MEDICAL INNOVATIONS
Smoking Cessation and Internet Telehealth Resources By John J. Seidenfeld, MD and Neal Meritz, MD
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n high school, I smoked with friends down in a ravine near my home. The Seidenfeld home was near Lake Michigan in a Northern Illinois town with ravines memorialized in Ray Bradbury’s “Dandelion Wine.” These were quiet, dark, but sun-speckled places under the shade of large leafy trees where we could be alone and discuss the critical issues of teens. Through high school and then college, smoking continued up to two packages of cigarettes per day and many were unfiltered so that I inhaled burning paper and tobacco deep into the lungs. Attempts at quitting were often met with failure, as the lure of the cigarette and the nicotine drew me back. Just before medical school started, I found a boarding house near campus which was wonderfully clean and quiet. The landlady, Mrs. Bishop, was an elderly woman who climbed the stairs backward to the second floor each day to change towels and clean. Why did she do this? I probably should have done a history and joint exam, but did not know how and why to do either at the time. Her only request was that I not smoke. Her request was a great excuse to quit “cold turkey.” No matter how many times you quit, the last time is “cold turkey.” I imagine there were withdrawal symptoms, but they were lost in the first few weeks and then months and years of medical studies. Each day the desire became less until today, many years later, when I fantasize that I will start again at age 90 (as there are so few studies of the effects of smoking or vaping on nonagenarians). Such is the strength of this disorder.
Smoking tobacco products is the leading cause of preventable deaths throughout the world. The smoke contains thousands of chemicals, and many have been identified as carcinogenic. People who smoke the equivalent of more than 20 cigarettes per day for over 20 years account for approximately $300 billion per year of hospital and health care resources as well as lost productivity. Tobacco executives have testified that they know their products are addictive, and have marketed to young people for years by making the smoker look attractive and sophisticated in movies, commercials and other media advertisements. Many of the large cigarette producers now own companies that sell tobacco vaping products to increase their market share. Currently, many pulmonologists feel that vaping and smoking are equally damaging to the body so that all references to cigarette smoking apply to vaping also in this article. Nicotine in tobacco smoke is one of the most addictive substances known to man. While it is common for many teens to become addicted to tobacco and begin a lifelong habit, quitting is extremely difficult, and few effective resources have been available to help in this effort. Who wants to quit? The motivated smoker who has just had a myocardial infarction (MI) or a pregnant patient have a quit rate near 50% with doctors’ advice and some guidance. Quit rates are usually gauged at six to 12 months after cessation and recidivism is common. Multimodal therapy with long-term counseling support and medications continued on page 18 Visit us at www.bcms.org
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