Colin Mendelsohn is a 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 vejping can lead to smoking cessation.
"Helping smoking patients to quit is one of the most important things a doctor can do. It should be the number one priority, but there is a lot of resistance to the most effective tool," says Colin Mendelsohn, author of the book "Quit smoking - Start vaping".
Australia 2021, the country with some of the the most comprehensive tobacco laws in the world. Nevertheless, it is more difficult to buy e-cigarettes (or rather e-liquid with nicotine) than analogue cigarettes. Travellers, or smokers for that matter, who want to use e-cigarettes to keep the cigarettes away, now have to get a prescription for the nicotine.
"But very few doctors prescribe it. Around 400 are medically authorised to do so, but of those, few know enough about vejpning to write a proper prescription," said Colin Mendelsohn.
"Terrible to see everyone failing"
Colin Mendelsohn is a doctor. He is also an activist and commentator on harm reduction. He has worked and researched smoking cessation for several decades. He is a general practitioner but also runs a stop smoking clinic in Sydney.
"When you work so closely with smokers, it's terrible to see everyone struggling, and failing, to quit smoking. Time and time again. These are patients who have tried everything and still fall back to smoking. They just get less self-confidence and eventually it affects the doctor as well" 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 were beginning to present promising studies on safety and risks, he made up his mind. He summarised the UK studies in a report on vejpning in one of the country's medical journals. And then began advising some patients to try the technology.
"Vaping is special because it allows the smoker to use nicotine without having to change much in the way of habits and behaviour. This is what makes e-cigarettes prevent relapse, even in the long term. And I found that it worked. A third of the most severe cases stopped smoking almost immediately. And this without the help of medication or nicotine drugs."
"The most effective method"
For Colin Mendelsohn it was not surprising when Cochrane Reviews Tobacco Addiction Group 2020 noted that vejpraining helps twice as many smokers to quit compared to traditional nicotine medicines. In harm reduction circles, this had been known for a long time. That the health risks of vejping 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 preconceived notions about nicotine. We know that smoking kills, and that e-cigarettes are the most effective tool for quitting smoking. The risks are relatively small and we know that e-cigarettes greatly reduce the risks of nicotine addiction," said Mr Perez. Colin Mendelsohn.
Laws discourage smokers
"At the same time, public opinion and legislation have gone the other way," says Mr Mendelsohn. As a result, e-cigarettes are now less accessible than analogue cigarettes in some countries. In Australia, different campaigns from different organisations stakeholder organisations received broad political support. Buying nicotine-containing e-liquid over the counter has long been banned in Australia. And since October, it is also not possible to import it 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 organisations, this has led to major misconceptions about the risks and benefits of e-cigarettes." says Colin Mendelsohn.
"Have to fail to get help"
In countries like United Kingdom and New Zealand e-cigarettes have been highlighted as a recommended smoking cessation tool. Ironically, even in Australia. However, according to Australian medical ethics guidelines, e-cigarettes should only be recommended to smokers after all other methods have failed.
"First, the smoker will try nicotine medicines, champix and so on. And fail. It's bizarre, really. A smoker must first fail several times to quit smoking, before the doctor can proceed with the most effective method. It's very disappointing and cynical and not ethically defensible." says Colin Mendelsohn.
Wants to spread knowledge
He also points out that doctors' knowledge, but perhaps more importantly their attitude towards both e-cigarettes and nicotine, is a significant problem. This was one of the reasons why the book... "Quit smoking - Start vaping" came into being.
"I couldn't deal 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 must 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 between smoking and vejping, how e-cigarettes work in smoking cessation and why the technology has become so controversial.
"There is a huge resistance, not just in Australia, but everywhere. And as I see it, it's not about the scientific evidence. It's clear that vejping 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 means that science and evidence are being overlooked.
"There is everything from a genuine concern that tobacco companies just want to attract new customers, to non-smoking young people trying it out. But there are also purely economic interests. Some organisations risk losing their funding if e-cigarettes and harm reduction become more prominent in the political debate." says Colin Mendelsohn.
"Doctors believe that 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 for smoking cessation than others? Colin Mendelsohn believes that a majority of medical professionals do not know enough about nicotine to make vital decisions for patients. Much less to have the courage to prescribe it.
"A survey in the US showed that 80 per cent 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 Mr Perez. Colin Mendelsohn.
It is important to give smokers confidence
In the UK, the authorities have simplified the process to make e-cigarettes available on prescription. Mendelsohn sees this as positive, but with reservations.
"I have nothing against a medical model for e-cigarettes. But it can't 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 to give the technology confidence. But the prescription model here in Australia will not work. Doctors don't know how to use it - and then it becomes, on the contrary, detrimental," says Mr Perez. Colin Mendelsohn.
Hope that education helps
Through the Australian Tobacco Harm Reduction Association (ATHRA), he provides training for doctors who have concerns about vejp in Australia.
"Doctors are often conservative and very risk-conscious. But if they have the evidence clearly explained to them and start to understand the principle of harm reduction, it can actually lead to an important change."
How has your commitment to vejping and e-cigarettes influenced you in your professional role?
"I have worked in 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 when it arrived, surrounded by rumours and misconceptions. However, my commitment to e-cigarettes has meant that I am no longer invited to speak at conferences organised by pharmaceutical companies. And I am often accused of working for tobacco companies, which I have never done and will never do. And then there are some colleagues who don't contact me anymore."
Believe in the future of harm reduction
In addition to over 400 references to scientific studies and reports, Quit Smoking Start Vaping includes 15 testimonials from ex-smokers who quit using e-cigarettes. Some from Colin Mendelsohn's clinic, but also politicians and other doctors who use e-cigarettes. He believes the vejp has a future - even if the technology is taking longer to establish itself than it should.
"Every day I come face to face with ex-smokers who have got their lives back through vejping. 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."
Will there be any change, do you think?
"I think the number of users needs to reach a critical mass, like in Sweden with snus. Then the issue can't be ignored anymore and politicians will make reasonable decisions instead of coming up with devastating solutions like bans. In the meantime, it is important to meet the arguments with facts, and to reach smokers with accurate information", Colin Mendelsohn told Vejpkollen.