Colin Mendelsohn is the doctor who goes against the grain. In a country where e-cigarettes are more or less banned, he helps doctors and smokers understand the technology and how vejpning can lead to freedom from smoking.
"Helping patients who smoke to quit is one of the most important things a doctor can do. It should be priority one, but there is a lot of resistance to the most effective tool" says Colin Mendelsohn, author of the book "Quit smoking - Start vaping"
Australia in 2021, the country with some of the the most comprehensive tobacco laws in the world. Despite this, it is more difficult to buy e-cigarettes (or rather e-liquid with nicotine) than analog cigarettes. Road users, or smokers for that matter, who want to use e-cigarettes to kick the habit now have to get a prescription for the nicotine.
"But very few doctors prescribe it. Around 400 have a medical license to do this, but of those, few know enough about vejpning to write a proper prescription," says Colin Mendelsohn.
"Terrible to see everyone failing"
Colin Mendelsohn is a doctor. He is also an activist and debater on the issue of harm reduction. He has been working and researching smoking cessation for decades. He is a general practitioner but also runs a stop-smoking clinic in Sydney.
"When you work so closely with smokers, it's awful to see everyone struggling, and failing, to quit smoking. Time and time again. These are patients who have tried everything, and still fall back into smoking. They just lose confidence and eventually it affects the doctor too" says Colin Mendelsohn to Vejpkollen.
Started recommending e-cigarettes
When e-cigarettes appeared on the market, he became curious. And after a visit to United Kingdom, where many colleagues started to present promising studies on safety and risks, he made up his mind. He summarized the UK studies in a report on vejpning in one of the country's medical journals. And then started advising some patients to try the technology.
"Vaping is special because it allows the smoker to use nicotine while habitual routines and behavior do not need to change much. This is what makes e-cigarettes prevent relapse, even in the long term. And I noticed that it worked. One third of the most severe cases stopped smoking almost immediately. And this without the help of medication or nicotine replacement therapy"
"The most effective method"
For Colin Mendelsohn it was not surprising when Cochrane Reviews Tobacco Addiction Group 2020 found that vejpning helps twice as many smokers quit This had long been known in harm reduction circles. That the health risks of vejpning are small, although not non-existent, compared to smoking, has become the consensus among researchers in the field.
"Evidence is what should guide anti-smoking efforts. Not ideologies based on preconceptions about nicotine. We know that smoking kills, and that e-cigarettes are the most effective tool for quitting. The risks are relatively small and we know that e-cigarettes greatly reduce the risks of nicotine addiction." Colin Mendelsohn.
Laws prevent smokers
At the same time, public opinion and legislation have moved in the opposite direction," says Mendelsohn. As a result, e-cigarettes are now less accessible than analog cigarettes in some countries. In Australia, various campaigns from different i interest groups has received broad political support. It has long been illegal to buy nicotine-containing e-liquid over the counter in Australia. And since October, it has not been possible to import them for personal use without risking heavy fines.
Colin Mendelsohn sighs.
"The rules make it very difficult for smokers to even test an effective e-cigarette. Combined with outright misinformation from doctors, authorities and advocacy groups, this has led to major misconceptions about the risks and benefits of e-cigarettes." says Colin Mendelsohn.
"Must fail to get help"
In countries like United Kingdom and New Zealand e-cigarettes have been highlighted as a recommended tool for smoking cessation. Ironically, even in Australia. However, according to medical ethics guidelines in Australia, e-cigarettes should only be recommended to smokers after all other methods have failed.
"First, the smoker will try nicotine medication, champix and so on. And fail. It's bizarre, really. A smoker first has to fail several times to quit smoking, before the doctor can proceed with the most effective method. It's very disheartening and cynical and not ethically defensible." says Colin Mendelsohn.
Want to spread knowledge
He also points out that doctors' knowledge, but perhaps more importantly, their attitude towards both e-cigarettes and nicotine, is a real problem. This was one of the reasons why the book "Quit smoking - Start vaping" came into being.
"I couldn't cope with all the myths and misinformation, among doctors, health professionals, politicians and smokers. I wanted to present the scientific evidence in a clear way. Everyone needs to be able to make informed decisions based on the science that is actually available. The book contains over 400 scientific references" says Colin Mendelsohn.
A huge resistance to vejpning
In the book, he answers questions about the relative risks of smoking and vejping, how e-cigarettes work in smoking cessation and why the technology has become so controversial.
"There is huge opposition, not just in Australia, but everywhere. And as I see it, it's not about the scientific evidence. It's clear that vejpning is significantly less harmful than smoking. And that they work well for smoking cessation"
Ideology and profit interests in focus
The debate has become more ideological, says Colin Mendelsohn. And that puts science and evidence in the shade.
"There is everything from a genuine concern that tobacco companies just want to attract new customers, to getting non-smoking young people to try it. But there are also purely economic concerns. Some businesses risk losing their funding if e-cigarettes and harm reduction become more prominent in the political discussion." says Colin Mendelsohn.
"Doctors believe nicotine causes cancer"
One of the big questions is about nicotine. How harmful is nicotine, if it is decoupled from smoking? Why do some delivery methods work better in smoking cessation than others? Colin Mendelsohn believes that a majority of doctors do not know enough about nicotine to make vital decisions for patients. Even less to dare to prescribe it.
"A survey in the US showed that 80% of doctors believe that nicotine causes COPD, cancer and heart disease. Which is simply not true. We certainly have the same situation here in Australia" says Colin Mendelsohn.
Important to give smokers confidence
In the UK, the authorities have simplified the process to make e-cigarettes available on prescription. Something that Colin Mendelsohn sees as positive, but with reservations.
"I have nothing against a medical model for e-cigarettes. But it should not be the only way, like here in Australia. At the same time: some people only trust their doctor. So it can be useful to have the option of a prescription and thus give the technology confidence. But the prescription model here in Australia will not work. Doctors don't know how to use the option - and then it becomes, on the contrary, harmful" says Colin Mendelsohn.
Hope that education will help
Through the Australian Tobacco Harm Reduction Association (ATHRA), he provides training for physicians who have concerns about vejping in Australia.
"Doctors are often conservative and very risk-averse. But if the evidence is clearly explained to them and they start to understand the principle of harm reduction, it can actually lead to an important change."
How has your commitment to vejpning and e-cigarettes affected you in your professional role?
"I have worked in the field of smoking cessation for many years and have experienced resistance to all forms of new nicotine drugs and medications. As a champix for example, it was also controversial at the time, surrounded by rumors and misconceptions. However, the commitment to e-cigarettes has led to me not being invited to speak at conferences organized by pharmaceutical companies anymore. And I am often accused of working for tobacco companies, which I have never done and will never do. And of course, some colleagues don't contact me anymore."
Believe in future of harm reduction
In addition to over 400 references to scientific studies and reports, Quit Smoking Start Vaping includes 15 testimonials from former smokers who quit using e-cigarettes. Some from Colin Mendelsohn's clinic, but also politicians and other doctors who use e-cigarettes. He believes that vejpningen has a future - even if the technology takes longer to establish itself than it should.
"I come face to face every day with former smokers who have gotten their lives back through vejpning. Politicians or activists who fight tooth and nail against e-cigarettes never see this. Today, the focus is only on the absolute risks of e-cigarettes and the concerns of the few young people who try them. Exaggerations of the risks are common, often unfounded and more rhetorical than reasonable."
Do you think there will be any change?
"I think the number of users needs to reach a critical mass, like in Sweden with snus. Then the issue can no longer be ignored and politicians will make reasonable decisions instead of coming up with devastating solutions, like bans. In the meantime, it's important to counter the arguments with facts, and to reach smokers with accurate information," Colin Mendelsohn told Vejpkollen.
Hello!
Can I have the source of this?
Hi! You might have to be more specific ;-). If there is no direct source in Vejpkollen's articles, it is because it is an original material. The article in question is based on an interview with Colin Mendelsohn (which took place in mid-December). He has a website too (link to this can be found in the article, same as link to the book). Or was there something else you were thinking of? 🙂
Sincerely, Stefan Mathisson, Publisher and Editor