Salmon Upstream, LLC

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Letter on Vaping to Governor Ralph Northam

This is a new threat in a smoldering battle that has been going on as long as I have been in practice. As the director of our lung cancer program, I am well past tired of seeing people die from a disease that largely wouldn't exist were it not for smoking.

Governor Northam,

I am genuinely sorry to bother you, as I know you are extremely busy with this governing thing (I do not envy you there). Unfortunately, I promised my friend here In Lynchburg, VA that I would write you, and she happens to be a pediatrician. You know how they are: always wanting to save the world, especially when there's kids involved.

I will try to be quick (but I usually fail at it): this vaping thing? There's a lot of yelling back and forth and all kinds of data and money being thrown around so much that it's hard to figure out what the truth is. Plus, this is all new to our generation, so you almost have to ask kids what's going on, and it's not like youngsters are big into prospective, randomized clinical trials. Personally, I think all of the arguing is just a big distraction. Is it safe? Should it be legal? Should it be taxed? On and on. Who cares? The most important fact is written (by law) right on the side of the box: nicotine is addictive. Period.

Who cares if it's safe? The whole reason anyone goes to the trouble to make this stuff is because it's addictive, and they know the kids that get started using it will keep using it for rest of their lives. We saw this with cigarettes, and that was when everyone knew they were terrible for you. Because kids don't understand future consequences, which is exactly why the industry markets this stuff to kids in the first place (although no one is going to actually admit it...)

And some of these people making these vapes are really smart. I don't know how much you know about this company Juul, but they are some clever bastards, I tell you. They captured 70% of the tobacco market in like 9 months, before anyone even knew what was happening. Doesn't that make you wonder? I mean, they say they made this thing to help people quit smoking. We're both doctors; don't you think it's odd that they never talked to us about it? And how did they do all that without putting ads on TV and in magazines, things that smokers would see? Our little city of 85,000 has seventeen vape shops. Seventeen.

And good luck stopping them through legislation. The law never stopped kids from starting smoking, and that was before the internet. That's how those Juul folks got it done so fast: they marketed straight to kids on social media, knowing they could easily get around any regulations and have it delivered. They even made it look like one of these new computer gadgets, so you and I wouldn't even know what it was. Real clever bastards, I tell you.

So now we have all these teens addicted. I hope they were genuine about finding ways to get people off nicotine, because we are going to need it.

This is a new threat in a smoldering battle that has been going on as long as I have been in practice. As the director of our lung cancer program, I am well past tired of seeing people die from a disease that largely wouldn't exist were it not for smoking. Most adults who smoke would rather not smoke, but that is addiction. People compare this to alcohol, but they are not the same at all. I know recovering alcoholics. I have seen people -- young and old -- die because of alcohol. But most of the adults I know drink socially, and virtually all are not addicted to alcohol. I don't know anyone who uses nicotine that is not addicted. None. That is the difference.

So what do we do? I suggest that we look at what we did in the past that worked, (which arguably wasn't enough, but it's all we have). And don't pour money into something doesn't work just because it feels good, because we don't have much extra.

First, don't be fooled: all of these things should be lumped together. Vaping is just the direction this industry wants to go so they can expand on markets that have been contracting. It doesn't matter that it is safe, it remains incredibly addictive. If we treat one product one way and one product another, it just opens a door that becomes a cultural floodgate. No teacher can tell what is in vapor, nor can I. When I see a cloud of smoke coming out a car window that looks like someone is heading to a casting call for a reboot of Cheech and Chong, I don't care who says it's safe, I don't want to be breathing that crap. And I shouldn't have to: I have a right to clean air, and so do our kids. This stuff should not be in public places, and all vaping should be lumped in with smoking as far as community health is concerned.

Next: hold them to their claims: if this is about saving all the current smokers, then act like it. Much of it should be coming from doctor's offices or smoking cessation programs. What is sold over-the-counter should be sold in pharmacies, which would not be an inconvenience to any existing user. Vape shops are not about quitting smoking. If that's what vaping is about, there is no need for the shops.

And finally, educate. Unfortunately, the folks we really need to educate are kids -- young kids. This stuff starts in middle school, and that's why in Lynchburg we are starting with 5^th^ graders. Last year, we began a program in our city schools that was patterned after an anti-smoking program put out by the American Academy of Family Physicians called Tar Wars, but since this whole issue is changing, we are changing too. We have now taken to calling it VaporLies. We built it to be sustainable and to connect with every fifth grader across the city. We enlist the help of local college and graduate students and train them to connect with these kids in hopes of delivering a message that they are already hearing, but in a way that may be more effective (the young preceptors are more like peers than their teachers or some grumpy old doctor). Some good news: it's cheap. Really cheap. That makes it good value for dollar. But the best news: any town can do this. This is a program that every school system across the state could emulate, this year. Let's work together to perfect it, to streamline it, and get the word out to all our kids.

Those kids: every single one of them is our collective responsibility, like it or not. The downstream repercussions of addiction -- whatever they turn out to be -- will someday fall in our laps. And I don't want to go through this all over again.


John M. Salmon IV, MD

Pathology Consultants of Central Virginia

Physician Liaison to the Commission on Cancer, Alan B. Pearson Regional Cancer Center

Director, Thoracic Cancer Program, Centra Health, Lynchburg, Virginia

Founder, Unified Potential, Inc.