The head of the US Federal Department of Public Health has just released 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.
The 11 January 1964, the Dr. Luther Terry, chief of the federal public health service of the United States, published the first report of the Surgeon General on the health risks of tobacco. The report was not satisfied to establish a correlation between cigarettes and cancer, but attested to a real cause and effect link between the consumption of the first and the occurrence of the second.
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 WWII and his stint in the military, went to sift through the data underlying the report's findings, he would stop overnight. . One year after the report came out, legislation obliges all packages to mention the now famous "cautionFrom the Surgeon General. This campaign to reduce smoking in the United States has been one of the greatest epidemiological successes in modern medicine.
Therefore, when the Dr. Vivek MurthyAs the current Surgeon General, announced the upcoming release of his institution's very first report on e-cigarette consumption among adolescents and young adults, I expected a compendium of data that could deal as fatal as welcome a blow to the thriving and non-traditional nicotine industry. As a doctor, even quite simply as an individual frequenting the outside world, I consider at least painful the increasing incursion of the electronic cigarette in places free from tobacco until recently. I also thought that, containing nicotine mixed with various additives, electronic cigarettes and other similar products were almost as harmful as smoked or chewed tobacco. And hoping that the report was going to be a farewell to vaping, I wanted to take the time to read it in full (or almost, the whole of around 300 pages).
Electronic cigarettes are nowhere near as harmful
To my surprise, it has nothing of the kiss of death 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 many other health problems as serious as lasting. 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.
Obviously, exposing adolescents and young adults to any level of nicotine is dangerous. But the story does not end there.
The report meticulously records the state of the science on the issue of electronic cigarettes what we know, what we don't know, never underestimating or overestimating anything. Here's what we know: that the use of electronic cigarettes has grown exponentially among adolescents and young adults over the past five years; as additives in electronic cigarettes and others "electronic nicotine delivery systems”(Or ENDS for“ electronic nicotine delivery systems ”) are not without risk, contrary to what one can commonly believe; that the inhaled vapors (to speak of aerosols would be more appropriate) indeed contain many chemicals likely to present health risks - even if none visibly reaches the level of danger of traditional nicotine products.
What is more, the report focuses on adolescents and young adults and documents some correlations between nicotine consumption and abnormal brain development (cognition, attention, etc.), mood problems (with, for some, d 'possible cause and effect relationships) and other behaviors relating to the consumption of drugs and addictive substances. Except that the evidence for a causal relationship is slim, and indeed, it is not surprising that e-cigarette addicts report other problems.
Some advantages
There is another point on which the report is categorical: pregnant women should not expose themselves (and their fetuses) to nicotine, as the consequences on brain development are likely to be seriously deleterious. Except that even concerning the fetus, the evidence attesting to a correlation between exposure to nicotine and brain damage is not sufficient to point to a causality.
All in all, the evidence is pretty slim. Obviously, they are sufficient reasons to strongly advise adolescents, young adults and pregnant women to use ENDS. But there is certainly no real downside to using them.
And there are even some advantages. Of course, if you have to choose between advising your patient to use ENDS or not, you should tell them not to use them. But if the alternative is between ENDS and, say, cigarettes, ENDS is much better for him and for you. Their harmfulness seems ridiculous compared to tar and other dangerous products generated by cigarette smoke. At present, the Surgeon General's report admits that the data allowing «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, in adults, nicotine may be beneficial for attention and ability to concentrate (although it should be noted that other analyzes have concluded the exact opposite).
Should we encourage the use of electronic cigarettes? Obviously no. But are ENDS a good alternative to cigarettes? No doubt, even if we do not know 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 evidence that e-cigarettes are effective in stopping smoking is «very weak». Except that you have to be honest and specify 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 carcinogens would be ideal. But in reality, most, if not all, companies have one defect or another. And honesty requires admitting that some shows are better than others. An addiction
Moderate caffeine is better than addiction to cocaine or opiates. Nicotine and e-cig vapors, while they are certainly more dangerous than consuming vegetables or inhaling mineral water, are arguably among the least risky substances to which individuals or society can be exposed. (And they are also one of the cheapest). In other forms, nicotine is very dangerous, but this is primarily because of tar and other tobacco additives.
In any case, we must also say something about the apathy generated by the multiplication of health alerts: when we cry wolf about all the possible dangers of all possible and imaginable substances, we ignore real dangers. Carcinogens are a prime example. Cigarettes and tobacco are two of the very few products known for certain to cause cancer in humans - a reality that has been proven time and time again. Scientists have found others, such as certain foods (bacon) or chemicals (such as formaldehyde), which are correlated with cancer, without this correlation being able to establish a cause and effect relationship.
From 2017, the FDA plans to add the mention «WARNING: this product contains nicotine with a risk of dependence» on all ENDS. We could add this kind of label on the coffee, without the Third World War being declared. Oddly enough, the FDA still hasn't considered banning vaping marketing directly and specifically targeting teens - and there are tons of them, be it the call for rebellion, sexy study, and the like. «7.000 perfumes available» (including the very infantile "Bear cub"). Something they could have done since 2009, they have the legal authority. What is more, it would be a very simple campaign to implement.
But, at the moment, they simply don't have enough data to justify more stringent regulation of e-cigarettes.
Source : Slate.fr
