18 OPINION
18 OPINION
16 JUNE 2023 ausdoc . com . au
| THE | RESPIRATORY ISSUE
Insight
Vaping puff piece lingers
The decade-old paper continues to blow smoke .
Associate Professor Michelle Jongenelis Deputy director at the Melbourne Centre for Behaviour Change , University of Melbourne .
IT ’ s 2013 . Harlem Shake is on the radio , and e-cigarettes are becoming a thing . A group of researchers convenes to discuss these and other products containing nicotine .
The following year , a paper comes out detailing the outcomes of that meeting , with the authors rating “ electronic nicotine delivery systems ” ( e-cigarettes ) as having
Optimal dosing
Write-off here and ideally three lines if possible please , thankyou Obitius molupienime quat im num nume sust , simus doluptas
lets your PEI patients opt in to life . * 1-5
*
Optimal dosing of Creon ® can lead to an improved quality of life . 1 – 5 Creon ® can optimise nutritional status and normalise digestion , pain , and bowel movements , which may improve QoL in patients with PEI . 5 , 6
Suggested adult maintenance dosing : 1 , 5 ® ®
Pull Quote here Si odi totatiatem faccusa erovid magnimus , sitatum PEI , pancreatic exocrine asitiis insufficiency ; QoL eariatio , quality of life . es qui cuptiorDolupid quam , sunt . Nis ne as recto et facia qui ut quiam , quis ma nullorest inctum ligendaerum
“ only 4 %” of the maximum relative harm of cigarettes .
Critically , the authors stated their understanding of the potential hazards of e-cigarettes was “ at a very early stage ” because they lacked “ hard evidence for the harms of most products on most of the criteria ” they examined .
In other words , they noted their work was methodologically weak
PBS Information : Creon is listed on the PBS as a digestive enzyme preparation ( 10 repeats ). Restricted benefit : for cystic fibrosis patients under a GP Management Plan or Team Care Arrangement ( 21 repeats ).
and their estimates were just that — guesses based on their opinions rather than scientific evidence .
But one of those guesstimates went on to become the most cited piece of vaping misinformation globally : e-cigarettes are 95 % less harmful than tobacco cigarettes . The problem is , it ’ s wrong . Public Health England used the 95 % figure in its 2015 review
Before prescribing please review the full product information available on request from Viatris or telephone 1800 314 527
MINIMUM PRODUCT INFORMATION : CREON ® CAPSULES ( pancreatic extract 10,000 , 20,000 * 25,000 , 35,000 , 40,000 * BP ) CREON ® MICRO enteric coated granules ( Pancreatic Extract ) INDICATIONS : Pancreatic enzyme replacement in paediatric and adult patients with pancreatic exocrine insufficiency ( PEI ). PEI is often associated with , but not limited to cystic fibrosis , chronic pancreatitis , pancreatic surgery , gastrointestinal bypass surgery ( eg . Bilroth II gastroenterostomy ), ductal obstruction of the pancreas or common bile duct ( e . g . from neoplasm ) CONTRAINDICATIONS : Hypersensitivity to porcine protein or any of the ingredients . PRECAUTIONS : Fibrosing Colonopathy , Pregnancy , Lactation . INTERACTIONS WITH OTHER MEDICINES : Antacids : Antacids should not be taken at the same as time as with Creon . If necessary , it is recommended that at least one hour should elapse between use . ADVERSE EFFECTS : The most commonly reported adverse reactions were gastrointestinal disorders and were primarily mild or moderate in severity . Common adverse reactions included , nausea , vomiting , constipation , diarrhoea , abdominal distention , rash , pruritus , urticaria , abdominal pain . Some of these adverse events are similar to the symptoms associated with PEI and underlying conditions . DOSAGE AND ADMINISTRATION : The capsules : Capsules should be swallowed without crushing or chewing , with enough fluid during meals . If unable to swallow capsules , open and add minimicrospheres to acidic soft foods and consume immediately . Do not chew or crush minimicrospheres . Ensure that none is retained in mouth . The dosage should be individually titrated and depends on the severity of the disease and the composition of food . Cystic fibrosis : 1,000 lipase units / kg / meal for children less than four years old ; 500 lipase units / kg / meal for those over age four . For adult patients with PEI associated with other conditions , initiate at 25,000 to 40,000 BP units of lipase per meal and half of that dose for snacks . If required , 80,000 BP units of lipase per meal and half of that dose for snacks . Max dose 10,000 units lipase / kg body weight . The granules : Can be added to acidic soft food . The scoop provides 100 mg or 5,000 units of lipase . Any mixture of the granules with food or liquids should be used immediately . The dose is adjusted to the fat content of the meal and the severity of the disease . Cystic fibrosis : 1,000 lipase units / kg / meal for children less than four years old ; 500 lipase units / kg / meal for those over age four . Most patients should remain below 10,000 lipase units / kg body weight per day or 4,000 lipase units / gram fat intake . * Not currently marketed in Australia . Minimum PI updated : 21 April 2021 .
References : 1 . Smith RC , et al . Australasian guidelines for the management of pancreatic exocrine insufficiency . Australasian Pancreatic Club , October 2015 . Available at : https :// www . pancreas . org . au / resources [ Accessed January 2023 ]. 2 . Sikkens EC et al . J Gastrointest Surg 2012 ; 16:1487-92 . 3 . Kuhlmann L et al . JOP J Pancreas ( Online ) 2018 ; 19 ( 4 ): 183-89 . 4 . Keller J et al . Gut 2005 ; 54 ( Suppl VI ): vi1-vi28 . 5 . Creon ® Product Information . 24 January 2022 . 6 . Ramesh H et al . Pancreatology 2013 ; 13 ( 2 ): 133-39 .
Creon ® is a Viatris company trademark . Copyright © 2023 Viatris Inc . All rights reserved . Viatris Pty Ltd . Level 1 , 30 – 34 Hickson Rd , Millers Point , NSW 2000 , Australia . ABN : 29 601 608 771 . Call : 1800 314 527 . Date of preparation : January 2023 . CRE-2022-1126 . MYL0752 .
of e-cigarettes but failed to mention the caveats of the guesstimate .
This prompted widespread criticism from experts .
An editorial in The Lancet labelled the 2014 paper “ an extraordinarily flimsy foundation ” on which to base the major conclusion of Public Health England ’ s review .
The Lancet editorial noted that Public Health England had used the guesstimate despite it being based on “ the opinions of a small group of individuals with no pre-specified expertise in tobacco control ” and “ an almost total absence of evidence ”. The 2015 editorial also raised concerns about conflicts of interest , noting that some researchers involved in developing the guesstimate had connections to Big Tobacco .
Despite this , the 95 % figure remained in Public Health England ’ s communications and spread to e-cigarette advertising .
By 2020 , the guesstimate had become a factoid : unreliable information repeated so often it becomes accepted as fact . Yet given the growing evidence of harms associated with e-cigarette use , the factoid was even less valid seven years later .
The industry and its allies have been so effective at publicising this unscientific guesstimate that it continues to be used to undermine Australia ’ s public health policy .
In submissions made to Australia ’ s 2020 Senate Inquiry into Tobacco Harm Reduction , industry bodies and allies leaned heavily on the factoid in their arguments for legalising e-cigarettes .
They continued to do so in the TGA ’ s 2020 consultation on the rescheduling of nicotine as prescription only and most recently in the 2022 consultation on proposed reforms to the regulation of vaping products to limit importation and improve product standards .
Although this factoid has been debunked , it continues to influence people ’ s thinking .
Misinformation researchers refer to this as the continued influence effect : once it takes hold , it ’ s notoriously difficult to dislodge . As a digestible , attention-grabbing stat , it circulates in the media and is repeated again and again .
And because we are more likely to believe false information when it has been repeated many times ( the illusory truth effect ), the misinformation becomes truth even after we have been told it ’ s false .
This article is republished from The Conversation .