Vaping – France vs the US

As someone who has spent a fair amount of her life in different countries I can say with certainty that medicine swims in the cultural sea and is influenced by it in a way we can’t see until we end up elsewhere where advice given in one country conflicts with that given in another.  Doctors, researcher and policy makers in different countries can approach a public health issue from very distinct cultural viewpoints and can vehemently disagree about what should be done, if anything.

In 2019, vaping has become one of those controversial issues.  As someone who has family in the US, who reads US news, and who uses electronic cigarettes, I am aware of what has happened recently with vapers ending up in the hospital and even dying.  The US Center for Disease Control (CDC) has told Americans to stop vaping.

But here on the outskirts of Paris the consensus among the many French medical professionals I have consulted recently is that the Americans have gone a little nutsy cuckoo, and they don’t agree at all with the CDC recommendation.

Being a curious sort, I asked why and got some interesting answers.  Most had to do with their overall impressions of the US:  incompetent government, poor regulation, “wild west” mentality.  We in France trust our government to do its job and make sure such things are safe and properly regulated before allowing them to be inflicted on sold to the general public- that good old principe de précaution.

As for the “wild west” perception there were a few shots at American DIY culture.  Making your own vape liquid?  Buying vape products on-line?  Adding THC or CBD to the mix?  A mind-boggling lack of common sense, they said, and it’s behavior they don’t see here in France.  Vape products with nicotine are only sold in regulated tobacco stores with name brands, limits on nicotine levels, and “made in France” on the vials.

Interestingly enough the science and the research came last in the discussions.  Most of the cases in the US have a connection to THC use, they pointed out.  That and the under-regulated US market probably explains most of the problem.  The French government is nonetheless keeping an eye on it here.  However, the information I am getting is that while French doctors are open to new information from the US, for now they think the CDC no vaping recommendation is unjustified and perhaps even harmful.

Because smoking, folks.  The doctors have all the information they need based on years of research to say that smoking will kill you.  Vaping has a lot of unknowns but based on what research has been done, they are absolutely convinced that it is better for you than continuing to smoke.  The approach here, based on my experience, is mitigation. It’s an imperfect world with flawed human beings.  So let’s shoot for improvement, not perfection.

The approach in the US is very different and may explain the harshness of the CDC recommendation. While there are different opinions, the overall approach toward smoking (and opioids or alcohol) in the US heavily favors abstinence from all nicotine products.  A very popular US internet-based stop smoking program goes so far as to condemn the use of nicotine patches or gum to quit. Cold turkey or nothing, they say.

And that is not at all what I see here.  While no one I know talks about smoking as a good thing, there is a tolerance for human weakness (and a sense that we all have weaknesses and thus we are all vulnerable to attack) and a disinclination to turn smoking or drinking into moral issues.

To that I can add conspiracy theories that are circulating here.  Some say that the tobacco companies are behind the attack on vaping because people who stop vaping will probably start smoking regular cigarettes again and that’s good for business.  And that’s funny because in the US they say the opposite – the tobacco companies are trying to hook people on vapes because that would be good for business. How can both of these things be true?

Culture complicates the global conversation about public health issues with disagreements about the scope of a problem, the approach, the relative trustworthiness of government agencies, and perceptions about one population’s behavior versus another.

As someone who straddles two cultures on a daily basis, it sure doesn’t make it easy to come to a decision.  Do I trust the American government or do I listen to my French doctors?  And I am very aware that the answer says a lot about me.

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Victoria

Born in Seattle, USA. Generation Xer. Lived on 3 continents (North America, Asia and Europe). Country agnostic. Mother of two Frenchlings. MA in International Migration

4 thoughts on “Vaping – France vs the US”

  1. Hi Victoria, welcome back. I am sorry to hear of your illnesses this past year. I worked in the health care industry in the USA. It was my career choice. So here is my opinion.

    Yes companies now control the government in the USA and why would they want to? Because they can improve their profit line if they do. So yes, I do indeed believe that the tobacco industry has an interest now and has always had an interest in having people use their products. I thought you and I were about the same age. Lung cancer is ordinarily a very rare disease. Tobacco has been proven to be addictive. The mechanization of cigarette production, the public entertainment enhance the view that smoking was an elegant yet inexpensive way to style one’s life. Then after WW2 when the main goal was to place a television in every house the commercials for cigarettes gave every reason for smoking, i.e.: they suppressed appetite, calmed one’s nerves allowing relaxation at the end of a working day, physicians advised their patients with menopausal symptom to smoke so they wouldn’t have a ‘nervous breakdown’ and their patients with asthma for more or less the same reason. Many people made the reasoning that smoke calmed bees it would also calm people. There were many studies and animal experiments that connected smoking with uprising Lung Cancer rate. Yet the Tobacco Industry disputed this scientific data and continued to manipulate propagandizing the health merits of cigarette smoking. But by the late 60’s I recall people coming into the emergency rooms coughing up blood. Everyone seemed to have lung complaint. We noticed that newborns born to smoking mothers were smaller and less reactive after birth. It seemed to me that every family I knew in our small town had a family member dying of Lung Cancer. Researchers became confident that cigarettes were the connected with the rise of Lung Cancer. Yet the Tobacco Industry fought hard against the association and having a label attached to package of cigarettes that smoking tobacco was a strong link in the risk of lung cancer. I remember that they even got the farm industry in the game with farmer from the south giving tours of their large farms, we were suppose to be impressed with how clean every thing was. Then it was finally discovered that the Tobacco Industry had been gas-lighting the public, bribing some politicians to cover-up all connection to smoking and lung cancer, although research had been trying to be recognized since the 40’s. So, yes, Tobacco is addictive and profitable for the Tobacco Industry and if they can find new ways to encourage more addiction, the better it is for the industry. The industry and those involved in its function lack any sense of guilt in this manipulation because it is there job to care more about the industry than the customers (people) it serves.

    Just as the gun manufactures have interest in gas-lighting ordinary people by investing in gun ownership. They bought the soul of the National Rifle Association so they can use it like a hammer to improve their profit lines. The use propaganda not unlike the Tobacco Industry, “Guns don’t kill people; people kill people” and now there’s “Only an insane person would kill people”. People are convinced that there is a huge amount of crime and they need to have more guns because law enforcement is to slow to respond to a call for help. There are states where The Stand Your Ground law has resulted in deaths without the right to prosecute the murders because he or she state they feared for their lives. 2010 data indicates that the USA ranks the highest out of all the OECD for firearm-related suicides. I personally impacted by that data; my sister shot and killed herself. But there’s more 2010 OECD data that the USA has the highest gun-related homicide rates also. Yet gun regulation is kept to a minimum in the USA.

    Just like Big Pharma, Purdue and other drug manufactures understood that opioids were addictive but continued sending out literature to the contrary. Big Pharm has actively courted Physicians and Patient Pharmacies with luncheon, dinners, gifts, and hospitals pharmacies with unit hours work shops that are used by the healthcare givers to maintain their mandated continuing educations hours.

    When industry governs people are a commodity to the government that’s set in place just for that reason. When people control a government then industries are seen as the potential enemies of the people.

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  2. Great to see you, Sauve! And thank you for the very thoughtful comment. You are absolutely right to point out that bad behavior by big business has done great harm. The global consensus today is that smoking is a bad bad thing. In all my travels in the world I have never met a single person who touted smoking as benign or even a good thing. Even smokers. The French authorities are keenly interested in getting the rates down in France and it is a priority here. The price of a pack of cigarettes just rose again to 10 Euros a pack. Nicotine replacement therapies like patches are paid for by state insurance. In my experience with healthcare professionals here they see NRTs like vaping, gum and patches as part of a toolkit to help people quit and they are happy happy to write you a prescription. And yep these nicotine products are seen as a blow against big tobacco, not a bonus for them. That is the complete opposite of the view in the US which sees the hand of big tobacco in these products. That is an interesting cultural difference that I have no explanation for.

    In thinking about smoking versus vaping (or drinking, opioids and other addicting substances) I find it helpful to separate two issues here: addiction versus harm. Not easy for me because I stopped drinking though AA which is a total abstinence program. That’s my model and it would be far too easy for me to say, well, it worked for me and others I know, therefore anyone can do it. That would be me on my moral high horse. With age (and sobriety) I’ve acquired a more nuanced viewpoint. Because even with AA or rehab most alcoholics don’t make it. They drink until they die. Ditto for all the other substances that people use and abuse. Relapse rates are very high (like 80 to 90%). Many if not most addicts are not going to quit – and by quit I mean a lifetime quit/sobriety/no using.

    That presents public authorities and healthcare professionals with a real dilemma. Do you hold people to the gold standard of total abstinence as THE prescription for addiction (and effectively write off as goners those who can’t or won’t do it) or do you look at harm reduction? This means methodone and other aids for drug addiction and NRTs for smokers.

    Nicotine is a natural product that comes from a plant and like weed you could grow it in your garden if you wanted to, if your climate is suitable for it. Nicotine does not cause lung cancer. Most of the harm done to smokers comes from a delivery system that has thousands of chemicals (cigarettes) and not the nicotine itself. And the harm is catastrophic for the individual and society. And you have to ask why it would be a problem for someone to take methodone or wear a patch for life, if needed. From a purely medical standpoint, it’s management of a chronic condition, which is light years from a perspective that says you are a bad person because you use and you can only redeem yourself through total abstinence.

    So that’s where I am at on this one. I will add one last thing which is a conversation I had with a twenty-something woman I know well and who works in a local shop I frequent. Her take on it was that if smoking were really as bad as everyone says, then the French government would make it illegal. That really knocked me for a loop. And, yet, she has a point and that goes for the US as well. Putting aside conspiracy theories, behavioral studies, addiction research there is a serious disconnect between what we say versus what we do. Cigarettes are a legal product and that puts a halo over it (alcohol is another one where this is true) that is not lost on the young.

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