Dr. Thomas Erling Kottke looks forward to a future when we might say, "Boy, was that a dumb idea." The medical director for well-being with HealthPartners, and a cardiologist for 40 years, Kottke of St. Paul is talking about ubiquitous e-cigarettes. His particular concern is young people with developing brains who have taken to vaping like candy — and who can blame them when the devices offer up flavors like bubble gum and birthday cake? With lung illnesses and deaths rising across the country, including at least three vaping-related deaths in Minnesota, Kottke urges parents, teachers and community leaders to step up to protect our youth. He elaborates below.
Q: On a scale of 1 to 10, 10 being the most urgent, where would you place the issue of teens and vaping?
A: We're at about 15.
Q: That's a powerful statement. What concerns you most?
A: In addition to the problem of nicotine interfering with adolescent brain development, I'm concerned about the number of Americans who will be irreversibly damaging their lungs by vaping. We have experience from workers in the microwave popcorn industry inhaling aerosolized butter flavoring. The only definitive treatment of that harm is lung transplant. There are about 15 million high school students in the U.S. If even 1% vape and get really sick, that's 150,000 students in need of lung transplants. Surgeons in the U.S. do about 2,000 per year now. The math is not hard.
Q: People seem to be vaping everywhere now, but I believe that e-cigarettes only came onto the scene about a decade ago. Do you know the back story of why they were introduced? Was it altruistic (really to help people quit smoking) or cynical (a new way to hook people as cigarette smoking declined)?
A: I'm willing to concede that some of the development was altruistic, but I find it hard to believe that the development of Juul was. After all, what 50-year-old trying to quit smoking needs flavorings like bubble gum and birthday cake delivered in a device that looks just like a thumb drive and can be secreted in the palm of the hand? Juul had a relatively rocky start with venture capital financing, but now has enough capital to push back hard against control efforts.
Q: What role, if any, does Big Tobacco play?
A: To the best of my knowledge, Big Tobacco wasn't behind e-cigs initially, but they are heavily invested now.
Q: Where does the U.S. Food and Drug Administration stand on e-cigarettes as a quit-smoking aid?
A: The FDA has not approved them as quit aids. Their website says that products such as electronic nicotine delivery systems (i.e. electronic cigarettes) "would need to be proven safe and effective for smoking cessation and regulated as a drug product." But I think the FDA has been much less active and effective than their website suggests.
Q: What's the youth appeal of vaping? The flavors? The way it looks?
A: It's been more than half a century since I've been young, so it's probably best to ask some young folks. However, what we do know from surveys is that adolescents believe that vaping is safe. With the flavored nicotine, the user gets something that tastes like candy and gives a buzz. Plus, with Juul, the user can do it right in class as a way of thumbing their nose at the teacher. Vaping cannabis is about getting a hit. Lung to brain time is very short.
Q: Speaking of that, health officials are doubly concerned about illegal vape pods, some containing THC (the active ingredient in cannabis) — because teens and young adults might not have any idea what is really in them. As a doctor, have you seen some scary outcomes of misuse of vaping devices?
A: Absolutely! This is the big fear, because unidentified chemicals that come with the vaped THC are causing most of the deaths. The bootleg pods are very difficult to distinguish from the legitimate pods, and we have no idea about what is in the bootleg pods.
Q: How do we parents convince our kids we're not being alarmist?
A: Some parents will try and some won't. And parents who vape are unlikely to convince their kids of the risk. This is a "yes, and" moment. Yes, this is dangerous and we both need to stop. We need everybody on board to address this looming disaster — parents, teachers, clergy, community leaders. But, frankly, I don't think that giving advice to people not to vape will stop the current epidemic. Personally, I think what we need to do is what San Francisco has done — prohibit the sale of vaping devices.
Q: Some say it's harder to quit vaping than smoking cigarettes. Why?
A: I can't say for sure, but if quitting vaping is like quitting spit tobacco, the user can get much higher levels of nicotine and, with products like Juul, they can do it anywhere and everywhere.
Q: If someone wants to stop vaping, what do you recommend?
A: We know that having a quitting coach and using FDA-approved medications, such as Chantix, Wellbutrin and nicotine replacement products, increases the odds of success. So if they are vaping nicotine, I'd suggest they call 1-800-QUIT-NOW, the smoking cessation quit line. If they are vaping THC and are having a hard time quitting, they should see a primary care physician so that they can be referred to a psychologist or psychiatrist.
