continued from Page 6 and membership of the national Australian Health Research Alliance. It was that same growing spirit of cooperation and recognition that the past practice of competing within WA rather than together for WA that underlined the formation of the WAHTN and the ANPC. Cooperation of our universities, medical research institutes, Department of Health, hospitals, the Chief Scientist and the Department of Jobs, Tourism, Science and Innovation, among others, helped create both entities. That spirit of cooperation was rewarded early in the piece with interim funding flowing from Lotterywest to acquire initial core funding for WAHTN and equipment for the ANPC. Both Jeremy and I accompanied Health Minster Roger Cook on a trip to Israel last year where we got a glimpse of a health system that seamlessly integrates service delivery, research, innovation and commercialisation. While the trip highlighted some of the challenges we face in WA, it also reminded us of the many advantages we have. WA's climate is not too hot, not too cold, and our population is not too big, but not too small. We know success breeds success and it is no surprise that already the ANPC is attracting both additional staff and industry to WA. We also hope the collaborative spirit that created the ANPC will enable more world class initiatives to emerge from WA. Professor Gary Geelhoed, Executive Director, WATHN
RACGP smoking guidelines The Royal Australian College of General Practitioners (RACGP)’s new guidelines, Supporting smoking cessation: A guide for health professionals (2nd edition), recommends greater flexibility in prescribing for smoking cessation pharmacotherapy. 8 | MARCH 2020
Pharmacotherapy options available in Australia include nicotine replacement therapy (NRT, e.g. a transdermal patch or acute forms such as an oral spray, gum, inhaler or lozenge), varenicline and bupropion hydrochloride. Oral forms of NRT, gum and lozenges, are the sole PBSsubsidised therapy. This means that combination NRT (i.e. using two forms of NRT together such as a patch and gum) is not currently PBS-subsidised. Under PBS rules, a maximum 12 weeks of PBS-subsidised NRT is available per 12-month period. The Government should act to assist those who struggle to afford the medicines that are proven to help people quit smoking. Some people can quit, unassisted. However, those who take advantage of behavioural support and vital medicines including combination NRT, varenicline and bupropion will substantially increase their chances of quitting. A host of randomised clinical trials tell us that these medicines work. Varenicline or combination NRT almost triples the odds of quitting and bupropion and NRT alone almost double the odds of quitting versus a placebo at six months. The evidence is also clear that combination NRT is most effective. However, as things stand, we have fixed PBS rules that don’t reflect best-practice medical assistance. As a result, people trying to quit smoking miss out on PBS subsidies that could make a real difference. It’s vital to allow for PBS-subsidised combination NRT, which is proven to be the most effective form of NRT. We should also allow GPs to prescribe a second round of PBSsubsidised NRT within a 12-month period because it will help reduce relapse in people who have stopped smoking at the end of a standard course of NRT. This is a public health policy no-brainer, pure and simple. These medicines work, we just need to do more to help get them into the hands of people who need them most and removing restrictions on prescribing will do just that.
(ATHRA), the RACGP has not “endorsed” vaping nicotine. The relevant item in the guidelines reads: Recommendation 15 – Nicotinecontaining e-cigarettes are not first-line treatments for smoking cessation... The lack of approved nicotine-containing e-cigarettes products creates an uncertain environment for patients and clinicians, as the constituents of the vapour produced have not been tested and standardised. However, for people who have tried to achieve smoking cessation with approved pharmacotherapies but failed, but who are still motivated to quit smoking and have brought up e-cigarette usage with their healthcare practitioner, nicotine containing e-cigarettes may be a reasonable intervention to recommend. This needs to be preceded by an evidence-informed shared decisionmaking process, whereby the patient is aware of the following: • no tested and approved e-cigarette products are available • the long-term health effects of vaping are unknown • possession of nicotine-containing e-liquid without a prescription is illegal • in order to maximise possible benefit and minimise risk of harms, only short-term use should be recommended • dual use (ie with continued tobacco smoking) needs to be avoided. Conditional recommendation for intervention, low certainty
GPs and PrEP Researchers from UNSW Sydney are aiming to better understand the implementation and prescribing of HIV Pre-Exposure Prophylaxis (PrEP). We are conducting interviews with GPs across WA who have prescribed PrEP at least once. In the phone interview, which takes up to an hour, we discuss your clinical experiences of prescribing PrEP and your professional perspectives on HIV prevention. In recognition of time, participants are compensated with a $125 pre-paid gift card. Findings from this study will inform clinical education and policy. GPs can participate by emailing anthony.smith@unsw.edu.au. See www.prepinpractice.com for further information. Anthony K J Smith, Ph.D. Candidate, Centre for Social Research in Health
Dr Harry Nespolan, President, RACGP ED: Contrary to a blog on the Australian Tobacco Harm Reduction Association
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