On September 26, 2018, Physician’s Weekly hosted a live discussion on Twitter (a TweetChat) as part of the #PWChat series, co-hosted by Physician’s Weekly Editor-in-Chief, Linda Girgis, MD, with the intention of highlighting what physicians should know about the topic and how to discuss it with patients. It quickly became clear that discussing vaping with patients is no easy task.

On Track?

The chat started as most #PWChats have, with a seemingly standard question and answer flow:

Physician’s Weekly: Have you seen an increase in #vaping among teens?

Linda Girgis, MD: I have definitely seen an increase in #vaping among my teen patients. Many are attracted by the flavoring additives. I also suspect it is the next “cool thing” for them to do.

Farzana R. Hossain, MD: Yes! Vaping now an epidemic among US high schoolers, 900% increase in e-cigarette use by high school students from 2011 to 2015, cnn.it/2GCUuSi.

PW: In your experience, was the increase in #vaping preceded by a decrease in teen cigarette smoking?

Linda Girgis, MD: I have seen many take up #vaping who never smoked before. And yes, I have seen a decrease in teen smoking in my own practice.

PW: How do you respond to patients who say/believe #vaping is safer for them than conventional cigarette smoking?

Dr. Girgis: I tell them that we still don’t know all the harm ecigs can cause but there is clear evidence that there is some and they are not as safe as many people believe.

Matthew Loxton: We know full well that inhalants are risky, and now we have players with dubious benevolence packaging dozens of chemicals into a fluid that gets aerosolized and directly and deeply inhaled

 

Off the Rails

While initially constructive, the conversation was derailed by mostly British non-healthcare professionals, vehemently advocating vaping as a clearly safer alternative to conventional cigarette smoking. When their tweets touting the benefits of vaping began flooding in—ultimately lasting more than 24 hours—the presence of United States-based HCPs in the chat vanished.

The proponents of vaping challenged any medical concern raised by HCPs in the TweetChat. They noted the lower level of chemicals in ecigarettes; questioned the effects or addictive nature of nicotine when not delivered via tobacco smoke; and claimed that vaping is 95% safer than cigarette smoking and that only 0.1% of never-smoking kids vape regularly. Some even questioned the validity of the WHO and CDC. One “vaper” claimed that many studies suggesting the dangers of vaping are “riddled with methodological flaws that any vaper could have pointed out had they been consulted.”

Dr. Girgis and Matthew Loxton continued to participate, and tried, with little to no help, to keep the conversation on topic. They pointed out that nicotine is a pesticide that is addictive and, when smoked or taken into the lungs in vaper aerosol, causes inflammation in respiratory endothelium (the precursor of a host of respiratory diseases). While they both even agreed that as a smoking cessation tool, vaping could be effective, they expressed that their biggest concern was the lack of research supporting the safety of vaping and defining the dangers of long-term use. But the pro-vapers continued…

 

Shall We Try This Again?

With nine questions unanswered in the Tweetchat (with our hope of discussing 12), we decided to co-host a part II of the chat on October 10th. This time, we invited an armamentarium of healthcare professionals, including pulmonologists, oncologists, epidemiologists, addiction specialists, respiratory therapists, and pediatricians. Many expressed initial interest and supported our efforts, but few showed up—and those who did, didn’t participate. The arguments by pro-vapers were the same, but this time, some crossed the lines of respectful disagreement, and attacked Dr. Girgis, suggesting she have her medical license revoked and be burned at the stake and calling her an anti-vaping activist!

 

Here is what these experiences left us wondering …

 

Our Questions to You

Our experiences with this two-part chat left us with many questions that we implore you to help answer (via the form at physiciansweekly.com/contact or through our social accounts):

  1. Why do you think HCPs were hesitant to join the TweetChat discussion? Do you agree with our guess that there was a general unwillingness to “argue’ with a strong, stubborn group of pro-vapers, whose persistence was known ahead of time, on a relatively new topic?
  2. Do you fully support and encourage the use of ecigarettes as a smoking cessation tool?
  3. Do you agree with any of the arguments the pro-vapers presented?
  4. If you were confronted by patients with the same arguments made by the pro-vapers during our chats, how would you respond?

 

Please submit your answers in the comment section below. We appreciate your feedback!