Are e-cigarettes actually less harmful to health than traditional ones? Science is divided and the debate is still open: it was discussed again in Paris, on the occasion of the International Conference on Harm Reduction in Noncommunicable Diseases. There are one billion smokers in the world today, and if a certain decline in the prevalence of smoking is expected in the coming years (from 22 to 19%), between now and 2025 the total number of smokers should remain the same, due to the increase in the world population. In Italy there are 11,6 million smokers: more than one compatriot out of five, of which 4,5 million are women, and this is precisely one of the figures that is most worrying.
Indeed, in our country smokers have increased especially in the southern regions (22,4%, against 12,1% in the Center and 14% in the North). On the other hand, in Italy ex-smokers are already about 12,1% of the population. “Quitting smoking is really important. In the last century we had 100 million tobacco-related deaths worldwide and for this century things will not get better: we will have one billion smoking-related deaths”, commented Laura Rosen of the Department of Health Promotion of Tel Aviv University (Israel). .
“Today – added the expert – we know that smoke damage is related to combustion and we have several devices available to help you quit. In fact, doing so increases life expectancy by up to 10 years. But how effective are the available devices? A meta-analysis of 61 studies showed that 4% of those who tried nicotine replacement therapies were able to quit after 14 years. There is a result, but all in all it can be improved”. In short, nicotine is the substance that causes addiction, but the damage is caused by combustion: "We need to find new technologies to administer nicotine in a safer way, technologies managed by doctors and inaccessible to the very young", said Rosen.
"As a doctor I can only invite my patients to stop - added Peter Harper, British oncologist former director of Oncology at Guy's, King's and St. Thomas Hospital in London - but I know that it is a complex undertaking: quitting permanently is not easy. If I recommend to my patients to wear a helmet on the ski slopes, I am only reducing their risk. And as a doctor, I now have the tools to reduce the harm associated with smoking". Could one of these tools be e-cigarettes?
Yes, according to Harper: “The World Health Organization considers vaping or heated tobacco products to be no less harmful alternatives to cigarettes. Well, I think the latest WHO report on the matter is not based on all the scientific evidence available. It is true that there are no long-term data yet, but an independent study presented to the Food and Drug Administration has shown that with these products there is an important reduction in exposure to toxic substances. This is a given. Sure: zero cigarettes is better, and this is our advice to patients. But quitting permanently is not easy, and everything we doctors do aiming at harm reduction is aimed at obtaining a concrete result. As doctors, we want to reduce the danger to patients."
“We need to stop smoking – Laura Rosen added again -, implement contrast policies, protect the very young and fight secondhand smoke. But the data we have on heated tobacco e-cigarettes also tell us that these products have substantially reduced exposure to toxic substances. More long-term data is needed to fully evaluate e-cigarettes".
That it makes sense to take the path of damage reduction (if zeroing is really not possible) was also argued in the Paris assembly the well-known French oncologist David Khayat, past president of the French National Cancer Institute: “We now know the weight of lifestyle on the risk of developing major chronic diseases, from diabetes to cancer. But it is not easy to change people's habits. And this even if they are aware of the danger: just think that 64% of lung cancer patients continue to smoke. This is why, as an oncologist, I am convinced of the importance of an approach that aims at harm reduction”.
