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No Quit in the Battle Against Smoking

Pulmonologist Trishul Siddharthan worries that vaping could reverse progress made in reducing tobacco use
Illustration of e-cigarettes in a traditional cigarette box

Illustration by John Kuczala


lthough cigarette smoking has dramatically fallen from epidemic levels in the 1960s, tobacco still kills more than 480,000 Americans every year and costs nearly $300 billion annually in related illnesses. That’s the good news-bad news world that Trishul Siddharthan, M.D., lives in.

Dr. Siddharthan, a pulmonologist and assistant professor of medicine at the Miller School, studies the effects of tobacco use on lung function. “Smoking is the single largest preventable risk factor for cardiopulmonary disease in the U.S., and significantly contributes to pulmonary-related morbidity and mortality,” he said, stating facts verified by the 2020 Surgeon General’s report on smoking cessation, to which Dr. Siddharthan contributed.

The report was the 34th since the first one, in 1964, when more than 42% of Americans smoked, compared to about 14% today. While those statistics are truly remarkable, nicotine — the highly addictive drug in tobacco — remains a serious public health problem, as reflected in the American Lung Association’s latest report on tobacco control. That report celebrated the continuing progress made in smoking cessation over the past 20 years, but it also had a dark side. “A new generation of tobacco products, including e-cigarettes, threatens the progress made, as more than two million middle- and high-school students reported using e-cigarettes in 2021,” the ALA stated.

Vaping, as the use of electronic cigarettes is commonly known, has been controversial since the products were introduced in 2007. “They have been marketed as an alternative to cigarette smoking,” Dr. Siddharthan said, although research has not concluded that e-cigarettes help people quit smoking, and they are not approved for smoking cessation by the Food and Drug Administration. The FDA has approved nicotine gum, patches, certain prescription drugs and other therapies.

“Vaping delivers very high levels of nicotine,” Dr. Siddharthan said, which is proven to have deleterious effects on the brain and the cardiovascular system. He advocates for more federally funded research on nicotine’s harm, specifically to adolescents, and FDA regulation of vaping devices, flavoring additives and advertising aimed at children. “The concern,” he said, “is that we are going to have another generation addicted to a different form of inhaled nicotine.”