Mad Men and E-Cigs

Ask Dr. Matt

I must confess, on Sunday nights I kick back with my teenage sons and watch Mad Men. Sometimes we wear suits and ties, and you will always find us clutching double Arnold Palmers (iced tea and lemonade) on the rocks, and see us periodically taking slow, contemplative drags from pretend cigarettes held delicately between our sophisticated fingers. We find a dull golf pencil makes for the perfect ersatz cigarette. I support this ritual, as it allows us to explore and discuss the perils of the philandering cocktail culture of mid-20th-century America (that's my story).

What is the allure of smoking? For me and my boys in the context of Mad Men, I think it is the desire to embrace the calm, intense importance of Don Draper. Yet for more and more teens, it is no fantasy. They are reaching for another pseudo-incendiary device that actually delivers a nicotine payload — the e-cigarette.

Although e-cigarettes may not involve the inhalation of tar and other nefarious toxins that arise from a burning cigarette, it's too soon to tell what impact the inhalation of a vapor of propylene glycol laced with liquid nicotine and "flavor additives" may have on the delicate respiratory tract.

So what exactly is in an e-cigarette? Who knows? E-cigarettes remain an unregulated product with no oversight from the FDA. Part of the concern with any unregulated chemical substance — ingested, injected or inhaled — is the uncertainty about what chemicals are actually being delivered. Studies have shown that the dose of nicotine delivered from device to device, and formulation to formulation, is highly variable. Additionally, substances added for flavor are a complete wild card. As far as real-world risk, with custom blends shared by friends, I worry what other substances — legal or illicit — might be added to a solution. I never underestimate the creative capacity of humans when it comes to ways to harm themselves and others; unfortunately, this holds especially true for adolescents. Indeed, calls to poison control centers related to e-cigarettes are up 200-fold over the past four years.

But even when used exactly as intended, a major concern is that the availability, funky fresh flavors, and relatively stealthy operation of e-cigarettes may serve as an entry point — with accompanying nicotine addiction — to uninitiated youth who would never have used tobacco in any of its other formats. This concerns me as a parent and a health care provider. For now, we need to convey to kids that even if the e-cigarette is vegan-friendly, gluten-free and broccoli-flavored, it is still the vehicle of an addictive, detrimental chemical derived from a tobacco plant, and should be avoided. They should stick with a golf pencil if they want to be cool.

Matt Thompson is a pediatrician at Spokane's Kids Clinic.

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