Articles avec #reduction du risque tag

Publié le 29 Mai 2014

Dr Margaret Chan
Directrice Générale
Organisation Mondiale de la Santé

Avenue Appia 20
CH-1211 Genève 27

 

CC : Secrétariat de la CCLAT, Parties de la CCLAT, Bureaux régionaux de l'OMS

 

26 mai 2014

 

Réduire le nombre de décès et de maladies dus au tabagisme – La réduction du risque tabagique et la Convention cadre pour la lutte antitabac (CCLAT)

 

Chère Dr Chan,

Nous vous écrivons avant le début des importantes négociations sur les politiques de contrôle du tabac qui auront lieu plus tard cette année, lors de la sixième Conférence des Parties (CdP) de la CCLAT. Le travail de l'OMS et la CCLAT restent cruciaux dans la réduction du nombre intolérable de cancers, de maladies cardiovasculaires et de maladies respiratoires, causés par l'usage du tabac. Comme l'OMS l'a déclaré, le tabac causera au 21ème siècle jusqu'à un milliard de décès prématurés et évitables. Un tel nombre de décès, de maladies et les souffrances qui les accompagnent, exigent que nous recherchions sans relâche toutes les manières pratiques, éthiques et légales possibles pour réduire ce fardeau.

Nous constatons avec inquiétude qu'une stratégie critique semble avoir été négligée ou même délibérément marginalisée dans les préparatifs de la CdP-6 de la CCLAT. Il s'agit de la stratégie de «réduction du risque tabagique» - l'idée que les 1,3 milliard de personnes qui fument actuellement pourraient faire beaucoup moins de mal à leur santé s'ils consommaient de la nicotine sous une forme à faible risque, non-combustible.

Nous savons depuis des années que les gens «fument pour la nicotine, mais meurent de la fumée» : la grande majorité des décès et des maladies attribuables au tabac proviennent de l'inhalation de particules de goudron et de gaz toxiques dans les poumons. Nous observons un rapide développement de produits à base de nicotine qui peuvent effectivement se substituer aux cigarettes, mais présentant des risques très faibles. Ce sont, par exemple, les e-cigarettes et d'autres produits vaporisés, du tabac non fumé à faible contenu en nitrosamines, comme le snus, et d'autres produits non combustibles à faible risque à base de nicotine ou de tabac, qui peuvent devenir des alternatives viables au tabagisme dans l'avenir. Pris ensemble, ces produits de réduction du risque pourraient jouer un rôle important pour atteindre les objectifs de 2025 de l'ONU concernant les maladies non transmissibles (MNT), en faisant baisser la prévalence tabagique et la consommation de cigarettes. En effet, il est difficile d'imaginer des réductions importantes des maladies non transmissibles liées au tabac sans la contribution de la stratégie de réduction du risque tabagique. Même si la plupart d'entre nous préfèreraient que les gens arrêtent de fumer et d'utiliser de la nicotine, l'expérience montre que de nombreux fumeurs ne peuvent pas ou ne veulent pas renoncer à la nicotine et continueront à fumer s'il n'y a pas d'alternative plus sûre disponible qui soit acceptable pour eux.

 

Nous suggérons respectueusement que les principes suivants devraient sous-tendre l'approche de santé publique de la réduction du risque tabagique, sous l'impulsion de l'OMS:

 

  1. La réduction du risque tabagique fait partie de la solution et non du problème. Elle pourrait apporter une contribution significative à la réduction du fardeau mondial que représentent les maladies non transmissibles causées par le tabagisme, et le faire beaucoup plus rapidement que les stratégies classiques. Si les instances régulatrices traitent les produits à base de nicotine à faible risque de la même manière que les produits du tabac traditionnels, et cherchent à réduire leur utilisation sans reconnaissance de leur potentiel en tant qu'alternative à faible risque au tabagisme, elles les définissent incorrectement comme une partie du problème.

  2. Les politiques de réduction du risque tabagique doivent être proportionnelles au risque et fondées sur les preuves, et tenir compte de la réduction importante de risque qui est obtenue lorsqu'un fumeur passe à un produit à base de nicotine à faible risque. La règlementation doit être proportionnée et équilibrée pour exploiter les bénéfices considérables pour la santé, tout en gérant les risques résiduels. L'architecture de la CCLAT n'est actuellement pas bien adaptée à cet effet.

  3. Par mesure de précaution, les instances régulatrices devraient éviter de soutenir les mesures qui pourraient avoir l'effet pervers de prolonger la consommation de cigarettes. Les politiques qui sont excessivement restrictives ou contraignantes pour les produits à faible risque peuvent avoir pour conséquence involontaire de protéger les cigarettes de la concurrence des alternatives moins dangereuses, et par là même de causer des dommages. Toute politique relative aux produits à faible risque, c’est-à-dire les produits non combustibles à base de nicotine, doit être évaluée pour ce potentiel effet pervers.

  4. Les objectifs et les indicateurs de réduction de la consommation de tabac devraient être ciblés afin d'atteindre le but ultime de réduire les maladies et les morts prématurées, sans se focaliser sur l'utilisation de la nicotine en soi, et donc se concentrer principalement sur la réduction du tabagisme. Lors de la conception des objectifs du cadre des Maladies Non Transmissibles (MNT) ou sur les Objectifs de Développement Durable, il serait contre-productif et potentiellement dangereux d'inclure les produits à base de nicotine à faible risque, telles que les e-cigarettes, au sein de ces objectifs. Au contraire, ces produits devraient avoir un rôle important dans la réalisation de ces objectifs.

  5. La réduction du risque tabagique est fortement compatible avec les bonnes politiques et pratiques de santé publique, et il serait contraire à l'éthique et nuisible d'empêcher les fumeurs de passer à des produits de réduction du risque. Comme la Charte d'Ottawa de l'OMS l’affirme: «la promotion de la santé est le processus qui permet aux personnes de mieux contrôler et d’améliorer leur santé". La réduction du risque tabagique permet aux fumeurs de contrôler les risques associés à la prise de nicotine et de la réduire à des niveaux très faibles ou négligeables.

  6. Il est contre-productif d'interdire la publicité pour les e-cigarettes et pour les autres alternatives au tabagisme à faible risque. Le cas de l'interdiction de la publicité du tabac repose sur les méfaits que le tabac provoque, mais aucun argument de ce type ne peut s'appliquer, par exemple aux e-cigarettes, qui sont beaucoup plus susceptibles de réduire les dommages par la réduction du tabagisme. Le contrôle de la publicité visant les non-fumeurs, et en particulier les jeunes est certainement justifiée, mais une interdiction totale aurait de nombreux effets négatifs, y compris la protection du marché de la cigarette et le soutien implicite pour les compagnies de tabac. Il est possible de cibler la publicité vers les fumeurs, pour qui les avantages sont potentiellement énormes et les risques minimes. Il est inapproprié d'appliquer l'article 13 de la CCLAT (publicité sur le tabac, promotion et parrainage) à ces produits.

  7. Il est inapproprié d'appliquer aux produits vaporisés la législation visant à protéger les personnes ou les travailleurs contre la fumée de tabac. Il n'existe aucune preuve à l'heure actuelle de risque significatif pour la santé de la vapeur émise par les e-cigarettes. Les décisions quant à savoir s'il est permis ou interdit d'utiliser une e-cigarette dans un espace particulier devraient incomber aux propriétaires ou exploitants de ces espaces publics, qui peuvent prendre un large éventail de facteurs en compte. L'article 8 de la CCLAT (Protection contre l'exposition à la fumée de tabac) ne doit pas être appliqué à ces produits.

  8. Le régime fiscal pour les produits à base de nicotine doit tenir compte du risque, et être organisé pour inciter les utilisateurs à basculer du tabagisme vers les produits à faible risque. Une taxation excessive des produits à faible risque par rapport au tabac fumé dissuaderait les fumeurs de les essayer et causerait plus de tabagisme et de mal qu'une taxation raisonnable.

  9. L'OMS et les gouvernements nationaux devraient adopter une vision objective des arguments scientifiques, et ne pas accepter ou promouvoir les interprétations erronées des données diffusées par les média ou certains activistes. Par exemple, on a fait grand cas de «l’effet de passerelle», dans lequel l'utilisation de produits à faible risque pourrait, dit-on, amener à utiliser des produits fumés à haut risque. Nous ne sommes au courant d'aucune preuve crédible qui soutiendrait cette hypothèse. En effet, des arguments similaires ont été faits sur l'utilisation de tabac sans fumée en Scandinavie, mais la preuve est désormais faite que ce type de produit a apporté une contribution significative à la réduction de la prévalence tabagique et des maladies liées au tabac, en particulier chez les hommes.

  10. L'OMS et les Parties de la Convention cadre doivent se baser sur des évaluations scientifiques et politiques objectives, dans une perspective internationale. Le Groupe d'étude de l'OMS sur la réglementation des produits du tabac (TobReg) a produit une série de rapports d'experts de haute qualité entre 2005 et 2010. Ce comité devrait être composé d'experts de renommée mondiale et chargé de fournir d'autres conseils indépendants de haute qualité à l'OMS et aux Parties, sur les questions soulevées ci-dessus.

 

 

Le potentiel de ces produits de réduire le risque tabagique, afin de réduire le fardeau des maladies dues au tabagisme, est très grand, et ces produits pourraient être parmi les innovations les plus importantes du 21ème siècle en matière de santé– pouvant peut-être sauver des centaines de millions de vies. L'envie de les contrôler et de les supprimer, en tant que produits du tabac, devrait être réfrénée, et une réglementation adaptée à leur usage et conçue pour libérer leur potentiel devrait être défendue par l'OMS. Nous sommes profondément préoccupés par le fait que la classification de ces produits en tant que produits du tabac, et leur inclusion dans la Convention cadre, puisse faire plus de mal que de bien, et entraver les efforts visant à atteindre les objectifs de réduction des maladies non transmissibles, pour lesquels nous sommes tous engagés. Nous espérons que, sous votre direction, l'OMS et la CCLAT seront à l'avant-garde scientifique, qu'ils adopteront une politique contre le tabac efficace et éthique, incluant la réduction du risque tabagique.


Nous vous serions reconnaissants de bien vouloir nous adresser votre réaction à ces propositions.
 

Cordialement,

 

 

Signataires de cette déclaration au 26 mai 2014

Professor David Abrams
Professor of Health Behavior and Society.
The Johns Hopkins Bloomberg School of
Public Health. Maryland. USA.
Professor of Oncology (adjunct).
Georgetown University Medical Center,
Lombardi Comprehensive Cancer Center.
Washington DC.
United States of America

Professor Tony Axéll
Emeritus Professor Geriatric Dentistry
Consultant in Oral Medicine
Sweden

Professor Pierre Bartsch
Respiratory physician,
Faculty of Medicine
University of Liège
Belgium

Professor Linda Bauld
Professor of Health Policy
Director of the Institute for Social Marketing
Deputy Director, UK Centre for Tobacco
and Alcohol Studies
University of Stirling
United Kingdom

Professor Ron Borland
Nigel Gray Distinguished Fellow in Cancer
Prevention at Cancer Council Victoria
Professorial Fellow School of Population
Health and Department of Information
Systems
University of Melbourne,
Australia

Professor John Britton
Professor of Epidemiology;
Director, UK Centre for Tobacco & Alcohol
Studies,
Faculty of Medicine & Health Sciences
University of Nottingham,
United Kingdom

Associate Professor Chris Bullen
Director, National Institute for Health
Innovation
School of Population Health,
University of Auckland,
New Zealand

Professor Emeritus André Castonguay
Faculty of Pharmacy
Université Laval,
Quebec,
Canada.

Dr Lynne Dawkins
Senior Lecturer in Psychology,
Co-ordinator: Drugs and Addictive
Behaviours Research Group
School of Psychology,
University of East London,
United Kingdom

Professor Ernest Drucker
Professor Emeritus
Department of Family and Social Medicine,
Montefiore Medical Center/Albert Einstein
College of Medicine
Mailman School of Public Health
Columbia University
United States of America

Professor Jean François Etter
Associate Professor
Institut de santé globale,
Faculté de médecine,
Université de Genève,
Switzerland

Dr Karl Fagerström
President, Fagerström Consulting AB,
Vaxholm,
Sweden

Dr Konstantinos Farsalinos
Researcher, Onassis Cardiac Surgery
Center, Athens, Greece
Researcher, University Hospital
Gathuisberg, Leuven,
Belgium

Professor Antoine Flahault
Directeur de l'Institut de Santé Globale
Faculté de Médecine, Université de
Genève, Suisse/ Institute of Global Health,
University of Geneva, Switzerland
Professor of Public Health at the Faculté
de Médecine, Université Paris Descartes,
Sorbonne Paris Cité,
France

Dr Coral Gartner
Senior Research Fellow
University of Queensland Centre for
Clinical Research
The University of Queensland,
Australia

Dr Guillermo González
Psychiatrist
Comisión de Rehabilitación en Enfermedad
Mental Grave
Clínica San Miguel
Madrid,
Spain

Dr Nigel Gray
Member of Special Advisory Committee on
Tobacco Regulation of the World Health
Organization
Honorary Senior Associate
Cancer Council Victoria
Australia

Professor Peter Hajek
Professor of Clinical Psychology and
Director, Health and Lifestyle Research
Unit
UK Centre for Tobacco and Alcohol
Studies
Wolfson Institute of Preventive Medicine,
Barts and The London School of Medicine
and Dentistry Queen Mary University of
London,
United Kingdom

Professor Wayne Hall
Director and Inaugural Chair, Centre for
Youth Substance Abuse Research
University of Queensland
Australia

Professor John Hughes
Professor of Psychology, Psychiatry and
Family Practice
University of Vermont
United States of America

Professor Martin Jarvis
Emeritus Professor of Health Psychology
Department of Epidemiology & Public
Health
University College London,
United Kingdom

Professor Didier Jayle
Professeur d’addictologie
Conservatoire National des Arts et Métiers
Paris,
France

Dr Martin Juneau
Directeur, Direction de la Prévention
Institut de Cardiologie de Montréal
Professeur Titulaire de Clinique
Faculté de Médecine,
Université de Montréal,
Canada

Dr Michel Kazatchkine
Member of the Global Commission on Drug
Policy
Senior fellow, Global Health Program,
Graduate institute, Geneva,
Switzerland

Professor Demetrios Kouretas
School of Health Sciences and Vice Rector
University of Thessaly,
Greece

Professor Lynn Kozlowski
Dean, School of Public Health and Health
Professions,
Professor of Community Health and Health
Behavior,
University at Buffalo,
State University of New York,
United States of America

Professor Eva Králíková
Institute of Hygiene and Epidemiology
Centre for Tobacco-Dependence
First Faculty of Medicine
Charles University in Prague and General
University Hospital in Prague,
Czech Republic

Professor Michael Kunze
Head of the Institute for Social Medicine
Medical University of Vienna,
Austria

Dr Murray Laugesen
Director
Health New Zealand, Lyttelton,
Christchurch,
New Zealand

Dr Jacques Le Houezec
Consultant in Public Health, Tobacco
dependence,
Rennes,
France
Honorary Lecturer, UK Centre for Tobacco
Control Studies,
University of Nottingham,
United Kingdom

Dr Kgosi Letlape
President of the Africa Medical Association
Former President of the World Medical
Association
Former Chairman of Council of the South
African Medical Association
South Africa

Dr Karl Erik Lund
Research director
Norwegian Institute for Alcohol and Drug
Research,
Oslo,
Norway

Dr Gérard Mathern
Président de l'Institut Rhône-Alpes de
Tabacologie
Saint-Chamond,
France

Professor Richard Mattick
NHMRC Principal Research Fellow
Immediate Past Director NDARC (2001-
2009)
National Drug and Alcohol Research
Centre (NDARC)
Faculty of Medicine
The University of New South Wales,
Australia

Professor Ann McNeill
Professor of Tobacco Addiction
Deputy Director, UK Centre for Tobacco
and Alcohol Studies
National Addiction Centre
Institute of Psychiatry
King's College London,
United Kingdom

Dr Hayden McRobbie
Reader in Public Health Interventions,
Wolfson Institute of Preventive Medicine,
Queen Mary University of London,
United Kingdom

Dr Anders Milton
Former President of the Swedish Red Cross
Former President and Secretary of the
Swedish Medical Association
Former Chairman of the World Medical
Association
Owner & Principal Milton Consulting,
Sweden

Professor Marcus Munafò
Professor of Biological Psychology
MRC Integrative Epidemiology Unit at the
University of Bristol
UK Centre for Tobacco and Alcohol Studies
School of Experimental Psychology
University of Bristol,
United Kingdom

Professor David Nutt
Chair of the Independent Scientific
Committee on Drugs (UK)
Edmund J Safra Professor of
Neuropsychopharmacology
Head of the Department of
Neuropsychopharmacology and Molecular
Imaging
Imperial College London,
United Kingdom

Dr Gaston Ostiguy
Professeur agrégé
Directeur de la Clinique de cessation
tabagique
Centre universitaire de santé McGill
(CUSM)
Institut thoracique de Montréal,
Canada

Professor Riccardo Polosa
Director of the Institute for Internal
Medicine and Clinical Immunology,
University of Catania,
Italy.

Dr Lars Ramström
Director
Institute for Tobacco Studies
Täby,
Sweden

Dr Martin Raw
Special Lecturer
UK Centre for Tobacco and Alcohol
Studies
Division of Epidemiology and Public Health
University of Nottingham,
United Kingdom

Professor Andrzej Sobczak
Department of General and Inorganic
Chemistry,
Faculty of Pharmacy and Laboratory
Medicine,
Medical University of Silesia, Katowice,
Poland
Institute of Occupational Medicine and
Environmental Health
Sosnowiec,
Poland

Professor Gerry Stimson
Emeritus Professor, Imperial College
London;
Visiting Professor, London School of
Hygiene and Tropical Medicine
United Kingdom

Professor Tim Stockwell
Director, Centre for Addictions Research of BC
Professor, Department of Psychology
University of Victoria, British Columbia,
Canada

Professor David Sweanor
Adjunct Professor, Faculty of Law,
University of Ottawa
Special Lecturer, Division of Epidemiology
and Public Health,
University of Nottingham,
United Kingdom

Professor Umberto Tirelli
Director Department of Medical Oncology
National Cancer Institute of Aviano
Italy

Professor Umberto Veronesi
Scientific Director
IEO Istituto Europeo di Oncologia
Former Minister of Health,
Italy

Professor Kenneth Warner
Avedis Donabedian Distinguished
University Professor of Public Health
Professor, Health Management & Policy
School of Public Health
University of Michigan
United States of America

Professor Robert West
Professor of Health Psychology and
Director of Tobacco Studies
Health Behaviour Research Centre,
Department of Epidemiology & Public
Health,
University College London
United Kingdom

Professor Dan Xiao
Director of Department Epidemiology
WHO Collaborating Center for Tobacco or
Health
Beijing Institute of Respiratory Medicine,
Beijing Chao-Yang Hospital,
China

Dr Derek Yach
Former Executive Director, Non-
Communicable Diseases
Former Head of Tobacco Free Initiative,
World Health Organisation (1995-2004)
Senior Vice President Vitality Group plc
Director, Vitality Institute for Health
Promotion
United States of America

 

 

 

 

 

 

 

 


 

Voir les commentaires

Publié le 28 Mai 2014

Mise à jour de la position de ASH (Londres) sur l'ecig.

http://www.ash.org.uk/files/documents/ASH_715.pdf

1. Les cigarettes électroniques ne sont pas des cigarettes. Elles ne contiennent pas de tabac et leur utilisation n'est pas fumer.

2. ASH, en ligne avec les recommandations de NICE sur la réduction du risque, indique qu'il est toujours mieux de cesser toutes les formes d'utilisation de la nicotine.

3. Cependant, pour ceux qui restent dépendants à la nicotine, NICE recommande l'utilisation de produits contenant de la nicotine comme alternative à la cigarette ou pour réduire sa consommation, ou en cas d'abstinence temporaire, pour aider à réduire les méfaits du tabagisme.

4. NICE ne peut pas recommander l'utilisation de la nicotine par des produits non médicamenteux, mais de nombreux fumeurs trouvent que les cigarettes électroniques peuvent les aider. Les enquêtes de ASH montrent que leur utilisation a triplé au cours des deux dernières années, passant de 700.000 à 2,1 millions d'utilisateurs.

5. Les cigarettes électroniques se révèlent plus attrayantes pour les fumeurs que les substituts nicotiniques, tout en leur offrant une alternative plus sûre par rapport à la cigarette. Des preuves existent qu'elles peuvent être efficaces pour aider les fumeurs à arrêter, et peu de preuves qu'elles sont utilisées par des personnes n'ayant jamais fumé.

6. Le nombre d'enfants et de jeunes qui utilisent régulièrement des cigarettes électroniques reste très faible et leur utilisation est presque entièrement due aux fumeurs et aux ex-fumeurs. C'est aussi ce que l'on observe dans d'autres pays comme les Etats-Unis.

7. ASH est en faveur d'une réglementation renforcée pour assurer la sécurité et la fiabilité des cigarettes électroniques et empêcher leur promotion aux non-fumeurs et aux enfants.
8. Toutefois, en l'absence de preuve de préjudice important pour les personnes à proximité, ASH ne soutient pas l'idée d'inclure les cigarettes électroniques dans les lois d'interdiction de fumer, qui interdirait complètement leur utilisation dans les lieux publics.

Nos associations de lutte antitabac et autres Haut conseil de la santé publique pourraient s'en inspirer... c'est un peu plus basé sur les preuves !

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Publié le 27 Mai 2014

Journée Mondiale contre le tabac : une conférence de presse bâclée.

Sur le site de l'AIDUCE :

À l’approche de la Journée Mondiale contre le tabac le 31 mai, l’Alliance contre le tabac a organisé hier une conférence de presse à l’Assemblée nationale, à laquelle l’AIDUCE a assisté. Une partie des propositions concernait un durcissement des contrôles anti-tabac, notamment l’interdiction de fumer devant des enfants, que ce soit sur les terrasses des cafés, en voiture, dans les parcs ou sur les plages et une autre consistait en une attaque en règle contre le vaporisateur personnel (VP), couramment appelé cigarette électronique.... Lire la suite

____________

 

L'aveuglement, ou la volonté aveugle de vouloir à tout prix éliminer le vaporisateur de nicotine, dont les fumeurs se sont emparés pour arrêter de fumer et réduire leur risque tabagique, conduit les associations de lutte contre le tabac dans le mur. Nous saurons leur rappeler le moment venu, qu'ils ont œuvré à favoriser le tabac et son industrie, qu'ils se targuent de vouloir contrôler!

Les données scientifiques s'accumulent, et ils ne pourront plus bientôt, au même titre que l'OMS, assimiler le vaporisateur de nicotine aux produits du tabac, et renvoyer les fumeurs au tabac, sans qu'un jour ils n'aient à rendre compte de leurs actes.

A l'occasion de la journée sans tabac, de nombreuses voix se feront entendre. Que nous réservent les autorités, si elles se fient à ces associations qui veulent étouffer dans l'oeuf le vaporisateur de nicotine? Elles ne passeront pas seulement à côté de ce qui est clairement une des plus grandes innovations de la santé publique des trois dernières décennies, pouvant sauver des millions de vies, mais elle dérogeront à la charte de l'OMS qui propose de permettre aux consommateurs de prendre le contrôle de leur propre santé, ce qu'ils font déjà eux-mêmes par millions grâce à leur vaporisateur.

 

Nous saurons les mettre devant leurs responsabilités le moment venu.

 

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Publié le 21 Mai 2014

Tout d'abord, je dois vous assurer que je suis profondément européen. Je crois en l'Europe, mais pas celle qui nous est donnée actuellement.

Je crois en des valeurs que certains politiques partagent, et que j'ai toujours soutenus jusqu'à présent, aucun parti en particuliers, mais des valeurs de solidarité, d'égalité, de partage, de développement durable, d'écologie.

Nos représentants au Parlement européen n'écoutent plus les gens qui les ont élu. C'est facile de faire des promesses qui ne sont jamais tenues. Mais arrive un moment ou le peuple ne "marche" plus dans la combine.

Ce soir je viens d'entendre encore des promesses, plus alléchantes les unes que les autres, mais que je sais n'être que des mots vides de sens. D'où ma colère.

Bien sûr, ma supplique ici ne concerne que le tabagisme... qui s'en préoccupe vraiment?

Juste un "truc" comme ça, parmi d'autres... pourtant, en France cela représente 200 morts par jours, près de 80 000 morts par an... en Europe 700 000..., mais non, personne parmi la classe politique ne daigne s'y intéresser. Ou alors, c'est après avoir écouté d'une oreille distraite les suppliques des lobbyistes des grandes firmes qui leur expliquent que ça ne sert à rien de prendre des mesures drastiques, sauf contre les seules choses qui pourraient avoir un impact véritable sur la santé publique. Bien sûr on ne leur présente pas les choses de cette façon...on les menace de délocalisation, de perte de revenus fiscaux, de choses qui leur sont si douces à leur oreilles....

Pourtant depuis quelques temps les fumeurs ont décidé de prendre leur destin en main. C'est rien, juste une petite chose qui est arrivée en catimini, mais qui par le bouche à oreille s'est développée de façon considérable. En plus, ils ont eu l'outrecuidance de parler entre eux, de créer des forums de discussion, de se conseiller entre eux, de s'entraider, de se rebeller,et même de créer une association (AIDUCE)...

Cette petite chose c'est le vaporisateur personnel (VP) de nicotine (autrement appelé cigarette électronique, mais je n'aime pas ce mot, l'objet est tellement aux antipodes de cette "tueuse" comme ils l'appellent). Oh, le gros mot!!! Quoi? les fumeurs auraient l'incivilité de trouver un moyen de se sevrer du tabac sans qu'on le leur ait donner l'ordre? Horreur!!!

Alors, tout le monde se pointe vent debout pour mettre un peu d'ordre dans tout ça. Les gouvernements, les médecins (même si depuis certains ont pris la mesure des choses, heureusement), la presse bien sûr! Faire peur, ça fait vendre! et puis surtout la communauté du contrôle du tabac, toutes ces associations bien pensantes, qui veulent tellement de bien à leur concitoyens. La dépendance à la nicotine, quelle horreur! La dépendance c'est mal, même si ça ne fait de mal à personne, c'est juste que ça dérange la morale des bien pensant.

On nous refait le coup du snus, ce produit du tabac le moins dangereux qui soit, et que l'Europe s'est empressée de bannir en 1992, de peur (tiens c'est bizarre, ce sont les même arguments qu'on entend maintenant!) que ça rende les jeunes dépendants. Résultat des courses, quelques centaine de milliers de morts, voire plus, qui auraient pu être évitées. Pourtant, nous avons une expérience naturelle, en Suède et en Norvège, qui montre que ce produit aurait pu sauver la vie de tant de fumeurs. Mais non, on a préféré interdire de vente ce produit.

Et vous voulez nous resservir les mêmes arguments pour le VP? Ah oui, mais là, les vapoteurs ne sont pas d'accord. Ils ne se laisseront pas faire (ICE de l'EFVI). Vous l'avez bien vu en octobre au Parlement européen. Ils vous l'ont fait savoir. Ce qui a permis au moins, dans un premier temps, d'éviter la classification du VP en tant que médicament. Mais qu'à cela ne tienne, les lobbies ont tôt fait de rectifier le tir. Puisque les députés européens ont dit non, on va passer par la Commission, tellement plus malléable. Et derrière des portes fermées, cette institution, non élue, s'est empressé de remettre les choses dans le droit chemin. Elle a obtenu ce qu'elle voulait. Classifier la e-cigarette, ni tout à fait comme un produit du tabac, ni tout à fait comme un médicament, mais certainement pas ce qu'elle est, un produit de consommation courante qui permet aux fumeurs de prendre leur santé en main, sans que cela ne coûte un cent aux gouvernements!

C'est la même chose partout, le MHRA anglais tiens absolument à en faire un médicament, la FDA, un produit du tabac, et l'OMS ne veut même pas en entendre parler, il faut tout simplement l'interdire, car pour elle c'est la même chose que le tabac!

Vous n'avez même pas écouté les scientifiques qui vous ont dit, grâce à leurs études, que ce produit innovant et déstabilisant pour la cigarette, pouvait être un bénéfice révolutionnaire pour la santé publique. Ou plutôt, vous avez repris leurs études en les déformant, en interprétant leurs données de façon erronée, pour justifier vos buts préconçus, totalement moralistes, sans qu'ils ne soient basés sur les preuves.

Pourtant depuis, les études montrent que ces scientifiques avaient raison, les ventes de tabac reculent, les fumeurs arrêtent de fumer avec le VP, les jeunes arrêtent aussi de fumer...

Ce qui va résulter de ces élections risque d'être catastrophique pour la démocratie. L'exemple du VP n'est que la pointe de l'iceberg que je mets en avant ici, mais réfléchissez bien, c'est la même chose pour tous les domaines. Vous avez perdu le lien avec vos concitoyens. Votre seul but c'est d'être élu, et ré-élu, pas de défendre vos concitoyens. Il ne faudra pas venir vous plaindre après ces élections.

Mais, c'est décidé, je n'irai pas voter dimanche, même si cela me coûte.

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Publié le 14 Mai 2014

Mise à jour: 31/05/14
Mon message sur le blog de Mme Touraine a été validé.

Notre Ministre de la santé répond à Nicolas Bedos, daignera-t-elle répondre à mon message? (pas à ce jour en tout cas)

http://www.marisoltouraine.fr/2014/05/lettre-a-nicolas-bedos/

J'en doute. Je le reproduis donc ici.

Madame la Ministre,
Je vous ai déjà écrit plusieurs fois, sans réponse… http://jlhamzer.over-blog.com/d%C3%A9saccord-avec-les-propos-de-la-ministre-de-la-sant%C3%A9-concernant-la-e-cigarette
Les ventes de cigarettes reculent comme jamais (http://jlhamzer.over-blog.com/2014/05/les-ventes-de-cigarettes-reculent-encore-de-7-9-en-mars.html), est-ce un hasard? NON !
Les arguments que vous avancez pour limiter l’utilisation du vaporisateur personnel de nicotine (VPN), comme je préfère l’appeler, ne sont validés par aucune étude scientifique. Tout comme la réglementation proposée par l’Europe (http://jlhamzer.over-blog.com/2014/01/d%C3%A9claration-scientifique-sur-la-directive-tabac-europ%C3%A9enne.html). La France pourrait devenir, grâce à la situation particulière que nous avons jusqu’à présent, un laboratoire expérimental de l’utilisation du VPN. Réfléchissez, vous pourriez devenir la Ministre qui a eu la vision de l’avenir, celle qui aura eu le courage politique de résister à l’appel de Big Tobacco, et qui démontrera que le VPN peut sauver des vies. Vous le savez très bien, 73000 morts par an, 200 par jour (et encore, si seulement nous avions des données plus récentes!!!). Ne soyez pas sourde aux messages innombrables des vapeurs. Ecoutez-les. Travaillons ensemble à définir des normes de fabrication, qui rassureront les utilisateurs, et convaincront les fumeurs que ce produit peut leur sauver la vie. Vous ferez la plus belle action de santé publique du siècle! Regardez, écoutez, même les tabacologues ne sont pas sourds à ce point (http://jlhamzer.over-blog.com/2014/04/l-oft-publie-un-avis-d-experts-sur-le-recours-a-l-e-cigarette-dans-l-arret-du-tabac.html). Les organisations internationales comme l’OMS se trompent et sont mal conseillées, nous allons (avec un groupe d’experts du monde entier) envoyer une lettre à la Directrice de l’OMS, Margaret Chan, en espérant que cette institution, si importante et si écoutée, comprenne enfin que la réduction du risque tabagique n’est pas un vain mot. Le status quo actuel, « quit or die » est insupportable. Comment pouvez-vous vous en satisfaire?
S’il vous plaît, écoutez ce que les scientifiques ont à vous dire. Des millions de vies dépendent de vos décisions. Ce n’est pas rien. Sans vouloir être emphatique, imaginez que votre nom puisse être associé à celui de Simone Veil ou de Robert Badinter, rien de moins. Il suffit d’un peu de courage, que nous serons des millions à applaudir. Vos services de la DGS savent où me trouver, je suis à votre disposition.
Avec tout mon respect, et en espérant que vous puissiez lire ces quelques lignes.
Jacques Le Houezec
Conseiller en santé publique, dépendance tabagique.

Si seulement ces quelques lignes pouvaient changer le cours des choses....

I have a dream... !

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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 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 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 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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Publié le 10 Février 2014

Si vous avez raté cette conférence, vous pouvez écouter le podcast sur le site du CNAM.

Ma présentation est ici.

Vous pouvez aussi consulter Le n°74 de Swaps, et un résumé de ma présentation.

La cigarette électronique s’est invitée sans y être conviée dans le champ de la prévention du tabac. Sa diffusion spontanée semble avoir fait chuter les ventes de cigarettes en 2013.

La "e-cigarette" est-elle une mode ? Une approche résolument nouvelle pour les addictions ? L’industrie pharmaceutique et celle du tabac sont-elles bousculées par cet intrus ? Des spécialistes et des usagers viennent nous éclairer sur ce qui en train de devenir une question de société.

Programme

  • 15h - Accueil - Didier Jayle, professeur du Cnam
  • 15h10 - Réflexions d’un bloggeur qui connaît le risque et la santé- William Dab, professeur du Cnam en santé et sécurité
  • 15h20 - Que savons nous vraiment de la toxicité de la nicotine ? Jacques Le Houezec, consultant tabacologie
  • 15h30 - Tout ce qu’on sait en 2014 de la e-cigarette Gérard Mathern, pneumologue
  • 15h55-16h15 - Discussion
  • 16h15 - Quand la réduction des risques s’applique aux drogues licites Alain Morel, fédération Addiction
  • 16h30 - Le point de vue de l’usager Brice Lepoutre, président de l'Association des usagers de cigarette électronique (Aiduce)
  • 16h45 - Le point de vue de l’État Pascal Melihan-Cheinin, sous-directeur, direction générale de la Santé
  • 17h-17h30 - Discussion
  • 17h30 - Conclusion

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