Vaping debate: doctor’s reticence over declaring tobacco money raises questions about conflict of interest
A GP opposed to the government’s vaping reforms and whose nicotine prescription website is being assessed by the drug regulator has given school vaping education sessions and spoken at a student conference without declaring she has received financial support from a tobacco company.
Dr Carolyn Beaumont owns the vaping telehealth service medicalnicotine.com.au, which allows people to obtain a prescription for nicotine vapes in minutes, without speaking directly to a doctor or pharmacist.
The Medical Board of Australia confirmed that this was legal but said the lack of real-time direct consultation was not good practice.
The platform is among a number of vaping prescription websites under assessment by the Therapeutic Goods Administration for potentially encouraging patients to request a particular prescription medicine.
In September 2023 Beaumont spoke at the tobacco industry’s Global Forum on Nicotine in Seoul, South Korea, with the forum covering her expenses to attend.
She is also a recipient of a Knowledge-Action-Change tobacco harm reduction scholarship. KAC has received funding from the Foundation for a Smoke-Free World, which in turn is funded by Philip Morris International.
Beaumont’s biography for the Global Forum on Nicotine says that as a recipient of the scholarship she is “creating an educational presentation on tobacco harm reduction for Australian medical students”.
In June Beaumont spoke on a panel titled Media, Medicine and the Vaping Epidemic at the University of Melbourne’s medical student conference.
A University of Melbourne spokesperson said the panellists had been asked to declare any conflicts of interest.
“Dr Beaumont declared that she had no conflicts of interest,” the spokesperson said. “At the commencement of the panel session at the conference, all speakers were asked to identify any relationships with industry/research funding. As Dr Beaumont declared no conflict of interest, no declaration was included in the visual display nor was a verbal declaration made.”
On her medicalnicotine.com.au website, Beaumont says she runs education sessions for secondary school students and parents about “teenage vaping concerns, and the dangers of becoming addicted to nicotine”.
Her website previously included an endorsement from Beaumaris Secondary College, a Victorian government school.
A Victorian government spokesperson said Beaumont “proactively approached Beaumaris Secondary College, volunteering to present”.
The spokesperson said Beaumont did not declare to the school benefits received from the tobacco or vaping industry: “She did not seek the school’s approval to reference it in promotional materials, and was not paid for her services.”
There is no policy requiring guest speakers who are running an education program in schools to disclose any potential conflicts of interests. Guardian Australia understands that policy is now under review.
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Beaumont declined to answer questions from Guardian Australia. After she was contacted for a response, a conflict of interest declaration was added to her website. It says that due to the cost of international travel, and without research institution funding, “it has been necessary on occasion to have travel costs covered in part by [the] tobacco industry”.
“Note that any such arrangements have been completely unconditional, and have never influenced my clinical decisions.”
In the statement Beaumont says “on the balance of evidence” she supports tobacco harm reduction and the role of vaping for adult smokers, as well as reducing youth uptake and “removing the blackmarket”.
“Occasional unconditional tobaccoindustry funded travel costs are required to achieve these aims, in the absence of alternative sources of funding.”
She says the decision to accept such funding is “never made lightly”, and she has “never sought to hide” these sources of funding.
Telehealth platform
Beaumont is opposed to federal government efforts aimed at reducing the supply of nicotine vaping products, including an import ban on disposable vapes. The government has said the aim of its reforms is to reduce supply to children, and they are not intended to criminalise individuals who use vapes, whether adults or children.
On her website Beaumont states: “I am passionate about educating teenagers about the real risks of blackmarket vaping – unregulated products with unknown nicotine content, electrical safety hazards, no quality control and unknown levels of harmful contaminants.”
In an interview with the Global Forum on Nicotine’s media channel in December, Beaumont spoke of her hopes for 2024, saying: “What I most wish for is for the Australian ban on disposable vapes scheduled to occur on New Year’s Day to be stopped.
“I wish for the planned ban on all personal importation of any vapes scheduled for March to be stopped. I wish for the Australian prescription model of vaping to stop and for the barriers to accessing a doctor to be truly understood and acknowledged.”
Despite this, Beaumont operates her own prescription vaping telehealth platform, medicalnicotine.com.au.
Guardian Australia followed the steps for obtaining a script online through the site in late February.
A Medicare number was not required to be entered, nor was a phone or video consultation needed.
After declaring that they are over 16 (which has since been changed to 18) and paying $40,patients are directed to fill out a short questionnaire to receive a script for a six-month supply of vapes, which must be used at the online pharmacy QuickRx. Patients can choose their own vape strength as part of this process, along with their preferred product – pods, disposable vapes or liquid nicotine.
Patients are not required to try firstline, evidence-based treatments first. They can simply tick a box stating: “I am not interested in nicotine replacement therapies.”
Guardian Australia selected “I wasn’t a regular smoker, but have started vaping instead of taking up smoking (because I have found other benefits to it)” as the reason for wanting a prescription.
A spokesperson for the Royal Australian College of General Practitioners said: “Nicotine vaping products are not recommended for first-line smoking cessation, but may be suitable for smoking cessation in conjunction with behavioural support where first-line therapies have failed.
“It is not recommended that nonsmokers or non-vapers start vaping.”
The spokesperson said patients should also be informed that due to the lack of available evidence, the longterm health effects of nicotine vaping products are unknown; that their safety and quality have not been established; that the lack of uniformity in vaping devices increases the uncertainties and risks associated with their use; and dual use of tobacco and vapes should be avoided. The importance of the patient returning for regular review and monitoring should be emphasised, they said.
None of these were communicated in the process of obtaining a prescription from Beaumont’s site.Some parts of the form and questions have been updated since inquiries were made by Guardian Australia.
Beaumont did not respond to questions from Guardian Australia about accessing a prescription but did comment on an article about vaping on the Medical Republic site.
In the comments section, she appeared to refer to some of the questions put to her by Guardian Australia.
Beaumont set out why she did not do phone or video consults: “Firstly, timezones.
“I’m in Victoria, and many patients are from WA,” she wrote.
“There’s a 3 hour gap, so realistically I can’t make calls until midday. Consider also that as a whole, heavy smokers are more likely to work jobs such as construction, mining or hospitality. These jobs don’t lend themselves to taking time out for a phone consult.”
She wrote that she disagreed with the Medical Board that telehealth without a phone or video consult was not best medical practice.
• This story was amended on 26 March 2024 to give correct dates for the tobacco forum and student conference