Friday, March 7, 2014

Vaping Vs. Toking. The Politically Correct Choice.

The Los Angeles City Council last Wednesday voted to treat the newly trendy electronic cigarettes the same way tobacco cigarettes are treated: no smoking allowed inside restaurants, bars, or workplaces. Their justification is that vaping, the term for using an e-cigarette, has not been studied well enough to understand the long term effects of the second hand water vapor that emanates from these devices on the health of innocent bystanders. Plus they fear that the nicotine in e-cigs might lead the user into using the real tobacco product so they must protect the public for its own good.

Frankly I don't advocate anybody putting any flaming substance to their lips and inhaling. But I can't applaud the City Council's actions when I consider their perverse embrace of marijuana dispensaries dotting the landscape all around LA. While e-cigs are legal devices, medical marijuana, with a couple of exemptions, are illegal in most states and throughout the country under federal law. Yet members of the Council have made impassioned pleas for marijuana shops to be allowed to operate without excessive regulation.

This embrace of the still unauthorized marijuana reaches all the way up to the top of this left wing presidential administration. The country's number one law enforcer, U.S. Attorney General Eric Holder, is even giving advice to banks on how to work with marijuana dispensaries in the hope that these businesses, wink wink, can become more successful.

All this love for marijuana seems misplaced. While tobacco smoking has been linked to lung cancer, smoking marijuana can lead to respiratory illnesses too. Tokers are placing burning plant leaves into their lips and mouths, inhaling the smoke just like cigarettes. Consequently particulate substances reach down into the lungs the same way tobacco particles do. Don't tell me marijuana leaf particles are somehow more benign than tobacco. The City Council's concerns regarding the potential addictive qualities of the nicotine in e-cigs also doesn't jibe when they dismiss the addictive nature of marijuana. The reason pot users need to toke every day is because of their addiction, not because of their glaucomas.

I can understand why the city government is advocating for a banned substance while shutting down the use of a legal one. Most of these members probably have used pot in the past. They're mostly of the baby boomer generation who flauted laws as a matter of pride. Drug culture became their culture. That's why before every concert and ball game there is a public service announcement saying no smoking is allowed but everybody starts lighting up their pot as soon as the event begins. Yet there isn't a bouncer in sight who will throw out a pot user but if somebody lights up a tobacco cigarette there would be mass hysteria to get the user kick out. And no, not all of us enjoy the second hand smoke from marijuana.

So while it's good and well that the LA City Council members are looking after the welfare of e-cigarette users by attempting to keep them off the nicotine dispensing devices, their words would carry more weight and appear less hypocritical if they also embraced the fact the marijuana can be equally harmful. Plus what part of ILLEGAL don't they understand?


  1. Hey ZMD,

    I'm a med student who loves what you write! I'm seriously considering anesthesiology. Just wondering if you would still do anesthesiology given today's environment with all the doom and gloom under ObamaCare? Is there a still a future for it? I see posts over at Student Doctor Network like this and get a little worried --

    Any thoughts for hopeful med students?

    If not anesthesiology, I'm considering critical care.

    1. Wow there sure is a lot of anxiety and fear among medical students. This is just the latest in a long string of emails and comments recently asking me for my prognostication of the future of anesthesiology. All I can say is that I love the work that I do. It is challenging every day, every case, even if it is just a hernia repair.

      There isn't much I can do about the future of medicine. I contribute to ASAPAC every year to make sure anesthesiologists are being heard on Capitol Hill. Whether lawmakers actually act on our ideas though is questionable. If students and residents are worried about the encroachment of CRNA's, then I've got news for you: mid level healthcare workers are expanding their scope of practice in all fields. There is no escape by going into IM since PA's and NP's are also concentrating their efforts there. Surgery may be a refuge but most surgeons I know hate their lifestyles and the low reimbursements.

      So all I can say is that you go into a field that you would love to work in every day. If you're in it for the money, better drop out of medicine now. This is not for you. Job security? This is the 21st century. Nobody, not even Googlers, city union workers, or members of Congress, is guaranteed a job for life. Uncertainty is the only constant until we toil off into the void.

    2. Thanks ZMD! I appreciate your response.

      Please don't get me wrong, I do love anesthesiology (as well as critical care and a couple of other specialties, though you're right I wouldn't touch anything surgical due to lifestyle and low reimbursements!). I'm not doing it purely for the money. My primary motivation is of course interest in and even passion for a field. For example, I also like pediatrics (despite the parents!) and the PICU even though pediatrics including PICU is well known to be a much lower paying field than other fields including anesthesiology. So I would totally agree you have to do what you love, first and foremost, and not let other concerns including concerns about money and lifestyle dictate which fields to enter or not enter.

      However, I don't see how it's somehow verboten to take other concerns like money and lifestyle into consideration? They need not be primary concerns, but I don't see why they can't be secondary or tertiary or later concerns. For example, if someone loves two or three or even four fields equally, then what's wrong with looking at money and lifestyle to help decide?

      In addition, regarding anesthesiology, it's not just medical students like me who are anxious about the future of anesthesiology. Judging by what I see and hear at my institution as well as places like SDN, it also seems there are lots of attending anesthesiologists themselves who are worried about the future. And these worries apparently include worries about "lifestyles and the low reimbursements" too, so it's not just surgeons who have these concerns. Although I'd agree, based on what I've seen, anesthesiologists even in our currently "bad" medical climate still seem to have far better lifestyles than many surgeons, which is another reason I'm personally not interested in surgery!

      But for someone who is interested in and passionate about surgery, then the argument that we should do what we love rather than consider the money or lifestyle would apply to surgery too. Do what you love, and if that's surgery, that's awesome. So it seems to me what you're saying here cuts both ways.

    3. At the same time, there are also many other fine anesthesiologists (like yourself) who don't seem to be as anxious. Or who are a lot more realistic about the entire situation. That's great, and also a huge consideration for me, as well as a huge encouragement, because as a potential hopeful anethesiologist, I can see it's not necessarily all doom and gloom.

      As for mid-level encroachment, I don't know? I never thought it was such a big deal, at least not at my institution. Both anesthesiologists and CRNAs seem to get along and work well with each other. And CRNAs don't seem to want to cut into the anesthesiologists' territories so to speak. But then again, I'm just a med student, so maybe I'm limited in what I see as a med student rather than what I might see if I were on the other side, so to speak. Plus, I would think it's possible anesthesiologists working together with CRNAs in academia can be quite different from anesthesiologists working together with CRNAs in private practice. Maybe it works well fine in academia, but not so well in the private world? But thanks for letting me know about how other specialties also face mid level encroachment! I didn't know that.

      Basically, as a medical student, I'm just trying to get a better picture of all sides of the issue, the positives and the negatives. It's hard to know what to believe or who to believe since I have so little knowledge and experience. But I follow your weblog and appreciate your knowledge and experience in many areas like politics, technology, and of course medicine, and I've come to trust your very well informed opinions, so I thought I'd ask you. Again, I appreciate what you've written! It helps me have a clearer perspective so I can weigh the pros vs. the cons of the field, and come to a better conclusion for myself. Thank you, ZMD.