Eat, Drink, Smoke, Vape, Run.

It’s been an interesting week. The floods down South didn’t appear up here, but there was enough wind to blow the Tay half way across the city. And this weekend we’ve had the first proper frost of the year: -2.5 when I started to defrost the car this morning to go and set up parkrun. Brass Monkeys.

The telebox has been inundated by programs about obesity this week, at least this is the week I’ve noticed it most. The new show is Weight Loss Ward, where the massively obese people in and around Sunderland go to lose weight, prep for gastric banding, and ultimately have their ‘life saving operation’. Images of Terry, 300+ kg were followed by his gastric balloon insertion, and subsequent weight loss of 15 stones, leaving him only double his ideal weight. There’s a lot of chat in the show about him being able to get up the stairs, into the bath, and out of the house, but not a lot of discussion about the respiratory efforts of such a degree of morbid obesity. A couple of students recently asked me about the effects of obesity, and the benefits of gastric banding/balloon surgery on respiratory function, and breathlessness – here’s a very nice review of just that from Thorax back in 2000. A colleague has said for many years that patients at our ‘breathlessness query cause’ clinic should simply be redirected to the obesity clinic – a slight over exaggeration , but an analysis of the BMI of the patients in that clinic would make an interesting student project.

The obesity epidemic can be ‘halted or reversed’ say ‘doctors’ in this piece in the Independent this week.The Mail tells us that 58% of the UK population are overweight. Not new news, but not a lot has changed since this paper 11 years ago showed very clearly the cardiovascular risks of obesity.

If ‘sugar is the new tobacco’, ‘weed is the new weed’ and it’s legal in Colorado, and the purveyors of the finest weed are charging a premium, yet the first 10 days of legal sales has already generated 5 million US$ of sales. Prices are inflated by 100 – 150 %, comparing the legal shop price to last year’s ‘underground’ prices, but much of that is Colorado state tax. Legalisation of marijuana can be seen as ‘normalising’ casual drug usage, or perhaps it is just a money generation exercise. A more detailed investigation of the economics of legal marijuana can be found here. For a review of the potential harmful effects of marijuana smoking (written by my boss) look here. If you’re thinking of a ski-ing holiday to Colorado to get a legal high, they’ve sold out.

If sugar is the new tobacco, and over a third of US states are moving to legalised marijuana, what of the humble cigarette? I think smoking is still a bad thing.

One of our registrars gave a nice presentation at our department education meeting this week on the rise of the eCigarette. eCigarettes, not regulated by anyone in particular in the UK, provide the ‘vaper’ with nicotine in an aerosol of propylene glycol, which is essentially antifreeze – though ethylene glycol is the really nasty one in the glycol family. There’s no set amount of nicotine in any brand, or design, and there’s no regulation of whatever else can go into an eCigarette. The sales pitch is that they are for current smokers who wish to continue with the pleasurable parts of smoking, but avoid the harmful aspects. There’s some evidence that they aren’t harmful (despite the antifreeze). They haven’t been advertised as nicotine replacement therapy, or a means to quit, in the UK at least, because that would mean they were a drug, and therefore subject to stringent testing. As one of my colleagues pointed out, coffee contains nicotine in reasonably high quantities, and we don’t get worked up about his Nesspresso machine in his office – I do wonder if there should be *some* limitation on coffee availability… I digress. If vaping is a safe, reliable alternative to smoking, and reduces, even removes, the risks to health associated with smoking, surely there is no argument? We should be telling all our smoking patients to switch to vaping forthwith. Can’t get long term oxygen therapy because you’re still smoking? Switch to vaping, and you can have your concentrator in 5 working days. Love the taste, but don’t want the risk? There’s an eCigarette for you. Tried NRT and Champix, and nothing works? Vaping is the answer. But there is some evidence, such as the seemingly controversial study in 60 Million Consumers, a French Consumer magazine, that reported Les cigarettes electroniques ne sont pas sans danger!. The Daily Mail’s usual journalistic rigour can be seen here.

But perhaps there’s something a little bit more sinister going on. ‘Big tobacco’ has been very quick to scoop up the eCigarette manufacturers, not to immediately close the factories, and essentially put an end to their competition, but to support and promote their use. If big tobacco can keep the nicotine doses low enough, and the price just about affordable, but more than a pack of 20, then what does the nicotine craving, thrifty vaper do?

One of our SpRs told us about a new craze at his son’s school: shisha sticks. Very easily available online, these are eCigarettes without any nicotine, just a fruit flavour in an antifreeze propylene glycol aerosol. They look like an eCigarette, come in a variety of colours, and flavours, and using one looks a lot like smoking, French inhale and all. They cost ¬£3 for 500 inhalations, and the kids are ‘all doing it’. Will they progress to vaping eCigarettes, or smoking tobacco? If there’s a cheaper one..? Looking ridiculous is obviously not a concern of kids in school, so long as they all look the same ridiculous, but “smoking looks cool”.

A quick walk the length of Dundee’s main shopping street this afternoon, on the way to the library (via the video game store), I saw 3 ‘bus stop’ of adverts, and 2 ‘rotating poster’ adverts for differing eCigarettes, on top of 3 stalls in the shopping centres selling the brands at discount to anyone and everyone. At the one in the Wellgate, a woman was helping her early-teenage daughter pick out a shisha stick, whilst at the one in the Overgate, a group of mid-teenage boys were buying their first nicotine-included eCigarette. They didn’t look 18 to me, and no-one bats an eyelid. But they’re safe, as far as we know.

John Britton, in his excellent Thorax editorial, concludes:

In short, these products represent a huge opportun- ity to improve the health prospects of millions of smokers in the UK and world- wide. They will present challenges and problems, but are an opportunity not to be missed.

Back to parkrun.

At time of writing over 56,000 people did a free, timed, 5k run in a park at a parkrun event this morning, either at 9, or 9:30 am. As a comparator 37,500 people did the London Marathon in 2013. This weekend our local parkrun saw a record attendance for 4 runs in a row. 154 Dundonians, out running through the ice and freezing winds, through a park, at 9:30 in the morning, reducing their cardiovascular risk, and enjoying the fresh air. But, running in sub zero temperatures does put one at risk of cold air induced bronchospasm. Scottish Ironman Triathlon Record Holder Graeme Stewart was in just that position today after tough run through the park, and he was not alone. The physiology required to Swim 3.8k, Cycle 120 miles, and then run a marathon, all in eight and a quarter hours, undone by the cold air in Camperdown.

There’s a clear sense of health and wellbeing at all the parkruns I’ve been to, and certainly it is a rarity to see any runner smoking before or after the run, and I presume not during – I wonder how long until people vape after parkrun? I’ll stick to the Mars Bar cheesecake in the Camperdown wildlife centre cafe after my park running.

Remember to check out the feed Thorax Weekly to find things I scoop up from the internets during the week (Eg. Are eCigarettes Safe, YouTube asks)

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