Wednesday, March 23, 2016

Public Health Malpractice? Nursing Journal Article Recommends Scolding Smokers Who Quit Using E-Cigarettes

Cited Guidelines by AACR and ASCO Demand Conflict of Interest Disclosures, But Fail to Disclose their Own Conflicts

In a review article published online ahead of print Monday in the Journal of the American Association of Nurse Practitioners, a University of Pennsylvania Nursing School professor makes a number of clinical recommendations regarding communications that nurses should have with patients about tobacco and nicotine use. One of those recommendations is that practitioners should not commend smokers who have successfully quit smoking by switching completely to electronic cigarettes.

The author writes:

"Currently, it is neither advisable for practitioners to recommend e-cigarettes for smoking cessation, nor is it recommended to commend patients for making the switch to e-cigarette use over traditional cigarette smoking (Brandon et al., 2015)."

The article cited to support this recommendation is a joint policy statement issued by the American Association for Cancer Research (AACR) and the American Society of Clinical Oncology (ASCO). In this statement, these organizations emphasize that in any articles regarding e-cigarettes:

"Consistent with best practices, investigators should disclose potential conflicts of interest such as funding received from pharmaceutical, tobacco, and ENDS industry sources."

The Rest of the Story

Imagine that I, as a physician making recommendations about the treatment of high blood pressure, issued a recommendation to my fellow physicians that they not commend any patients who successfully get their blood pressure under control using an exercise routine and dietary restrictions. In lieu of commending these patients, what I am really suggesting is that physicians scold their patients for successfully lowering their blood pressure. Not only would this be a ridiculous recommendation, but it would at least border on public health malpractice, since scolding patients for lowering their blood pressure violates any medical standard of care and will likely cause damage by discouraging those patients from continuing to control their blood pressure through diet and exercise.

Unfortunately, the recommendation made by the nursing professor in this article is essentially the same thing. She is essentially telling nurses to scold patients who successfully quit smoking using electronic cigarettes. This is ridiculous, and may represent public health malpractice, since scolding patients for quitting smoking violates any nursing standard of care and will likely cause damage by discouraging those patients from continuing to avoid smoking by using vaping products instead.

The article also seems to criticize e-cigarette users for having the perception that vaping is safer than smoking. For example, the author writes:

"The majority of adult e-cigarette users studied in the nine research articles in this review perceived that e-cigarettes contain less toxins than traditional cigarettes. This could be because of the marketing strategies that label e-cigarettes as “healthy,” or the fact that they come in a variety of flavors."

Well, there's another possible reason for this perception: namely, that e-cigarettes do contain fewer toxins than traditional cigarettes.

The author implies that this is an incorrect or even dangerous perception, but this "perception" is absolutely true.

Can you imagine someone writing that: "Many people have the perception that exercise and dietary changes can precipitate weight loss." Would you not agree that such a statement implies that this perception is incorrect? It is not just a perception, it is the truth. The same is true about the "perception" that e-cigarettes contain fewer toxins than traditional cigarettes. It is not  "perception"; it is the truth.

It would be one thing if the author merely recommended that e-cigarettes not be used as first-line therapy. But to actually counsel health practitioners not to commend patients who quit smoking - regardless of how they quit - reveals much about the state of the current tobacco control movement.

It reveals that what is now most important is not saving the lives of smokers, but controlling them. The goal is apparently not to protect the health of smokers, but to make them comply with our ideology of no addiction to nicotine being allowed. It's not enough for smokers to quit; they have to quit the way we tell them to quit. And since we weren't the ones who came up with the great idea of vaping products, it is not acceptable for smokers to use that method to quit. It is either our way, or no way. If they don't quit using our methods, then we can't take credit for it. And apparently, credit is more important than health right now.

Now to the joint policy statement by the AACR and ASCO. The statement recommends that physicians not advise patients to use e-cigarettes to quit smoking. This is unwise and inappropriate advice. But what is even more disturbing is the fact that these organizations make such a big point about the need for disclosure of conflicts of interest. In itself, that's not disturbing. What makes it disturbing is the fact that in this very article, both of the organizations fail to disclose their own conflicts of interest with Big Pharma, which stands to gain significantly if the policy statement's recommendation is followed.

The AACR has received funding from a large number of pharmaceutical companies, including Bayer, Bristol-Myers Squibb, Merck, Jannsen, Lilly, Astra Zeneca, GlaxoSmithKline, and Pfizer.

Similarly, the ASCO has received funding from a large number of pharmaceutical companies, including Novartis, Astra Zeneca, GlaxoSmithKline, Onyx, Lilly, Sanofi, Bayer, and Pfizer.

I guess that the need for disclosure of conflicts of interest that AACR and ASCO emphasize only applies to other organizations, not to them.

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