2023-05-07 06:00:00
– Why Doctor: The drop in smoking in France was very significant from 2014 to 2019, but recently released figures show that this drop would have stopped, and even that the number of smokers would continue to increase in certain categories. Would we have on smoking, a bit like in road safety, reached an incompressible threshold of smokers?
Pr Bertrand Dautzenberg : The answer is no ! The problem is the tobacco figure in France which is poorly measured since we only have major surveys which are carried out by Santé Publique France and which are published almost a year and a half or two years after the collection of the data and the INCA figures which were measured in the middle of Covid, which really distorted the measurements quite a bit despite all the corrections that were made to them. The Covid has changed the lives of the French a little and some have smoked more, others less, so there are biases that can be explained.
The second measure that we have of smoking is the deliveries of cigarettes, which are much more reliable and which are announced month by month and region by region. It is very homogeneous with small effects that we see on the border sectors when the prices are increased and there is generally a permanent decrease.
Over the last 10 or 15 years, we have seen that tobacco sales have decreased significantly. We are at 30 billion cigarettes sold per year, we were at 84 billion when Jacques Chirac declared war on tobacco with the first Cancer Plan. This constant decrease will lead to less than 5% of smokers in 2032 as expected. It is anticipated that all young people born after 2014 will be smoke free by age 18 and I think we are on the right trajectory.
– What data do you rely on to justify your optimism?
If we look at other more recent figures that have been published for the year 2022, while the figures put forward in recent days date from 2021, there again we have a decrease and we arrive at 16% of regular smokers while we had started three times earlier. There are also the figures from the Escapade study, carried out during Defense and Citizenship Day, with 18-year-old boys and girls and therefore truly representative of the French population, and these data show a constant collapse of tobacco consumption and which has even accelerated since the previous survey.
– Does this collapse result in a decrease in the consequences of smoking on health?
It is very very clean! The clearest figures are for lung cancer, which is a disease which is essentially linked to tobacco and there we have an evolution in men and women. In men it is in very significant decrease, in particular in the less than 45 years. Today, there are a third fewer lung cancers than 30 years ago in men, while in women it continues to increase, but we are coming to the end of this increase. And when we look at the curves of lung cancer and tobacco sales they are exactly parallel, even if there is a delay of 15-20 years between the cause and the effects.
But beware, these positive figures should not hide the fact that we still have 75,000 deaths per year due to smoking! We still die a lot more than from AIDS or road accidents! Tobacco remains by far the leading cause of preventable death in France, so we cannot say that the case is won.
– The government has just announced a new rise in tobacco prices, some anti-smoking associations would like to go even further. What do you think ?
We are on a downward trajectory which I like. We could go a little faster but we have to stay reasonable. Especially since if we take measures that are not accepted, there are rebound effects. We saw this with the first Cancer Plan when tobacco prices had increased considerably, this had caused a collapse in consumption, but after two or three years it had become socially difficult to accept and finally there is had a kind of backtracking with Nicolas Sarkozy who raised tobacco prices less than what the level of inflation was. Currently we are a bit between two waters since there we say that we are increasing tobacco consumption while we are only barely catching up with inflation.
But the price of tobacco in France remains one of the most expensive in Europe and we also have something very favorable since the price of quitting smoking is one of the cheapest in Europe. Nicotine substitutes are great assets for people who decide to quit smoking. The fact remains that we are going slower than the English on quitting smoking: they are 15% smokers, we are still 25% and they plan to reach 5% smokers for the whole population whereas with us, this figure is only targeted for those under 18 years of age. To do this, they have effective measures like the one that just consisted of distributing a million electronic cigarettes to people who needed them.
– Precisely, the debate still exists on this electronic cigarette, is it beneficial, is it dangerous? Today the discussion focuses on its disposable formula, the “puffs” that the Minister of Health says he is ready to ban…
In France, the electronic cigarette has a position that is opposed by some and for me in a counter-productive way. The “puff” which is a very particular electronic cigarette is above all a stupidity in terms of ecology since this product contains plastic, metal and a battery and is most often thrown on the ground after use!
With these disposable cigarettes, we have been spared in France the problem of doctored liquids that the United States has experienced thanks to appropriate European legislation. This legislation designates the nicotine level in milligrams per milliliter – in particular because large laboratories wanted at the time of the negotiation that these products could be presented as drugs – which makes it possible to block all products which have higher levels and which should not be sold in France, even if some arrive on the market through circuitous routes.
– But should we ban these “puffs” or not, or even put new constraints on the use of any electronic cigarette?
These products appeal to young people but also to adults! I see it in some of my patients in tobacco consultation, there are a number who have bought “puffs” and to whom I say ‘but don’t take a disposable thing, rather buy a device that you fill yourself , there are some that are very easy to use.
But we are in the process of finalizing a study on the effect of electronic cigarettes on the initiation of smoking among young people and which shows that all that is said is nonsense or in any case a misinterpretation of studies. I continue to believe that the electronic cigarette is more a diversion from smoking than a gateway, even if I do not yet have all the concrete elements to affirm it with certainty before having demonstrated it.
For the moment, if we take objective data, the majority of electronic cigarettes that are used by young people are used after taking tobacco. The first product consumed is tobacco, the electronic cigarette only comes second, which shows that it is not the gateway to smoking that we have already experienced before. , it’s the opposite !
– Electronic cigarettes allow you to vape with products that contain addictive nicotine. Doesn’t this still represent a risk of diving or re-diving into smoking?
From the point of view of theoretical risks, we can always think that, from the point of view of practical risks we can also think that, for those who have started to smoke, keeping the right dose of nicotine is the surest way out. cigarettes.
– On these effects of nicotine, what is the difference between an electronic cigarette and a real cigarette?
There is a huge difference between the electronic cigarette and the cigarette, it is the kinetics of the delivery of nicotine. When it is delivered extremely quickly in peak nicotine, in a few minutes, then it creates addiction since at the end of a cigarette there is in many smokers more nicotine than free nicotine receptors to receive this nicotine and the brain sends a signal back by desensitizing the receptors a little and multiplying their number. So each cigarette smoked makes you want to smoke the next one!
If you take a shisha, for example, which is also horribly toxic and I’m totally against that product, but it only takes 45 minutes to come up instead of 5 minutes with a cigarette, there’s no overshoot receivers and there is less dependency that sets in. This is the principle of patches with a continuous delivery that does not generate any dependency.
For the electronic cigarette, the way to use it, in reality, is to take two or three puffs, stop, two or three more puffs and stop again, so to have a fairly nicotine delivery plate. Obviously, if a vaper reproduces the way of smoking of a cigarette smoker, we will find the nicotine peak and its effects on addiction, but in real life, this is only very rarely the case, it is not is not how vapers smoke who only take very small doses and not the big bottomless glass like with a cigarette!
The addictive power to nicotine of the electronic cigarette is thus much less than that of the cigarette. When we compare in England those who use nicotine substitutes and those who prefer electronic cigarettes, we see that the latter are more numerous to stop smoking after one year.
However, one country, Australia, has already banned disposable electronic cigarettes and has just announced strict measures to limit vaping. Wouldn’t that be, to hear you, an example to follow?
Proposing bans on electronic cigarettes in countries where people still smoke is nonsense! Australia has done it but in this country there are less than 1% of smokers among 18 year olds. From the moment there are no more smokers, should electronic cigarettes be banned? I said yes at first, now I’m less sure: in Australia, since there are no more smokers, there are still 6% of young people who use electronic cigarettes… and they don’t don’t become smokers!
In countries where there are 20% smokers, it must be made compulsory, where there are 10% smokers, we must see and in countries where there are no more smokers, perhaps ban it. For any smoker, the electronic cigarette is good, for any non-smoker, it should be avoided!
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