The electronic cigarette, a tool to quit smoking? The French health authorities have just rejected the idea at the same time when the United Kingdom fully assumes this choice, differences which testify to persistent uncertainties after years of controversy.
Electronic cigarettes “cannot to date be presented as tools for reducing the risks associated with tobacco”, summarizes, in an opinion published this week, the High Council of Public Health (HCSP), one of the organizations guiding the health policies in France. This is the latest response to an old questioning: how far do these “vapers” mark progress compared to conventional cigarettes?
Unlike the latter, electronic cigarettes do not contain tar or carbon monoxide, the two main elements at the origin of countless cancers and cardiovascular diseases linked to smoking.
But more often than not, they are loaded with nicotine, the substance at the origin of tobacco addiction. And their vapor contains fine particles whose long-term effects are unknown.
Because of this uncertain status, vapers have been at the origin of controversies for several years which sometimes oppose several authorities.
In 2019, the French Academy of Medicine, for example, defended electronic cigarettes against the World Health Organization (WHO), which considered them “unquestionably” harmful.
Not a tool for doctors
It is not all up for debate. There is little doubt that vapers are significantly less dangerous than traditional cigarettes.
Conversely, there is a broad consensus to consider that electronic cigarettes should not be considered as an “innocent” product of everyday consumption. We should therefore not recommend them to a non-smoker.
But, between these two extremes, there is a whole range of unresolved questions. For example, among young people, does the electronic cigarette reduce the risk of starting to smoke or does it, on the contrary, encourage them to take the plunge?
Or again, the question addressed this week by the French health authorities: for lack of anything better, should we suggest to a smoker to vape to get him out of his addiction?
No, they say, and that’s a hardening. In their previous opinion, five years earlier, they judged that the electronic cigarette could “be considered as an aid” to reduce its consumption.
The health authorities certainly do not exclude that the electronic cigarette can help some smokers to get by on a case-by-case basis, but they refuse to make it a tool for doctors.
This position contrasts with the British situation. The United Kingdom is indeed set to become the first country where electronic cigarettes can be prescribed medically and, therefore, partially reimbursed by the health system.
This is the consequence of a measure taken in October 2021 by the British government to effectively allow manufacturers of electronic cigarettes to have their vapers approved by the health products regulator.
Inconclusive studies
This decision has, again, caused sharp divisions in the scientific and medical world. The government justified it by the state of scientific studies in progress.
But, paradoxically, this is also the argument used in France by the High Council of Public Health not to recommend vaping to smokers who seek to quit.
Who to believe? In fact, studies on the subject are struggling to be conclusive one way or the other, even though they have accumulated in recent years.
There is “moderate” evidence that electronic cigarettes are more effective in quitting smoking than other treatments, such as nicotine substitutes, according to a well-respected organization in the scientific world, Cochrane, which compiles numerous studies on the same subject and regularly updates its conclusions.
But these remain cautious and other works of the same type are even less affirmative.
“We have not found solid data that establishes a link between electronic cigarettes and quitting smoking,” judged in November the authors of a study published in the journal Tobacco Prevention & Cessation.
This work, like that of Cochrane, compiles several dozen preliminary studies. The authors admit that some of these tend to establish a link between vaping and quitting smoking.
But these studies are “systematically” of low quality, they conclude.