Listen to Dr. Lester Hartman talk about teen vaping and its effects on the body. Empower yourself as a parent and get the knowledge you need to get ahead of the vaping game and find resources to help if the problem becomes real for your family.

‍0:00:02.3 S1: Hello, welcome to the Wellness Essentials podcast. I am the host today, Patty Post, founder and CEO of Checkable Medical, and today we are talking with one of the advisors that we have had for Checkable Medical for years, Dr. Lester Hartman, who is a pediatrician that dedicated his professional career to his patients and families for 35 years. Dr. Hartman is a pediatrician and also a Master's of Public Health from the School of Public Health at Harvard. He resides in Massachusetts, in the Greater Boston area, and has been with Boston Children's for over 35 years. Now, he identifies as a Cajun as he grew up in Louisiana. And he is an advocate for our kids’ health, and today what we are talking about is vaping, and that this has really turned into a huge epidemic for families and for kids. From the legislation, things that he has changed by being extremely involved, he gives us information today on books to read, on advocates that we should follow, on groups that we should be a part of as parents so we can keep ourselves informed, and it really sends the message that it is not too early to talk about vaping with your children.

0:01:31.1 S1: You can start as early as kindergarten to make them aware of it, that it is very serious because our kids are extremely vulnerable to the fancy and creative marketing that these companies are putting forward. They are not targeting adults and they're not looking at it as a target for smoking-cessation devices, they are looking for recurring tobacco users, and we now are finding new products such as pods, things like synthetic nicotine that isn't even derived from tobacco, it is brand new products such as Bello, such as Drift, another one with a number: 2One. There are serious side effects to vaping, we have heard of the lung issues that were pre-pandemic, we heard a lot more about this, but they are still very serious. He recommends talking to your pediatrician. So with that, this episode is going to be for parents of kids that are kindergarten through high school, and really talking about the important subject of vaping, and if you suspect that your child is what to do, the signs to look for and how you can get involved, so your kids are not targeted by this. So with that said, we will leave it to Dr. Hartman

0:03:07.1 S1: Hope you enjoy and please look for the items that we post of how you can educate yourself and be aware of all of the resources out there. Hey, this is the Wellness Essentials podcast. WE for short, the We Podcast is all things health and wellness, a place where women like you can come to be their authentic self and be a part of a community that supports them in their health journey and every stage of life, this is the podcast for engaging health and wellness entertainment with actionable steps you can take into your everyday life. No topic is off-limits when it comes to health and women's lifestyle, let's face it being a woman comes with all sorts of fun. Hear real, raw conversations and teachings from experts and everyday women who have been in your shoes and be inspired to make things happen and have the tools to do so. This is the WE podcast. I actually was shocked when I heard that you are going to retire 'cause I thought this is his passion, but at the same time, I would expect it frees you up to do some of this research that you are so passionate about for that next generation of kids and making a difference for kids all over the US.

0:04:45.8 S1: And the standard, the standards that go through the government...

0:04:50.7 S2: Yes, it's the utilitarian philosophy, you know, the greatest good for the greatest number. And that's where I feel I've landed. I was fortunate to go to the Harvard School Public Health and get my Masters in Public Health. And my public health leadership professor was an oral surgeon, and was hugely involved in anti-vaping and was very innovative in the state of Massachusetts and nationally, he was the head of... I believe at one point, he was Head of the Department of Public Health, and he pushed me along to get in this advocacy work, and it was more than enough for me, because as I found out in hindsight later how much it has hugely affected my family personally, although that was not the total motive, it's for all kids, but having mom die of a stroke at 66 and a heart disease were age 50 on, and autoimmune disorders which are associated with cigarettes, even though people don't realize that. And also my nephew’s son who died of Sudden Infant Death Syndrome after he started smoking [when the son was] at two months of age, pass, and my mother smoked at least for part of the pregnancy with me, and I have a club foot and had learning disability, so school wasn't always...

0:06:12.9 S2: Let’s say it this way: school was fine, behavior wasn't great. So you know, it was an uphill battle. The classic description of an ADHD child before the ADHD label ever existed in 1967-68, and now we've gone from cigarettes from the last century, and now in the 21st century, it's vape. And some of this stuff... What's interesting, now it looks like hookah, you can look at the Star Wars bar scene and you can see the devices that they were smoking, and I don't think it was Star Wars’ intent to market it, but that's what was on towards the end of the 20th century, into the 21th century. Wow. And I think that that was kind of the harbingers of what was to come and what is coming now. I just learned that the total amount of profit that's made per year in the world from tobacco, and that doesn't just mean tobacco in cigarettes, but it means vape, gum, and there's a new gum called Lucy, we can talk about a little bit, and patches, it's $825 billion a year. Wow. In profit, so it's almost a trillion dollars, tobacco is... And when we talk about tobacco, it has to be with nicotine, even though the companies are trying to split it so they can get around the law, nicotine is tobacco by legal definition since it's extracted from the plant, but now there's some synthetic type that the claim is not extracted from the plant.

0:08:01.2 S2: That make up the newer generations of tobacco products, ie, the dips that are being made like Zen, Drift and brand 2One. 2 O-N-E. I can’t quite keep up. Okay, yes, and the other one that's been on TV advertised is Bello, which is another. It's a pouch saying it’s tobacco-free nicotine. And the problem with all this is, and this is what the adult community, pro-Vape and pro-these products doesn't talk about because it reduces heart disease, lung disease and all this, but they don't say anything about what happens to the teen brain. Anxiety, depression, rage attacks from withdrawing. I've seen these where kids throw computers or punch holes in walls at home or at school, because the potency of these products are three and a half times greater per pod of Juul in this country than is allowed in England. However, what I've learned about what's gone on in England is they tended to skirt around this by the wick. It's like a candle wick that's used in this country is a silicon-based wick, whereas they use a cotton wick there and the cotton wick absorbs more... Henceforth, you inhale more of the product, so 5% seems to be the level that gets kids addicted and that's what they wanna get it at, but they're not allowed to have it in England like that.

0:09:47.0 S2: So the way they try to skirt is they've adjusted the nicotine to be in a cotton filament wick rather than a silica, which is more kind of like sand. So that's why the absorption is better, so it gives closer to a 5% hit, which gives the buzz that all the kids want to get with this. And gets 95% of the lifetime use of nicotine products to begin before the age of 21. 90% before the age of 20. So you know that the marketing, though they deny, is all in youth marketing in ways that are trying to avoid parents knowing about it. And a classic one right now that has been used is TikTok for vaping nicotine and now vaping on non-nicotine products like melatonin, essential oils and vitamin B12, which we have no idea what that does to the lung lining, and there's no long-term evidence, it's not controlled by the FDA either. One hopes that nicotine, which is supposedly supposed to be controlled by the FDA from the Family Smoking Act that Obama signed, they have failed to enforce that every single product on the market today that e-cigarettes is illegal, they're all illegally on the market because the FDA was supposed to test and review them before they ever go on the market, and finally they are doing it, and that's why Juul, early September, why were supposed to get an answer, but they have not given an answer about Juul at this point, so it's all wait and see game at this point of what they're gonna do with things like Juul...

0:11:40.8 S2: And Gottlieb was doubly duped by Philip Morris, and he trusted him. The second time was when Philip Morris said to him, Oh, we’re going to stop our vape product, Mark 10. And at the same date in time, they stopped the vape product, Mark 10, they bought Juul, but they did not tell them they bought Juul... It gave the impression short-term that they were getting out of the e-cigarette market to dupe Gottlieb into thinking that they were just getting out of this harmful, these harmful products and they weren't, in fact, they were getting deeper into it. They followed the money trail. He did, and he's a real smart guy, but he just... He'd been very involved in the industry itself, but I don't think that was the answer, I don't know exactly why he allowed himself to be duped a second time on this and... It's crazy, it's sad.

0:12:38.9 S1: Let me just introduce you, and then let's talk about how you found all of this out, started to symptoms you saw from your patients, what concerns parents are bringing to you and things that you've done in Massachusetts to change legislation and change where physically the sale of vape products. And then what are things that parents can look for, that we should as parents of teenagers, are there signs and symptoms and how can we prevent it? And we gave a little bit of this, but you have been a pediatrician for 35 years, and you started one practice, grew to two, and now you just retired. We connected over Strep, but the other areas that you focus on are really the chronic conditions such as asthma, such as weight management, mental health, eating disorders,  you had talked about, and then you knew that I had teenagers and you gave me tons of insights on vaping and just your connections with your pediatric patients, I was very surprised because as a man that's been 35 years older than some of these kids, these kids really open up to you and... Can you just first talk about that, how you came to find that vaping was almost an epidemic before anyone else knew about it?

0:14:21.0 S2: I work with a gentleman, Jonathan Winnecook, who's a Harvard professor, and we've collaborated on this the whole time, the big thing we had focused in on... And after I finished my Master's, a year of an MPH at Harvard School Public Health. He and I combined to push Massachusetts into Tobacco 21. And it took six years and 164 Board of Health meetings for me working with him and going through the House twice before it was passed to get that law put into place. And we were in 2019... I think it was 2018, 2019, we witnessed the House vote and we got a standing ovation from the Massachusetts House after they passed it. We both start crying. And then already vape had come out, and the big thing about the vape was the flavors too. And this was starting to come out... Let me go back, I'm sorry, there are flavors in tobacco, they were co-cigarettes, cigarillos, they were cognac, cherry flavored, and they were basically... This isn’t a legal definition, but little cigarettes, and the problem is these were enticing to kids 'cause of flavors. So this is where the state was involved with that, not 21, but we did 21, and then we followed with the state and helped in the flavor banning in Massachusetts and the ban was on all flavors, including mint and menthol, which the tobacco industry had weasled that Mint is not a flavor and menthol is not a flavor.

0:16:15.3 S2: Therefore, it can stay on the market. And if you look at the history, for example, in the African-American community called Black Lives Black Lungs, it's incredibly devastating to see nine-year-old kids be given mentholated cigarettes, and this translated into mentholated what started coming out in the market, and the reason it came out is they made the contention that combustible cigarettes are more dangerous than vaping, so heating up a vapor, vapor rising, not burning a liquid was safer than the combustible cigarettes with no long-term data to prove this. Okay, so as a result, flavors came out in the form of these products as well, and the vape industry, the tobacco industry lobbied against losing flavors than compromised and said we want menthol saved and mint, and menthol is a form of mint. So it was interesting at this point, because what we noticed is the state where all these towns had passed the flavor restriction, they did not include menthol for mint, and as a result, what happened is it is substituted and use those instead, and the rate of vaping in the states continue to rise. It was absolutely insane. I was in Needham of the first town in the country to go to 21, not to my credit, but was the reason I started this, I noticed Needham was the only town in the country and maybe the world to have gone to 21 with tobacco and was ahead of the game and the flavors and all this stuff, all the towns around us who exempted mint and menthol seemed to my gestalt increased mint vaping.

0:18:15.7 S2: And we had to get rid of that because...

0:18:21.3 S1: So then that means mango goes down, but mint goes up. Absolutely.

0:18:27.7 S2: That's just what happened, because the industry pleaded with the towns, please don't do this, at least save mint and menthol for the adults, that wasn't what they were saving it for, and so as a result, there are all these mentholated products, peach ice, which is actually menthol ice. Lush cherry, lush means mentholated. Frozen cinnamon. That means there's menthol in it. Let me say one thing. Also, everybody knows the name Philip Morris. Okay. But Philip Morris US no longer exists. Okay, Altria, A-L-T-R-I-A is now former-Philip Morris. My friends, I ask them, Do you know what Altria is? And they have no idea. And this is the full intent is to stay clandestine with these products because if parents find out this is associated with tobacco, they would not like this, so I may be getting a bit on a tangent here and I apologize, but anyway, we pushed menthol in the flavor ban for the state, and Massachusetts has the most restrictive laws in the country around vape and around tobacco and flavors, but by no means is it perfect, because for a while there... a lot of states around us had stopped flavors, but had not stopped mint and menthol.

0:20:00.6 S2: And the age in New Hampshire was 19, so kids would go across the border and would go and buy a ton of mint and menthol vape products and bring them in to Massachusetts to sell them. And they still continued to do that. But it stopped. I wrote a letter to the governor of New Hampshire, and I don't know if they had any influence, but about a year later, these products had finally been taken off the market, in New Hampshire as well, and the age was 21. What people don't realize is if the federal government enforces 21 and the state can still enforce 18 or 19, so their agents will write people up who violate at 18 or 19, and the Feds in the same state, if kids are under 21, so it's kind of a crazy situation, and the states have to adopt so their locally funded health agents can enforce the rules that correlate with the federal government, and so that's why it takes longer, sometimes and it's a slower process, and we know Biden just said mentholated cigarettes are banned, but that's probably five to six years of litigation that's gonna go on before this definitely happens, and now we're into the vape. With combustible cigarettes and not vape. Vape is still mentholated. And in Massachusetts it's banned, but around most of the country, except for certain cities like San Francisco, a number of cities in California and in the Midwest. Not the south, which  aways troubles me, because life expectancies, probably about the top 10 worst states for life expectancy, at least six of them are southern states.

0:21:53.9 S2: So.

0:21:54.4 S1: As a parent, how can you recognize that a child is vaping...

0:22:00.7 S2: Yeah, it's very tricky. I think the way you do it is, there are kids that get so addicted they suddenly start going into their rooms and have changes in their personalities. A New Zealand study claims that they get dry mouths and sore throats more. These are the common things you see when kids are starting to vape: moodiness with families when their kids haven't been moody, which is a difficult thing to distinguish sometimes when you have adolescents... Right. But more isolated, the room might smell like pleasant, funny flavors, somebody walks in, they smell this, it could be a SC Johnson Glade Plug In, something like this, and the device is so small, it's easily hidden. So these are the things. I find it's mostly mood change in socialization change that really triggers it for parents. Nowadays, people don't know it, most of the vape products now are decentralized, they're not as much in vape shops in those parts of the country that enforce laws, but like for example, in the South, in the Midwest and parts of the West, it's not banned, so therefore, kids can go to vape shops still and get these products. So as a result, you've got a patchwork across the country, and there is a bill...

0:23:29.9 S2: In the New Jersey House of Representatives, but it's not being put to the Senate because there's too much fear that it's gonna be not passed, partly because if they're Democrats that are from states that are tobacco producing, they're not gonna join on board. Basically, it's the mood issues. Now, a chronic cough with losing weight and vomiting are key things, and those things are with nicotine and/or THC. And then the final stage, which people heard about a lot before Covid, But CDC has stopped measuring this is EVALI E-cigarette Associated Vaping Lung Injury E-V-A-L-I. And as a result, no one has any idea how much of this is going on, and I suspect the 3.6 million kids who are vaping are vaping worse now because of the pandemic. And if you vape, you have a five-fold greater chance of getting covid as well, and these kids, they're bored, they don’t have anything to do, so this is a way to stimulate themselves, and if they get depressed or they're anxious, they kinda self-medicate with this stuff, and I've seen that go up, even though the youth risk survey, the Center for Disease Control, the CDC, says it's actually gone down, it's still at epidemic levels, and the kids that are vaping, are vaping daily. And getting back to EVALI, there were 2000 cases in this country recorded right when the pandemic hit.

0:25:14.6 S2: Some of the pulmonologists at Boston Children's here, I've talked to feel that some of these cases called covid lung disease are actually maybe vaping lung disease or a mix of vape and covid. Okay, now, the other thing that was vaped was pot. People that vape nicotine often vape pot as well, and there's this whole thing where vitamin E suspension was the cause, it's only in marijuana was the cause of the EVALI lung disease, which is not true. And Juul claims it never had vitamin E in its product yet South Korea's Department of Public Health found vitamin E in vape, which is supposedly the part that causes damages to the lungs. Though we don't know that for sure. but even still 20% of the people that they scoped. And then washes in their lungs, had no vitamin E in their lungs at all to show the damage that they had, it was just purely nicotine, so the jury's out on what's really the cause. Unfortunately, I've got kids that do marijuana and they have no plans to come off of it, and it really hit the kids now, they don't vape marijuana anymore, they're either doing edibles or they’re using smoking.

0:26:36.2 S2: And edibles are so much easier 'cause it doesn't smell, and as a result, that's what they're using much more. And I had to use a little harm reduction by saying, Please don't vape, and I don't really want you using this and I don't think it's good for your growing little brain right now. And I've seen kids that daily vape and then have a psychotic break, and oftentimes those kids have schizophrenia in their family history, so it's pretty scary 'cause then you flip a kid into a disorder that may be permanent. From vaping. Vaping marijuana in this case. But it can be not just vaping marijuana but the brain is affected, the executive function of the brain, organization, judgment and things like that are affected and affect the brain, nicotine affects the wiring in the brain, so as a result, this is why really nobody should be experimenting with this stuff until 25 when you're much less a sensation-seeking compulsive creature, and the frontal lobe has matured, which has been confirmed by functional MRI studies that on average, the average teenage, young adult kid doesn't fully develop their judgment and to around 25.

0:28:03.7 S2: And that's what the car rental industry said. They basically looked at it from a more practical point, when the brain neuroscientists ask, Why did you make 25 the cut off to when you can start renting cars? And of course you can rent them earlier now but you're gonna pay a lot more 'cause of the risk. And why do you do that? I said it's simple, our crash rates don’t significantly drop until 25. So as a result, optimal judgment isn't reached until about 25, and we put kids behind the wheel at 16, and that is controversial, but that's what we do, and the simple thing, the thing that's amazing about brain maturation in Massachusetts, they finally said, delayed by six months, your ability to drive somebody else other than your parents, and when they did that, they had a 25% reduction in highway deaths in teenagers as a result of waiting just those six months. Llet the brain ripen as they say. Yep, that was huge. This is why the longer you wait, the better the brain matures. Sure, just because you can go to war doesn't mean that you have optimal judgment, in fact, sometimes people don't have optimal judgment, we just follow our orders better, and in some cases this is a huge problem.

0:29:30.8 S2:. My nephew started smoking and his two-month-old kid died of SIDS. I begged him not to smoke in front of his kid, I wasn't listened to, and I saw him carrying in his whole dress blues, carrying a little white coffin to a burial site. And you know, this is something that's always been in the back of my mind. Why I've done this, I think.

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0:30:28.5 S2: So if parents want information, I think go to the Truth Initiative or Tobacco-Free Kids, all the information about how to quit, and how to talk to my child in a non-judgmental way. See, most parents I see come in with their kids have just caught them with it and become so upset and angry at the kids for doing it, but the issue here is if we don't talk in a non-judgmental way, they're gonna shut down instead of just ground you said, Tell me what's appealing to you about it, tell me how you feel when you use it. Right, okay. Get used to talking about those kinds of things. About where do you do it? When do you do it? Why do you do it at that time? It's interesting, most kids I see, for example using marijuana, use it at bed time, towards bedtime, 'cause they said I use it to help me sleep. Okay, and now that's why they're vaping melatonin, and we don't know how safe 'cause it's not regulated at all.

0:31:39.8 S1: Is there still such a thing as puffer lung? Popcorn lung. Diacetyl.

0:31:46.2 S2: Yes, that's not what we're seeing with EVALI. E-cigarette Vaping Lung Injury. That's the diacetyl, the popcorn lung, we're not really seeing that, but the vitamin E is the one that's being used. I mean, there's one kid in Detroit, his lungs were so damaged, he had to have a bilateral lung transplant. Oh my gosh. I have had some EVALI kids and they get on steroids and they gain 30, 60 pounds, puffing up on steroids because if they go off the steroids, they can't breathe, so it's a real catch 22 and their body image is destroyed. I had one fellow, dependably know this, but there's a nasopharyngeal cancer that usually the onset is the earliest is age 40, he vaped THC and nicotine for three years, and he had that nasopharyngeal cancer, he developed. And we have no idea if it’s related. This is what upsets me to no end about this basic assumption by some of the UK and some of the public health people in this country that it's safer than cigarettes. We have absolutely no long-term evidence... Zero, zilch that this is the case. Short term, maybe a little, that may show a difference, but we have nothing 20 years out, 30 years out, 40 years out, so all the people who are vaping now are lab rats of the future, and it's just what the industry did, Tobacco did...

0:33:24.0 S2: Into the 20th century. And this is what we're seeing again, and this is why parent groups called PAVE, Parents Against Vaping E-cigarettes is a fantastic group out of New York, and Meredith Berkman, and Dorian Fuhrman are just...they’re rabid mothers, I say jokingly. I say, and they talk about “you messed with the wrong moms,” and I know them, I've worked with them, and I feel they're a very legitimate organization that takes the science and really looks at the science of this, and they've had sons...that have both been addicted. I don't think either of them, but there's a story of a kid who was inhaling it so much that they seized from nicotine. Awful. And there are now new devices on the market called Puff Bar and Crave and Hide, and some of them have 3500 puffs, which is the equivalent to somewhere between 6-8 packs of cigarettes. Wow. And The concerning thing about that is there's no signal to an end point, in other words, on a cigarette, you smoke it, you had 20 puffs and that was it. Then you had to light up again, this doesn't do that, and you'll see kids, I’ve counted, every five seconds inhaling another one and another one, and another one, and they can easily go a pod is a pack cigarettes a day, and I've seen kids go two to four pods a day. And so this is...

0:35:00.8 S2: This was so many years ago, they had done a study on mice because in the 70s when all the CEOS of the tobacco companies were brought before the Senate and Widen said to them... Answer this question, yes or no. Do you think nicotine is addictive... And they all said no. They all said No. Now, when they do this again, now they say, and we're trying to help people get off and how they found out how addictive it is, they started in Louisiana, there was a lawyer who had been involved in somehow on the research, and they had taken lab rats and they made nicotine pills or liquid, and every time the rat would hit this lever, some of the nicotine liquid would come out and they drink it, and it was really something... What you see is the lab rats just taking their hand and just beating it, going boom, boom, boom, and to say they weren't addictive was crazy, and the lawyer and his Cajun voice said “ooh, we got a lawsuit”, and that the tobacco settlement in Louisiana, a part of which was about 250 million dollars, paid over a certain time period, but this is the issue, and now it's going into these products like tobacco-free nicotine, that are synthetic, supposedly not taken from the tobacco plant and Puff Bar is trying to get their product cleared.

0:36:42.5 S2: This can be used, it's not a problem, it's safe, it's not safe to the teenage brain, nicotine is not safe for the teenage brain. Wires them into addiction, it increases a risk of using other drugs, it may have cancer-causing agents themselves, it affects the elasticity of your arteries and increases hence, increases risk of strokes, and it also raises your blood pressure, which we don't know long-term what that does, plus these products have propylene glycol, which we don't know what that will do. And one of the books I read, The Devil's Playbook, they have a section where they took about 24 beagle puppies and, they had them inhale propylene glycol liquid for 28 days, then sacrificed them for their lungs, and looked at their lungs. They said, Oh, there was some hemorrhaging in the lungs, but it's insignificant. And I'm saying you only did 28 days, how are you gonna have a... You can't draw a conclusion from a 28-day study, part of the problem is the FDA tells these people to do the research, the Phillip Morris and things like that. Yeah, they found a Juul’s doctor, their own research. The other things in these products are heavy metals, there's lead, chromium, nickel, and things like that. These agents are lung carcinogens, and they also, because they're heavy metals, will affect the neurological development of children, so this is...

0:38:24.6 S2: We think this means that an infant who inhales the second-hand vape, or because it's an oily-based propylene glycol in vegetable oil, it coats the furniture, coats the floor, and the kid crawls on the floor and they put their hand in their mouth and they're getting what we would consider low levels of Cadmium, Nickel, lead and chromium, but for these kids, it's just like lead, it's toxic, right? So we don't know the long-term effects of this, so as a result, our infants are lab rats as well with parents that vape; vape, marijuana or nicotine, and so this is a deep concern. All this stuff was put out on the market and it wasn't supposed to be allowed. And it was during the Obama administration when they were distracted by the Family Smoking Act and everybody celebrated this, but the industry was light years beyond them looking at the vape products already and looking at ways they could get it through the FDA, get out there in the market without having the FDA bother them... And this is the key thing, this is a philosophy of big vape and also the philosophy of Silicon Valley: do what you wanna do and apologize later.

0:39:49.1 S2: And that has been the issue with big tobacco and big vape, and the people who developed Juul were from Silicon Valley. They're Silicon Valley guys, I mean they're geniuses, but they said they were out to save a billion people in the world from dying from tobacco-related diseases, which in this country is the most preventable cause of death. 450,000 people die a year from tobacco-related diseases, lung and heart, but there are also 50,000 people a year die on average, who inhale second-hand smoke, and we don't know what second-hand vape is gonna do and I have a close relative who has bladder cancer, and the only thing I can think about is this person's father was a three-pack a day smoker. No way. Yeah, so there are people who get cancer from secondhand smoke, and as I saw this kid, I worry about kids having... And none of the stuff's gonna come out. The average age somebody has an onset of cancer, if they smoke is 70, and then the average age with heart disease and stroke, they may start showing signs at 56, so in their late 50s, but that means they have to go a long time before we see this, and that's why none of this stuff should be allowed on the market, 'cause there is no long-term study to show it's any better.

0:41:18.0 S1: Yeah, it's gonna take time to get things off the market, so if you're a parent though, things that we should look for, packaging, the names of things, looking in pockets, what are some of the tips that you...

0:41:34.6 S2: Well, there are things you can look at about... If you're hiding Juul in the kids room, there are actually things like those cube gums you can buy and at the grocery store, you start to come in 60, chewing gum, they have fake bottoms for those, but they put Juul pods, but now they're not doing Juul pods so much because pods that are coming on and off replaceable, you can't do... By the way, let me also say something, reading about tobacco, kids were referred to as replacement customers, that's what they call... And they call them the sticky customers as well. Sticky means they're addicted. So this is how they use their language as well, but anyway, going back to that, I think you can look in the room, you can also... One of the things I think parents should join PAVE, they have the world's experts come on, you should go through the podcast, and I think parents of African-American descent should look at that, and parents who are not of African-American descent be quite frank, Black Lives Black Lungs, it's only 15 minutes long, but it's a real eye-opener of how they treated the African-American kids because it's somewhere between 90 and 98% of African-American kids that use tobacco products, use mentholated tobacco products 'cause they're so strongly marketed to in this country, and we have also seen a 30% increase in quit rate in adults in Canada, they found when they took menthol out of cigarettes.

0:43:08.8 S2: Really? Yeah, yeah, because menthol’s purpose is to numb the throat to allow the harshness of a cigarette to be tolerated, and that's why it was also used with kids. But also I think it goes back to smell, and I just think the mood of a kid, there isn't many signs and symptoms, but I think going through the room and your kid may have a text number to a nicotine drug pusher and text them and they say they meet downtown, in downtown in the center or square and a little town or something, and the guy drives up... You give him the money, he gives you the packages of nicotine, and it should be parents in a community working together, you know... Oh, I saw Johnny out there. There’s this car that drove up, and I couldn't see what he handed him, but he handed him something and then he was given something back. Imagine a parent's friend, who just happened to be driving in the area and sees it, you report it to the parents, you tell them what's going on... We're not gonna tolerate this. Making sure the packaging that comes to the house, that you know what's coming in the house.

0:44:23.3 S2: Okay, because some of these kids will wait around till the packaging shows up and then grab it and you won’t know, and some of these kids used to go to New Hampshire or here and have a mailbox in New Hampshire, and they would order things and put in their mailbox in, kids are very smart, and the thing that I often deal with is the parents being surprised kids have used this... Okay, in some school systems 50% of the kids vape. Come on. I don't care who the kid is, they don't have optimal judgment at 14, 15 and 16, and they want to be included with their friends... Right, and all us were as guilty of this, and that's what you have to say back then too. When I talk to kids, my judgment was impaired at this age, your mother's judgment was impared and your dad’s was probably a little bit more 'cause men are stupider... Sorry, I say to them, but it's true. And I think that the assumption could be, Oh, my kid doesn't do this 'cause they’re good. This is not a good kid, bad kid issue, this is something that an industry promotes and one in four to one in three kids who try nicotine products in vape form will become addicted. Will become addicted.

0:45:44.8 S1: And they're targeting our kids. Bottom line is they’re marketing to the kids, the flavors are to the kids, Juul was totally marketing to the kids, even though they were running clinicals as a smoking cessation, their marketing, which they were spending millions, hundreds of millions of dollars to market to our kids. And the reality is that these vape shops are doing the same thing and these manufacturers are doing the same things, and big tobacco is too, so as parents, we really do need to talk to our kids about these things and some of the things that you said.

0:46:22.0 S2: In first grade. This is not something you wait until the kids in middle school or high school, this is starting in first grade. We have an industry of addiction: alcohol, marijuana, nicotine, nicotine and opioids, and they profit off getting your kids hooked..

0:46:45.3 S1: And I would say Caffeine too, wouldn’t you? Some of those to a point, but…

0:46:50.1 S2: Nothing like these... Nothing like these other products overusing caffeine, there can be trouble, but we don't have any data showing you get cancer, you get heart disease or lung disease from it. So as a result, we need to protect our kids because even the government, SAMHSA, S-A M-H-S-A, which is a governmental website on addiction, Dr. Nora Volkow runs it, and she's very eloquent. Talks about the addiction industries and how they prey on younger kids where the brains are vulnerable to addiction, and that's why if you're talking to kids in fifth grade, it's too late. It's almost too late, you gotta start earlier. The thing I wish schools would do is start a curriculum in kindergarten on brain health. You want six-pack abs, don't you want a six-pack brain? Because this is the thing that's bothersome to me, there's no science curriculum until you get to third grade in this country, which is a travesty to me, and I think if they wanna start with something... it's brain health. Yeah, these are the things they're gonna mess your brain up. These are the things that are gonna cause you problems, and the younger you try them, the more likely you’ll get addicted. And I have had 11 and 12-year olds in my practice hooked on these products as well.

0:48:17.4 S2: Though the advertising has reduced, it’s still happening, and it's happening by closed doors in bedrooms during the virtual visits and all this...They were, oh my God, Puff Bars had all this stuff and advertising that looked like “getting pesky texts from your parents? Take a break, hit a few puffs of your Puff Bar.” Oh my gosh, really? [Attorney General] Maura Healey, Massachusetts, when they raided Juul headquarters, when finally got... We got somewhat smart, but still continued to be duped, Maura Healey got about 50,000 pages of marketing strategy, and there wasn't a single page on getting adults off nicotine, it was all about getting youth on nicotine. Oh my gosh, it's so bad. They lied. No stockholder-driven company should be left unregulated, and I'll say this, you wanna go to an unregulated place, come to Haiti with me. Okay. Where there's no tax base, there's no nothing, and it's all that to people that are poor and are not educated properly with no advancement, that's why we got all these people under the bridge in Texas right now is because they have no regulation of government and there's a very wealthy, subset of people, very, very wealthy versus 80, 90% of people there live off about a dollar a day at most.

0:49:55.1 S2: Part of this is the fact that we don't regulate. Massachusetts is in the top four or five in life expectancy, Louisiana, Mississippi, Arkansas, and Georgia are in the bottom five, and West Virginia. And so when you see all this stuff, I always talk about life expectancy, because I don't think politicians talk about life expectancy, they always talk about money, but nobody's saying, Don't you wanna live in a state where you have a better life expectancy? And Minnesota is very good too, by the way, but there are a lot of Midwest states that aren't so good, Missouri, Wisconsin, aren't the strongest states with this, so people think government overreach, well, do you wanna live a little bit longer. The difference between Louisiana and Massachusetts is about three or four years cut off in life expectancy, it's even worse when you smoke, it's 10 years cut off, so that is integrated into this... And not everybody smokes. And that's why it's not 10 years. This is what people don't realize, if the goal is you wanna live a longer and healthier life, this means regulations that help, and this was regulations in Massachusetts started in Paul Revere’s time. This is stuff that's been in Massachusetts since them, that’s unique in Massachusetts; every town determines its own health destiny.

0:51:29.5 S2: So the advantage to that is you can go on all these little towns and work with them, instead of trying to go into a state level where they've been hooked in with big tobacco as much doesn't mean big tobacco doesn't reach down to the small town, 'cause I fought in 160 meetings, I fought so many of them, and lawyers that would come in and say, “How much you getting paid for doing this?” and they'd look at me and they wouldn't say... But they did, they said, this is how much I get, I put up my hand. Zero. I would start on the moral high ground. 'cause these people are terrible. What they're doing is terrible because they're not looking at what the harm they're doing 'cause it's not my kid. Right. This is the horrors about that...

0:52:18.5 S1: I think it starts as being educated. Absolutely, we will post on social media as well as our website, a lot of these different references that you have talked about today, it really is about being an advocate for your child and educating them early. Lilly, who is in fifth grade…never too early to talk about these things, so I think that's a huge thing that I need to do a better job at talking with her about these, and that it's not glamorous. And show them a product... Don't just talk, they need to see the pictures of these things as well.

0:52:57.0 S2: Let me just tell you the most indicting thing to a convenience store that sells this and to the distributors is the product itself, and I bring all the products with me. Here's a bag of... Yeah, I bring them and I pass them around. And any lawsuit that somebody has should be passing these around to the jury so they can look at it, because this is the hard evidence that you need, and I'm not saying buy one or your kid can see it, just look at pictures with it. So anyway, and talk to your pediatrician, they may not be the source, they might be the source to help you because there's a lot of problems with success with patch and gum, but it's not-not worth trying, it's just off-label use if your kids are under 18, so that's the challenge, but people should look up online, you have texting, they can text your kid daily on addiction things, check in with them. And this is no cost. And so I think it's important that parents, if they know their kids are doing, or suspected, see if your children's hospital, if you have one locally, has a clinic for vaping.

0:54:15.1 S2: Boston Children’s now, there's the vaping clinic, and there's a adolescent’s substance abuse clinic, and Children's Boston is the first hospital in the country to develop a pediatric addiction fellowship. So Pediatricians can sub-specialize in addiction. This is the first place in the United States and maybe in the world. And Sharon Levy is the one who started the program, she’s great.

0:54:42.9 S1: Really good resource. Well, thank you so Lester. Thank you for your dedication and just seeing this through, and like you said, you racking up a bill to be the advocate for kids, that this is really because it affected you years and years ago, like you said, your nephew, and it's things that cause generational differences. Behavior that can affect us generationally. So thank you so much for joining me.

0:55:16.0 S2: And it's my ticket to heaven, in addition to my wife.

0:55:19.7 S1: So thank you, Lester. Thank you. We hope you enjoyed this episode of The WE Podcast as much as us. If you want more wellness goodies, head over to the wellness essentials Podcast, dot com for show notes, lengths and resources mentioned in today's podcast. Remember to hit subscribe on your favorite podcast platform to get all the wellness details as soon as they're released. Cheers to living your healthiest and happiest life.