Demystifying Medicine One Week at a Time

Thank you for Not Smoking

How well does e-smoking approximate the real thing?

Hope you had a pleasant Thanksgiving. GlassHospital was on the road again, taking the kids to visit the hometown of Cleveland, health mecca of the eastern Midwest.

E-cig smoked by a stunt double for my Uncle Ron.

Had Thanksgiving dinner at my aunt and uncle’s. My aunt is a culinary master; she loves to pull out all the stops, including the homemade apple pie that helped define my youth.

I came away feeling a bit gluttonous. Fitting, I suppose, for the holiday.

But gluttony is not the sin for today. No, today’s sin is smoking.

There has been a convergence of recent news stories regarding the nasty habit that have grabbed my attention:

First, a Lancet article (subscription required) claiming that secondhand smoke kills–to the tune of six hundred thousand lives per year worldwide. The study was done by the World Health Organization (WHO?), and compiled statistics from 192 countries. A data set that broad is not too shabby. [Readers from almost that many countries have enjoyed reading GlassHospital, if we’re to believe Google Analytics.]

Secondly, a recent commentary written under the heading “Ideas and Opinion” in the Annals of Internal Medicine introduced me to something that I’d never seen before Thanksgiving: the electronic cigarette (the “e-cig”).

Oddly enough, in our post-Thanksgiving stupor, what do you think I saw? My Uncle Ron, a longtime smoker, proceeded to sit in the comfy TV room chair and “light up” cigarette after cigarette.

I was surprised, because Uncle Ron’s smoking has been shunned by the rest of the family to the point where he’ll usually go outside or hide in his room if he’s going to light one up. I was also surprised since even though he’s an inveterate smoker, I’d never seen him chain smoke one after the other like that.

And with kids in the room!

Then I noticed the strange glow from the tip of the cigarette. Orange. Bright orange. Perfectly bright orange with a blue halo. And the way the smoke seemed to come out in a consistent volume whether he was puffing on it or not.

Uncle “Smoke” (as my niece and nephews affectionately used to refer to him) was smoking an e-cig!

Coincidence? I think not.

My cousin had introduced his Dad to the e-cig in the hope that he’d use the device(s) to help himself quit.

The e-cig is an aerosolized nicotine delivery device that uses a battery to deliver the “medicine” and create the “vapor” that emanates from the cigarette’s tip to simulate the controlled burn of tobacco and paper in a real cigarette.

As the title of the Annals piece states, e-cigarettes are “a rapidly growing internet phenomenon.” As such, it behooves us to treat this phenomenon with a healthy degree of skepticism. The Annals piece concludes by making the unsurprising claim that more research needs to be done into the products, their effects, and their unintended consequences. For example, just how “safe” is that vapor for non-users in the vicinity of an e-cigarette? And, is there any compelling evidence that absorbing nicotine in this way really helps hard core smokers to cut down or quit?

My first impression was that my uncle was actually “smoking” more, since he no longer was leaving the room to smoke.

After Thanksgiving, my curiosity about e-cigarettes grew. If they’re so “safe,” could they be smoked in hospitals so that addicts could get their fix of nicotine in a way non-harmful to others?

Indeed, a quick internet search turns up this. But take it with a boulder of salt, since it’s a press release from a manufacturer. They do not identify the Tampa hospital that purportedly permits this, nor do they give other examples of accommodating hospitals, even though the headline boasts of e-cigarettes being accepted in “many hospitals.”

For his part, Uncle Ron seems to like the products. He’s “present” more at work, since he now doesn’t need to go outside to smoke. As to whether the e-cigs are helping him quit his tobacco habit, he (and those around him) remain uncertain.


  1. Have witnessed this in person— not sure and I probably doubt the e-cig curtails the addiction. Would love to hear more on how beneficial this product is, to the smoker and to those who surround him. Keep us in the loop as more info becomes available.

  2. I looked this up with my old clinic partner, and if I remember correctly, an e-cig delivers 9 times the amount of nicotine as a regular cigarette. So it seems it would ramp up the addiction, rather than tamp it down. The question is if it’s the smoke inhalation or the nicotine itself doing the first and second-hand damage. We may find out just how bad nicotine alone is for the body.

    In the meantime, the danger, I think, would be the youngsters getting used to seeing people with cigarettes in their mouth accepted into living rooms once again rather than shunned into the cold lonely outdoors. Is that a slippery slope to a new generation of smokers?

  3. glasshospital

    November 29, 2010 at 9:16 pm

    Those are both excellent points. Agree that shunning has strong negative associations for smoking as a behavior, not to mention just about anything else one could be shunned for.

  4. dollarsdownthedrain

    November 30, 2010 at 12:04 pm

    Someone should have told our Illinois legislature that there are alternatives to smoking like the e-cig. I am appalled at our legislators adding to health care costs. I guess the gambling industry has a stronger lobby than the health care industry!!

    An Illinois House committee has approved a measure that would allow gamblers to smoke for the first time in nearly three years on riverboat casinos.

    The legislation sponsored by Chicago Democratic Rep. Andre Thapedi would permit the state’s nine casinos to set up segregated, enclosed smoking areas.

    Proponents say the 2008 statewide smoking ban has hurt gambling because money has gone to other states that still allow smoking on riverboats. Opponents say the legislation is a step backward for public health and that revenue is governed by how nice the facility is — not whether you can smoke in it.

    Thapedi says a study has shown that Illinois is losing $200 million a year in gambling revenue by banning smoking.

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