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The Alternatives to Cigarettes

Hello and welcome. I'm Dr. George Lundberg, and this is At Large at Medscape.

"Tobacco is a dirty thing and so is alcohol. Into my mouth they will not go; when tempted, I'll say NO." I had that little ditty drilled into my head for years, at home, at Sunday school, even in public school.

Did it work? No, but it did delay my beginning these habits. I learned to drink in medical school -- peer pressure, of course. I tried to learn how to smoke in the Army -- peer pressure, of course -- but I never could learn how to inhale successfully, so I never got hooked.

But how about all those hundreds of millions of Americans who did successfully inhale and got hooked, either immediately if young enough, or after many efforts at inhalation if older? Of course they did not get hooked on tobacco; they got hooked on nicotine. Cigarettes are simply the dispensing agents.

What is it in tobacco that kills nearly 450,000 Americans each year? A host of noxious, toxic, fellow-traveling chemicals -- not the nicotine itself.

Then why not simply provide those hopelessly hooked tobacco addicts with the nicotine they must have without all those carcinogens and other nasty toxins?

Great idea. Does that work? Well, it does if the slope of the blood nicotine uptake is steep enough to produce the hard-hitting charge that the nicotine addict must have. How about nicotine gum? It works poorly. How about lozenges? Not good enough. Patches? No, too bland. Intravenous nicotine could work, but there's potential for infections. An inhaler? Now you are getting closer.


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