I was thinking of former U.S. Surgeon General C. Everett Koop recently.
When I was a second-year medical student, I got to meet the man who became “America’s doctor.” It was an awesome experience for me to chat with this champion of public health.
Dr. Koop passed away not too long ago. I was reminded of him when I read recent reports about the rising use of electronic cigarettes, especially among youths. I think Dr. Koop would have been concerned about this new trend in the use of habit-forming nicotine products.
Just last month, both the American Academy of Pediatrics and the American College of Physicians drew attention to the growing problem of e-cigarette use.
The American Academy of Pediatrics pointed out the results of a new survey indicating that e-cigarette use by middle and high school students tripled in 2014.
The National Youth Tobacco Survey demonstrated that for the first time e-cigarette use had surpassed use of traditional cigarettes and that, for the first time in a generation, there has been an overall increase in tobacco-product use by young people.
Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, attributed the rise in e-cigarette use in part to an aggressive marketing campaign and e-cigarette features, such as added flavors.
E-cigarettes, also known as electronic nicotine delivery systems, are devices with battery-powered mechanisms that vaporize or aerosolize liquid nicotine, permitting inhalation.
The devices first appeared in 2007 with claims they would facilitate smoking-cessation efforts. Yet, despite increasing use of e-cigarettes, evidence about their safety or effectiveness is still lacking. As the devices have become more popular, with sales exceeding $2 billion, e-cigarettes have now become a popular “entry level” tobacco product for youths, with many adolescents ultimately pursuing dual use of electronic and traditional cigarettes.
Nicotine is an addictive substance. As pointed out by a recent position paper from the American College of Physicians, nicotine can negatively affect neurologic development in teens and has been shown to compromise cancer treatment and possibly promote tumor growth.
In addition, e-cigarette aerosol or vapor contains toxic chemicals including formaldehyde, acetaldehyde and other known cancer-causing agents. The nicotine liquid contains propylene glycol, which can irritate the respiratory system. Some brands also have been found to contain heavy metals, such as nickel and lead.
Flavoring of concentrated liquid nicotine products increases risk of consumption by small children, in whom nicotine overdose can lead to severe illness and even death.
Experts recommend FDA oversight of e-cigarettes, with elimination of flavoring, appropriate health warnings, purchasing age-limits, child-resistant packaging and prohibition of marketing that targets young people. Consideration also should be given to prohibiting use in indoor public places.
Dr. Matthew A. Clark is a board-certified physician practicing at the Ute Mountain Ute Health Center in Towaoc.