Discussing Health Implications From W.Va.’s Nicotine Problem

On Wednesday, the American Lung Association released its annual “State of Tobacco Control” report and West Virginia again earned failing grades. Health reporter Emily Rice spoke with Dr. Robert Heron, a general thoracic surgeon at WVU Hospital about the health implications of long-term tobacco use.

The transcript below has been lightly edited for clarity.

Herron: My name is Dr Robert Herron. I’m a general thoracic surgeon at West Virginia University Medicine Wheeling Hospital. My primary area of practice is surgical treatment of thoracic diseases, namely lung pathologies like lung cancer, as well as esophageal diseases and anything within the chest. I’m also the director of our low dose CT program for lung cancer screening at Wheeling hospital.

Rice: You are on the ground with this report card here. This is my third year covering the report card. Our grades pretty much remain the same, and the recommendations also kind of remain the same. But I’m interested to hear from your perspective, what you think? Is it a societal mindset that needs to change, and you know, how could we go about that?

Herron: As you alluded to, unfortunately, on the state of tobacco control, West Virginia, which is a state that I grew up in, have family and friends here, we scored, you know, very low. I mean, they graded us on various categories, and our letter grades were all in the D to F range. So to answer your question, I think it’s a lot of different factors. Is it a societal you know? Yeah. I mean, smoking, smoking has been a long standing part, not necessarily, of the culture, but it but it’s been somewhat ingrained, not just in West Virginia, but, you know, a lot of states in the country, Appalachia seems to be more affected. And I think to kind of break the mold. The issue that we see a lot is younger generations. You know, their parents smoked, their grandparents smoked years prior. It’s, it’s just kind of hard to break that mold, unfortunately.

Rice: Absolutely so it definitely, is a bit of a generational thing here. So when we get down to it, and prevention and cessation, I guess, let’s talk about what you’re seeing when patients come to you. What’s the cost of tobacco use in a healthcare sense when they come to you?

Herron: Yeah so, you know, being a thoracic surgeon, a lot, a big part of a practice, not just of my practice, but any practitioner within this, specially a lot of the lung pathologies. You know, how we get lung cancer, it puts us at risk is is smoking. So a lot of the patients that come to see me with a lung nodule, whether it be found incidentally or through our low dose CT program have, have, the vast majority, have a history of prolonged and substantial smoking. So the burden in place is not just on increased risk of lung cancer, but the cardiovascular effects and the the underlying, you know, lung effects with emphysema and COPD, that not only you know if the if smoking leads to a process like lung cancer. Well, how do we best treat it based on their health and the smoking you know, can affect their health in a lot of ways, from a cardiovascular standpoint or a lung function standpoint, which, in the most extreme cases, can limit the options we can offer that patient for treatment, i.e., surgery.

Rice: Are you seeing any changes with the increased rates of vaping? Obviously, teenagers aren’t going to be coming to you yet. You know you’re going to see them in 10, 20, years.

Herron: Correct.

Rice: Have there been any significant changes that you’ve noticed in the patients that you treat in the past few years?

Herron: In my anecdotal experience, you know, vaping is on the rise. We have a lot of patients, when I say young patients, I’ve had to operate on patients as, you know, as young as their late teens, early 20s, where it’s not necessarily for cancer, but they’ve never smoked cigarettes, but they vaped, that a lot of these patients will get collapsed lungs that require surgical intervention to fix. And again, anecdotal experience, but these cases kind of stick out because they’re, they’re younger, and a lot of the lungs, and I have this discussion with the patients are, you know, you get in there surgically, you know, you’re obviously looking at the lungs. And all, you know, a lot of those lungs look like the patients that have, you know, smoked for a prolonged period. And I take care of, you know, on the on the back side, like a lung cancer. And I, I always tell these patients that. So vaping is fairly new, so I think it’s going to be, you know, it’s going to take years for all this to kind of, you know, settle out, and this data to settle out. But, you know, I would be surprised if we don’t find coming years that that vaping is is just as bad, if not worse. Well, I always tell my patients, young or old, that the best kind of smoking is, is no smoking.

Rice: Alright, so you know, when it comes to our grades, you know, the main recommendation from the American Lung Association is for our lawmakers to invest in cessation and prevention efforts, because they’re trying to stop it before it even starts. I am very well aware that you’re a physician and not a lawmaker, but I’m sitting here looking at the fiscal note in the ALA report, the cost that tobacco has on West Virginia. You know what it does to the workforce? Could you speak to that a little bit?

Herron: A lot of, a lot of jobs, especially in West Virginia coal miners, and you need good lung function to for the manual labor jobs. So it does take a toll. But, yeah, I mean, lawmakers, I, you know, my, my biggest inclination is that, you know, this is, these have got to be kind of ground up programs, you know, start early ages with funding for school education programs that reach out to young kids as early as possible, to you know, to plant this that smoking, smoking is not, not good for you. And I think that’s approach is very important for for education. I think education is, is, is, is the, probably the best, strongest foundation for this type of undertaking, in my opinion.

Rice: Do you run across that with your patients? Do they come in with these conditions, and they’re like, ‘Well, nobody ever told me that.’ Does that happen?

Herron: Nowadays, everyone knows that smoking, smoking is bad for you. I mean, but a lot of the issue is they start younger, and they may not have known, but once you start smoking, it’s very addictive. A lot of, if not all my patients who smoke, they want to quit, but it’s just physically and mentally it’s so difficult because of the addictive properties that challenge can be overcome. I mean, we have cessation programs through debut that are very effective. But despite all that, it’s a very tall mountain to climb. So the best approach is if, I mean, easier said than done, but if you never pick them up, then never, never start, then it’s then, obviously that’s a lot, lot easier.