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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Servicio de neumolog&#237;a del Hospital Universitario Nuestra Se&#241;ora de la Candelaria</p><p id="par0010" class="elsevierStylePara elsevierViewall">Ninguno de los autores tiene conflictos de intereses con la industria farmac&#233;utica ni con la industria tabaquera&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Smoking is the leading cause of disability and preventable death worldwide&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In Spain&#44; despite uneven application of the law due to institutional laxity&#44; reflected in the latest EDADES survey&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> the WHO Framework Convention<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> provided the support needed to stand up to tobacco industry lobby and achieve such notable milestones as reduced prevalence&#44; delayed start of consumption&#44; greater protection for the passive smoker&#44; and better support for individuals addicted to this legal&#44; accessible&#44; and affordable drug&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Given the negative impact of their star product&#44; tobacco companies have put their weight behind 2 old chestnuts in the anti-smoking debate&#58; first&#44; discrediting scientific evidence and manufacturing doubt&#59; and second&#44; the image of social responsibility&#44; backed by notions such as a lesser evil and the free will of the consumer&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The first is what Robert Proctor calls agnotology&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> the &#34;science of creating ignorance&#34;&#46; This attitude has gained ground and has been adopted by deniers in many different terrains&#44; ranging from climate change and gender violence to the evolution of the species and even of the roundness of the Earth&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The second strategy has been backed by the technological revolution that has been part of our lives since the beginning of the 21st century&#59; today&#44; we all hold in our hands a window to the world that by far exceeds the limits imagined by science fiction 50 years ago&#46; This&#44; coupled with the need for a new&#44; responsible image&#44; creates a &#34;market opportunity&#34;&#44; a gap that the tobacco companies have not hesitated to fill&#46; Although the quest for the &#34;least bad&#34; option is nothing new&#44; the surge in new nicotine products only emerged in the 2000s&#58; electronic cigarettes&#44; e-cigarettes with and without nicotine &#40;ENDS and ENNDS&#44; respectively&#41;&#44; and heated tobacco products or &#8220;heat-not-burn&#8221;&#44; as manufacturers prefer to call them&#44; removing the word tobacco from the name to give a false impression of &#34;healthy consumption&#34;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Sales and use of these products have increased exponentially since their appearance&#44; especially in the Anglosphere&#44; and within the past 5 years among the youngest members of the population&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> It is precisely in this latter group where technology and marketing have the greatest impact&#58; JUUL ENDS&#44; promoted through social networks&#44; surpassed other ENDS available on the market&#44; sending consumption skyrocketing&#44; even among never-smokers&#46; Historically&#44; the tobacco industry has defended tobacco use as a decision made by independent adults&#44; based on social culture&#46; However&#44; the audiovisual media&#44; including fashionable streaming platforms aimed at adolescent and young adult audiences&#44; often revive the 1950s &#34;rebel without a cause&#34; man-and-his-cigarette cinematic image to portray people using ENDS&#44; particularly JUUL&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The emergence of these products has sparked intense debate among the scientific community about their usefulness in cessation&#44; their safety&#44; and the possibility of risk reduction&#46; The recently published official SEPAR statement on electronic cigarettes and IQOS<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> summarizes the main points of interest and discussion&#46; In the first case&#44; studies do not show that these devices are useful for cessation and&#44; although a positive effect compared to placebo may be seen in some cases&#44; results are marginal&#46; The low number of patients and the range of confidence intervals have led a Cochrane meta-analysis to assign this strategy a low grade recommendation &#40;GRADE&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The damage to health caused by these products also remains unclear&#46; Both heated tobacco products and e-cigarettes contain IARC Class I carcinogens that have no safe exposure limit&#59; heated tobacco products&#44; for their part&#44; consist of processed tobacco&#44; so we can expect them to cause damage similar to ordinary tobacco&#46; In terms of e-cigarettes&#44; the e-cigarette and vaping product use-associated lung injury &#40;EVALI&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> syndrome was declared an epidemic in the USA in July 2019&#46; Incidence peaked in September 2019&#44; and by the first week of January 2020&#44; more than 2&#44;500 people had been hospitalized&#44; and up to 57 deaths had been reported&#44; predominantly in young people using both nicotine and tetrahydrocannabinol and cannabidiol&#46; Although this entity has been associated with irregularly obtained e-liquids and vitamin E acetate&#44; research is ongoing&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Harm reduction strategies are not exactly new<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#59; the most obvious example is the effective public health intervention conducted in the 1980s and 1990s for injecting drug users in the face of the threat of HIV&#47;AIDS&#46; The problem with assuming that these devices&#44; especially vaping&#44; can limit harm is that we do not know their real toxicity&#44; and moreover&#44; there is a risk of individuals getting stuck in a chronic pattern of dual consumption of e-cigarettes and conventional cigarettes&#46; It is also important to bear in mind that strategies of this type are sponsored by public health programs&#44; and the normalization of tobacco use must always be avoided&#46; Such strategies cannot be promoted by the tobacco industry&#44; and health professionals cannot and must not support such initiatives&#44; as this practice is contrary to the WHO FCTC&#44; of which Spain is part&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The mass marketing of these products has caught health professionals by surprise&#44; leaving them with questions about how to advise and treat their patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> It is imperative that all stakeholders disseminate knowledge and promote training in this respect&#44; as this is the only way we can offer quality care and avoid finding ourselves at the mercy of the tobacco industry&#46; It is time for members of the scientific community to take the reins&#44; and ensure that the WHO&#39;s hopeful <span class="elsevierStyleItalic">Endgame for Tobacco</span> initiative is not a mere pipedream&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0060" class="elsevierStylePara elsevierViewall">None of the authors has a conflict of interest with the pharmaceutical industry or the tobacco industry&#46;</p></span></span>"
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Editorial
The seduction of technology and smoking
Technology Seduction and Smoking
Ruth Pitti Pérez, Lorenzo Manuel Pérez Negrín
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Servicio de neumolog&#237;a del Hospital Universitario Nuestra Se&#241;ora de la Candelaria</p><p id="par0010" class="elsevierStylePara elsevierViewall">Ninguno de los autores tiene conflictos de intereses con la industria farmac&#233;utica ni con la industria tabaquera&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Smoking is the leading cause of disability and preventable death worldwide&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In Spain&#44; despite uneven application of the law due to institutional laxity&#44; reflected in the latest EDADES survey&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> the WHO Framework Convention<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> provided the support needed to stand up to tobacco industry lobby and achieve such notable milestones as reduced prevalence&#44; delayed start of consumption&#44; greater protection for the passive smoker&#44; and better support for individuals addicted to this legal&#44; accessible&#44; and affordable drug&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Given the negative impact of their star product&#44; tobacco companies have put their weight behind 2 old chestnuts in the anti-smoking debate&#58; first&#44; discrediting scientific evidence and manufacturing doubt&#59; and second&#44; the image of social responsibility&#44; backed by notions such as a lesser evil and the free will of the consumer&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The first is what Robert Proctor calls agnotology&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> the &#34;science of creating ignorance&#34;&#46; This attitude has gained ground and has been adopted by deniers in many different terrains&#44; ranging from climate change and gender violence to the evolution of the species and even of the roundness of the Earth&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The second strategy has been backed by the technological revolution that has been part of our lives since the beginning of the 21st century&#59; today&#44; we all hold in our hands a window to the world that by far exceeds the limits imagined by science fiction 50 years ago&#46; This&#44; coupled with the need for a new&#44; responsible image&#44; creates a &#34;market opportunity&#34;&#44; a gap that the tobacco companies have not hesitated to fill&#46; Although the quest for the &#34;least bad&#34; option is nothing new&#44; the surge in new nicotine products only emerged in the 2000s&#58; electronic cigarettes&#44; e-cigarettes with and without nicotine &#40;ENDS and ENNDS&#44; respectively&#41;&#44; and heated tobacco products or &#8220;heat-not-burn&#8221;&#44; as manufacturers prefer to call them&#44; removing the word tobacco from the name to give a false impression of &#34;healthy consumption&#34;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Sales and use of these products have increased exponentially since their appearance&#44; especially in the Anglosphere&#44; and within the past 5 years among the youngest members of the population&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> It is precisely in this latter group where technology and marketing have the greatest impact&#58; JUUL ENDS&#44; promoted through social networks&#44; surpassed other ENDS available on the market&#44; sending consumption skyrocketing&#44; even among never-smokers&#46; Historically&#44; the tobacco industry has defended tobacco use as a decision made by independent adults&#44; based on social culture&#46; However&#44; the audiovisual media&#44; including fashionable streaming platforms aimed at adolescent and young adult audiences&#44; often revive the 1950s &#34;rebel without a cause&#34; man-and-his-cigarette cinematic image to portray people using ENDS&#44; particularly JUUL&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The emergence of these products has sparked intense debate among the scientific community about their usefulness in cessation&#44; their safety&#44; and the possibility of risk reduction&#46; The recently published official SEPAR statement on electronic cigarettes and IQOS<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> summarizes the main points of interest and discussion&#46; In the first case&#44; studies do not show that these devices are useful for cessation and&#44; although a positive effect compared to placebo may be seen in some cases&#44; results are marginal&#46; The low number of patients and the range of confidence intervals have led a Cochrane meta-analysis to assign this strategy a low grade recommendation &#40;GRADE&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The damage to health caused by these products also remains unclear&#46; Both heated tobacco products and e-cigarettes contain IARC Class I carcinogens that have no safe exposure limit&#59; heated tobacco products&#44; for their part&#44; consist of processed tobacco&#44; so we can expect them to cause damage similar to ordinary tobacco&#46; In terms of e-cigarettes&#44; the e-cigarette and vaping product use-associated lung injury &#40;EVALI&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> syndrome was declared an epidemic in the USA in July 2019&#46; Incidence peaked in September 2019&#44; and by the first week of January 2020&#44; more than 2&#44;500 people had been hospitalized&#44; and up to 57 deaths had been reported&#44; predominantly in young people using both nicotine and tetrahydrocannabinol and cannabidiol&#46; Although this entity has been associated with irregularly obtained e-liquids and vitamin E acetate&#44; research is ongoing&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Harm reduction strategies are not exactly new<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#59; the most obvious example is the effective public health intervention conducted in the 1980s and 1990s for injecting drug users in the face of the threat of HIV&#47;AIDS&#46; The problem with assuming that these devices&#44; especially vaping&#44; can limit harm is that we do not know their real toxicity&#44; and moreover&#44; there is a risk of individuals getting stuck in a chronic pattern of dual consumption of e-cigarettes and conventional cigarettes&#46; It is also important to bear in mind that strategies of this type are sponsored by public health programs&#44; and the normalization of tobacco use must always be avoided&#46; Such strategies cannot be promoted by the tobacco industry&#44; and health professionals cannot and must not support such initiatives&#44; as this practice is contrary to the WHO FCTC&#44; of which Spain is part&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The mass marketing of these products has caught health professionals by surprise&#44; leaving them with questions about how to advise and treat their patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> It is imperative that all stakeholders disseminate knowledge and promote training in this respect&#44; as this is the only way we can offer quality care and avoid finding ourselves at the mercy of the tobacco industry&#46; It is time for members of the scientific community to take the reins&#44; and ensure that the WHO&#39;s hopeful <span class="elsevierStyleItalic">Endgame for Tobacco</span> initiative is not a mere pipedream&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0060" class="elsevierStylePara elsevierViewall">None of the authors has a conflict of interest with the pharmaceutical industry or the tobacco industry&#46;</p></span></span>"
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Article information
ISSN: 15792129
Original language: English
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