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E-cigarettes for Physicians. James Sargent MD Professor of Pediatrics Geisel School of Medicine at Dartmouth. Cigarette Smoking is Very, Very Bad. Highlights of the 2014 Surgeon General's Report on Smoking and Health 20 million people have died since 1964 from smoking-related illnesses .

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E-cigarettes for Physicians

James Sargent MD

Professor of Pediatrics

Geisel School of Medicine at Dartmouth


Cigarette smoking is very very bad
Cigarette Smoking is Very, Very Bad

  • Highlights of the 2014 Surgeon General's Report on Smoking and Health

    • 20 million people have died since 1964 from smoking-related illnesses.

    • 5.6 million children alive today will die prematurely from smoking if current smoking rates persist.

      • That's 1 in 13 children in this country.

    • Smokers today have a greater risk of developing lung cancer than they did in 1964, even though they smoke fewer cigarettes

      • Because of changes in the design and composition of cigarettes

    • Report calls for an end to the use of cigarettes

    • How do we accomplish that?




Vapor vs smoke no tar no co
Vapor vs. Smoke—No Tar, No CO

Electronic Cigarette Vapor

Cigarette Smoke

Nicotine

Tar component

Particulate matter

Phenol

Tobacco-specific nitrosamines

Volatile chemicals

Formaldahyde

Benzene

Heavy metals

Gasses

Carbon monoxide

Hydrogen cyanide

  • Nicotine

  • Vapor component

    • Propylene glycol

    • Glycerol

  • Flavor components

  • Contaminants

    • e.g., oils, heavy metals


Types of e cigs
Types of E-Cigs

  • E-cigarettes are distinguished by the following features:

    • How you refill them

      • Disposable

      • Rechargeable

    • Technology

      • Atomizer

      • Microprocessor technology



Rechargeable tanks
Rechargeable (Tanks)

Small Firms

Vape Shops


Studies of about 50 published
Studies—(of about 50 published)

  • Chemical

    • Juice

    • Vapor

  • Toxicological

  • Behavioral

  • Epidemiological


E cig levels of various toxic substances 10 500 times lower than cigarettes
E-cig Levels of Various Toxic Substances10-500 times Lower than Cigarettes

Goniewicz et al, Tob Control 2013


Chemical studies
Chemical studies

Passive vaping

Schripp et al, Indoor Air 2013





The Public Health Endgame—Clive Bates

Billon Adults >15 years

Scenario – 15% global prevalence by 2050


The Public Health Endgame—Clive Bates

Billon Adults >15 years

Scenario – 15% global prevalence by 2050


The Public Health Endgame—Clive Bates

Billon Adults >15 years

HARM




The endgame – a nicotine product contest?

Billon Adults >15 years

Dual Use


The endgame – a nicotine product contest?

Recruitment of intermediate risk adolescents

Billon Adults >15 years

Dual Use


Summary statement
Summary Statement

  • Electronic cigarettes: here to stay

  • They contain many fewer toxins than cigarettes

  • The industry is rapidly evolving

  • FDA has issued “deeming” documents for e-cigs

    • They will eventually be regulated

    • The big question is how?


E cigarettes and accountable care

E-cigarettes AND Accountable Care

Why ACOS Should Care

How E-cigs Could Change the Game


Aco aim
ACO--Aim

  • The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.


Aco consequences of success
ACO—Consequences of success

  • When an ACO succeeds both in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.



Harm reduction e cigs could be a game changer
Harm Reduction—E-cigs could be a game-changer

  • Certain patient groups stand to benefit greatly by switching to e-cigarettes

    • Smokers with COPD

    • Smokers with diabetes

    • Smokers with coronary artery disease

    • Smokers with cancer

    • Smokers with lung nodules

      • Testing aspirin as a tumor growth inhibiter

      • Why not e-cigarettes?

        • Cigarettes contain many cancer promoters


Problem nothing is known
Problem—Nothing is known

  • We need Phase 1 trials for to explore:

    • The proportion of these patients that can successfully switch to e-cigarettes

    • The short term effects on medical outcomes

      • Lung function—COPD and Asthma

      • Diabetes complications

      • Cardiovascular function—Heart disease

      • Tumor nodule growth—lung nodule patients

    • The short term effects on health costs


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