To close this month without tobacco, Professor Daniel Thomas, former head of the cardiology department at the CHU Pitié-Salpêtrière in Paris and vice-president of the Alliance against tobacco, sheds light on the electronic cigarette.
Why doctor – What does the term “electronic cigarette” mean on the market?
Professor Daniel Thomas – The electronic cigarette is constantly evolving. The third generation of these products aims to deliver nicotine more efficiently to the body and brain, with a mechanism that increasingly resembles the absorption of nicotine by a traditional smoker. This is for example the operation of the JUUL brand, an electronic cigarette of an extremely small format, promoted to young people, who can thus fall into a real addiction to nicotine. It is less serious than tobacco addiction, but it is not without health consequences.
I take this opportunity to point out that heated tobacco, a new product sold for example by Philip Morris via its IQOS brand, has absolutely nothing to do with electronic cigarettes, contrary to what the tobacco industry would have us believe.
– What is the impact of electronic cigarettes on health?
First of all, you should know that it is a product on which we have little perspective, because it has only been on the market for ten years, and new types of electronic cigarettes come out regularly (for the tobacco, it took more than fifty years to demonstrate its deleterious effect on health). We do not have a lot of data on these products in the medium term, and not at all in the long term.
Regarding the effects of electronic cigarettes on health, we do not currently see any clinical manifestations, that is to say in terms of the expression of a heart attack or cancer for example. . They are impossible to demonstrate at the moment, given the time-limited exposure of vapers.
What we currently have are many studies that focus on the biological effects of electronic cigarettes, that is to say their intermediate effects. Vaping thus has proven effects on vessels and inflammation, as well as toxicity on cells. For a non-smoker, the vape is therefore certainly toxic.
But for smokers, exposed to thousands of toxic products on a daily basis, switching to electronic cigarettes reduces the risks to their health. In the vape, there is in particular no combustion, therefore no carbon monoxide.
– Does the electronic cigarette make you dependent?
It depends on the products, and how they deliver nicotine into the body. If they do it almost as effectively as the classic cigarette, the vaper risks being hooked on the vape as he can be hooked on the cigarette.
A non-blind study recently showed that twice as many smokers quit with vaping than with nicotine substitutes. However, once quitting tobacco, only 13% of users of pharmaceutical substitution products still consumed them, while 80% of vapers still used electronic cigarettes. Here, we see that addiction has moved from smoked tobacco to vaping, in particular because smokers find in the vape the nicotine peak they appreciate when they smoke a cigarette.
– Is it better to avoid starting the electronic cigarette?
If you are a non-smoker, it is absolutely necessary to avoid starting the electronic cigarette, and this at any age, because it is a product whose long-term health effects are not known. Not only do we not have enough perspective on the toxicity of electronic cigarettes, but the biological observations described above indicate a negative impact on health.
– Is there a risk of switching from electronic cigarettes to tobacco, especially among young people?
The data is very contradictory on the subject, there is a lack of longitudinal research. Nevertheless, studies suggest that yes, in particular because when you have become addicted to nicotine, consuming electronic cigarettes is more complicated than going to buy your package at the corner tobacconist.
In the United States, there has been such a progression of vaping among young people that there is now a new generation of vapers who are addicted to nicotine, even though they have never smoked tobacco. For them, it is a real public health problem. In France, it is a rather marginal phenomenon, but it does exist.
– Is it a good idea to use the electronic cigarette to quit smoking?
Yes, but under certain conditions. My recommendations can be summarized as follows:
– If you are a non-smoker, you absolutely must not start vaping.
– If you are a smoker, the electronic cigarette is a possible option to get out of tobacco, provided you have the objective of stopping vaping as completely. Because remaining exclusively vaper is not a guarantee of good health in the long term, since we do not yet know what it gives.
I specify that staying on mixed consumption, which alternates electronic cigarettes and conventional cigarettes, is not a good option. Indeed, studies show that, even when consumed occasionally or in small daily quantities, the impact of tobacco is harmful to health. There is no light smoking, it is for this reason that smoking has been banned in enclosed public places, in order to prevent passive smoking.
– To quit smoking, is the electronic cigarette more effective than cognitive and behavioral therapy (CBT) or patches?
It’s not white or black. We must neither demonize the electronic cigarette, nor idealize it. In France, the HAS does not recommend electronic cigarettes as first-line for smoking cessation, because there is a lack of perspective on the toxicity of the product. Nevertheless, if the products recommended as first-line and reimbursed – such as patches or tablets (champix, zivan) – do not work, electronic cigarettes should be considered. Even if this product can cause a new addiction, it is an effective way to get out of tobacco, which remains much less dangerous for health than manufactured cigarettes. As for therapies, it can also be effective, but it is a more complex treatment to implement.
In summary, if a person wants to quit smoking, I will not offer them the electronic cigarette first. But if it’s ultimately the means of smoking cessation that suits her best and she accepts it more than pharmaceutical nicotine replacement therapy, well, I’m going to encourage her.
– Do you want to add anything in conclusion?
The medical world is still too little interested in the problem of tobacco in the population, much less for example than cholesterol, high blood pressure or diabetes. It is not enough to tell his patients that they must quit smoking, they must also be helped, because tobacco is a hard drug. There is a terrible flaw in prescriptions for smokers, who feel guilty for smoking, when they are only victims.
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