Does the risk of e-cigarettes exceed potential benefits? You betcha!

The use of e-cigarettes continues to dramatically increase, and the debate over their safety and appropriate use has heated up, in parallel. We as pulmonary clinicians are called upon to advise our patients and others about e-cigarettes, which presents challenges given the current limitations of the data upon which our advice should be based. What do we say?

At first glance the use of e-cigarettes appears to be an attractive option. Evaluation of the ingredients and particulates associated with e-cigarette vapors has demonstrated a substantial decrease in carcinogens compared with the traditional cigarette…E-cigarettes can deliver nicotine in a form that is familiar to the traditional smoker, yet lacks many of the harmful constituents of cigarette smoke. The optimist envisions a cohort of multi-pack year smokers switching to the e-cigarette with a resultant rapid decrease in risks of heart disease, chronic lung disease, and cancer. But is this optimism justified by empiric evidence of safety, and favorable data on patterns of use, or is this simply wishful thinking?…

Most defenders of e-cigarette use base their perspective on the concept of harm-reduction, and the assumption that the only users of e-cigarettes are or will be current tobacco smokers looking for a safer cigarette. One of the early concerns with the e-cigarette, however, was that it might introduce young, nontobacco users to nicotine addiction, and there is recent evidence to support the validity of that concern. A recent cross-sectional survey-based study reported on trends of e-cigarette use from 2010 through 2013. E-cigarette use increased dramatically over this interval. The highest prevalence of use was among very young adults, ages 18-25. A third of current e-cigarette users were nonsmokers and 1.4% were never-smokers…

The trend toward younger groups being aware of and using e-cigarettes is also on the rise. A survey of 4,780 middle school and high school students from Connecticut identified a high rate of awareness, as well current and lifetime use, of e-cigarettes among those students…Additionally, a study that sought to gauge “openness” to starting tobacco products identified the use of e-cigarettes as a significant factor in being likely to try tobacco products in the future…

What all of these studies tell us collectively is that the cohort of e-cigarette users is growing, young, and open to using both e-cigarettes and traditional tobacco products — not a group of seasoned smokers trying to quit or looking for an alternative to the traditional cigarette. The e-cigarette may well contribute to an overall increase in nicotine addiction.

E-cigarettes have not been marketed as cessation aids (as doing so would have implications for FDA regulation) but have been advocated for this purpose, and many smokers have purchased these products as a way to stop smoking. Despite anecdotal reports that suggest effectiveness, there is not good evidence to suggest that e-cigarettes are superior to traditional, FDA-approved approaches to smoking cessation…

Multiple studies have reported on the toxicities that are associated with e-cigarette use. These studies have established that e-cigarettes are associated with increased nausea, vomiting, headache, choking, and upper airway irritation…One study demonstrated that after only 5 minutes of smoking an e-cigarette, subjects’ airway resistance significantly increased from baseline. In these same individuals exhaled FeNO was also decreased indicating that after only 5 minutes of exposure there was a significant change in the biologic function of the lung.

In other words, don’t believe the bullshit and quit smoking via reliable, proven means and methods. And don’t let your kids feed you a snowjob about e-cigarettes being a truly safe alternative to regular cigarettes. You lose. They lose.

My Apple Watch after 5 days! – Living with Usher Syndrome by Molly Watt

I don’t especially do reviews of hardware or software. Folks who know me well know I spent 22 years in the IBM/Microsoft environment and then walked away [happily] into the Apple world in 2005 with the advent of the Mac Mini. As Steve Jobs expected, many folks like me became a switcher.

This blog post from Molly Watt was suggested by my friend Om Malik and deserves attention because of Molly’s special needs – and uses of the Apple watch. Interesting, useful, a worthwhile read.

Having known about the Apple Watch for some time and knowing lots of my friends were planning to buy one, I was sceptical as my needs are quite different to that of those of the sighted and hearing.

I have to rely on specific accessible features.

However, I was curious as Apple products have been more than just up market gadgets to me, they really have been my access to the many things most take for granted but that those of us with deafblindness, particularly struggle with.

I was born deaf and registered blind when I was 14. The condition I have is Usher Syndrome Type 2a. I am severely deaf and have only a very small tunnel of vision in my right eye now so I was concerned not just about the face size but how busy it would appear to me and also if there would be an uncomfortable glare…

I should explain that I wear two digital hearing aids and communicate orally – not everybody with usher syndrome communicates orally and there are not two people with the condition the same, but there are similarities.

I had been wearing a Bradley Timepiece since last summer and love both the retro look and the practicality of a completely tactile watch brilliant and stylish, quite a rarity when it comes to anything designed specifically for people with disabilities.

I can read the time by touch completely independently with my Bradley and I still love it…

I decided to order the Apple Watch Sport 42mm (the bigger face size) with white strap so I’d not lose it quite so easily…

I was surprised to receive an email the day before launch date to say my Apple Watch had been dispatched and you guessed it “I was excited!”

I was delighted when the long white box arrived on Friday morning as I was heading into London that afternoon.

Please read on.

Giant rats saving lives — by Nicholas Kristof

hero rat
Click to enlarge

I’m walking in a minefield here in rural Angola, tailing a monster rat.

This is a Gambian pouched rat, a breed almost 3 feet from nose to tail, the kind of rat that gives cats nightmares. Yet this rat is a genius as well as a giant, for it has learned how to detect land mines by scent — and it’s doing its best to save humans like me from blowing up.

These rodent mine detectors have been dubbed HeroRats, and when you’re in a minefield with one that seems about right. You’re very respectful, and you just hope this HeroRat doesn’t have a stuffed nose.

I’m here because five years ago, my kids gave me a HeroRat for a Father’s Day present through I didn’t actually take physical possession (fortunately!) but the gift helped pay to train the rat to sniff out explosives. And now I’ve come to minefields of rural Angola to hunt for my rat.

There are 39 HeroRats here, and they underscore the way the aid world is increasingly embracing innovative approaches to old challenges.

I’ve seen land-mine detection in Afghanistan and elsewhere, and it’s dreadfully slow and inefficient. Typically, men in body armor walk in precise rows holding metal detectors in front of them. Whenever they come across metal, they stop and painstakingly brush away the soil until they see what it is.

Usually it’s an empty AK-47 cartridge or a nail. Sometimes there is metal every few inches. Each time, the whole process stops until the soil can be brushed away.

In contrast, the rats scamper along on leashes. They respond only to the scent of explosives, so scrap metal doesn’t slow them down.

At this minefield, which is full of metal objects, a human with a metal detector can clear only about 20 square meters a day. A rat can clear 20 times as much.

“Rats are also more reliable,” said Alfredo Adamo, a field supervisor here. “With humans, concentration wanes after a while, but rats just sniff away.”

The rats are paid in bananas, peanuts, avocados and apples, and they don’t need body armor — partly because they’re too light to set off land mines. (They can still weigh up to 2.5 pounds, which is a lot of rat when you’re face to face.)

I think I found my rat: a scraggly codger named Boban who is just the right age to have been trained when my kids sponsored the rat. Boban was named after a Tanzanian soccer star, and the handlers said he was highly dependable.

A story very much worth reading. A program very much worth supporting.

You also might consider telling your elected officials in Congress to press to sign the Mine Ban Treaty. The United States still hasn’t done so.