From The Doctor's Company

The Doctors Company's 2018 Executive Advisory Board meeting--a gathering of some of the leading figures in medicine in the United States--featured a conversation between The Doctors Company Chairman and Chief Executive Officer Richard E. Anderson, MD, FACP, and the United States Surgeon General, Vice Admiral Jerome M. Adams, MD, MPH.

In this second of two articles highlighting key excerpts from the conversation, Dr. Anderson and Dr. Adams discuss the dangers of e-cigarettes and the movement to population health.

Dr. Anderson: The Surgeon General's office has been relentless in highlighting the dangers of cigarette smoking. My impression is that despite a decades-long reduction in the overall incidence of smoking, the percent of smokers in the United States is still very high--I think something around 20 percent, which leads us to a major controversy--and that is the role of e-cigarettes, vaping, and nicotine substitutes for cigarettes. It's a complex issue with a lot of tentacles, but we would be grateful if you would give us some of your thoughts about that.

Dr. Adams: This is a very important and personal topic for me. I've got three young kids. I'm not just dealing with this as a surgeon general or as a physician; I'm dealing with it as a dad.

Respectfully, I think that folks are purposely making it a complicated issue. I don't think it's that complicated.

We know that the combustible cigarettes are bad. We know that nicotine is addictive. E-cigarettes and vaping can be two things at once. There can be harm reduction compared to combustible cigarettes for current smokers, but they can also be a dangerous initiation into the world of smoking.

I believe, and I hope all of you in the audience can say it loudly: No young person should be vaping. No young person should be using e-cigarettes. No one should be marketing these products with flavors like cotton candy and bubble gum to young children.

I'm working with the FDA and Commissioner Scott Gottlieb on this issue. We know the brain continues to develop up until age 26, and we know the folks are susceptible to developmental delays and effects on the brain, which prime it.

Dr. Anderson: The healthcare delivery system in the United States is undergoing a kind of once in a hundred-year cycle of change in the way care is delivered in almost every parameter of care; there are new technologies, new medications, new surgical potential, as well as different ways of accessing care throughout the system.

But an important part of the conversation in that transformation is the discussion of population health versus the traditional doctor-patient and the individual patient and the individual office. It's really struck me that this conversation is very much akin to the entire discipline of public health, which after all is focusing primarily on population health. How do you find that your background in public health helps you? How does it affect the way you see this national transformation?

Dr. Adams: A lot of our problems stem from the fact that we don't teach enough about public health and population health to our medical students or nursing students. We don't teach enough about how to discuss proper diet, how to talk about exercise, or how to talk about smoking cessation--all things that are promoted as part of public health.

That said, we're all quickly being forced to get to grips with that because of changes in payment models. We found that in paying for procedures and cutting things up piecemeal and then reimbursing for them is not only ineffective, it's costlier. And so now when we look at paying for outcomes, we're having to embrace population health. The good news is doctors, nurses, and healthcare professionals are all more satisfied when they're able to do that. When systems are put in place that give them that freedom, flexibility, and the tools they need, it allows them to serve the patient.

It empowers professionals to refer patients or to write a prescription for food; it allows them to refer patients to community recreation centers where they can exercise--and ultimately, that patient becomes healthier because of something that you've been able to facilitate as a medical practitioner. So, we're shifting in that direction; some people are kicking and screaming, others are embracing it.

Dr. Adams is the 20th Surgeon General of the United States, a post created in 1871. He holds degrees in both biochemistry and psychology from the University of Maryland. In addition, the Surgeon General has a master's degree in public health from the University of California at Berkeley, and a medical degree from the Indiana University School of Medicine. Dr. Adams is a board-certified anesthesiologist and associate clinical professor of anesthesia at the University of Indiana. He has been active in a number of national medical organizations, including the American Society of Anesthesiologists and the American Medical Association.