Why I cancelled my membership of the Australian Medical Association
Posted on January 10, 2019
I cancelled my membership of the Australian Medical Association (AMA) last month after 30 years as a loyal member. I could no longer tolerate the AMA's hypocrisy on harm reduction, in supporting pill testing but opposing vaping to reduce the harm from smoking.
The AMA's flawed policy was highlighted recently by its vocal support for pill testing at music festivals. Pill testing is sensible harm reduction policy which aims to the reduce harm from illicit drugs.
The AMA accepts that people will continue to use drugs in spite of the risk. Pill testing is a pragmatic solution which aims to reduce the harm that will inevitably occur in some cases.
However, with smoking the AMA takes a zero tolerance approach and rejects safer alternatives such as vaping for smokers who are unable to quit
Smoking is a powerful addiction and quit rates are low. Most smokers want to quit, but try and fail repeatedly to do so, even with the best available treatments. The average 40 year-old smoker has tried and failed more than 20 times. The AMA advice is just to keep trying.
This advice is especially troubling as the stakes are so much higher for smoking than for illicit drug use. Each year in Australia, 19,000 smokers die prematurely from their smoking. Smoking rates in Australia have not declined since 2013.
Are the lives of smokers less important than those of drug takers at music festivals?
Vaping is a way out for addicted smokers and millions of smokers have quit overseas by vaping. However the AMA has shut the door on vaping. In its Position Statement it tells members there is no place for e-cigarettes. As a result, many smokers will continue to smoke and many will die unnecessarily.
The policy inconsistency suggests there are hidden reasons for opposing vaping than the ones officially given. The AMA has a long-standing commitment to a 'quit-only' approach to smoking. Accepting a behaviour that resembles smoking and involves nicotine may be seen as an admission of failure. It can be hard to change established thinking.
The AMA position is based on fear of potential risks. These fears, such as the 'gateway theory', the risk of 'renormalising' smoking and uncertainty about safety, are exaggerated and are not supported by the evidence to date. In setting its position, the AMA fails to accept the growing international evidence that vaping is an effective and legitimate quitting aid.
There is also a moral or paternalistic feeling about the AMA attitude. 'We know best and smokers should just do as you are told'. Er... no. It is actually their right to make an informed decision about a behaviour that harms no-one else.
AMA Code of Ethics
The AMA is also in breach of its own Code of Ethics which advises doctors to consider the interests and well-being of their patient first. This principle applies to smokers who have tried and repeatedly failed to quit. If these smokers switch to vaping they are likely to have substantial health improvements. If they continue to smoke, up to two in three will die as a result. The AMA says they should keep smoking.
If the AMA reviews the evidence and reverses its position on vaping, I will renew my membership. But I am not holding my breath.
Posted by Colin Mendelsohn, firstname.lastname@example.org