This article is taken from the monthly journal Sciences et Avenir – La Recherche #902 of April 2022.
Twenty years ago, and yet the “smog” of e-cigarettes has never been so thick. In October 2021, the United Kingdom announced that this weaning instrument should be considered a real medical device, asking doctors to prescribe them. Lacking other scientific evidence, France sent the exact opposite signal on January 4: The High Council of Public Health (HCSP) recommended that healthcare professionals not offer electronic nicotine delivery systems to those who would like to quit smoking. Opinion opposite to the one he himself published in 2016. In fact, the e-cigarette did become the first weaning aid used by smokers. But in its latest opinion, the HCSP believes it lacks sufficient scientific evidence to balance benefit and risk.
What does science really say?
“it’s a little schizophrenic“, admits Dr. Ivan Berlin, member of the HCSP working group and deputy secretary general for research of the French-speaking tobacco company. However, the health problem is a serious one. According to Santé Publique France, “smoking continues to be the leading cause of preventable death, with over 75,000 deaths“estimated annual figures. But what does the science really say? It should be noted that she is primarily confronted with inconsistencies in research on the effectiveness of e-cigarettes as a means of weaning. The latest, published in February in BMJ Tobacco Control, in which 3578 smokers were followed up for two years, concluded that e-cigarettes are less effective than nicotine replacement therapy. 10% of vapers successfully quit smoking compared to 18% in the other group. However, a study published in 2019 New England Journal of Medicine achieved exactly the opposite result: 18% of teetotalers among vapers versus 10% among users of nicotine substitutes… Effective or not, the debate remains open.
No studies of large cohorts of vapers
While waiting for a decision, the question of the safety of the vapoteus arises. However, since the electronic cigarette is neither a medicine nor a medical device, manufacturers are not required to conduct research to obtain the right to put their products on the market. Of course, unlike a traditional cigarette, an electronic cigarette does not cause combustion and therefore does not release carcinogens such as carbon monoxide. But e-liquids are not safe, especially for the lungs. In 2014, Professor Philippe Camus, former Head of Pulmonology and Respiratory Care at Dijon University Hospital, began collecting all pulmonary side effects associated with e-cigarettes in the scientific literature in his Pneumotox database: “The first signals are cough, asthma, pneumopathy, but this can reach acute respiratory distress syndromes, exacerbations of COPD. (chronic obstructive pulmonary disease, ed.)down to the white lungs, where all alveoli contain steam derivatives“, he explains.
Research published in 2020 in European Journal of Cardiology compared the risk of chronic obstructive pulmonary disease: it increases by 194% when using e-cigarettes versus 704% when using conventional cigarettes. Therefore, the risk is lower, but far from zero. Vaporized e-liquids can also damage blood vessels, the heart, and the brain. Some reviews of the scientific literature suggest an increase in oxidative stress, an increase in arterial stiffness, and therefore a risk of heart attack and stroke. But again, the harmful effects of e-cigarettes are unclear.
However, after twenty years of marketing, shouldn’t the first followers of vapoteus have an answer? “We still do not have large cohorts of vapers“, laments Ivan Berlin. It is clear that the adoption of the device in large quantities is not worth scientific study. And the ambiguity remains. But in addition to the device, another issue was included in the discussion in the summer of 2019: the nature of the liquids used. About fifty were registered in the United States that year. deaths from lung disease in vapers.After an investigation, the culprit was identified: vitamin E acetate added to “cut” e-liquid used for vaping products.Thus, at the end of 2019, the French Public Health Service set up a system for reporting cases of severe pneumonia in e-cigarette users.The latest report from January 2020 reported five cases, confirming the work of ANSES (National Food Safety, Environment and Labor Agency) responsible in 2016 for collecting the manufacturer’s declaration of composition.”Of the 1775 substances, we have identified 106 for which risks need to be assessed as a matter of priority.“, says Benoît Labarbe, Head of the Tobacco Mission at ANSES.
In this list, published in January, most of the substances are carcinogenic. “But composition is not everything he remembers. When heated, these substances release others. Sucralose, a sweetener, for example, can break down into chloropropanol, which has carcinogenic potential.“The danger can also come from interactions between substances, vaping methods, or even the material itself. To measure all of these parameters and estimate actual exposure levels, ANSES will use a vaping robot. But the results are not expected for two and a half years. And they are already subject to warning.
Compiling Your Own Liquids Increases Risks
“There’s a blind spot in the rules warns Benoît Labarbe. Manufacturers offer to make their own liquids by dosing flavors that are not subject to mandatory declaration. “However, a third of vapers would choose this solution. On the other hand, the transparency of manufacturers is not perfect. Adding all the ingredients, ANSES specialists did not always come out 100%. And”a large number of substances did not allow an exhaustive study of the dangers of each of them“, acknowledges the agency. Pending final studies, where should we place this tool? In a report published in May 2021, the European Commission calculated that “Because e-cigarettes help people quit smoking, they must be regulated in accordance with pharmaceutical law.A ban on flavored liquids, already planned in Denmark and Lithuania, is also under study.
When Tobacco Companies Recycle Their Methods
The tobacco industry has not stopped its lobbying activities. Latest Episode: A study proving that nicotine protects against SARS-CoV-2 was withdrawn in 2021 due to conflicts of interest among some of its authors. The electronic cigarette is no exception to these methods. “Because the tobacco companies needed growth relays, they bought e-cigarette manufacturers. Therefore, it is necessary to be vigilant towards the authors of the studies.“, warns Professor Philippe Camus, former head of the pneumonia department at Dijon University Hospital. Altria, the owner of Marlboro, for example, owns 35% of Juul. Philippe Camus relies on a systematic review of 826 studies published in 2019 to substantiate his claim.”It clearly shows that when research is financially supported by manufacturers, the share of e-cigarette safety advocates increases..” And lobbying even affects healthcare institutions. Lancet showed that a 2015 report from the British public health agency Public Health England stated that “e-cigarettes are about 95% less harmful than tobacco“, was based on a study in which three authors were paid by e-cigarette manufacturers.