A call for a moratorium on the sale of inhalable products [PODCAST]

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“The inflammatory response elicited by the novel coronavirus can do great damage to the essential function of lungs. People with underlying lung disease are more vulnerable to this coronavirus, including people with asthma, emphysema, lung fibrosis, and even people with high exposure to air pollution. Smoking and vaping are perfectly preventable forms of high-intensity air pollution. We strongly urge city, county, and state governments across the planet to place a temporary moratorium on the sale of all inhalable products to protect our lungs and our freedom.”

Jayshree Chander is an occupational medicine physician.

She shares her story and discusses her KevinMD article, “A call for a moratorium on the sale of inhalable products.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Jayshree Chander. She’s an occupational medicine and family physician, and she wrote the KevinMD article “A call for a moratorium on the sale of inhalable products.” Jayshree, welcome to the show.

Jayshree Chander: Thank you, Kevin. I really appreciate being invited to talk with you today.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you just share your story and your journey to where you are today?

Jayshree Chander: I graduated from med school at the University of Wisconsin in Madison. I did my internship in Minnesota at Hennepin County Medical Center, then came out to San Francisco for a residency in family and community medicine at UCSF, and I did a fellowship in occupational and environmental medicine, also at UCSF. Throughout my career, I was primarily practicing urgent care for the homeless, medically indigent, and underserved populations of the Bay Area. I’ve spent a little bit of time in India as well, and now I’m doing primary care.

Kevin Pho: Tell me a little bit about your practice. How is the pandemic affecting your practice?

Jayshree Chander: I’m working with a health care system, and it’s a private corporation. Our demographic is relatively well educated and relatively wealthy, sort of. It’s in the financial district of San Francisco, so there are a lot of tech kids, relatively young. The main thing that I’ve been seeing during these past six or seven months is anxiety, depression, loneliness, and actually overworking. With people working from home, they’re finding that they’re working a lot. Many people really like the work-from-home thing, and many people don’t like it. But my experience so far has been that the primary impact has been an exacerbation of anxiety and depression. My experience of the pandemic has been a desire to actually calm people down.

Kevin Pho: What kind of advice are you giving to patients who are coming to you for increased anxiety and depression?

Jayshree Chander: I have learned over the course of my career that advice is probably the worst thing a doctor can give people. My approach is actually to listen, ask questions, reflect, and elicit the advice from the person themselves, right? Because I think that a lot of patients, when they start to question their thoughts because of my questions, and inquire into the thoughts that are making them anxious, it produces their own relief. I also teach them how to self-empathize with their feelings, identify their needs, and then think about strategies that they can use to meet their own needs. So the homework is actually theirs; they have to find it.

I do try to help them at least start getting better sleep, because that’s the foundation. Some people I’ve had to start on medications. Many of my patients don’t want to start on medications. It’s just that demographic, I think, and maybe it’s also the San Francisco Bay Area culture. People try the holistic approach a little bit more. And maybe that’s also the patients that are drawn to me, who have seen my profile and know that I’m kind of a medical minimalist.

Kevin Pho: So let’s transition into your KevinMD article, “A call for a moratorium on the sale of inhalable products.” Now, for those who haven’t read the article, can you just walk my audience through it and maybe share a story of why you decided to write it?

Jayshree Chander: It was at a time in the course of the pandemic when we were concerned about our ICU capacity and the availability of ventilators. We also were very clear that the impact was primarily on people who had underlying diseases: underlying heart disease, underlying lung disease, obesity, diabetes, and other immunocompromised states. So that’s our population of concern, and the elderly.

My general approach to medicine and public health is to think horizontally as well as vertically, because I think that’s what gives us a whole picture, right? So if we’re only focused on the virus and testing and tracing and tracking, then we will address one disease with all our efforts. We will invest whatever it is, 500 billion dollars, in one disease. Whereas if we just step back and look at the underlying diseases that are predisposing to the vulnerability of COVID, then we are getting more bang for our buck, and we are getting additional benefits from our efforts.

So in my opinion, and this is an opinion, it is not a fact, it’s an opinion, and I’m willing to own it as an opinion, if we were to have a massive national quit-smoking campaign or a massive global quit-smoking campaign, we could reduce the mortality of COVID-19 significantly. But we would also reduce the mortality from influenza, from pneumonia, from lung cancer, from emphysema, from heart disease. We would be having multiple benefits for the price of the same campaign.

A moratorium is a temporary hold on the sale of, or the participation in, a specific activity. So I recognize that people are addicted to nicotine or are very habituated to using nicotine, and especially with an increase in stress, anxiety, and depression, and actually just a lack of other activities to do, smoking may actually be increasing during this time. I actually haven’t seen the data on whether people are smoking more or less.

Kevin Pho: Sorry, to be clear, you’re talking just about smoking? What about vaping and other non-smoking-related inhalable products?

Jayshree Chander: Inhalable products would include vaping, it would include marijuana, it would include nicotine, or whatever else people are smoking. I mean, our lungs are not designed for smoke. They’re designed for very, very clean air. They’re not even designed for polluted air. They’re not designed for air that is full of the smoke from wildfires. That’s not what our lungs are designed for.

I would suggest that in a time when we are focusing our public health efforts and our clinical efforts on reducing the impact of COVID-19, and we’re in a state of emergency, a global emergency, putting a moratorium on the sale of inhalable products would actually help us in our efforts.

Kevin Pho: We’re talking to Jayshree Chander. She’s an occupational medicine and family physician. She co-wrote the KevinMD article “A call for a moratorium on the sale of inhalable products.” Jayshree, so we talked about it from a policy standpoint in terms of what you think we should do, but how about in the room, face-to-face with the patient, if they’re using inhalable products, if they’re smoking, if they’re vaping? What are some of the techniques that you use to help these individuals perhaps stop smoking, especially during a time of COVID?

Jayshree Chander: Well, I counsel them. I actually have a few patients who did quit smoking during COVID, and I have some patients who increased their smoking habits during COVID. So again, I don’t take the advice approach; I take the information and empathy approach. So I offer the information, and I do have a podcast on my podcast site where I have interviewed a researcher who has done research on the toxicity of cannabis. The preliminary results are showing that cannabis smoke is essentially as toxic as tobacco smoke, and that we shouldn’t be thinking that cannabis smoke, marijuana smoke, is less toxic. There is that public perception that somehow tobacco smoke is more harmful, and that is actually not true. So I offer that information because I do have a lot of patients that don’t smoke tobacco, but they do smoke marijuana. I offer that information, and that often is new information to them.

But my approach to either product is more to inquire: What are the needs that are being met? When you find yourself wanting to smoke, what needs are being met for you? We list out those needs, because unless your needs are being met, you’re not going to be fulfilled and satisfied, and that’s the key to a fulfilling and satisfying life: to have your needs get met. So let’s brainstorm, because for every need there are at least 100 strategies to meet it, right? So let’s think of just even three to five strategies to meet each of those needs that smoking meets. People find it very helpful, because they realize, “Oh, I can get my needs met. I don’t have to remain anxious just because I’m not smoking. I don’t have to remain bored. I can create another ritual. I can find another way to connect with myself.” There are so many reasons that people choose to smoke, and it does make a difference.

Kevin Pho: And my final question, Jayshree: What is your take-home message that you want to leave with the KevinMD audience?

Jayshree Chander: My take-home message, at least in terms of this article, is that addressing our underlying health is critical, and it has multiple benefits, including reducing the impact of COVID.

Kevin Pho: Thank you so much for sharing your insight, and thanks again for being on the show.

Jayshree Chander: Thank you, Kevin. Thank you for inviting me, and thank you for sharing my article. I look forward to more collaborations with you.

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