![]() This could start to erode distrust of these products by physicians as they use them and advise their patients to use them. The same could happen with nicotine pouches. ![]() Once achieved, this could legitimize the category and open the doors to widespread physician acceptance of the products. To get medically licensed requires proof of quality, safety and efficacy. The fact that none of this is based on science has not stopped the opposition.Ĭould Medically Licensed Products Break Through and Reach Physicians?Īt a recent Keller and Heckman meeting, Ian Fearon, chief scientific officer at McKinney Scientific Advisors, described the “halo” effect of having medically licensed e-cigarettes on the market. They are bamboozled daily by well-funded nonprofits and WHO messages about the dangers of these products for kids, and the impact of them on cancer or heart disease. They fear these are a new tactic by the tobacco industry to keep the next generation addicted. Recent experience shows that physicians have been resistant to these products for several reasons. How Do We Engage Physicians in Scaling up Access to These Lifesaving Products? E-cigarettes and nicotine pouches are well placed to form the basis of a new approach to cessation and harm reduction. Food and Drug Administration as “appropriate for the protection of public health”: heated-tobacco products, e-cigarettes, snus and most recently nicotine pouches. We now have a full range of feasible options that have been authorized by the U.S. It is long overdue that physicians have access to far more efficacious and effective ways of ending smoking. Numerous reports, such as those issued by the Foundation for a Smoke-Free World, have pointed to the failure of the pharmaceutical industry to bring better cessation tools to the market despite advances in behavioral and neuroscience that have led to new therapies for a range of diseases. The World Health Organization’s own reports to the World Health Assembly this year pointed to slow progress in addressing cessation. None have success rates that exceed 15 percent over the year, and most are associated with repeated relapses. Quit cold turkey, counseling, nicotine-replacement therapies (NRTs) and a few other pharmaceutical and behavioral services remain the mainstay of cessation. The basic advice given by physicians has changed little. Sluggish Progress on Improving Cessation Outcomesįor decades, physicians have followed a “medicalization” path to cessation, so it is not surprising that they have neglected tobacco harm reduction (THR) options. Products that are not endorsed or approved by physicians rarely achieve population benefits and may face stiff regulatory approval. Physician leadership gives credibility to new products. Innovations in healthcare are usually led by physicians armed with solid epidemiological and clinical data showing the benefits of new interventions for patients and the population. ![]() Physician Leadership Is Crucial for the Introduction of Innovative Interventions In such settings, we cannot expect to see substantial progress in ending smoking if we stick with the status quo. There are few examples of physician-led reports like those of the RCP or SG from middle-income or lower middle-income countries. Smoking rates among the physicians in these countries are about the same. Globally, smoking rates among men approach 40 percent to 50 percent in countries as diverse as China, Bulgaria, Jordan and Bangladesh-or 50 years behind where the U.K. And it takes about a decade before the population benefits start appearing. Internationally, the evidence is clear: No country experiences a serious decline in their smoking rates before it declines among physicians. Only then did modest public health policies emerge. The world had to wait eight years before the World Health Organization passed its first modest resolution on smoking. The reports’ statement that “smoking kills” led to rapid changes in physicians’ smoking behavior well before regulators took up the challenge. The 1962 Royal College of Physicians (RCP) Report on Smoking as well as the 1964 Surgeon General’s (SG) Report on the same topic were led by physicians and drew upon the best epidemiological evidence available. That was certainly the case with tobacco and health. The alarm about the risks of products to health is usually first sounded by physicians.
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