San Diego VA Physician Promotes Unsupported Fear of Brain-to-Bladder Vaping Dangers & Diseases

 

During my 26-year career as an oral and maxillofacial pathologist at the University of Alabama at Birmingham, I had the opportunity to participate in diagnosis and treatment of patients at the Birmingham Veterans Administration Medical Center (VAMC).  There I observed a high rate of smoking among veterans (confirmed here) and an elevated rate of admissions for related serious illnesses.  Many patients would drag their IV lines, catheters, nasogastric feeding tubes and other medical equipment outside in order to satisfy their craving for cigarettes.

When I enrolled smokers in the first-ever open label pilot study of reduced risk products (Skoal Bandits, study published here), I expected veterans to be likely adopters of smokeless tobacco products, but I was unable to convince the VA to offer their patients that option.

VA clinicians aren’t obligated to tell cigarette-consuming patients about safer smoke-free substitute products, despite the fact that their Hippocratic Oath requires them to do no harm.  But a recent article by the VA Office of Research and Development demonstrates deadly deception. 

The VA article centers around Dr. Laura E. Crotty Alexander, a physician at the San Diego VAMC and University of California San Diego who co-authored a journal article, “Vaping and Lung Inflammation and Injury.”  Dr. Crotty Alexander said that she “has heard from more and more patients over recent years that they’re thinking of switching to vaping e-cigarettes as a safe alternative to traditional cigarettes.”  Her response has been to tell them that switching is a “dangerous situation,” that e-cigarettes come with wide-ranging dangers of their own, and that they have far more dangers than even she expected.  “[E]-cigarettes cause their own set of diseases that seem to impact just about every organ in the body—from the brain to the bladder.”

What evidence of dangers and diseases did she provide?  None.

In fact, the VA authors admit in their journal article that the dangers and diseases have only been observed by researchers torturing cell cultures and mice.  Crotty Alexander’s co-author Dr. David Christiani acknowledged, “The disease process can be very long and difficult to unravel” -- in other words, the authors can’t point to actual human impact.  They do, however, have “lingering questions” about “whether there is a risk of lung cancer from chronic e-cigarette use, and what risks exist beyond the lungs—to heart vessels and a woman’s reproductive system, for example.” 

The authors assert, “Additional research is ongoing to clarify the dangers from vaping, and how vaping damages the lungs and other organs.  Long-term human studies, in particular, could bring the risks from e-cigarettes into better focus…further research could help untangle how vapers’ bodies develop disease” and “promise to identify early indicators of—and ultimately treatments for—vaping-related disease.” 

In the absence of actual evidence of danger or disease, and with proof of the harm reduction attributes of smoke-free tobacco products, clinicians ought to adhere to the Hippocratic Oath and advise their patients who smoke of confirmed truths, rather than attempt to scare them with unsubstantiated brain-to-bladder speculation.