DOCTORS' LOUNGE
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in the family are willing to eat. But not everybody in the family has
to be willing. They just have to be hungry. They have to, eventually,
eat what is there, since that’s all there is.
I tell them it’s okay to fix the same things every workday. If you
have figured out that you can microwave eggs in three minutes, eat
an apple in the car, and take a cream cheese bagel for midmorning
snack, you are victorious. When you have accomplished a healthy
breakfast for a while, then you can figure out an actual lunch: pro-
tein, fruit or vegetable, dairy or grain: same rules. What is sad is
that my patients say, “My mother used to make my lunch and I so
miss those days.” They have nobody to mother them now, and they
are too beaten down to mother themselves.
The working single parent is the most stressed person in my
practice. Everyone grabs for their time. Everyone demands they be
this or that or the other, and be here, there and the other, and they
want to be with their kids at all sports and school events. When I
see their frazzled and exhausted faces, I wish we had a new national
service corps: mandatory, as in Israel. Join the Army, the Navy or
the Corps of Engineers, or join the new Family Helper Corps and
get this country healthier. Domestic work, yard and garden, chauf-
feuring, coaching, tutoring, baby and elder care: if every 18-year-old
kid in the country did this for a year, paid for by us in taxes - no
exceptions for wealth or poverty, no exceptions for religion - we’d
have a nation bound together by shared labor. Over time, we would
understand each other better. Over time, the working parents of
this nation could take a walk, ride a bike, go to the YMCA. Over
time, more people would see each other as equals, as opposed to
Us vs Those Horrible Different Ones.
I can only imagine the intense opposition to this idea by every-
one who is not a working parent. I know we are so far lucky in this
country, in this century, that we have not had widespread war inside
our borders. We are not being bombed and strafed and burned
and tortured by our enemies. But the backbone of the nation, the
working adults and grandparents, are exhausted and fattened and
embittered, addicted and angry and ashamed, because they have
no time and no help. They know better, but they don’t know how.
Still, they can reclaim the essential phrase, at least in eating
healthy foods: “Because I said so.” It saved Britain, and it can save
lots of us.
Dr. Barry practices internal medicine with Norton Community Medical Associates-Bar-
ret. She is a clinical associate professor at the University of Louisville School of
Medicine, Department of Medicine.
CURBING THE ELECTRONIC CIGARETTE EPIDEMIC:
RATIONALE FOR A NICOTINE-LEVEL-BASED TAX
A
AUTHOR Gordon Tobin, MD
n old song of nostalgia for innocent
days of school may need an update.
Now, it might go like this: “School
days, JUUL craze, dear old golden
vapor haze. Reading and vaping
and ‘rithmetic, taught in the rush
of a nicotine kick…”
Measures are urgently needed to address
this new threat to the health of our youth. The growing popularity
of electronic (e-) cigarette use (vaping) has surged exponentially
among youth (Fig 1), prompting state and national public health
officials to declare an “epidemic.” Between 2011 and 2014, middle
and high school users increased tenfold nationally, with nearly
15% of high school students using e-cigarettes (2015 CDC data).
In Kentucky schools, users nearly doubled between 2016 and 2018,
with nearly one-third of high school students having indulged. The
e-cigarette industry has strategically and vigorously targeted youth,
creating a new generation of nicotine addicts (Fig 2), according to
a US House of Representatives committee, who conducted a July
2019 hearing on this subject, and to David Kessler, MD, and Scott
36
LOUISVILLE MEDICINE
Gottleib, MD, the last two FDA Commissioners.
Most popular with students is the brand JUUL. Its compact
design (resembling a computer USB flash drive) is easy to hide,
and it’s pods are available in many candy, fruit and dessert flavors.
Notably, JUUL has also been engineered to deliver nearly three times
the nicotine content (5.9%) compared to combustible cigarettes or
earlier vaping devices (1.5-2%), which gives an economic advantage
to using JUUL, while increasing addiction risk.
The e-cigarette industry has promoted e-cigarettes as a withdrawal
aid for combustible cigarette smokers, and it has given repeated
assurances of product safety, based on the absence of carcinogenic
“tars.” However, Dr. Aruni Bhatnagar, Director of the Christina Lee
Brown Environmental Institute at the University of Louisville, and
a recognized expert in the field, finds that proof of these assurances
has not been established. 1 Recently, reports of many emergency
hospitalizations from vaping have surfaced. Five deaths and over
450 cases of vaping-generated hospitalizations have been reported
as of September 2019, with many victims requiring ventilators for
weeks and one requiring ECMO (heart/lung bypass). Nearly all
were youth and young adults. The exact mechanism of lung injury