I will admit that I have done some questionable things in my life. Underlying my stoic image I try to promote is a rebellious nature. The older I get the more I try to channel that rebellion into more productive venues.
Well, the medical industry has sunk its claws into patient care. Since becoming a provider it has become increasingly evident to me just how invasive their influence is. The lobbying for government approval bars many competitors from entry. The agencies that are supposed to protect you actually make you far more vulnerable to rises in cost and to being taken advantage of.
In light of this awareness I have of my own field, and with my demographic of patients frequently being tobacco users, my interests were piqued a couple years ago when some libertarian podcasts I listened to were talking about the bogus reports of “popcorn lung” and some of the other scary headlines about vaping. It isn’t that there weren’t some concerns with the devices, but the medical conditions were from bootleg or after market replacement cartridges for those e-cigs and vaping pens.
These articles struck a chord with me, because I trust that brands have a vested interest in protecting their image and reputation. In the wake of these articles, not a single brand was pulling any products from circulation.
In the land of actually understanding markets and some economics, that means a lot. It means they weren’t afraid of being taken to court for their products, because their products weren’t at fault.
As I dug deeper, it also became very clear that there was something very under appreciated about vaping products. While some were concerned that vaping was going to act as a gateway to tobacco use, the exact opposite was actually true. Actual people who were using tobacco were adopting vaping products and removing tobacco from their habits. So why wasn’t this sanctioned by regulating bodies?
Read that again and if you still don’t understand it, what I’m saying is that a known carcinogen was being replaced by a vastly more benign product, and it was being adopted on a very wide basis. It didn’t require any frying eggs in pans with threat of what your lungs would look like, or even any taxes to penalize bad habits. It just required giving a better alternative and letting it compete.
Providing medicine was still difficult, though. Until the recent FDA approval of some vaping products this week, it wasn’t sanctioned and formally recommending it to patients wasn’t sanctioned. I also couldn’t prescribe it as nicotine replacement.
That didn’t stop me from letting my rebellious nature work, though.
I would talk to patients about the difficulty of stopping and that it is only likely if the patient really desires it. Sometimes I would even be blunt and tell them if they really wanted to stop, they could do so cold turkey. I meant it. If someone really wanted to stop, they could. The problem is that most smokers who want to stop also don’t want to deal with the symptoms of withdraw that come from stopping the nicotine.
Brutal honesty is my policy. I share these thoughts in concerning ways, but I won’t soften the truth.
I tell them the purpose of the nicotine replacement is simply to help them avoid the symptoms of stopping the nicotine. The symptoms would only last for 2 or 3 days for the majority of people, but we spread those symptoms out over weeks which lessens their effect and allows people to slowly remove nicotine.
It works.
What is problematic is that far more often, people struggle because the gum doesn’t get them their social work break. The patch doesn’t give them the oral fixation that has also become a mental habit. The drive to put something to their lips and get a drag off the item is too strong to avoid simply by their own willpower. I actually think if it wasn’t for those other factors, the vast majority of my patients seeking smoking cessation would actually just quit. They miss the breaks, the drag, and the social camaraderie that comes with their habit, though.
Vaping offered me an alternative to offer patients. The fact that I was pitching it to a younger audience that also probably had a sense of rebellion among them, increased the adoption of this secret that I offered them and refused to put in my notes.
Here’s the best part. It works.
Just the other day I had a patient come to me for smoking cessation. This patient had already transitioned to vaping with nicotine products and was cutting back on the nicotine through the vaping pods. Instead of packs per day, we’re going to have to change our jargon to pods per day. This patient had already reduced the nicotine pod to the lowest nicotine percentage available and each pod was lasting 2-3 days.
This meant nothing to me. I don’t smoke, and I don’t vape. Nothing in my smoking cessation training taught me anything about doing nicotine replacement options for pod per day usage.
I called in the big guns…the clinical pharmacist.
He didn’t know either. So after several phone calls with the patient from each of us, we gleaned that the amount of nicotine the patient was consuming was the equivalent to 1.8 cigarettes, over 2-3 days.
Yup. You read that correctly. The patient had already essentially removed nicotine entirely of their own accord by simply moving to lower nicotine percentage pods.
After conversing with the pharmacist the decision seemed clear. There is no prescription dosing of nicotine replacement therapy available for the patient that is lower than what the patient was currently consuming. I would actually be prescribing a higher dose of nicotine if I tried to give a patch or replace the frequency of vaping with gum.
I awkwardly called the patient and offered good news and bad. She wanted the bad news first. “There is nothing I have to offer you.” Silence. She asked what the good news was, so I informed her that she could simply move to nicotine free pods and she would have completely removed tobacco and nicotine from her life entirely. She had managed to treat her own nicotine addiction and control it on her own accord better than I could have done for her by leveraging the best resource available for any service or product any of us could need…the free market.
She actually apologized to me for wasting an appointment. I was in hysterics. I congratulated her for doing an incredible job.
I also instructed her not to worry and thanked her for the appointment. The pharmacist and I were both stumped and impressed by the results. We both learned and we are both recommending it to patients who seek our care regarding smoking cessation going forward (I didn’t tell him I have been recommending it for a couple years). Her scheduling of that encounter improved my knowledge of the subject, will improve my counseling of patients in future encounters, and will improve results for patients all over the place.
The only downside I have noted, and intentionally kept from her, is that now I will have to find a new way to rebel, considering my counseling to transition to vaping products is sanctioned by the FDA, I can actually include it in my notes and not just in the private conversations with my patients I don’t record.
Oh well. It won’t take me long to find another frustrating oversight in medicine. Have I told you about the egregious way we allow corporations and government to drive the costs of medicine higher?
Stand by.
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