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.