Demystifying Medicine One Month at a Time

Tag: smoking

Age is Just a Number, Right?

In case you missed them, a couple of lay press articles hammered home the idea of our lifespans being finite.

ezekiel_emanuel_0First there was Zeke Emanuel’s provocatively titled “Why I Hope to Die at 75” in the Atlantic.

The title was unnecessarily inflammatory. A lot of people saw that and thought “Health Care Rationing…” and “what a jerk!

One of the core points of his article is well-taken: when we hit a certain age (75? 80? 85?), it no longer makes sense to “look for disease.”

Health care must continue improving and striving to reflect and honor the wishes of patients, but in addition, we should be more rational about whom we screen for disease and how often. It makes no sense to perform colonscopies in octogenarians to “screen” for colon cancer. Even if they have it, the colonoscopy  is unlikely to extend their life or improve its quality.

I think readers are right to quibble with Emanuel’s contention that at 75 creativity takes a nose dive. He was using that opinion, and the statistical evidence of age-related slowdown, in support of his point about the cutoff age for aggressive medical care. I hope sensible debate is not lost because of his tone and the fact that he’s seen as too political. He did work for the administration during President Obama’s first term, after all.


Cohen in younger days.

That same week, the New York Times published an opinion piece by Jason Karlawash of Penn, who wrote about musician Leonard Cohen’s decision to resume smoking (something he’d quit) upon turning 80. Titled “Too Young to Die, Too Old to Worry,” Karlawash examined how the 80+ population has grown from a half of one percent of the population to more than 3.5%. Doesn’t seem like a huge percentage, but it is certainly a significant increase and a huge demographic shift.

As Karlawash writes in the key paragraph of his piece

…Mr. Cohen’s plan presents a provocative question: When should we set aside a life lived for the future and, instead, embrace the pleasures of the present?

Thank You for Not Smoking Redux

Your employer can tell you to smoke outside. Can they tell you not to smoke at all?

As a doctor, I’m pretty happy that many states and institutions have banned indoor smoking. With the patients I treat, there’s a drastic difference between smokers and non-smokers in terms of suffering and longevity. Smokers get lots more of the former, less of the latter.

They don't call 'em death sticks for nothing.

I wrote previously about e-cigarettes and their growing ubiquity in the para-smoking world. I also blogged from the Cleveland Clinic’s 2010 Patient Experience Summit, where I learned that Mike Roizen, the Clinic’s Chief Wellness Officer, had successfully banned all smoking in employees.

“Kind of par for the course for a hospital,” I remember thinking at first blush. Then he repeated his statement: he’d banned smoking entirely.

Translation: if you smoke, they don’t hire you. If you start smoking, they fire you (at the time I heard him the policy was three years old; two employees had been fired to that point under the policy).

“How can they know what you do on your own time?” you ask. Well, like life insurers, the Clinic tests prospective employees for nicotine metabolites in the urine. You can fib on the questionnaire, but if you’ve recently smoked tobacco, you can’t escape the test.

Now the NY Times is reporting that hospitals in eight states have adopted similar policies. Many have been consulting the Clinic for guidance, where the policy has been in place since 2007.

I’ve always been slightly amused when I walk by clusters of nurses, transporters, environmental service workers (janitors) or patients clustered near the exits of our medical center, getting their fix, usually in shirt sleeves, before heading back into the building. Sometimes I wish the designated smoking areas were a couple of miles away from the exits–then we’d be less likely to inhale a train of smoke as we walk the gauntlet. At least the employees should know better, I often think, stunned to see respiratory therapists in the mix. The same therapists whose job it is to suction pus from the lungs of asthmatics and emphysemics.

Though I find the article’s trend-spotting interesting and in line with my professional values, I think it goes a bit too far in the personal privacy realm. After all, cigarettes, though vilified, are still legal for adults. Will employers start the practice of not hiring other “health-risky” employees (e.g. obese, hypertensive, or diabetic patients)?

What do you think about this?

Clever incentive to make workers at health care institutions walk the walk, or trampling of a civil liberty? Let me have your comments.


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.

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