The electronic cigarette is the best addiction possible

The head of the US Federal Department of Public Health has just published a landmark report on the issue of electronic cigarettes, but his conclusions are not strong enough to justify a very strict control of these devices.

On January 11, 1964, Dr. Luther Terry, Chief of the US Federal Department of Public Health, published the first report of the Surgeon General on the health risks of tobacco . The report was not content to establish a correlation between cigarettes and cancer, but showed a real causal link between consumption of the former and the occurrence of the latter.

This is a historic moment for the fight against smoking. When my grandfather, an ophthalmologist at the University of California at Los Angeles and a daily smoker since World War II and his time in the military, would go through the data underlying the report’s findings, he will stop overnight . One year after the release of the report, legislation requires all packages to mention the now famous ” warning ” of the Surgeon General. This campaign to reduce smoking in the United States has been one of the greatest epidemiological successes of modern medicine.

Therefore, when Dr. Vivek Murthy, current Surgeon General, announced the next release of his institution’s first report on e-cigarette use among teens and young adults, I was expecting a compendium of data that could deal a fatal and welcome blow to flourishing and non-traditional nicotine industry. As a doctor, or simply as an individual attending the outside world, I consider at least painful the growing incursion of electronic cigarette in places cleared of tobacco here again. It was also my opinion that by containing nicotine mixed with various additives, electronic cigarettes and other similar products were almost as harmful as smoked or chewed tobacco.all of around 300 pages).

Electronic cigarettes are far from being so harmful

To my surprise, he has nothing of the kiss of death that I imagined. After reading, I concluded that electronic cigarettes are very far from being as harmful for the vast majority of the population as traditional cigarettes or chewing tobacco – two modes of consumption clearly causing cancer and very many other health problems as serious as they are durable. According to this report, which will have been clearly written in the highest degree of scientific methodological seriousness, it is impossible to say anything about the electronic cigarette and its equivalents.

Of course, exposing teens and young adults to any level of nicotine is dangerous. But the story does not end there.

The report meticulously records the state of science on the issue of electronic cigarettes – what we know, what we do not know, without ever minimizing or overestimating. Here’s what we know: that e-cigarette use has grown exponentially among teens and young adults over the last five years; additives for electronic cigarettes and other ‘electronic nicotine delivery systems’ (ENDS )) are not without risk, contrary to what we can commonly believe; that inhaled vapors (talking about aerosols would be more adequate) actually contain many chemicals that may pose health risks – although none of them visibly reaches the level of danger of traditional nicotine products.

In addition, the report focuses on adolescents and young adults and reports some correlations between nicotine use and abnormal brain development (cognition, attention, etc.), mood problems (with some possible cause-and-effect relationships) and other behaviors related to the use of drugs and addictive substances. Except that the evidence of a causal relationship is slim and, in fact, it is not surprising that kids who are followers of e-cigarettes are showing other problems.

Some advantages
There is another point on which the report is formal: pregnant women should not expose themselves (and expose their fetus) to nicotine, as the consequences on brain development are likely to be seriously deleterious. Except that even for the fetus, evidence of a correlation between nicotine exposure and brain damage is not sufficient to indicate causality.

All in all, the evidence is pretty thin. Of course, there are reasons to strongly discourage teenagers, young adults and pregnant women from using ENDS. But there is certainly no real disadvantage to using them.

And there are even some benefits. Of course, if you have to choose between advising your patient to use or not ENDS, you should tell him not to use it. But if the alternative is between ENDS and, for example, cigarettes, the ENDS are much better for him and for you. Their harmfulness seems very derisory compared to tar and other dangerous products generated by cigarette smoke. At present, the report of the Surgeon General admits that data to “infer the presence or absence of a causal link between exposure to nicotine and cancer risk”are insufficient. In the report, data even suggests that nicotine in adults may be beneficial for attention and concentration (although it should be noted that other analyzes have concluded the exact opposite).

Should the use of electronic cigarettes be encouraged? Obviously no. But are ENDS a good alternative to cigarettes? No doubt, even if we do not know well whether they are an effective tool for smoking cessation. On this point, the available data are mixed. The Surgeon General’s report states that the data to say that e-cigarettes are effective in stopping smoking are “very low” . Except that it must be honest and clarify that this is also the case for all the data cited in the document and considering that electronic cigarettes are dangerous for health.

Sufficient data
A society without addiction or carcinogenic substances would be ideal. But in reality, most, if not all, companies have one defect or another. And honesty requires admitting that some exhibits are better than others. Moderate dependence on caffeine is better than addiction to cocaine or opiates. Nicotine and e-cig vapors, while certainly more dangerous than eating vegetables or inhaling mineral water, are probably among the least risky substances to which individuals or a society may be exposed. (And they are also among the least expensive). In other forms, nicotine is very dangerous, but it is primarily because of tar and other tobacco additives.

In any case, it is also necessary to say something of the apathy generated by the multiplication of health warnings: when we cry to the wolf concerning all the possible dangers of all the possible substances and imaginable, we do not know real dangers. Carcinogens are a perfect example. Cigarettes and tobacco are two of the very few products known to be known to cause cancer in humans-a reality that has been demonstrated time and time again. Scientists have found others, such as certain foods ( bacon ) or chemicals (such as formaldehyde ), that are correlated with cancer, without this correlation being able to establish a cause and effect relationship.

As of 2017, the FDA plans to add the words “CAUTION: this product contains nicotine with a risk of dependence” on all ENDS. We could add this kind of label on coffee, without the Third World War being declared so far. Oddly enough, the FDA has still not considered banning the marketing of vaping aimed directly and specifically at teenagers – and there are tons, be it the call to rebellion, the sexytude, and other “7.000 perfumes available ” (including the very infantile ” sweet bear ” ). Something they could have done since 2009, they have the legal authority. And it would be, moreover, a very simple campaign to implement.

But, for the moment, they simply do not have sufficient data to justify a more severe regulation of electronic cigarettes.