Publié le 8 Mai 2014

OFDT : Tableau de bord mensuel Tabac

(scroll down for English)

Selon ces données de l'OFDT, les ventes de cigarettes reculent de 7,9 % en mars 2014 par rapport à mars 2013. La chute amorcée en 2013 semble se confirmer et s'accentuer. Le cumul janvier-mars 2014 représente une baisse de 8,9% par rapport à la même période en 2013.

Il en va de même pour le tabac à rouler, qui baisse 8,0% en mars 2014 ( -7,5% sur le cumul janvier-mars).

Les ventes de traitements pour l’arrêt du tabac continuent de chuter, de 42,8% en mars, -32,4% pour le cumul janvier-mars, les patchs étant les plus touchés (-56,5%), et les consultations en tabacologie ont accueilli moins de nouveaux patients, et le nombre d’appels à Tabac info service stagne.

Afin d’éclairer ces évolutions, l'OFDT rappelle les résultats de l’enquête ETINCEL sur la cigarette électronique, publiés en février 2014.

Les ventes de cigarettes reculent encore de 7,9% en mars

According to these OFDT data, cigarette sales felt by 7.9% in March 2014 compared to March 2013. The trends observed in 2013 seem to be confirmed and accentuated. The cumulative data for January-March 2014 represent a decrease of 8.9%.

A similar trend is observed for roll-your-own tobacco, which decreased by 8.0% in March (-7.5% for January-March), compared to last year.

Sales of smoking cessation treatments continued to fall, -42.8% in March, -32.4% for January-March, patches being the most affected (-56.5​​%). Smoking cessation centers received also fewer new patients, and the number of calls to the quitline (Tabac info service) are stable.

To inform these developments, the OFDT points to the results of the ETINCEL survey on electronic cigarettes, published in February 2014.

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Publié le 5 Mai 2014

Voici un reportage de Radio Canada sur le vaporisateur de nicotine avec l'accent si chantant de nos cousins d'Amérique ;-)

Les vapeurs reconnaitrons sans doute un reviewer qu'ils connaissent bien. Il faut souligner le courage des médecins, tabacologues, et infirmières comme Martin Juneau ou Martine Robert, et même le représentant canadien de Droit des non fumeurs, François Damphousse, qui osent parler ouvertement du bénéfice du VP dans un pays où l'on n'a pas le droit d'acheter des liquides nicotinés... quoique...regardez le reportage.

http://ici.radio-canada.ca/emissions/telejournal_18h/2013-2014/Reportage.asp?idDoc=336549&autoPlay=http://www.radio-canada.ca/Medianet/2014/cbft/2014-04-30_18_00_00_tj18h_0003_04_400.asx

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Publié le 30 Avril 2014

Le rapport est ici.

An English translation of this Expert opinion (Adaptations of smoking cessation practice in the context of electronic cigarettes ?) is available here.

PARIS, 30 avril 2014 (APM) - Dix experts, réunis à l'initiative de l'Office français de prévention du tabagisme (OFT), ont formulé 45 constats et recommandations pour guider les professionnels de santé sur la conduite à tenir concernant le recours à la cigarette électronique notamment dans l'arrêt du tabac.

"Il existe depuis plusieurs années une autre façon de consommer de la nicotine et elle apparaît comme une bonne solution provisoire pour arrêter les produits du tabac", a commenté mardi auprès de l'APM le président de l'OFT, le Pr Bertrand Dautzenberg. "L'objectif reste de quitter définitivement le tabac. Mais il est possible avec la cigarette électronique de le faire en douceur, avec plaisir."

L'OFT a initié ce travail pour "aboutir à un consensus sur la conduite à tenir par les professionnels de santé" qui sont "parfois en porte-à-faux pour répondre" à leurs patients, faute d'études probantes et d'une bonne connaissance personnelle de ce produit.

Cet "avis d'experts" a été essentiellement fondé sur l'écoute des usagers et de leurs pratiques. "Nous nous sommes également reposés sur les données de l''evidence-based medecine' mais les publications restent limitées et les enquêtes sont souvent biaisées", fait observer le Pr Dautzenberg.

Le fondement de ces recommandations repose dans le premier constat de cet avis: "Avec 73.000 décès annuels, le tabagisme est la première cause de mortalité évitable en France en 2014. Tout ce qui le fait régresser est bénéfique à la santé publique".

"L'objectif est d'aider un plus grand nombre de fumeurs à quitter le tabac en permettant aux différentes méthodes de s'allier", souligne le pneumologue. Et du tabac sous toutes ses formes, a-t-il ajouté, interrogé par l'APM sur le "vaporisateur" de tabac lancé en France il y a une dizaine de jours par Japan Tobacco.

Les experts distinguent cinq principales situations et proposent pour chacune une stratégie thérapeutique. D'abord, pour le fumeur qui envisage d'arrêter au moyen de l'e-cigarette, ils proposent d'"exposer et proposer les méthodes médicales efficaces, tout en restant ouvert à la demande du fumeur d'utiliser la cigarette électronique".

Pour le "vapoteur" qui garde quelques cigarettes, il faut "l'aider à éliminer les dernières cigarettes" et, face au fumeur en sevrage qui n'arrive pas à éliminer les dernières cigarettes, les remplacer par la cigarette électronique pour faciliter "l'arrêt total peut être une option".

Un "vapoteur" exclusif, qui se pose ou non la question de l'arrêt, peut être aidé par les professionnels de santé dans une démarche de sevrage complet de la nicotine, "dès lors qu'il n'existe plus de risque significatif de retour au tabagisme".

Enfin, l'ex-fumeur, l'ex-vapoteur et le non-fumeur ne doivent plus toucher à la cigarette électronique.

Pour les experts, les méthodes d'arrêt du tabac validées -les thérapies cognitivo-comportementales, l'entretien motivationnel, les substituts nicotiniques et les médicaments de prescription- restent "la prise en charge de première intention des fumeurs".

"Dans l'accompagnement thérapeutique, la cigarette électronique n'est envisageable que chez le fumeur qui ne veut pas ou n'a pas pu arrêter avec les traitements validés ou qui est demandeur de son utilisation, ou qui a déjà commencé à l'utiliser."

BIEN CHOISIR SA E-CIGARETTE

Les professionnels de santé doivent aussi expliquer aux candidats au "vapotage" dans une démarche d'arrêt du tabac "la nécessité de bien choisir sa cigarette électronique et ses e-liquides pour en optimiser l'usage à chaque étape et augmenter ainsi ses chances de remplacer totalement les cigarettes", par exemple en veillant à bien adapter les doses de nicotine du liquide aux besoins.

Ils abordent également quelques situations particulières (grossesse, chirurgie, malades cardiaques) et rappellent la toxicité de la nicotine, formulant des recommandations concernant les accidents de manipulation de l'e-cigarette et des liquides de recharge.

Considérant que la cigarette électronique, même sans nicotine, "pourrait contribuer à renormaliser le tabac dans notre société et favoriser l'initiation, en particulier chez les adolescents", les experts jugent qu'il "justifié que sa vente soit interdite aux mineurs et que sa publicité soit interdite".

En revanche, ils n'abordent pas, dans cet avis, l'usage de l'e-cigarette dans les lieux publics, notamment dans les structures de soins publiques ou privées, pour certains patients hospitalisés en psychiatrie ou en centre de soins palliatifs. "Un avis sur ce thème serait cependant nécessaire pour éclairer les décisions à prendre".

Lors d'une intervention mardi matin aux Amphis de la santé, colloque co-organisé par l'Association des cadres de l'industrie pharmaceutique (Acip), le Quotidien du médecin et l'Essec, le directeur général de la santé (DGS), Benoît Vallet, a estimé qu'il fallait avoir une attitude "homogène" entre la cigarette classique et la cigarette électronique dans les lieux publics, comme le font par exemple les compagnies aériennes. Une mesure sur l'interdiction de "vapoter" dans les lieux publics pourrait être prise dans le cadre de la stratégie nationale de santé, a-t-il indiqué.

L'avis d'expert a été élaboré notamment avec le soutien de Pierre Fabre qui n'y a participé "en aucune façon", indique l'OFT. Le laboratoire commercialise les gammes de substituts nicotiniques Nicopatch* et Nicopass*.

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Publié le 15 Avril 2014

Science & Avenir : E-cigarette. Combien de nicotine faut-il pour tuer un homme ?

L'article reprend la mise au point faite par Bernd Mayer que j'avais présenté au CNAM en janvier dernier.

Lire aussi cet autre article sur les cas d'intoxications repris dans la presse ces derniers jours, mais avec une interprétation plus nuancée :

E-cigarette. A quel point la nicotine liquide est-elle dangereuse ?

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Publié le 14 Avril 2014

Mise à jour 14/04/14

Hier c'est Vincent (Vaping Vince) qui est parti trop tôt. Ceux qui le souhaitent peuvent lui laisser un message ici: http://www.vaping-vince.net/content/vaping-vince-nest-plus-vive-vaping-vince

____________________

 

Ce soir, les vapoteurs sont tristes. Ils ont perdu l'un des leurs, même s'ils ne le connaissaient pas vraiment, juste par l'intermédiaire de ses messages sur le forum, parti trop tôt, bien trop tôt... Foubix avait 38 ans!

En hommage à sa mémoire, et en espérant que nos décideurs comprennent ce qui est en train de se jouer sous leurs yeux, je publie ici son dernier post où il fait part de sa volonté que son destin serve au moins à quelque chose et laisse une trace.

 

trop tard

Messagepar foubix » Sam 15 Fév 2014, 05:36

Salut a tous cela fait un peu plus de 3 mois que j'ai complètement arrêté la clope et cela du jour au lendemain !!
Et ça après 24 ans de clope a raison de 1 paquet par jour
donc merci a la cigarette électronique
Ainsi qu'a ce magnifique forum sur lequel j'ai appris énormément de choses
Tout devrais aller pour le mieux oui mais voilà
Le 29 janvier suite a d'atroces douleurs dans le ventre
Au niveau des cotes flottante
Je decide d'aller au urgence et il en faut pour que
Je me décide à y aller suis pas une chochotte
Au jour d'aujourd'hui je suis tjs a la clinique
Et après bon nombre d'examens le résultat est tombé
Cancer du poumon gauche du a une masse
Cancereuse de 6 cm sur 7
Je ne post pas ce message pour me faire pleindre
Juste pour dire que si j'avais connu plus tôt ce moyen d'arrêter de fumer
Que si les pouvoirs publics mettait en oeuvre un peu plus d'informations
Sur ce mode palliatifs au tabac bon nombres de gens seraient
Désintoxiquer de cette saleté de clope
Maintenant je compte me battre pour m'en sortir
Et symboliquement en sortant de la clinique je m'achète
une pince à crabe pour lui faire ça fête !!
Maintenant la plus dure des choses que je dois faire c'est d'annoncer
Cette nouvelle a ma fille de bientôt 13 ans qui vit avec ça maman et qui vient de faire comme les copines de ce mettre à fumer cette s@loperie de clope
Merci d'avoir pris le temps de lire ce post
Et s'il vous plais arrêtons et demandons à nos proches d'arrêter
pour le bien de nos enfants de fumer devant eux !!

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Publié le 7 Avril 2014

OFDT : Tableau de bord mensuel Tabac

(scroll down for English)

 

Selon ces données de l'OFDT, les ventes de cigarettes reculent de 7,6 % en février 2014 par rapport à février 2013. La chute amorcée en 2013 semble se confirmer et s'accentuer. Le cumul janvier-février 2014 représente une baisse de 9,4%.

Il en va de même pour le tabac à rouler, qui baisse depuis 4 mois (-3,5 % en février 2014, -7,2% sur le cumul janvier-février).

Les ventes de traitements pour l’arrêt du tabac continuent de chuter, de 34,5% en février, -27,8% pour le cumul janvier-février, les patchs étant les plus touchés (-52%), et les consultations en tabacologie ont accueilli moins de nouveaux patients. Par contre, le niveau d’appels à Tabac info service progresse encore, tout particulièrement ceux gérés par les tabacologues (probablement dû à la campagne média de début d'année).

Afin d’éclairer ces évolutions, l'OFDT rappelle les résultats de l’enquête ETINCEL sur la cigarette électronique, publiés en février 2014.

Les ventes de cigarettes reculent encore de 7,6% en février

According to these OFDT data, cigarette sales felt by 7.6% in February 2014 compared to February 2013. The trends observed in 2013 seem to be confirmed and accentuated. The cumulative data for January-February 2014 represent a decrease of 9.4%.

A similar trend is observed for roll-your-own tobacco, which decreased continuously during the last 4 months (-3.5% in February 2014, -7.2% for January-February).

Sales of smoking cessation treatments continued to fall, -34.5% in February, -27.8% for January-February, patches being the most affected (-52​​%). Smoking cessation centers received also fewer new patients. However, the calls to the quitline (Tabac info service) are still rising, especially those managed by smoking cessation specialists (probably due to the media campaign earlier this year).

To inform these developments, the OFDT points to the results of the ETINCEL survey on electronic cigarettes, published in February 2014.

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Publié le 1 Avril 2014

Results of ETINCEL-OFDT survey on electronic cigarettes

Prevalence, purchase behaviour, usage, and motivation of e-cigarette users

(Original publication in French is available from OFDT website)

(Scroll down for a PDF version of this translation)

 

OFDT - Observatoire Français des Drogues et des Toxicomanies [French Monitoring Centre for Drugs and Drug Addiction]
Note n°2014-01: results from ETINCEL-OFDT survey (November 2013)
Saint-Denis, France, 12/02/2014

Aurélie Lermenier and Christophe Palle (OFDT - «Indicators» Unit)
Design and follow-up of the survey : Marie-Line Tovar («General Population Surveys» Unit) & Aurélie Lermenier

English translation by Jacques Le Houezec, translation notes are indicated within brackets [ ]

 

Presentation of the survey

While electronic cigarettes appear as a growing phenomenon in France over the last two years, data on prevalence and usage remain fragmentary and difficult to interpret due to the lack of information on the methodologies used. Being deeply involved in issues related to tobacco, for the last ten years the OFDT has produced monthly statistical reports and launched every year a detailed summary review. However, it has become increasingly difficult to interpret trends in the tobacco market without taking into account electronic cigarettes. This is why, at the end of 2013, OFDT decided to conduct a survey focusing on this product, with the aim to provide the government and professionals, within a short time frame, the first reliable estimate of this phenomenon1, in order to measure its impact on tobacco for the 2013 annual report.

The ETINCEL-OFDT survey (telephone survey for information on electronic cigarettes) was conducted between 12 and 18 November 2013 among a representative sample of 2,052 individuals aged 15 to 75 years, from the metropolitan population (excluding Corsica). A land-line telephone data base (including numbers starting with 01 to 05 [old numbers denoting geographical areas, before introduction of cable and DSL connections] and 09 [non-geographical numbers, after introduction of cable and DSL], stratified by region and urban category) was randomly generated. The sample of individuals from this data base, interviewed by telephone during one week, was established by the method of quota sampling according to sex, age group, and occupational category. The results were calibrated to the latest data from the INSEE (Institut National de la Statistique et des Études Économiques [French National Institute for Statistics and Economic Studies]).

The questionnaire consisted of 17 questions (see Annex 1). It addresses the issues of awareness of electronic cigarettes, frequency of use, purchase behaviour of electronic cigarettes and e-liquids or refills, user motivations, etc. Questions about tobacco use were also asked to the respondents in order to know the smoking status (e.g. current or ex-smoker) of electronic cigarette users and measure the potential impact on smoking prevalence.

This paper presents the main results of the ETINCEL-OFDT survey and puts them in perspective with other studies conducted in France.

1 Other works and initiatives are under-way to better document the subject: the INPES survey, a regular monitoring and behavioural profile of users of the electronic cigarette by the polling organization IPSOS, a study commissioned by the Ministry of Health at the National Laboratory of Metrology and Testing (including an Internet user survey), and a working group including the Independent Association of E-cigarettes Users (AIDUCE), the E-cigarette Trade Association (ex-CACE, now FIVAPE), the French Office for the Prevention of Tobacco Smoking (OFT), and the National Consumer Institute (INC), with the aim of improving information on products.

 

A large majority of French people are aware of electronic cigarettes

In November 2013, almost nine out of ten French people (88% [86.8 to 89.6])2 stated that they were aware, at least by name, of electronic cigarettes. In March 2012, the Eurobarometer on tobacco3 indicated that electronic cigarettes awareness in France was already significant, but three points below the European average of 66%. Awareness of this product was greater among young people aged 15 to 24 years (93%) and among managers and higher intellectual professions (93%) and was slightly lower among 65-75 years (83%), and therefore among the retired (85%). Awareness among smokers, who are the target audience for electronic cigarette marketing campaigns (presenting it more or less openly as a means of smoking cessation), was higher than in people who never or virtually never smoked (93% vs. 85%).

2 Figures in brackets indicate the 95% confidence interval.

3 Survey conducted between February 25 and March 11, 2012 in the 27 Member States of the European Union (EU) on user behaviour and purchase of tobacco, with three questions on the electronic cigarette. In total, more than 26,700 individuals aged 15 years and older, selected by a random method, were interviewed face -to-face in all EU countries. In France, it was about 1,059 individuals (see TNS Opinion & Social, Attitudes of European Towards tobacco , Special Eurobarometer 385, Brussels , European Commission, 2012 , 167 p.).

 

What is an electronic cigarette?

Developed in China in the mid-2000s, the electronic cigarette, also known as the e-cigarette mimics the feeling of a classic tobacco cigarette. There are two types : disposable (looks like a real cigarette) and rechargeable (AC or USB cable ; it then rather looks as a large pen). Rechargeable electronic cigarettes (the majority of the French market) consists of a battery, a clearomiser that contain a resistance and the e-liquid, and a tip that allow to inhale the vapour generated at the clearomiser. By pressing a button, the battery supplies the resistance with power which heats the e-liquid soaked by the wick of the clearomiser and turns it into vapour, which is inhaled by the user. The e-liquid is made of propylene glycol and/or vegetable glycerin, various flavours (tobacco, mint, apples, etc.), a small proportion of alcohol and/or purified water, and may contain or not nicotine at different concentrations.

 

Already one in five French people used it at least once

At the end of 2013, 18% [16.7-20.1] of people surveyed reported having used at least once an electronic cigarette. This is 2.5 times more than in March 2012, when the rate of experimentation in France was 7 % (identical to that in all countries of the European Union).3

Among those who had not yet tried electronic cigarettes, only a small minority (2.3% [1.6-3.0]) intended to do in the near future. This proportion of potential experimenters was twice as high among manual workers (4.9%), and five times higher among smokers (11.2%).4

4 The over representation of manual workers among potential electronic cigarette experimenters is partly due to the fact they are more likely than average to smoke (33% vs. 27%). Unemployed people, and to a lesser extent, self-employed workers, merchants and business owners are also more likely than average to smoke and more often declare their intention to try electronic cigarettes, but the difference is not significant.

 

Rather young experimenters, and tobacco users

Men were more likely than women to have ever used electronic cigarettes (22% vs. 15%). The proportion of experimenters decreased as age increased (Figure 1) : nearly a third (31%) of 15-24 years-old had tried them, as opposed to no more than one in five of 35-44 years-old, and one in ten (9%) between 55-64 years-old. For reasons probably more related to age than professional status, retired people were less likely to try these products. Not surprisingly, being a smoker or having smoked in life influences the level of experimentation : half of smokers (51%) report having tried electronic cigarettes as opposed to only 12% in ex-smokers, and 3.5 % among respondents who never or rarely smoked.5 Thus, among the experimenters, three quarters were smokers, one in six was a former smoker and nearly one in ten (9% ) had never smoked or had only tried smoking. Furthermore, although the sample size makes it difficult to draw geographic comparisons, experimentation appears less common in the north (Nord-Pas-de-Calais: 7.9 %) than in the west (23,1% in the area consisting of the regions Brittany, Pays de la Loire, and Poitou-Charentes) and the South west (21,3% in Aquitaine, Limousin, and Midi-Pyrénées).

5 This difference by current or past smoking status is also checked in Britain where a survey of over 12,000 adults was conducted in February 2013 by the Association of Prevention Action on Smoking and Health (ASH ) for the prevalence of use ( cf. ASH , Use of e- cigarettes in Great Britain Among adults and young people (2013) , London, ASH , 2013 , 4 p.).

 

Electronic cigarette use concerns one in fifteen person in the last month

At the end of 2013, recent use (within the last thirty days and excluding experimentation) of electronic cigarettes concerned 6.0% [5.0-7.0] of French people, or a third of those who tried them.6 Although they were more likely to experiment than older people, 15-24 years-old were proportionately less likely to have used it in the month preceding the survey, followed by 25-34 years-old. It is after the age of 35 that people seemed more likely to "adopt" electronic cigarettes after having tried them (Figure 1): regardless of their age group, more than one experimenter in three reported recent use. It is likely that the trendy effect is playing more in young people experimentation, who would try it more by curiosity, while older users are more likely to use them specifically to reduce or stop tobacco use.

6 In March 2013, a so-called omnibus telephone survey ( on various topics ) Ipsos Observer, with a sample of 950 individuals representative of the adult population ( quota method ) resulted in a proportion of 3.5% of users more or less regular.

 


 

 

 

 

Figure 1 : Proportion of experimenters (blue bars), recent use (red bars), and daily use (green bars) of electronic cigarettes, by age group
Source : ETINCEL-OFDT survey (November 2013)

 

Unlike experimental use, more common in men, there was no gender difference in recent (and daily) use of electronic cigarettes. Apart from the lower proportion of retired people among users in the last month (3.1%), given their age, there was also no significant differences according to their socio-economic category. However, as for experimental use, use in the last month was higher in the West of the country (9.3%), and lower in the North (1.6%), possibly due to an easier access to cheaper tobacco in Belgium and Luxembourg.

All recent users of electronic cigarettes reported current tobacco use, or having used tobacco in their lifetime, but smokers were significantly more likely to use electronic cigarettes than ex-smokers (78% vs. 22%).

 

Slightly more than 3% of daily users

More than half (54%) of those who used electronic cigarettes in the last month use them daily, or 3.3% [2.5 to 4.1] of French people (Figure 2). As already observed for recent use, the difference between the youngest and the oldest users was confirmed for daily use: among recent users of electronic cigarettes, only 44% of 15-24 years-old used them daily, as opposed to 50-75% of 50-75 years-old. This seems to reinforce the hypothesis that young people would bow to fashion, whereas those being over 50 years-old are more likely engaged in giving up tobacco use or in harm-reduction, as soon as they try them, certainly in relation with being older. When faced with health damages, actual or perceived as very likely, caused by usually long-life (several decades) smoking, older smokers tend to turn to electronic cigarettes to reduce their risks.7

7 According to a British study, electronic cigarettes would deliver half as much formaldehyde (a known carcinogen), 23 times less toluene (a toxin), 130 times less acetaldehyde (suspected carcinogen) and 30-145 times less tobacco specific nitrosamines (highly carcinogenic): Maciej L. Goniewicz "E-cigarettes: a review of Their efficacy and potential for harm reduction."

 

Figure 2 : Proportion of experimenters, recent users, and daily users of electronic cigarettes in France
Experimental use: 18 %, Use in the last month: 6 %, Daily use: 3.3 %, Exclusive use: 1,3%

Source : ETINCEL-OFDT survey (November 2013)

 

Many daily users of electronic cigarettes are still using tobacco, since two-thirds of them were dual users (tobacco and electronic cigarettes). However, among them, more than six in ten (62%) used "electronic cigarettes most of the time and tobacco sometimes"; a quarter of them responded the opposite.
Exclusive electronic cigarette users, i.e those who do not currently use tobacco, represented 1.3% [0.8-1.8] of the surveyed sample, and the vast majority (81%) used them daily.

 

A growing usage since spring 2013

Three quarters (76%) of vapers8 who used electronic cigarettes during the thirty days preceding the survey started using them less than six months ago, that is to say, since April-May 2013, which coincides with a period of extensive media coverage, particularly related to a report on the subject submitted by OFT9 to the Ministry health. Only 13% reported having started to use them more than one year ago.

The vast majority (78%) of those who used electronic cigarettes in the last month owned their own electronic cigarette, while 16% used those belonging to other people (the remainder sharing them with one other user: spouse, friend, etc.). This latter figure may be explained by the desire to test the product and the liquid flavours before making a purchase that represents a certain upfront investment: a minimum spend of 50 Euros for a rechargeable electronic cigarette and a little less than 6 Euros per 10 ml bottle of e-liquid. A lower proportion of vapers aged 15-24 owned their own electronic cigarette (44%), probably because they are often less likely to be regular users, while the proportion rose to 93% among 35-54 years-old.

Nearly a quarter (24%) of recent users reported not knowing the nicotine content of the liquid or refill for the electronic cigarette they used (the majority of these being people who did not own their own). Among those who did know, 11% reported using a 0 mg/ml concentration (no nicotine), highlighting the low proportion of non-nicotine-dependent users, or those who have successfully given up, after a gradual reduction in nicotine dosage. Four in ten vapers choose a medium dosage (between 7 and 12 mg/ml), while the remaining users were equally distributed (24%) between low dosage (between 1 and 6 mg/ml) and high ones (greater than 12 mg/ml).10

8 The most common term for people using electronic cigarettes

9 French Office for the Prevention of Smoking, Report and expert opinion on e-cigarettes, Paris, OFT, 2013, 212 p.

10 Nicotine concentration rarely, if ever, exceed 20 mg/ml in French outlets.

 

Purchases mainly in speciality shops

The electronic cigarettes market is still poorly organized and regulated,11 and it is shared by many manufacturers and retailers. However, the majority of purchases by those surveyed (58%) were made in speciality shops for this type of product, even though the purchases in tobacconists [a monopoly for tobacco sales in France] was by no means negligible (21% - Figure 3). The Internet is a rather small source of supply: 9% of those surveyed bought their electronic cigarette online. Purchases from pharmacies [a monopoly for drugs in France, where there exist no GSL even for OTC drugs], which are actually prohibited to sale these products,12 or from supermarkets were mentioned, but concerned very few purchasers. Speciality shops were also the source of the majority of purchases of e-liquids and refills: 54% of those surveyed used them, whilst 24% did it in a tobacconist.

No matter where they purchased their electronic cigarette, a very large proportion of users used the same supply channel for purchasing refills. This was especially true for tobacconists (91%) but also for speciality shops (88%): although there is no evidence to establish whether this was in the same place, this figure may well suggest that users are attached to the personal relationship with a vendor who can advise them.

Finally, the market for disposable electronic cigarettes appears to be very small: only 4% of those who had used electronic cigarettes in the last month used these type of products, which are sold mostly for trial purposes, rather than of loyalty. Indeed, they are easy to use, similar to conventional cigarettes and allow to try the product at a low cost. It is likely that with the increase in electronic cigarettes use, disposables have experienced a decline in their market share.

11 A professional organization, the Collective actors of the electronic cigarette (CACE), [now called FIVAPE for Inter-professional Federation for Vaping) was created in January 2013. It includes manufacturers, distributors, retailers, etc. of the electronic cigarette sector, and aims to defend the interests of its members at national and European level, in particular by proposing specific regulations. They also initiated a training center for professionals near Bordeaux. In December 2013, another organization, the National Union of Professional of electronic cigarettes (Synapce) was also created.

12 Electronic cigarettes not being a medical device or a drug and not part of the list of authorized products for sale in pharmacies (Article L.5125-24 of the Code of Public Health), they should not be sold in pharmacies. Despite reminders from the National Agency for Medicines and Health Products (MSNA) and the Council of the College of Pharmacists, many pharmacies continue to sale them (http://pourquoi-docteur.nouvelobs.com/E-cigarette---l-Ordre-denonce-les-ventes-illegales-en-pharmacie-3025.html).

 

Figure 3: Distribution of locations where electronic cigarettes are purchased in France
Speciality shop 58%, Tobacconist 21%, The Internet 9%, Pharmacies 5%, Other places 8%

Source : ETINCEL-OFDT survey (November 2013)

 

Primary motivation : giving up completely

Half (51%) of people surveyed who reported simultaneous use of tobacco and electronic cigarettes spontaneously claimed that their main and ultimate goal was to stop completely the use of both products.13 Among the motivating factors reported, next came, but far behind, the reduction of tobacco consumption but without giving up entirely (11.5%), and then substituting electronic cigarettes for tobacco (8.2%), both of which might relate to a form of harm-reduction. Other users highlighted the decrease in health risks, reduction in tobacco inconveniences, cost, and the ability vape anywhere.

The product is therefore strongly linked to the idea of smoking cessation, and even beyond that to reduce or even to eliminate any nicotine dependence. According to a survey conducted in Great Britain among users of electronic cigarettes,14 the idea of smoking cessation was also the most common: 34% of vapers reported using electronic cigarettes to quit smoking, and 28% "because they had already tried to quit and wanted something to help to stop for good." They were 22% to want to reduce their consumption without giving up completely, and the same proportion to be motivated by the potential savings.15
Among the very small proportion of surveyed people who were former smokers (even occasional ones) and had used electronic cigarettes within the last month (namely 1.2%), most of them (84%) considered they had completely stopped smoking by using them: this represents 1% of the French population. Without presuming the effectiveness of electronic cigarettes for smoking cessation,16 especially as the numbers here are very small, it seems that smokers are convinced of its usefulness for achieving this goal, as an alternative to nicotine replacement therapy and smoking cessation medications. This opinion is also shared by a significant part of the population: as 43% of French people believe that these products are an effective mean to reduce or stop smoking.17

13 This objective was slightly more often cited by users aged 50-75, confirming the hypothesis that older users are more motivated to quitting than the younger ones, however, the difference was not significant.

14 Action on smoking and health (ASH), op. cit.

15 Unlike the question in this survey for which a single response ("primary and long-term objectives") was possible, the British respondents could give multiple answers, so the total exceeds 100%.

16 In September 2013 , The Lancet published the results of a study conducted in New Zealand (University of Auckland) on the efficacy of electronic cigarettes on smoking cessation: this product appeared to be comparable to the nicotine patch in helping smokers to quit over a period of at least six months, however, it was more effective in reducing daily consumption among those who did not quit, and seemed to be more appealing than the patch, particularly in the long-term (see BULLEN C. et al . "Electronic cigarettes for smoking cessation : a randomized controlled trial ," The Lancet , vol 382, 2013 , pp. 1629-1637.

17 Survey conducted by Clopinette, one of the market leaders in electronic cigarettes in France , on 22 and 23 November 2013 among a representative sample of 969 French adults (quota sampling method).

 

Conclusion

In November 2013, the vast majority of the French population had heard about electronic cigarettes, and between 7.7 to 9.2 million people had tried them, mainly young people and smokers. In the month preceding the survey, 6% of the population were using electronic cigarettes. Between 1.1 and 1.9 million people reported daily use of electronic cigarettes in France: some 67% of tobacco smokers used them mainly to stop or reduce their daily tobacco consumption, and therefore potentially the health risks associated with smoking. Although 9% of those using electronic cigarettes reported having never or rarely smoked tobacco, all the regular vapers were or had been smokers: electronic cigarettes appear therefore, at least for the moment, to rather be a way out of smoking, rather than a "gateway" into smoking.

The exclusive use of electronic cigarettes is fairly limited, but may increase over time, as smokers use these products to reduce their tobacco dependence. The ultimate goal of vapers is focused on complete cessation; with three quarters of regular users having started using electronic cigarettes less than six months before the survey, more time may be needed before effective cessation is confirmed, which at the end of 2013, represents 1% of the French population.

Rechargeable electronic cigarettes represent the vast majority of the market (over 95% of those who had vape in the month) and the purchase of the object itself and the refills are made primarily in speciality shops (over 50 %) and tobacconists (over 20 %).

Further surveys are needed to consolidate these findings and their evolution over time. At the beginning of 2014, the increased media attention and the strong momentum of the electronic cigarette market show no sign of slowing: it is therefore likely that the number of users, going from experimentation to daily use, will continue to rise.

 

 

 

Annex 1. Questionnaire

Survey on behaviour of use and purchase of electronic cigarettes and tobacco

 

Part I : Electronic Cigarette

Q1 - Have you heard, even if only by name, of electronic cigarettes, also known as “e-cigarettes”, “personal vaporisers” or “vaporette”?

1- Yes

2- No

 

Q2 - (if yes to Q1) Have you ever tried an electronic cigarette?

1- Yes

2- No

 

Q3 - (if no to Q2) Do you intend to try an electronic cigarette in the near future?

1- Yes - Go to Q10

2- No - Go to Q10

 

Q4 - (if yes to Q2) Have you used an electronic cigarette within the last 30 days (apart from for the first time)?

1- Yes

2- No - Go to Q10

 

Q5 - (if yes to Q4) How often do you use electronic cigarettes?

Interviewer: List responses

1- Every day

2- Several times a week

3- Once a week

4- Two to three times a month

5- Once a month

6- (Don’t know)

 

Q6 - (if yes to Q4) When did you start using electronic cigarettes?

Interviewer: List responses

1- Within the last 30 days

2- Between 1 and 6 months ago

3- More than 6 months ago, but less than a year ago

4- One year ago or more

5- (Don’t know)

 

Q6bis - (if yes to Q4) Do you have your own electronic cigarette?

Interviewer: List responses

1- Yes, I have my own

2- No, I share it with someone else

3- No, No, I use other people’s - Go to Q9

4- Other (explain) - Go to Q9

 

Q7 - ( if yes to Q4) Where did you most recently buy your electronic cigarette?

1- From a shop specialising in electronic cigarettes

2- Online

3- From a tobacconist

4- From a chemist

5- Other (explain)

 

Q8 - (if yes to Q4) Where did you buy your most recent e-cigarette refill (liquid, cartridge, etc.)?

1- From a shop specialising in electronic cigarettes

2- Online

3- From a tobacconist

4- From a chemist

5- Other (explain)

6- (Not applicable, I use disposable cigarettes)

 

Q9 - (if yes to Q4) What dose of nicotine do you use in your electronic cigarette?

Interviewer: for zero nicotine, use code 0 and for “don’t know” use code 99

/__/__/

 

Part II : Tobacco

We are now going to ask you some questions on your tobacco consumption (cigarettes, roll your own tobacco, cigars, cigarillos, pipe, shisha/hookah, etc.) in addition to your use of electronic cigarettes.

 

Q10 - Do you smoke tobacco, even if only occasionally?

1- Yes

2- No - Go to Q12

 

Q11 - (if yes to Q10) Did you smoked tobacco within the last 30 days…?

Interviewer: List responses

1- Every day

2- Several times per week

3- Once per week

4- Two to three times in the month

5- Only once in the month

6- (Don’t know)

 

Q12 - (if no to Q10) Have you ever in your life smoked tobacco regularly or from time to time?

1- Yes, regularly

2- Yes, from time to time

3- (I have only tried it) - Go to Q17

4- (Never) - Go to Q17

 

Q13 - (if yes to Q12 and yes to Q4) Did you completely stop smoking due to the use of electronic cigarettes ?

1- Yes - Go to Q17

2- No - Go to Q17

 

Q14 - (if yes to Q10) Where did you last buy your tobacco for your own consumption (pack of cigarettes, roll your own tobacco, cigars, cigarillos, pipe, shisha/hookah, etc.) ?

Interviewer: do not prompt

1- From a tobacconist in France

2- From a tobacconist in a country bordering France (Spain, Andorra, Monaco, Italy, Switzerland, Germany, Luxembourg, Belgium)

3- From a tobacconist in another country

4- From duty-free

5- Online

6- On the street

7- Other

8- (Don’t know)

 

Part III : Tobacco and electronic cigarette

Q15 - (if yes to Q4 and yes to Q10) Do you currently use…?

Interviewer: List responses

1- Electronic cigarettes most of the time and tobacco sometimes

2- Electronic cigarettes as often as tobacco

3- Tobacco most of the time and electronic cigarettes sometimes

4- (Other)

 

Q16 - (if yes to Q4 and yes to Q10) In the long term, is your main reason for using electronic cigarettes to…? ONE RESPONSE ONLY

Interviewer: Do not prompt – use codes

1- Stop smoking and vaping completely (tobacco and electronic cigarettes)

2- Reduce my tobacco consumption without stopping smoking tobacco

3- Reduce my tobacco consumption without stopping using electronic cigarettes

4- Substitute electronic cigarettes for tobacco

5- Reduce my spending on tobacco/save money

6- Be able to vape wherever I like (in the office, at home, etc.)

7- Reduce tobacco-related issues (bad breath, yellow teeth, smell of stale smoke, etc.)

8- Reduce the risk of harming my health without stopping smoking tobacco/they are less dangerous for my health

9- No longer be addicted to nicotine/gradually reduce my nicotine dependence using e-cigarettes

10- Other (explain)

11- (Don’t know)

 

 

Annex 2. Regulation

 

At National level

Current French legislation does not consider electronic cigarettes to be a tobacco products, since they do not contain tobacco and do not involve combustion. For this reason, they are not strictly speaking subject to tobacco product regulations, although they are tending towards it. An amendment prohibiting sale to minors was therefore included in the consumer bill (agreement having been reached on this point, this prohibition is set to become law in 2014) and the Ministry of Health wants to ban their use in public places and bars, restaurants etc., despite the fact that no legislative framework has yet been agreed (the Ministry having referred the matter to the Conseil d’État, which has yet to rule). For the moment, only an organisation’s internal regulations can limit their use (as is already the case for some public transport systems, such as RATP, SNCF, Air France, etc.) and the Saint-Lô city council is the only authority to date to have banned use of electronic cigarettes (by administrative order) inside local authority buildings.

Advertising electronic cigarettes is not specifically prohibited, but may fall within the ambit of France’s “Évin” law, which prohibits “any direct or indirect advertising or promotion of tobacco or tobacco products”. Indeed, the hand to mouth behaviour, the vapour released, the possible presence of nicotine, etc. are all so similar to a real cigarette that it is considered that they could possibly encourage smoking. It is this point of law, and more generally, the infringement of the monopoly on tobacco sales that have prompted a French tobacconist to take action for “unfair and illegal competition” against an electronic cigarette retailer located in the vicinity of his business. In December 2013, the Commercial Court of Toulouse found in his favour, relying on Article L.3511-1 of the Code de la Santé Publique [French Public Health Code], which defines tobacco products as “products designed to be smoked […] whether or not they contain tobacco, with the sole exclusion of products designed for medicinal purposes”. The electronic cigarette retailer has appealed this decision, which, if confirmed, could set a precedent and result in the closure of speciality shops in favour of reinstating the tobacconists’ monopoly.

In France, electronic cigarettes are also not considered to be smoking cessation aids or medicinal products, since no manufacturer has claimed as such, which would require them to obtain authorisation to place such products on the market. In the absence of sufficient scientific research on the safety of electronic cigarettes, or on any potentially harmful effects they may have on health, the Agence Française de Sécurité Sanitaire des Produits de Santé (AFSSAPS, which became the Agence Nationale de Sécurité du Médicament et des Produits de Santé, the French National Agency for the Safety of Medicines and Health Products, or ANSM) advised against using them in 2011 (http://ansm.sante.fr/var/ansm_site/storage/original/application/6badbfed8724d925b6fafc331da6becc.pdf).

 

At European and international levels

Discussions to provide a framework for electronic cigarettes at European level fall within the scope of the review of the Tobacco Products Directive 2001/37/EC, which regulates the manufacture, presentation and sale of these products. In December 2012, the European Commission submitted to the European Council and the European Parliament a proposal for a Directive, which was the subject of numerous debates between the various parties involved throughout 2013. Originally planned for September, the proposal to strengthen legislation on tobacco products was examined by the European Parliament in October 2013 (increase in the size of health warnings, prohibition on flavoured cigarettes (except for menthol, for which an extension is granted), list of authorised additives, etc.). The decision to classify electronic cigarettes as tobacco products or medicinal products having not yet been taken, their status as ordinary consumer goods will therefore be retained.

In mid-December, the 28 Member States of the European Union reached agreement on this future “Tobacco Directive” to control tobacco smoking and to better regulate the electronic cigarette market. Consequently, sales of these products to those under 18 years-old will be prohibited, although countries which deem them to be medicinal products may continue to do so (without obliging others, such as France, to do so), the maximum concentration of nicotine will be set at 20 mg/ml (which is a level rarely, if ever, exceeded in points of sale in France) and the European Commission is to submit a report on the health risks associated with using electronic cigarettes within two years.

This agreement is set to be ratified by the European Parliament and at a plenary meeting of the Member States in February/March 2014, before being definitively adopted. After this, each country will have two years to transpose the Directive into domestic law, which means it will not be in force before 2016.

At international level, the World Health Organisation advises against using electronic cigarettes, as long as there is no scientific evidence that they are safe. Only a few countries have imposed a total ban on this product, among them, Brazil, Argentina and Singapore; in others, such as Switzerland and Canada, only zero-nicotine electronic cigarettes can be marketed.

 

Download PDF version of this translation here

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Publié le 26 Mars 2014

Une enquête mensuelle est réalisée en Angleterre (Smoking Toolkit Study) sur l'arrêt du tabac. Depuis 2011 des données concernant l'utilisation de l'e-cigarette sont aussi collectées. Voici un extrait du dernier rapport, en date du 21 mars 2014.

Comme on peut le voir sur le graphique ci-dessous, l'utilisation croît toujours, mais à un rythme moins soutenu depuis un an.

Les dernières données anglaises sur l'e-cigarette

Le graphique ci-dessous montre qu'elle est surtout utilisée par les petits fumeurs de 2 à 5 cigarettes/jour (sans doute des utilisateurs mixtes, qui n'ont peut-être pas encore réussi à arrêter) et les ex-fumeurs (sans doute ceux qui ont réussi à arrêter avec).

Les dernières données anglaises sur l'e-cigarette

Chez les fumeurs qui utilisent d'autres sources de nicotine pour réduire leur consommation ou pour s'abstenir de fumer temporairement lorsqu'ils ne peuvent pas fumer (au travail, en voyage...), on observe que l'utilisation des substituts nicotiniques a diminué et est maintenant dépassé par l'e-cigarette.

Les dernières données anglaises sur l'e-cigarette

On observe à peu près le même phénomène chez les ex-fumeurs, mais l'utilisation de l'e-cigarette a diminué depuis un an (peut-être un arrêt de l'e-cigarette qui a été utilisée pour arrêter toute consommation de nicotine).

Les dernières données anglaises sur l'e-cigarette

Il est clair que chez les fumeurs, l'e-cigarette est devenu le moyen préféré pour tenter d'arrêter de fumer, même si là aussi on observe une légère stagnation depuis un an.

Les dernières données anglaises sur l'e-cigarette

Cependant, depuis un an, le déclin de la prévalence du tabagisme semble s'accélérer légèrement. Ceci est un point important, car il montre bien une diminution de la prévalence tabagique, qui laisse supposer que la e-cigarette n'est pas seulement utilisée pour réduire sa consommation, mais pour arrêter de fumer.

Les dernières données anglaises sur l'e-cigarette

Ce qui semble confirmé par le graphique ci-dessous, où l'on voit clairement une augmentation des arrêts réussis depuis 2011.

Les dernières données anglaises sur l'e-cigarette

Il est clair aussi ci-dessous, que l'utilisation par les non-fumeurs est négligeable.

Les dernières données anglaises sur l'e-cigarette

Tout comme en France (voir les résultats de l'OFDT), les ventes de tabac diminuent depuis 2012. Les ventes de substituts nicotiniques diminuent aussi, mais moins qu'en France (il faut souligner qu'ils sont remboursés par le système de santé anglais).

Les dernières données anglaises sur l'e-cigarette

Les conclusions :

  • il semble que l'augmentation de l'utilisation de l'e-cigarette se stabilise
  • la baisse de l'utilisation des traitements est moins prononcée qu'en France
  • il est clair que l'utilisation de l'e-cigarette ne diminue pas les tentatives d'arrêt du tabac, ni la baisse de la prévalence tabagique
  • l'utilisation de l'e-cigarette par les non-fumeurs est très rare
  • la disponibilité de l'e-cigarette ne semble pas contrarier les mesures de contrôle du tabac, mais au contraire participer à la baisse de la prévalence tabagique, en facilitant l'arrêt du tabac

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Publié le 25 Mars 2014

Mise à jour 26 mars: on continue dans la diffamation et la désinformation...

http://cevenol.blog.lemonde.fr/2014/03/26/les-croises-de-lecig/#comment-42

Hier, 24 mars, Marc Schindler publiait un article dans Médiapart reprenant un article du NY Time : E-cigarette : « C’est le Far-West »

N'étant pas abonné à Médiapart, il est impossible de répondre à cet article sur leur site. Pourtant ce Monsieur m'a diffamé dans son article, laissant entendre que comme tous les scientifiques qui supportent l'e-cigarette, je devais être financé par cette industrie.

Marc Schindler a cependant posté son article sur un autre blog où il est possible de répondre, ce que j'ai fait:

Jacques Le Houezec dit : 25 mars 2014 à 13:50

Cher Monsieur,
N’ayant pu laisser un message sur votre publication de Médiapart, c’est ici que je vous répondrais.
Nous assistons depuis quelques temps à une désinformation totale sur l’e-cigarette. Les journalistes, ou la plupart d’entre eux, reprennent sans analyse les dépêches de l’AFP ou des articles comme celui que vous avez mis en avant. Avez-vous enquêté, êtes-vous allé dans une boutique vendant des e-cigarettes en France? Je ne le pense pas. Vous auriez un tout autre discours.
La dernière étude californienne, qui a fait grand battage hier, est de la science de rebuts. La communauté du contrôle du tabac monte des études bidons et s’en sert médiatiquement pour diaboliser l’e-cigarette. Même l’American Cancer Society a critiqué de façon virulente cette étude (voir le blog de Clive Bates, http://www.clivebates.com/?p=2073 traduit ici http://www.ma-cigarette.fr/groupe-de-recherche-ouvre-a-nouveau-le-geyser-de-boue-sur-la-cigarette-electronique/).
Quant à l’article du NY Times que vous reprenez, ce n’est qu’une série de déclarations à charge, sans aucun fondement. J’ai honte pour le toxicologue qui ne connaît même pas la toxicité de la nicotine. Celle-ci a été surévaluée depuis plus de 150 ans, mais un article récent de Bernd Mayer a remis les choses dans le contexte. La dose létale de nicotine n’est pas comme on le prétend de 30 à 60 mg de nicotine ingérée, mais au minimum de 500 à 1000 mg absorbés (or, les premiers symptômes de l’intoxication sont les nausées et les vomissements, qui font qu’une grande partie est vomie), et une récente tentative de suicide par une patiente psychiatrique, qui avait avalé 1500 mg de nicotine, ne s’est conclue que par une forte intoxication, mais sans aucune conséquence grave (voir ma présentation ici http://www.e-cigarette-forum.com/infozone/Dr-Jacques-Le-Houezec ou ici en français http://data.over-blog-kiwi.com/0/60/75/08/20140325/ob_6a99bf_conference-cnam-24-01-2014-jlh.pdf).
Vous reprenez les données des centres anti-poison, avez-vous consulté les intoxications par la cigarette de tabac, ou par les produits ménagers? C’est ici : https://aapcc.s3.amazonaws.com/pdfs/annual_reports/2012_NPDS_Annual_Report.pdf
Comparez les chiffres ! Ce qui ne doit pas empêcher les utilisateurs de mettre hors de portée des enfants leurs produits, comme ils doivent le faire je l’espère avec les produits ménagers dangereux.
Enfin, je voudrais souligner la diffamation dont vous faites preuve me concernant. Tout d’abord, merci, mais je ne suis pas professeur. Je suis docteur en science et travailleur indépendant, Consultant en santé publique et dépendance au tabac. Je travaille depuis 30 ans sur la nicotine (j’ai été formé d’ailleurs à San Francisco dans le laboratoire du professeur Neal Benowitz). Je suis consultant pour le secteur public (je rédige par exemple la Lettre de la SFT pour les tabacologues avec une subvention de la DGS), mais aussi privé, pour des laboratoires fabricant des substituts nicotiniques ou des médicaments d’aide à l’arrêt du tabac. Je n’ai jamais travaillé ni pour l’industrie du tabac, ni pour celle de l’e-cigarette (j’ai failli accepter un contrat de NJOY, cité dans ma présentation de Londres, mais en fait je l’ai décliné car je n’était pas en phase avec ce fabricant américain). Je vous demanderai donc de corriger votre article, car en le lisant on pourrait croire le contraire. Je vous conseille aussi de bien lire les déclarations d’intérêts des professeurs Farsalinos et Polosa, vous réviserez j’en suis sûr votre jugement hâtif.
Pour terminer, vous me citez dans votre article, pourtant vous ne m’avez jamais contacté. Je ne sais même pas d’où sort cette citation, il aurait été convenable de mettre un lien, puisque vous l’avez repris sans doute d’une de mes interventions.
Merci de m’avoir permis, en publiant ici votre article, d’y répondre, car j’étais très frustré et en colère hier soir en le découvrant sans avoir la possibilité d’y répondre. C’est chose faite. Je suis à votre disposition pour de plus amples informations si vous le désirez.
Bien cordialement,
Jacques Le Houezec

Ce soir il m'a répondu par courriel ceci:

Cher Monsieur,

Je vous remercie d'avoir pris la peine de répondre à ma chronique sur mon blog du Monde. Je précise que je n'ai aucune compétence scientifique, je suis un journaliste suisse retraité, qui s'intéresse à l'actualité. Je suis un ancien fumeur, qui a cessé de fumer il y près de 50 ans et je n'ai jamais vapoté. Contrairement à ce que vous laissez entendre, je ne participe pas à une campagne contre l'e-cigarette. Je n'ai jamais enquêté dans une boutique vendant des e-cigarettes en France.

Je ne mets évidemment pas en cause vos compétences et votre expertise reconnue dans la lutte contre la tabagisme. Je vous donne acte de votre indépendance par rapport à l'industrie du tabac. Mais je m'étonne néanmoins de votre engagement militant en faveur de l'e-cigarette et de votre dénigrement systématique de toute opinion contraire, notamment à l'égard de l'OMS et de la FDA. Vos attaques répétées contre la presse et notamment le New York Times me semblent faire partie d'une campagne délibérée de certains scientifiques pour faire accepter par les pouvoirs publics la libéralisation de l'e-cigarette, sources d'énormes profits.

Je relève aussi que la SNRT dont vous faites partie reconnaît, dans son rapport 2013, que moins de 10% de ses revenus proviennent de l'industrie pharmaceutique. D'autre part, Pfizer et GlaxcoSmithKline financent généreusement les conférences de l'organisation. Vous reconnaîtrez certainement que ces financements ne sont pas les meilleurs garants de votre indépendance en tant que chercheur en santé publique.

Je n'espère pas vous avoir convaincu, mais je ne souhaite pas poursuivre avec vous ou avec quiconque une polémique sur les vertus ou les dangers de la cigarette électronique.

Veuillez croire, cher Monsieur, à mes sentiments les meilleurs.

Marc Schindler

Puisque ce Monsieur refuse de continuer la discussion, j'ai choisi de lui répondre publiquement ici.

Je suis aussi un ancien fumeur, depuis 30 ans. Et je trouve fort de café que ce soit vous qui me taxiez d'une campagne délibérée, alors que je ne fais que défendre un produit qui pourrait bien délivrer l'humanité du fléau du tabagisme, ce que toutes les tentatives antérieures, tant pharmaceutiques, que politiques ont échoué de faire. Il est étonnant de voir à quel point certains journalistes, et je ne parle pas des politiques comme on a pu le voir récemment avec la Directive tabac, s'acharnent à tuer dans l’œuf un produit qui révolutionne l'arrêt du tabac. Simplement parce qu'il procure du plaisir au fumeur, et que c'est pour cette raison qu'il est efficace. Comme s'il était normal d'arrêter dans la douleur (ne serait-ce pas des relents judéo-chrétiens?). C'est le fameux "quit or die" que l'on a rabâché aux fumeurs depuis plusieurs décennies.

Si j'attaque l'OMS et la communauté de contrôle du tabac, c'est tout simplement parce qu'elle a oublié le fumeur, oublié de lui venir en aide. Elle n'a plus comme leitmotiv que la destruction de l'industrie du tabac, même pas du tabagisme, non, juste l'industrie du tabac, afin de lui faire payer ses crimes. Elle est ainsi coupable d'avoir interdit en Europe la vente du produit du tabac le moins dangereux qui soit, le snus suédois, qui aurait pu sauver des millions de vies, tout comme il l'a fait dans les Pays scandinaves.

Vous attaquez aussi la SRNT, dont je suis un simple membre, sous prétexte que l'industrie pharmaceutique la subventionne à hauteur de 10%. Et vous vous en plaignez? Les 90% restants proviennent de fonds publics. Vous connaissez beaucoup de sociétés savantes qui peuvent se passer totalement du soutien de l'industrie pharmaceutique, ne serait-ce que pour fiancer leurs conférences? La SRNT à ce propos me paraît plutôt exemplaire.

Je suis consultant pour l'industrie pharmaceutique et le secteur public sur le domaine de la dépendance au tabac, c'est mon métier, j'en vis. Cet état de fait est connu de tous, je le fais en toute transparence. Et contrairement à ce que vous dites, cela ne devrait en rien affecter ma prise de position sur la e-cigarette (que je préfère appeler vaporisateur personnel pour l'éloigner encore plus du tabac), bien au contraire, puisque je refuse qu'on l'assimile à un médicament, ce qu'elle n'est pas, pas plus qu'elle n'est un produit du tabac.

Je pense que si vous aviez pris la peine de m'appeler avant de rédiger votre article, puisque vous m'avez cité sans me le demander, cela vous aurait évité de contribuer à la mauvaise image que la presse a tendance à entretenir par ces polémiques stériles.

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Publié le 24 Mars 2014

Mise à jour 25 mars, notre lettre publiée dans la Gazette de Montréal

http://www.montrealgazette.com/health/time+authorize+sale+electronic+cigarettes/9655937/story.html

March 19, 2014

The Honourable Rona Ambrose

Minister of Health, House of Commons, Ottawa, Ontario, K1A 0A6

Re: Open letter to the Minister of Health on electronic cigarettes

Dear Minister Ambrose,

We as doctors, professors and health advocates strongly urge you to authorize the sale of electronic cigarettes with nicotine on the Canadian market. These devices, which basically heat a propylene glycol or glycerin solution containing nicotine, offer a safer and more acceptable alternative for smokers to appease their addiction compared to regular cigarettes.

No doubt, tremendous strides have been made over the years to impose a strict regulatory framework on regular cigarettes. More obviously can be done. Unfortunately, it is wishful thinking that one day we will completely eradicate nicotine use. The vast majority of smokers want to quit. Unfortunately, only 10% of them, when surveyed, are still abstinent after trying to quit in the past year.

In such a context, we believe that the time has come for tobacco control to move beyond the usual approaches of education, total nicotine cessation and prevention. In a landmark report published in 2007, the Royal College of Physicians makes a compelling case why harm reduction should no longer be ignored by health authorities to lower the death and disease caused by tobacco use:

  • “Current conventional preventive measures focus entirely on preventing uptake of smoking and helping smokers to quit smoking.
  • This approach will be ineffective for the millions of smokers who, despite best efforts to persuade and help them to quit, will carry on smoking….
  • Tobacco control policy needs to be radically extended to address the needs of these smokers with implementation of effective harm reduction strategies.
  • Harm reduction in smoking can be achieved by providing smokers with safer sources of nicotine that are acceptable and effective cigarette substitutes.
  • There is a moral and ethical duty to provide these products to addicted smokers.”

Electronic cigarettes are such a substitute. First, they cannot even remotely be as toxic as regular cigarettes because there is simply no combustion of tobacco which produces the smoke containing for example the carbon monoxide and the bronchopulmonary irritants which are part of the 7000 chemical substances responsible for causing cardiovascular diseases, chronic obstructive lung diseases and at least 10 different cancers.

Although some toxic chemicals are detected in the vapor generated by electronic cigarettes, their concentrations are just a minimal fraction of what is in tobacco smoke. As with other health interventions, this is not about the absence of risk or a standard of absolute safety, but one of maximum practical reduction in risks and the replacement of products with safer alternatives.

Second, sales data show that these products are widely accepted by smokers. In fact, there has never been a product that has generated so much enthusiasm on their part. Such interest is not surprising since electronic cigarettes deliver nicotine much quicker than existing nicotine replacement therapies and provide a similar behavioral experience as smoking.

Opponents view the fact that electronic cigarettes are well accepted by consumers as a threat because they fear they will be a gateway to regular smoking. Such a claim has yet to be confirmed since current tobacco consumption trends are still dropping in countries such as France, the UK and the US where electronic cigarettes containing nicotine are sold legally. This is not to say that there are no risks of unintended consequences, but as with other health policy interventions there is a strong preponderance of evidence in favour of the intervention. The death rates from continued smoking are simply too high to accept a continued nicotine-abstinence policy orientation.

Electronic cigarettes need to be appropriately regulated so that good manufacturing practices are followed to protect consumers and that sales to minors are forbidden. However, any excessive regulations which could make it too difficult to communicate about the reduced risks of these products or to access them should be avoided. By making it possible to market electronic cigarettes with a broad range of nicotine levels to provide an effective substitute for smokers, such a decision would save countless lives and millions of dollars in health expenditures.

Sincerely,

Gaston Ostiguy, MD, MSc, CSPQ, FRCPC, Medical Director, Smoking Cessation Clinic, Montreal Chest Institute, Associate Professor, McGill University Health Centre

André Castonguay, PhD, Chimiste et toxicologiste du tabac, Professeur retraité, Université Laval

Jean-François Etter, PhD, Professeur associé, Institut de santé globale, Faculté de médecine, Université de Genève, Suisse

Linda L. Huehn, MD, FRCPC, Assistant Professor of Medicine, University of Ottawa,

Martin Juneau, MPs, MD, FRCP, Cardiologue, Directeur, Direction de la Prévention, Institut de Cardiologie de Montréal, Professeur Agrégé de Clinique, Faculté de Médecine, Université de Montréal

Jacques Le Houezec, PhD, Conseil en Santé publique, Dépendance tabagique, Honorary Lecturer, UK Centre for Tobacco Control Studies, University of Nottingham, England

Paul Poirier, MD, PhD, FRCPC, FACC, FAHA, Professeur titulaire, Faculté de pharmacie, Université Laval, Institut universitaire de cardiologie et de pneumologie de Québec

Riccardo Polosa, MD, PhD, Full Professor of Internal Medicine, University of Catania, Italy

Philippe Presles, MD, MBA, Tabacologue et éthicien, Économiste de la santé, Directeur de l'Institut Moncey, France

Martine Robert, MSc, Infirmière spécialisée en traitement du tabagisme, Institut de cardiologie de Montréal

David Sweanor, JD, Adjunct Professor, Faculty of Law, University of Ottawa

Fernand Turcotte, MD, MPH, FRCPC, Professeur retraité, Université Laval

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