While the President’s Forum is often used to discuss large global topics affecting all the physicians in Missouri, it is also used to address a single topic that has wide ranging ramifications. One topic that addresses both these issues is tobacco use either with combustible cigarettes or electronic cigarettes.
This issue has recently come back into the public discussion as St. Louis County has proposed an ordinance restricting purchase of tobacco products to those 21 years of age or older. St. Louis City has indicated that if this is enacted in the county, they will pass the same restrictions in the city. In this respect, St. Louis is fashionably late to the party. It will actually be the seventh city in Missouri to pass this law. Columbia was the first on December 15, 2014. This was followed by Kansas City, Independence, Gladstone, Grandview, and Lee’s Summit.
Proponents of similar laws nationally show statistics that teen smoking rates have dropped by up to 50% in cities where this has been enacted. The intent of the law is not just to discourage smoking among 18–20-year-olds, but even more importantly to prevent smoking in the younger teenagers, the 13-, 14-, 15-year-olds that have older teenagers as friends. This young group often does not have 21-year-olds as friends that would be willing to buy cigarettes for them, but does have 18-year-olds that might.
I have listened to the public debate on this issue, and am encouraged by the excellent information and facts being discussed about the risk of combustible cigarettes. I am, however, dismayed by the rhetoric and misrepresentation of the risks of e-cigarettes and “vaping.”
Voices have been raised claiming that vaping is safe and should be exempted from the Tobacco 21 (T-21) bill. Claims are also made that vaping is non-addictive and that it is not being marketed to children and adolescents. In addition, it has been argued that e-cigarettes are “safer” than tobacco and do not contain “harmful” ingredients, and finally that e-cigs help people to stop smoking conventional cigarettes.
As the President of the MSMA, I have the privilege of talking to physicians throughout the state that take care of patients who are suffering the effects of tobacco as well as e-cigarettes. I have had the opportunity to hear from these physicians as well as organizations they are members of.
As physicians, we are trained to evaluate facts and tune out the rhetoric. When one reads the available medical studies, it becomes very obvious that the arguments of the proponents of those wanting to exclude e-cigarettes from this bill are simply not true.
A study from the University of North Carolina at Chapel Hill linked e-cigarettes to a host of medical risks. One arm of that study showed that 53 genes that are associated with immune response (the body’s ability to fight infection) were significantly diminished.
One ingredient that was incredibly suppressive of immune gene was Cinnamaldehyde (a form of formaldehyde) which is the by-product of the cinnamon flavoring in e-cigs. These innocuous flavorings actually produce toxic substances which could, in large enough quantities, be fatal.
The e-cig proponents report that their cigarettes do not have nicotine which makes them “safer.” However, a study by New York University’s Langone Medical Center showed that while nicotine-laced vapors affected over 148 genes in the brain that led to significant behavioral changes, the non-nicotine vapors actually affect a whopping 830 genes in the same area. Almost seven times worse. In fact, some of the behavioral changes were similar to those seen with mental illness.
Yet another study at the University of Louisville in Kentucky showed that cigarette smoking showed evidence of atherosclerosis or heart disease, but that e-cigarettes were even more prone to cause cardiovascular plaque leading to heart attacks and severe cardiovascular problems.
These are only a few of the increasing number of studies showing very serious concerns with e-cigarettes. In fact, it is these concerns that have led the FDA to begin regulating the nicotine and contents in e-cigarettes.
A survey by the Center for Environmental Health of 97 different e-cig products showed the chemical acetaldehyde to be present. Acetaldehyde is associated with asthma and cancer. In addition, they found lead, cadmium, nickel, tin, and other heavy metals that are associated with nervous-system and respiratory problems.
A final argument of the pro e-cigarette lobby is that e-cigarettes help people to stop smoking; unfortunately, again, the studies do not back this argument.
A study showed no difference between e-cigs and nicotine patches in helping people to stop smoking. Another study actually found that teenagers who smoke and vape tend to actually smoke more conventional cigarettes than those who smoke and don’t use e-cigs.
In fact, these studies have led the U.S. Preventative Services Task Force to not recommend e-cigs as a smoking-cessation device.
To sum it up, as a physician there is simply no reason to exempt e-cigarettes and vaping from a very well thought out and comprehensive bill.
I am proud that the Missouri State Medical Association, after a spirited but cordial debate, voted to support T-21 on a statewide basis and that we are on record supporting tobacco control efforts wherever we can be helpful.
Biography
Ravi S. Johar, MD, MSMA President and member since 1995, practices OB/GYN in St. Louis, Mo.
Contact: rkjohar@att.net
