer pharmacies incentives to order vapes backed by one of the biggest players in the Big Tobacco industry were outlined in correspondence sent out by PharmaPrograms.
 
The IT solutions company, which works with the pharmaceutical industry, described how pharmacies could receive a $275 ‘readiness payment’ after ordering at least $250 worth of stock of VEEV pods and devices supported by Philip Morris International.
 
The leaked letter, which has been seen by newsGP, was signed by ‘Kos’, believed to be former Pharmacy Guild president Kos Sclavos, who works for PharmaPrograms.
 
Further details were revealed publicly for the first time by NewsCorp this Tuesday, including a proposal for a $5 fee for when pharmacists refer customers to a doctor for a vaping product prescription, $10 for educating a customer about the VEEV device, and a $5 payment every time a new script is dispensed.
 
Once the details came out, the outcry was swift from a range of health groups, including anti-smoking group Quit Victoria, as well as the RACGP and the Australian Medical Association.
 
RACGP President Adjunct Professor Karen Price called it ‘nothing short of appalling’ and urged pharmacists not to sign up.
 
‘What we essentially have here is a health organisation working hand-in-hand with a tobacco giant responsible for the deaths of millions and millions of people to incentivise pharmacists into pushing a harmful vaping product,’ she said.
 
Early on Wednesday, the condemnation had grown further. The Pharmaceutical Society of Australia (PSA) added its voice in opposition to the scheme. 
 
‘No healthcare professional should accept financial incentives or support from a tobacco company. Big Tobacco cannot, and should not, be trusted with the health of Australians,’ PSA President Dr Fei Sim said.
 
‘PMI’s [Philp Morris International] offer of financial kickbacks shows clear contempt for our profession and our dedication to the health and wellbeing of our communities.
 
‘It’s galling PMI are promoting these products while they remain unregulated and unregistered.’
 
Chemist Warehouse founder Jack Gance also denounced the proposal.
 
By the end of that day, the plans had been shelved – for now at least. The Australian Journal of Pharmacy reported a decision by PharmaPrograms to ‘postpone’ the scheme, allowing a ‘review of all components of the program’ to take place.
 
For Professor Nick Zwar, who chairs the Expert Advisory Group (EAG) that compiled the RACGP’s smoking cessation guidelines, the question is how the plans were ever formulated in the first place.

‘The fact that they tried to do it at all is the remarkable thing,’ Professor Zwar told newsGP. He welcomed the pausing of the scheme.

‘They are clearly responding to the media attention that it’s had, [as well as] the comments from Karen Price, the AMA, and Quit Victoria,’ he said.

Following a meeting of the smoking cessations guidelines EAG on Wednesday, Professor Zwar said the attitude would be to watch and wait rather than take immediate action.

‘Our view is that because the program appears to be dead in the water, there’s no need for us to do anything at this stage,’ he said.

Professor Zwar also gives Australia’s ‘unique’ prescription model – which was introduced last year – as context to the controversy.

‘It’s important to understand that in many countries, particularly in Europe, nicotine vaping products are largely now manufactured by tobacco companies, in particular Philip Morris International, and they dominate the market,’ he said.

‘So it’s not surprising that they want to get their products out into more markets around the world.

‘In most jurisdictions where nicotine vaping products are available as a consumer product, they go through marketing to consumers … as their main way of selling their product.

‘Here, there’s a commercial imperative in trying to do it through the medical model, and through pharmacy.’
According to Professor Zwar, the controversy also highlights a gap that he believes needs to be filled – the absence of any vaping product approved by the Therapeutic Goods Administration (TGA).
 
‘It would be so much more preferable if we had an approved nicotine, e-cigarette as a medicine, one that had been through the proper approval process and was a registered product as other medicines are with the TGA,’ he said.
 
‘Then doctors who were thinking that these could be valuable to their patients as a smoking cessation support would have confidence in prescribing in the way we prescribe other medicines.
 
‘Part of the reason why Philip Morris International were able to see this opportunity and try to exploit it was because of that context.’
 
Dr Hester Wilson, Chair of RACGP Specific Interests Addiction Medicine, agrees the system is not currently working as it should.
 
‘There’s very little prescribing of vapes going on in general practice,’ Dr Wilson told newsGP.
 
‘Patients aren’t coming to us because they’re buying them illegally under the counter, or they’re getting them from these online doctor sites.’
 
Both Professor Zwar and Dr Wilson believe carefully regulated vaping can help smokers quit.
 
‘There is a place for nicotine-based vaping products for people who are nicotine dependent, who have tried the other options, who really will have a vast improvement in health if they can stop smoking,’ said Dr Wilson.
 
However, she also says the emphasis needs to be on vaping as a short-term method of smoking cessation – and she also strongly condemned the now paused scheme to incentivise pharmacists to stock certain products.
 
‘This is straight from their playbook of what Big Tobacco always do. I’m pretty appalled that any pharmacy would think this is a good idea,’ she said.
 
‘You’ve got to really be careful where you take your money from and who gets to benefit from this.
 
‘Quite clearly the tobacco companies do not want their product to be used short term.’
 
Professor Zwar says that while his focus is on smoking cessation, the ‘alarming’ rise in the popularity of vapes among young people is a pressing public health issue that needs to be addressed.
 
However, he doubts that making them more accessible to consumers would address the issue.
 
‘Why would it necessarily stop if it was a consumer product?’ he asked. ‘I’m not sure there’s a logical connection there.’
 
A recent article that may add weight to Professor Zwar’s doubts was published by the BBC last month. It covered the issue of the supply of unsafe vapes being aimed at children in the UK, where vapes are legally more widely available.
 
Despite the looser regulation, the article points to ‘large numbers’ of the products being illegally smuggled into the UK.
 
In the meantime, while Professor Zwar is pleased Philip Morris International is no longer likely to offer incentives to Australian pharmacists, he will be wary of any similar move.
 
‘It is likely that the [program] will not re-emerge – but we’ll be watching out,’ he said.
 
The RACGP’s Supporting smoking cessation: A guide for health professionals guidelines are available on the college website.
 
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