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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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James Sargent MD Professor of Pediatrics Geisel School of Medicine at Dartmouth

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James sargent md professor of pediatrics geisel school of medicine at dartmouth

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?


William dunn chief scientist pm

William Dunn—Chief Scientist PM


E cigs delivering nicotine to smokers

E-cigs—Delivering Nicotine to Smokers


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


Disposable

Disposable


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


Nicotine delivery

Nicotine Delivery


Quitting adults

Quitting--Adults


Toxicity case reports

Toxicity—Case Reports


James sargent md professor of pediatrics geisel school of medicine at dartmouth

The Public Health Endgame—Clive Bates

Billon Adults >15 years

Scenario – 15% global prevalence by 2050


James sargent md professor of pediatrics geisel school of medicine at dartmouth

The Public Health Endgame—Clive Bates

Billon Adults >15 years

Scenario – 15% global prevalence by 2050


James sargent md professor of pediatrics geisel school of medicine at dartmouth

The Public Health Endgame—Clive Bates

Billon Adults >15 years

HARM


James sargent md professor of pediatrics geisel school of medicine at dartmouth

The Public Health Endgame—Clive Bates

Billon Adults >15 years


James sargent md professor of pediatrics geisel school of medicine at dartmouth

The endgame – a nicotine product contest?

Billon Adults >15 years


James sargent md professor of pediatrics geisel school of medicine at dartmouth

The endgame – a nicotine product contest?

Billon Adults >15 years

Dual Use


James sargent md professor of pediatrics geisel school of medicine at dartmouth

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.


How will acos be judged

How Will ACOs Be Judged?


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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