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Toronto Cardiac Surgeon With E-Cigarette Business


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http://www.cbc.ca/news/business/new-e-cigarette-industry-says-regulations-off-the-mark-1.3024944

 

Highlight: "You have an available worldwide market of $780 billion from smokers that are buying things they're addicted to, that is known to cause harm to them. And you have an alternative product that from my perspective is safer," he said, standing in his shop on Toronto's Yonge Street, still wearing his hospital green scrubs.

 

I'm thrown back to the physician spokesmodels of yonder promoting the use of a plethora of products now known to be harmful. Standing behind a product without adequate longitudinal testing seems questionable, at best, even if the harmful chemicals in e-cigarettes are a fraction of the amount found in the tobacco alternative. There is mounting evidence that e-cigarette use as a cessation aid is ineffective and that e-cigarette users, on average, consume more nicotine than traditional cigarette smokers. Not to mention the lack of regulation and of ease of availability for tweens/teens who are a rapidly growing market of consumers of e-cigarette products.

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http://www.cbc.ca/news/business/new-e-cigarette-industry-says-regulations-off-the-mark-1.3024944

 

Highlight: "You have an available worldwide market of $780 billion from smokers that are buying things they're addicted to, that is known to cause harm to them. And you have an alternative product that from my perspective is safer," he said, standing in his shop on Toronto's Yonge Street, still wearing his hospital green scrubs.

 

I'm thrown back to the physician spokesmodels of yonder promoting the use of a plethora of products now known to be harmful. Standing behind a product without adequate longitudinal testing seems questionable, at best, even if the harmful chemicals in e-cigarettes are a fraction of the amount found in the tobacco alternative. There is mounting evidence that e-cigarette use as a cessation aid is ineffective and that e-cigarette users, on average, consume more nicotine than traditional cigarette smokers. Not to mention the lack of regulation and of ease of availability for tweens/teens who are a rapidly growing market of consumers of e-cigarette products.

Talking to a friend in public health, they had me pretty convinced that current evidence showed that relative to the risk of continuing smoking tobacco cigarettes, E-cigs were a good alternative.  

 

Any links for the new evidence you mention? I haven't looked into it for almost a year now since that last conversation.

 

This is the last article I had bookmarked on the topic: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110871/

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Talking to a friend in public health, they had me pretty convinced that current evidence showed that relative to the risk of continuing smoking tobacco cigarettes, E-cigs were a good alternative.  

 

Any links for the new evidence you mention? I haven't looked into it for almost a year now since that last conversation.

 

This is the last article I had bookmarked on the topic: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110871/

 

Here's a description of one http://theincidentaleconomist.com/wordpress/study-e-cigarettes-did-not-help-people-quit-smoking/

 

Really, the research right now is fairly equivocal on the actual difference between e-cigarettes and normal cigarettes, so making hard claims in either direction probably isn't justified. Theoretically e-cigarettes should be safer, given a more pure product, but that hasn't necessarily been validated, nor has the claim that e-cigarettes help reduce or stop smoking.

 

In any case, while the relative merits might be up for debate, the absolute merits of e-cigarettes are fairly clear - they're not good for you. It might be better to substitute an actual cigarette with an e-cigarette, but it's definitely not better to have an e-cigarette than to not smoke at all. The emerging policies really just try to make e-cigarettes as difficult to get as regular cigarettes, so that they don't become an attractive option to those who would have never smoked a regular cigarette in the first place. So, a health care professional expressing opposition to new regulation on e-cigarettes is worrisome, especially since they profit off sales of e-cigarettes. Those regulations make no difference if the main goal of e-cigarette use is quitting smoking or as an alternative to conventional cigarettes. Where they do make a difference is in preventing expansion of e-cigarettes into new markets or new users (particularly children). It certainly sounds like this physician is more concerned with his own bottom line than the health of people using his products.

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It might be better to substitute an actual cigarette with an e-cigarette, but it's definitely not better to have an e-cigarette than to not smoke at all. The emerging policies really just try to make e-cigarettes as difficult to get as regular cigarettes, so that they don't become an attractive option to those who would have never smoked a regular cigarette in the first place. So, a health care professional expressing opposition to new regulation on e-cigarettes is worrisome, especially since they profit off sales of e-cigarettes.

 

Exactly this for me. It's one thing to suggest an e-cigarette as an alternative to traditional cigarettes, but to be promoting the sale of products in his own store while wearing his hospital scrubs is quite concerning to me. He's in a position of trust and privilege as a doctor and to use that as influence to leverage the sale of a product that is addictive and causes adverse health effects is inappropriate. Especially when he's lining his own pockets as a result of their sale.

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Sounds like this doc can't be trusted. My personal opinion only.

Who in their right mind desires to become a doctor / a public healer and leader and then at the same time stands behind something that lacks evidence and is potentinally harmful. Someone greedy for the $  $ $ of course.

 

It is one thing as a health professional to have personal enjoyments / habits like smoking or drinking; but it is entirely different when you are investing in a product for financial gain and it is to your advantage to have people do something harmful (smoke more) so that you can make a profit.

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Well, nicotine's not great, but doctors still recommend nicotine patches over smoking, yeah? I don't see any reason why we can't say "if you have to smoke and won't quit, e-cigs are better".

 

I agree with that sentiment and I don't take much issue with that. Stating to an individual that there is a less harmful alternative than what is currently being used if the ideal solution is not immediately viable seems reasonable and has been proven beneficial in other scenarios. Methadone clinics are an obvious example. The difference there is that there is a harm reduction model in place to support opioid dependent users under the guidance of a physician.

 

What I don't agree with here is selling a harmful product to the general public as a physician while wearing hospital scrubs, no less. I think that it's possible to go so far as to say that this is conduct unbecoming of the profession. Dr. Bhatnagar is promoting and selling a product for his own benefit under the guise of it being less harmful than traditional cigarettes.

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Well, nicotine's not great, but doctors still recommend nicotine patches over smoking, yeah? I don't see any reason why we can't say "if you have to smoke and won't quit, e-cigs are better".

But people who have never smoked don't generally just use nicotine patches for fun. That's the difference.

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Well, nicotine's not great, but doctors still recommend nicotine patches over smoking, yeah? I don't see any reason why we can't say "if you have to smoke and won't quit, e-cigs are better".

 

In addition to the point made that e-cigarettes are being sold as more than just a smoking substitute, it's also worth noting that e-cigarettes contain more than just nicotine. They have additives as well and the research on their overall safety - while likely to be superior to conventional cigarettes - is still lacking.

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Junior medical students condemning an established cardiac surgeon who has probably seen the effects of smoking cigarettes day in and day out for all of his time in practice.....quite rich. Especially since, some could say, he is improving access to less harmful substitutes for smokers that are refractory to quitting.

Cardiologists have come on in swarm (this surgeon isn't the first) to support e-cig use. The argument "the research isn't there to support it over smoking" is ludicrous. E-cigs generally have 4 ingredients in them: nicotine, propylene glycol (converts to pyruvate in the blood, and we all hopefully know what that is, no evidence to suggest it is an irritant to the lungs or a carcinogen of any form), vegetable glycerin (glycerol, again enters the krebs cycle after conversion in the bloodstream, and PS it is a regular circulating compound in the blood stream. Also no evidence to show it is harmful via the inhalational route), and flavouring. Cigarettes contain a shitload of chemicals and have been PROVEN to induce both cancer and COPD, as well as being implicated in a large number of other diseases. 

"But e-cig users use so much more nicotine!!!" you scream loudly. Oh well, it's a good thing nicotine is (again) a naturally produced neurotransmitter in the body, and is relatively harmless in most doses other than raising your BP slightly (impossible to overdose via the inhalation route, as you will get sick LONG before you OD. Easy peasy to OD via a patch).

There you have it. No research into the combined chemicals but anyone who says that cigarettes could be less dangerous than an e-cig is an imbecile. It simply doesn't make any sense. If I tell you that my pen is black, it's black. We don't need someone to do a survey to confirm that it's black, just like this. There is a whole other world at war here, and no one mentions it because it's a huge confounding factor the regulators don't want you to know about: the economy is helped in a huge part by the sale of cigarettes, which are heavily taxed. 

 

Oh and as for the argument that "if we allow this, kids who wouldn't have smoked otherwise would get addicted to smoking!" Surely not (for the most part) since a non smoker that wants to vape is likely to buy the nicotine-free liquids, not to mention that it is restricted in its sale to minors, anyways. Also, we can't use the argument for the "slippery slope", since the slope is in fact a fallacy. We have no idea if kids will be attracted to e-cigs and start using them. We can't know. It's just an argument the opponents of e-cigs (likely the tobacco companies) made up to try to keep their rise on the down-low.

 

And as for junior medical students condemning physicians for what they choose to do or not do: I'd tighten that up real quick. Having a reputation for being a dipshit and not respecting the hierarchy of medicine is a right quick way to find yourself unpopular around CaRMS time.

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I don't disagree with a doctor recommending e cigarettes over regular cigarettes. Like you said, the jury is still out on it, but there is most likely a harm reduction in smokers.

 

But I don't see why a doctor should be SELLING anything so questionable on the side.

 

Also, why are you so uppidy about "junior med students" having an opinion? Sure, they aren't experts yet, but that doesn't mean they can't voice an opinion. Perhaps give their views a bit less weight, but to say their views are invalid? That's taking credentialism too far.

 

Is discussion and critical thinking forbidden until you are an attending out of "respect for the hierarchy of medicine?

 

Sounds a bit scary to me.

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Junior medical students condemning an established cardiac surgeon who has probably seen the effects of smoking cigarettes day in and day out for all of his time in practice.....quite rich. Especially since, some could say, he is improving access to less harmful substitutes for smokers that are refractory to quitting.

 

Cardiologists have come on in swarm (this surgeon isn't the first) to support e-cig use. The argument "the research isn't there to support it over smoking" is ludicrous. E-cigs generally have 4 ingredients in them: nicotine, propylene glycol (converts to pyruvate in the blood, and we all hopefully know what that is, no evidence to suggest it is an irritant to the lungs or a carcinogen of any form), vegetable glycerin (glycerol, again enters the krebs cycle after conversion in the bloodstream, and PS it is a regular circulating compound in the blood stream. Also no evidence to show it is harmful via the inhalational route), and flavouring. Cigarettes contain a shitload of chemicals and have been PROVEN to induce both cancer and COPD, as well as being implicated in a large number of other diseases.

"But e-cig users use so much more nicotine!!!" you scream loudly. Oh well, it's a good thing nicotine is (again) a naturally produced neurotransmitter in the body, and is relatively harmless in most doses other than raising your BP slightly (impossible to overdose via the inhalation route, as you will get sick LONG before you OD. Easy peasy to OD via a patch).

There you have it. No research into the combined chemicals but anyone who says that cigarettes could be less dangerous than an e-cig is an imbecile. It simply doesn't make any sense. If I tell you that my pen is black, it's black. We don't need someone to do a survey to confirm that it's black, just like this. There is a whole other world at war here, and no one mentions it because it's a huge confounding factor the regulators don't want you to know about: the economy is helped in a huge part by the sale of cigarettes, which are heavily taxed.

 

Oh and as for the argument that "if we allow this, kids who wouldn't have smoked otherwise would get addicted to smoking!" Surely not (for the most part) since a non smoker that wants to vape is likely to buy the nicotine-free liquids, not to mention that it is restricted in its sale to minors, anyways. Also, we can't use the argument for the "slippery slope", since the slope is in fact a fallacy. We have no idea if kids will be attracted to e-cigs and start using them. We can't know. It's just an argument the opponents of e-cigs (likely the tobacco companies) made up to try to keep their rise on the down-low.

 

And as for junior medical students condemning physicians for what they choose to do or not do: I'd tighten that up real quick. Having a reputation for being a dipshit and not respecting the hierarchy of medicine is a right quick way to find yourself unpopular around CaRMS time.

I think this is really, really harsh. First of all, it's an Internet forum. None of us are going to walk around on the words criticizing our superiors. Big difference.

 

Second, although you make some good points, you are seriously over-exaggerating the points made by others on this thread.

 

No one said ciggarettes are safer. That's stupid.

 

Also, a lot of the concerns raised here were know regards to someone mostly likely advocating something in his practice, then also making money from the purchase of said product. It's sketchy.

 

Lastly, there are plenty of benefits of nicotine that people might be willing to try without the ick factor of ciggarettes. Weight suppression and mental focus come to mind. So I don't think your assertion that people who don't smoke will just get the nicotine free type is really all the strong.

 

Edit: I got distracted mid post and makingfetchhappen beat me to a lot of my points.

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Junior medical students condemning an established cardiac surgeon who has probably seen the effects of smoking cigarettes day in and day out for all of his time in practice.....quite rich. Especially since, some could say, he is improving access to less harmful substitutes for smokers that are refractory to quitting.

 

Cardiologists have come on in swarm (this surgeon isn't the first) to support e-cig use. The argument "the research isn't there to support it over smoking" is ludicrous. E-cigs generally have 4 ingredients in them: nicotine, propylene glycol (converts to pyruvate in the blood, and we all hopefully know what that is, no evidence to suggest it is an irritant to the lungs or a carcinogen of any form), vegetable glycerin (glycerol, again enters the krebs cycle after conversion in the bloodstream, and PS it is a regular circulating compound in the blood stream. Also no evidence to show it is harmful via the inhalational route), and flavouring. Cigarettes contain a shitload of chemicals and have been PROVEN to induce both cancer and COPD, as well as being implicated in a large number of other diseases. 

"But e-cig users use so much more nicotine!!!" you scream loudly. Oh well, it's a good thing nicotine is (again) a naturally produced neurotransmitter in the body, and is relatively harmless in most doses other than raising your BP slightly (impossible to overdose via the inhalation route, as you will get sick LONG before you OD. Easy peasy to OD via a patch).

There you have it. No research into the combined chemicals but anyone who says that cigarettes could be less dangerous than an e-cig is an imbecile. It simply doesn't make any sense. If I tell you that my pen is black, it's black. We don't need someone to do a survey to confirm that it's black, just like this. There is a whole other world at war here, and no one mentions it because it's a huge confounding factor the regulators don't want you to know about: the economy is helped in a huge part by the sale of cigarettes, which are heavily taxed. 

 

Oh and as for the argument that "if we allow this, kids who wouldn't have smoked otherwise would get addicted to smoking!" Surely not (for the most part) since a non smoker that wants to vape is likely to buy the nicotine-free liquids, not to mention that it is restricted in its sale to minors, anyways. Also, we can't use the argument for the "slippery slope", since the slope is in fact a fallacy. We have no idea if kids will be attracted to e-cigs and start using them. We can't know. It's just an argument the opponents of e-cigs (likely the tobacco companies) made up to try to keep their rise on the down-low.

 

And as for junior medical students condemning physicians for what they choose to do or not do: I'd tighten that up real quick. Having a reputation for being a dipshit and not respecting the hierarchy of medicine is a right quick way to find yourself unpopular around CaRMS time.

 

1) It's not just "junior medical students" taking this stance on e-cigarettes. There are many fully-qualified physicians who have expressed similar viewpoints, not to mention patient advocacy groups, Health Canada, and the WHO.

 

2) Lack of evidence of harm is not the same as evidence indicating no harm. I think it's quite likely that e-cigarettes are less harmful than traditional cigarettes, but more research needs to be done to establish exactly what the potential consequences of e-cigarette use might be. Until then, when dealing with a chemically addictive substance, it is reasonable to be cautious about promoting its widespread use. All that's being suggested is that e-cigarettes be treated the same as regular cigarettes. If they are truly meant as a harm-reduction method for smoking, there should be no issues with that - anyone who can get access to a cigarette now would still be able to access an e-cigarette under the proposed measures.

 

3) Tobacco companies all own e-cigarette brands and promote them. With smoking on the decline in North America, an expansion of the e-cigarette market does quite a bit to help their bottom lines. As you say, I'm a junior medical student, no one pays me anything, least of all tobacco companies. So when I say e-cigarettes are too accessible to minors, that's not an idea coming from a tobacco company.

 

4) Contrary to your assertion, nicotine is not an endogenously-produced neurotransmitter. We have nicotinic receptors in our bodies, not nicotine. I would think someone who is so quick to disparage and threaten junior medical students, promoting the "hierarchy of medicine", would at least know that basic fact.

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Junior medical students condemning an established cardiac surgeon who has probably seen the effects of smoking cigarettes day in and day out for all of his time in practice.....quite rich. Especially since, some could say, he is improving access to less harmful substitutes for smokers that are refractory to quitting.

 

Cardiologists have come on in swarm (this surgeon isn't the first) to support e-cig use. The argument "the research isn't there to support it over smoking" is ludicrous. E-cigs generally have 4 ingredients in them: nicotine, propylene glycol (converts to pyruvate in the blood, and we all hopefully know what that is, no evidence to suggest it is an irritant to the lungs or a carcinogen of any form), vegetable glycerin (glycerol, again enters the krebs cycle after conversion in the bloodstream, and PS it is a regular circulating compound in the blood stream. Also no evidence to show it is harmful via the inhalational route), and flavouring. Cigarettes contain a shitload of chemicals and have been PROVEN to induce both cancer and COPD, as well as being implicated in a large number of other diseases. 

"But e-cig users use so much more nicotine!!!" you scream loudly. Oh well, it's a good thing nicotine is (again) a naturally produced neurotransmitter in the body, and is relatively harmless in most doses other than raising your BP slightly (impossible to overdose via the inhalation route, as you will get sick LONG before you OD. Easy peasy to OD via a patch).

There you have it. No research into the combined chemicals but anyone who says that cigarettes could be less dangerous than an e-cig is an imbecile. It simply doesn't make any sense. If I tell you that my pen is black, it's black. We don't need someone to do a survey to confirm that it's black, just like this. There is a whole other world at war here, and no one mentions it because it's a huge confounding factor the regulators don't want you to know about: the economy is helped in a huge part by the sale of cigarettes, which are heavily taxed. 

 

Oh and as for the argument that "if we allow this, kids who wouldn't have smoked otherwise would get addicted to smoking!" Surely not (for the most part) since a non smoker that wants to vape is likely to buy the nicotine-free liquids, not to mention that it is restricted in its sale to minors, anyways. Also, we can't use the argument for the "slippery slope", since the slope is in fact a fallacy. We have no idea if kids will be attracted to e-cigs and start using them. We can't know. It's just an argument the opponents of e-cigs (likely the tobacco companies) made up to try to keep their rise on the down-low.

 

And as for junior medical students condemning physicians for what they choose to do or not do: I'd tighten that up real quick. Having a reputation for being a dipshit and not respecting the hierarchy of medicine is a right quick way to find yourself unpopular around CaRMS time.

Idk if you're implying you've already passed through the junior med student stage, but highlighted are the reasons there's no way haha

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I have an issue with people telling others not to upset the hierarchy of anything. Sometimes the hierarchy needs to be upset. Like when a cardiac surgeon is selling e-cigs.

 

=/

So much this. 'That's the way it's always been done' is almost never a valid argument.

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