Aeromedical Forum

If you read the Aeromedical Forum of October 2010 you would know that smoking is bad for you. Of course unless you live under a rock, you already knew that.

Fortunately, the marvels of medical science have come up with a variety of therapies to help folks quit. Nicotine patches, bupropion (Wellbutrin, Zyban) and Varenicline (Chantix) are commonly prescribed medications to aid in cigarette withdrawal. Hypnosis and/or talk-therapy may be helpful too. However, the sad fact of the matter is that none of these strategies are completely effective. The relapse rate is high.

Nicotine addiction is very hard to break. About seven years ago what was said to be a new weapon to fight addiction appeared-the e-cigarette. E-cigarettes don't burn tobacco. So they do not volatilize the panoply of tars and other junk in real cigarette smoke which causes a medley of cancers, emphysema, chronic bronchitis, heart disease and a lot more-all bad. Rather they use a battery powered heater to create smoke from a liquid-containing cartridge. In addition to nicotine, the brew in the cartridge may contain a variety of flavors ranging from bubblegum to chocolate to popcorn. Yum, pass me the nicotine stick!

These little wonders were initially marketed as a new way to stop smoking. Yet how exactly you would overcome nicotine addiction by continuing to inhale nicotine isn't completely clear to me. Admittedly the same criticism could be made of the nicotine patches but they allow tapering of dose and you are not inhaling anything. After a while some docs began to wonder how effective and safe the e-cigarette really was.

The answer to the first question is pretty straight-forward. There is no convincing evidence that smoking e-cigarettes helps to break nicotine/cigarette addiction. Indeed, the makers are no longer marketing their wares as aids to quit smoking but rather as "lifestyle-choice consumables."

Guess who they're marketing to? Children and teenagers who think it's really cool to be puffing on bubblegum that gives you a high. Guess who is buying up every e-cigarette manufacturer in sight? Right! Big Tobacco with Lorillard and British American Tobacco are leading the charge. This makes perfect albeit diabolical sense.

Since e-cigarettes don't help you stop smoking, perhaps they can be used to get you to start smoking. Tons of addiction research has demonstrated that regular use of addictive substances such as nicotine causes the user to become acclimatized to their current dosage. The thrill is gone. So they seek other ways to up the dose and the high. With nicotine this step up will be traditional cigarettes. The Director of the FDA's Center of Disease Control recently said of this despicable strategy: "The increased use of e-cigarettes by teens is deeply troubling. Nicotine is a highly addictive drug. Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes."

Another concern is e-cigarettes making smoking socially acceptable again. For years health officials have publicized the dangers of smoking. Nowadays smoking in public is about as socially acceptable as projective vomiting.

Will this change with the younger generation? It's worrisome, especially since a lot of the stuff in e-cigarettes is the same as or similar to chemicals in real cigarettes that cause cancer! It will take a few years to see if the risk is as great as with actual cigarettes but I sure would not want to be one of the guinea pigs in that study.

Finally, the liquid ooze that you put into these electronic marvels happens to be extremely toxic. Just last month the Minnesota Poison Control System reported that children and teenagers being poisoned by e-cigarette fluid rose sharply in 2013. Kids are especially at risk but as yet no state or federal law requires the producers of e-juice to use child-resistant packaging of their chocolate or strawberry flavored toxins.

So what's the bottom line for Joe Aviator?

• If you are a smoker and trying to quit, e-cigarettes are a dead-end. Talk with your doc about alternatives. And keep trying!

• If your teenager comes home with a "cool e-ret", slap him up one side of the head and down the other! Be a parent and explain the hazards involved.

• If you have younger children and there is e-cigarette fluid around the house, get rid of it before you kill your kid!

Fly wisely. See you next month!

As always, comments, questions and suggestions are welcome: jdlakin@mnallergyclinic.com.