MD submitting a Clinical Inquiry article on e-cigs

[elfstone]

I just want to clarify that at no point did I mean that your efforts are misplaced or in vain! They are admirable.

I happen to be less optimistic about the grassroots revolution, but I agree that's a worthy cause. I still think that the majority of the attacks on vaping are actually trying to equate PVs with medical delivery devices, and push for regulating them as such. FDA failed once, but I believe EU is really trying to do that. I don't mean that we shouldn't try to study the effects / benefits of vaping, but I think a good avenue remains marketing / popularizing vaping as reduced harm nicotine consumption, a recreational activity rather than a medical treatment.

I guess regulation / taxation is unavoidable, and indeed if there is evidence that vaping is indeed safer than smoking, then there is no argument to tax the hell out of it, but instead a case could be made to even subsidize it. Maybe... in a normal world.

On the other hand, if they manage to classify PVs as medical devices, a more draconic type of regulations will be possible and FDA and European counterparts will stop at nothing to eliminate any reduced harm alternatives as we learn from the Swedish Snus experience. It is obvious that the healthcare authorities prefer people dying from a habit with clearly known risks then using alternate, less harmful consumption methods.

Anti-tobacco activists actually have this pseudo-religious view on the issue: everyone should quit nicotine, and new generations should not pick up nicotine. To this end, there should be no perceived way to safely consume nicotine, even if really there is. It is better for some people to smoke and die and serve as a gruesome example to the rest of the population and especially new generations, than for said smokers to find safer ways to indulge in their vice and, by their success, maybe entice others to pick up the habit. This message isn't even veiled in papers and position statements out there. They explicitly say that the Swedish Snus data, for instance, is dangerous because it may create such perception in the population.

 

[Oneida]

Thank you for your work and posting the PP presentation. Maybe it's just me but my very first thought upon seeing the last PP slide of the various mods was, "Yikes, it looks like drug paraphernalia." I've been on ECF for about a month now, so I've seen plenty of mod photos before and always thought they looked pretty cool. However, I'm also a researcher and so was viewing the PP in scientist mode, not vaper mode. Anyway, thought I'd toss that out there as a possible indication of how medical professionals who aren't familiar with vaping might respond to that slide.

 

[sailorman]

....
This is going to be the most paranoid thing I've ever said. I guess I'm joining the "who's more paranoid than Rolygate" contest. What do I win?

So... there is a thin but present trend to link nicotine to terrorism as I pointed out above. Therefore, couple that with the NDAA and you could face going to a military prison for the rest of your life for vaping!

OF COURSE I'm exaggerating beyond reason here, but ... you know...

I think I already got the "who's more paranoid than Rolygate" prize. But someone stole it when I wasn't looking.

That whole stupid terrorism connection is built around the idiot in Norway. Right now, there are Chinese vendors who will ship you anything from 10% to 99.7% pure pharma grade nicotine. You can get a 25Kg. drum of it if you want, and compared to US prices for nic solution, it's incredibly cheap. Get hold of a fume hood, some basic labware and some bottling equipment and you can be the next Box Elder! Regardless of what they do, I'm old enough that, with a reasonable amount of money, I could easily acquire enough nicotine to last me the rest of my life. Kept sealed, dark and at approx. 0-10 degrees, it should be good for at least 10 years, probably longer.

BTW, 1 liter of 99.7% nic. would last, according to my calculations, a 4ml/day 24mg vaper for 455 years and 3 months. Hmmm...I guess I'll have to scale down my order a bit.

 

[sailorman]

Thank you for your work and posting the PP presentation. Maybe it's just me but my very first thought upon seeing the last PP slide of the various mods was, "Yikes, it looks like drug paraphernalia." I've been on ECF for about a month now, so I've seen plenty of mod photos before and always thought they looked pretty cool. However, I'm also a researcher and so was viewing the PP in scientist mode, not vaper mode. Anyway, thought I'd toss that out there as a possible indication of how medical professionals who aren't familiar with vaping might respond to that slide.

Any so-called scientist or doctor who would form an opinion based on some superficial resemblance like that doesn't deserve the title. That's what I'd expect from some frumpy church-lady or half-witted ditch digger, not someone who's supposed to be a scientist. Besides, I've seen a lot of paraphernalia in my day and never saw anything that resembled a PV, so where does that cliche come from anyway? The closest thing in the drug world to an ecig I've ever seen is an insulin pen or epi injector.

And this is what really, really irks me. It "looks like" a cigarette. It "looks like" smoke emanating from your mouth. It "looks like" drug paraphernalia. It "looks like" you're smoking. So, it must be bad. You must be smoking. Isn't anyone thinking about the children?????

Lets throw away a thousand years of science and re-define vapor as "smoke". Excuse me, there's smoke coming from my teapot. I wonder why every kid starts smoking when it turns cold outside. Who says horses don't smoke? Just look at any Courier & Ives winter scene.

How come we never hear this "looks like" crap about people who drink from cups? It looks like you're drinking a rum and coke!! Stop that! No drinking from cups while driving because it looks like you're getting drunk!!

And, you diabetics. You look like a bunch of junkies!! STOP THAT!!

Outlaw RYO cigarettes!! How do I know you're not smoking that other stuff?

UPS drivers. They look like drug couriers to me.

Are we to be a society where everything is judged by what, to the most ignorant witness possible, it "looks like" someone is doing? Is the criteria going to be, "I don't care what you're doing. I'm not interested in what you're really doing. I don't have to know. All that matters is what the stupidest person around thinks it looks like you're doing"? So now, we can replace all the laws to make the appearance of crime a crime in itself.

Sorry, but if I sound like I'm irked and p.o'd about the willful stupidity of my fellow humans, especially doctors who are paid far more than me to be above that, it's because I am.

And, I'm not saying anything about the poster I quoted. I'm writing in general terms here about a very distressing phenomenon I'm seeing.

 

[pmoraldo]

welcome Dr. and thanks for all you do for our cause!

 

[tbpeaceman]

Thank you for your work and posting the PP presentation. Maybe it's just me but my very first thought upon seeing the last PP slide of the various mods was, "Yikes, it looks like drug paraphernalia." I've been on ECF for about a month now, so I've seen plenty of mod photos before and always thought they looked pretty cool. However, I'm also a researcher and so was viewing the PP in scientist mode, not vaper mode. Anyway, thought I'd toss that out there as a possible indication of how medical professionals who aren't familiar with vaping might respond to that slide.

Good point...I'll clarify that this presentation is not being widespread in the medical communtiy...it was mearly to introduce my residency collegues, pharmacists and faculty to what my research topic was about. mostly residents like me and only like 12 people showed up b/c it was really early!! All I said about it was that this is a boutique interest at this point and many people who have found benifit in reduced of quit smoking with PVs go beyonfd the mall and infomercials and had these mods.. but I agree, to the wrong audience this could be deleterious to the cause. the actual article won't have any pictures o r editorials as such, just bare bones objective anaysis of available evidence.

 

[JmeMcG]

This is a good thread and I have enjoyed reading it this afternoon. I applaud the OP for starting this discussion and *think* I understand the purpose for compiling the information as a way to help "educate" other HC Professionals, that e-cigarettes can be effectively used as "stop smoking" or "harm reduction" tool/device/method... whichever term is more accepted.
Before I get started here, I just want to say that I am not trying to be confrontational or anything (so try to read this in a tone of a calm adult) I just really love a great discussion like this. I am going to list some of my thoughts as they came off the cuff while reading through this thead.
I am sure I fit right in with the paranoid club, so my thoughts are probably going to reflect this. I am a new vaper. I started vaping right around 40 days ago or so, so keep this in mind as well, as you read my ramblings.

1. I personally hope the FDA NEVER gets involved in the regulation and control of PV's, e-cigarettes, e juice and so forth. I am not even going to expand on this topic right now or this post would be pages long. I will just state that I do not believe the interests of the FDA are always for the best interests of "the people" that they are "protecting". If anone has some time and/or are just interested in a look into what the FDA regulates, just regarding the food you consume, I would recommend watching "Food, Inc.", "Food Matters" and a really good one that I believe all MD's, or anyone in the health care industry, should watch, is "Forks Over Knives". Just 3 good ones that come to mind. I'm not even going to touch the "drug regulations" of this fantastic faction.
2. While I like the idea that the OP, being a MD, would like to recognize e-cig use as a method for smoking cessation/harm reduction (I think this was kind of the idea...) and help educate other health care professionals about the use of ecigs and smoking cessation, I am not totally sure this is a good idea. My reasons: I am not sure I would have been successful quitting smoking if it had be recommended or prescibed to me by my MD. I am (was) a long time, PAD+ smoker. Tried many times in the past, with no success, to quit using the patch, gum, lozenges... etc. I would have NEVER gone the chantix route, as my feelings for Big Pharma's (lab created poisons and promises in pill form) motives and stance on "looking out for our best interests" is as bad, if not worse, than the FDA. Of course these two groups go hand in hand so... Anyway, when I decided to go the ecig route, I was REALLY ready to quit smoking. I had finally arrived at that point... myself. I have not had an analog since the day I started vaping and although I had times where I REALLY wanted a cig (in the first few weeks) I managed to not smoke by vaping, but I was also very determined to finally quit for good. I really feel this is the key for anyone to really quit... YOU have to WANT to quit. I will also say, that although I am not technically "smoking" anymore, I do fully understand that I am still using nicotine. If I had a nic patch on my arm, I'm sure the FDA would give me a gold star, but because I use a PV as a nicotine delivery device, I'm sure the attitude would be that I must be a ..... somehow.
Now if a patient came in and talked to their MD about their "opinion and thoughts" on using a PV to stop smoking, and MD's and other health care professionals were more educated about thier use and could say "Yeah. I think they could be an effective tool" or whatever... that would be good. I just don't want to see them being "prescibed" as a smoking cessation device for two main reasons. One which I covered in #1 and two because I would hate to see them prescibed, fail to "work" as a cessation device, which would make PV's seem even less credible and give even more "ammo" to the factions who are already against e-cigs, PV's... whatever you want to call them.

Big Pharma and the FDA are not ever going to admit that chantix, patches, gum, lozenges etc. are not highly successful methods for smoking cessation, as they would like for everyone to believe. They don't have to. At this point they have nothing to lose, it's not their fault it didn't work for you, you must be weak. Big Tobacco likes the fact that these FDA "approved" methods don't keep most from using their products... Oh wait... FDA, Big Pharma, Big Tobacco et al. are all "in bed" with each other so to speak. They all gain, gain, gain by keeping each other "in business".

Although I am glad I decided to start using a PV insted of smoking and wish that I could convince every smoker I know to "quit smoking and start vaping", I fear that (long term... I hope it's very far down the road) the more PV use starts cutting into BP and BT profits, the war will really be on against PV's and I fear that encouraging the use of ecigs (although I think it would be good) through the medical community will really speed up this probable "war on vaping". I'm sure the Drug Rep that visits the Dr.'s offices with Prozac, Chantix or whatever the next "miracle pill" would be thrilled to know that ecig use is encouraged. And what about the Dr's who get "perks" for prescribing certain meds... are they going to be on board with the endorsement of ecigs?

In my mind I keep hearing my father tell me all about the "Golden Rule". The definition I learned early on was: "Those with the Gold, make the Rules". Who do you suppose this will be? I fear it will be Big Pharma and Big Tobacco.

I do believe that the OP's ideas are good. Education is never a bad idea and people who are looking for a way to stop smoking need support. A Dr.'s help and advice regarding ecigs may really help confirm to those that are considering going the ecig route that it's OK. Some people may never try a PV otherwise. I don't know. I just don't want to see it get to the level of being prescibed or regulated by the FDA. I know this was too long, but just my

 

[sailorman]

@JmeMG

I agree with most all of your post, with one exception. Unlike some other drugs, I don't think you have to really want to quit all that bad to do it with e-cigs. At least that's not been my experience. I wouldn't want to see someone be discouraged from giving a smoker a kit because they aren't convinced that that person really, really wants to quit. This isn't like alcoholism or other forms of drug abuse.

When I quit, I had been smoking 35 years, almost the entire last 20 years of it at a rate of 3 PAD. The last couple years, I was stuffing my own tubes. The last few months, I was smoking about 2 packs and using snus. Had I gotten down to a pack a day and snus, I'd have been satisfied. I tried an e-cig because I was concerned with an increase in Snus price and a decrease of the selection I could get due to the new postal rules. I intended to be a triple-use tobacco user. I loved smoking. I smoked in the shower. I smoked at meals. I smoked while shaving and if brushing my teeth took over 3 minutes, I'd do it then too.

But I quit the day I got my first e-cig. Completely and with never a craving, even when I visited my local pub. I kept 2lbs of premium tobacco in my freezer and a machine with 2 cartons of filtered tubes in the closet for months, just in case.
I think a lot of the backsliding many people do can be attributed to vaping with too low a nicotine content and using one of those stupid cigarette-looking minis. There is a story every day here that bears me out on that. Other people crave the other additives and alkaloids in tobacco. This is where I may have had an advantage. The tobacco I used was additive free.

Still, I think that almost anyone who gives a decent e-cig an honest try can quit smoking even without a huge motivation or desire to do so. If they aren't turned off to the idea by nasty juice or wimpy vapor or the hassle and expense of continually charging and replacing batteries, I think most people could do it quite seamlessly with a minimum of willpower. God knows, that's one thing I'm sorely lacking in and if that was necessary, I'd be sitting here smoking like a chimney.