Electronic Cigarettes and Old-Fashioned Nicotine Delivery Devices

The next issue of The Medical Letter (November 26, 2012) will include an article on electronic cigarettes, which are, we explain in the first sentence, battery-operated nicotine-delivery devices designed to mimic the way a smoker uses a tobacco cigarette. They deliver vapor, not smoke, but that vapor does contain nicotine, and that should raise some questions about their use. I don’t want to spoil the story for our readers, so I’ll say no more about these electronic nicotine delivery devices, and reflect instead on the nicotine delivery devices I started using when I was 12 years old. They were called Chesterfields.

I don’t remember my first or second cigarette, but I remember the third one because I remember the feeling that I needed it. They say nicotine becomes addicting more quickly than heroin, and I believe it, even though, I hasten to add, I have had no experience with heroin (or cocaine or even marijuana). But I had quite a long history with tobacco. I continued to smoke cigarettes through high school, college, medical school, internship and residency. In those days, it seemed as though all doctors smoked. Thoracic surgeons smoked. Pathologists smoked. Conference rooms were filled with clouds of cigarette smoke. I never saw the chief of service during my internship without a cigarette or pipe in his hand. When someone asked him during one of our daily clinical conferences how he would like to die, he said at the age of 95, shot by a jealous husband. Fat chance, I thought, referring to the age of death. I knew nothing about his sex life.

When I was in the army, another doctor who lived next door was also a smoker, and I bet him a day’s pay that if we both quit, he would start again before I did. About 6 weeks later, he knocked on my door and sheepishly handed over the money. I never smoked another cigarette. For many years, though, I did smoke a pipe, and later an occasional cigar. That lasted until my children were old enough to go to school and become indoctrinated in the public health dictates of that generation. One day I lit a cigar, and my 6-year-old daughter screamed at me: “Daddy!!! What are you doing???!!!” And that was the end of it.

My former chief of service, in case you’re wondering, never made it to 95. He died, I was told, in his mid-80’s, and it was unclear which of his many cancers finally killed him. No jealous husband, no gunshot wound. Sad, no?

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