The Dangerous Flavors of E-Cigarettes
Mené au Royaume-Uni sur 886 fumeurs, cet essai randomisé compare l'efficacité, du point de vue de l'abstinence tabagique à 1 an, de la cigarette électronique et d'un traitement de substitution nicotinique laissé au choix des participants, en complément de conseils ou de soutien comportementaux
Nicotine is amazingly addictive. About 20 years ago, researchers in a nearby laboratory were studying the effects of cigarette smoke on lung function in mice. To expose a mouse to cigarette smoke, the mouse is placed in a plastic tube, head out. The tube is positioned in a stream of smoke, which the mouse then breathes. On the day of the first exposure, it is difficult to get the mouse to enter the tube. But on the second exposure, most mice run right into the tube. In contrast, mice not exposed to tobacco smoke on the first day continue to resist entering the tube on the second day. Exposed mice are eager to get another hit of nicotine. Electronic cigarettes are nicotine delivery devices for humans. Since smoking is not a natural behavior, like eating or drinking, the manufacturers of these devices commonly add flavoring to the liquid from which the nicotine aerosol is generated, to make the initial exposures more pleasurable. The flavoring enhances the appeal to first-time users — especially teenagers. Flavored e-cigarettes have been successful in the marketplace; the rates of vaping among teenagers are increasing at an alarming rate.1,2 We fear that the creation of a generation of nicotine-addicted teenagers will lead to a resurgence in the use of combustible tobacco in the decades to come. Even if these adolescents do not switch to regular cigarettes, creation of a large cohort of nicotine-addicted adults has consequences beyond the adverse physiological effects of nicotine.3-8 Since nicotine is a gateway drug that lowers the threshold for addiction to other agents, the use of e-cigarettes could help spawn even more opioid addiction.9 We also have no long-term data on the effects of decades of vaping on health. We do know that nicotine is as addictive as heroin, so once hooked, most young e-cigarette users will become long-term users. Scott Gottlieb, the commissioner of the Food and Drug Administration (FDA), has been admirably outspoken on this issue and has taken strong action. The FDA will soon be banning the sale of flavored products other than mint, menthol, and tobacco at most convenience stores and gas stations and will be halting online sales until websites have heightened age-verification standards. Last fall, Gottlieb had a showdown with the makers of e-cigarettes in which he threatened to pull their products entirely if the companies did not stop marketing them in ways that increase their appeal to adolescents. Although the makers of the products agreed to do so, recent events call into question the veracity of Big Tobacco in this arena. Altria, a large producer of conventional cigarettes with nearly a quarter of a million retail outlets across the United States, has entered into an agreement to acquire just over one-third of Juul, the maker of a popular brand of e-cigarettes preferred by adolescents. If this acquisition comes to pass, it could open up shelf space and potentially put Juul products within the easy reach of many more people in the United States. The cigarette company may well see e-cigarettes as addictive bait that will lead young people toward smoking. (...)