CARNETS DESCARTES

Preventing the Golden Holocaust

(Version Française)

It was not envisageable a few years ago to ban smoking tobacco, although there were some pioneers to propose such a ban; the French Journalist Martine Perez, from Figaro, did so in her book written in French (Interdire le tabac. L'urgence ! Le plus grand scandale de santé publique", 2012, éditions Odile Jacob),but she was not followed, to my knowledge, by any politicians, and that was one year ago. Most probably, it was because politicians had the intuition that addiction to nicotine is so strong among people that any ban would have never been tolerated. Politicians have elected positions, and in a democracy, such decisions cannot be taken on the sole basis of evidence. We do have evidence since the 50s, when Sir Bradford Hill (he became Sir later on) showed that smoking was tied to lung cancer (accessible archive online).One now estimates that smoking tobacco has killed 100 million people prematurely during the 20th century, and will kill about 1 billion individuals during the 21st, if trends are continuing at the same pace as today. Cigarettes kill 650,000 European citizens each year. We know that for a while, and it is not enough to stop smoking for most of us. Results have been more or less achieved, in most of developed countries: campaigns against tobacco, substantial tax increases, smoking restriction in public areas such as bars and restaurants, or workplaces. It is clearly not enough today, although in Europe, smoking has dramatically declined almost everywhere, e.g. in the UK where more than 90% of males were smokers in the 50s they are less than 30% now. However a plateau seems to have been reached since a few years.

Today, e-cigarettes may represent a disruptive momentum in the fight against smoking tobacco. It may allow what was not envisageable, a definite and full ban of smoking tobacco, with consensus from population if smokers can switch to e-cigs. Millions of lifes are at stake. Dozen of millions of healthy life years too: lower limb arteritis, ischemic heart diseases, COPD, cancer, vascular dementias, sexual disorders in males, low birth neonates, and many more other diseases...

I am not advocating oral consomption of tobacco. Be sure I have no conflict of interest with regards with that matter. Marketing of this emerging sector will do the job. However, I do believe that it is no more acceptable, and it may be a guilty attitude to procrastinate here, or to ask longer if electronic cigarettes are good enough for health, when the comparator is such a serial killer as smoking tobacco. Swedish males use for a while oral tobacco, they name snus. Sweden has obtained in its treaty of adhesion to the European Union to mention their right to produce and market snus for their national consumption (when it is strictly forbidden in the rest of EU, as if it was an illicit drug). In addition to a vigorous public policy against smoking tobacco, Sweden reached the lowest rates of smokers in OECD, with less than 17% of male users (when as many use snus). And results are striking, since Sweden reports the lowest rate of lung cancers in males in OECD (3 times lower than average), and the lowest rate of oral cancer (5 times lower). This represents a strong argument sustaining that oral tobacco is an effective harm reduction tool. It is not difficult to be less harmful than smoking tobacco indeed, and for sure oral tobacco is far less dangerous than any form of smoking tobacco, since there is probably not any product on our legal market as dangerous as cigarettes.

Electronic cigarettes are dramatically increasing their market share today in France. That worried tobacco retailers and tobacco industry when they did not see wind coming. Electronic cigarette is even fashionable, "à la mode" today in France, with retails looking as these new coffee shops. We are just looking for a renown actor telling us "what else?". What is hard to say today is if it reduces harm of smoking tobacco by 90 or 99%. We will know that with more precision in a few months or years since studies will probably be blooming on that topic.

Who will be the first courageous minister of health to take the lead in proposing a total ban of smoking tobacco in his/her country? Or the first mayor in his/her city? Of course in association with offering substitution with oral tobacco. Addiction to nicotine is a matter of fact. As for caffeine. Should we fight against these addictions? It is not obvious. I would say rather no. Public health is not acting as a new public morale. If addiction to nicotine is not harmful, particularly when smoking tobacco becomes forbidden, then it does not remain anymore a public health issue. If, thanks to a switch to oral tobacco, new business blooms, or if old ones are remaining wealthy, public health professional should not mind, since it is no more their business. Tobacco industry is guilty when it markets smoking tobacco, that one which is the first killer ever marketed. If tobacco companies produce nicotine for substitutes, including electronic cigarettes, then it can even act for the good of public health.

What is encouraging is that even with lack of courage of our politicians on this issue, market is doing the job by itself today. But at a slower pace. E-cig users are growing exponentially. A morning, France may wake up as Sweden, if I can say that, just because a large proportion of smokers will have switched to oral tobacco consumption, for the good of their health, since, as I repeat, nothing can be worse than smoking the non fashionable existing cigarettes.

I am calling for applying here the principle of precaution, which is written in our Constitution, to save millions of lifes. Let's do it just now! Shall we wait for a three digit precision on the benefit risk ratio of oral tobacco before taking such a decision? Let's ban definitely and immediately smoking tobacco and offer parallel substitution with oral tobacco, to let people live with their nicotine addiction if they wish so as informed adults.

Commentaires

  • Frederic Dardel 14/05/2013

    Nice post Antoine. Your position is strongly supported by the enlightening essay  :

    "Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition" by Science historian Robert N. Proctor.

    This book is based on the analysis of archives of the tobacco majors that were rendered public after federal trials in the US.

    I strongly recommend reading this solidly documented study.

    Frédéric Dardel

Antoine Flahault's blog (in English)

Antoine Flahault's blog (in English)

Antoine Flahault's blog. He is Faculty member, in public health, from Descartes School of Medicine, Sorbonne Paris Cité

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