All right let me just get into it then. So again, I'm Doc V, and today with Call Sign Wizard, we're going to be talking about veterans and tobacco harm reduction, which is really an interesting topic because of the amount of people that die from tobacco each year. It's 480, 000 people in the United States that die from some type of tobacco related illness each year. And It doesn't seem like we talk about it enough.'cause 480,000 is a lot. It's 8 million in the world in the on the globe, right? 8 million people die a year of smoking related stuff. And that number is supposed to be valid until 2030. After 2030, the numbers start to hopefully will start to decrease, but right now the prospectus is that it'll be valid until then, and that includes 19,000 people that are dying of. Secondhand smoke as well. So in terms of what, DOJ might look like at is the finances of things, right? Because there's 600 billion in healthcare costs wrapped up into smoking health related issues and non health related issues for that matter. So we're going to be focusing on veterans and there's another number that we should really look at as well. And that's 22. We all know and respect and keep in our hearts and our minds that 22 veterans a day suicide. I've known myself a couple veterans, a couple buddies who have taken their own lives. So first I want to give respect to that number. But then I want to start talking about other numbers, like 15. 15 represents the number of veterans that die of lung cancer each day. That is equal to about 5, 000 people per year dying of lung cancer. 5, 000 veterans dying of lung cancer each year. It's a pretty high number when you think about it. But that's not the only number we can talk about. We can also talk about 34, right? Which is the number each day that a veteran dies of a cardiovascular disease that has, that comes from smoking, directly related to smoking. Or 29 a day, which is the amount of people that die of chronic obstructive pulmonary disease. And that's a horrible disease to watch, right? Because and I've had my grandmother died of emphysema. My aunt also died of a lung disease as well. And then it's not just those lung diseases, but strokes and other cancers like head, neck, and esophageal cancer, all of these things, and add up to a number that's staggering, right? And this is an underestimation. But each day that we are going through today, 77 people are dying a day. of a smoking related illness. 77 people. And that's an underestimation. Because we take the estimation of everybody that smokes. But then we also need to pay attention to the fact that veterans smoke more. And so their number might even be higher than 77. Well, let's stick with that number, right? The conservative 77 veterans are dying. a day of, uh, a tobacco related illness. So when we do the, extrapolation of that, and when we pull that out and talk about how much, 77 a day ends up being, it's about 28, 000 28, 000 a year, right? So 28, 000 is about four times as many people that, that suicide. So these numbers are astronomical, and when we add them together, that's almost 100 veterans that are dying each day of, what we might call a preventable illness a preventable death. So, we do want to pay attention to, what's going on here, right? We want to understand that this is a big issue, and we want to take the time to really look at this issue and pull it apart. I just want to say, why aren't we talking about this? Why aren't we outraged about this? Why isn't there a 77 a day campaign? Like the, the twenty 22 a day that we have right now. Why don't we have a 77 a day campaign for each of the veterans that are dying of tobacco related illness? Okay, so that's what we're going to be talking about today, and that's 77 veterans that die. And I want you to be outraged, I want you to be furious, but most of all I want you to take action. Okay, so I just want to remind you this is Call Sign Wizard. This is a podcast that I do about once a week for therapists that work with veterans, and I'm your host Doc V. I am a veteran. I'm a therapist, and I'm trying to be your guide to navigating the complexities of working with those that served. Each podcast we go into working on critical topics like PTSD, chronic pain, military culture, evidence based care. Basically, all the different things that we can do to arm you with the tools that you need to provide the care, the best care possible for those that served. All right, so let's start talking about why veterans smoke now I mean anybody can start smoking for any reason when we look at the regular civilian world People will smoke because their friends smoke and it's not very Different to how sometimes things begin in the military when you think about a young soldier or airman or marine Joining the military. Sometimes this is the first time they've ever been away from their family And they're going there alone most of the time, so they don't have friends, they don't have people that they can go to talk about things that bother them. And how do they develop these friendships, right? They do what the crowd does. At times, that might be smoking, right? Especially in stressful circumstances or situations, when people have that moment to go on a break, and they go on a break together, some of them might be smoking. And in order to create that camaraderie, in order to develop that social bond, Sometimes people start smoking together. So there's a social reason for that. And there's also a stress reason. And that stress reason can be exacerbated when we talk about deployments and having people during a deployment working. Through battles, through convoys, and whenever they get a moment of rest, whenever they can pull over to the side, whenever there is a moment where they can just get together and just let the moment last as long as possible between chaos and disarray, right? In those moments, yep, they'll smoke, they'll smoke them if they got them, right? And this is something that's been around forever. Uh, well, maybe not forever, but in the military there was a culture of giving out cigarettes at one point. We put them in the rations, in the MREs. We don't do that anymore, but that was something that was done. And so there's a culture that comes from this as well, and some veterans that are still around today were of that culture, were from that time, and are currently suffering from the issues that came from that. So maybe Right now, as people are going through and exploring cigarettes maybe veterans are still using it to deal with their stress after they come back from the military. They know it works. They've used it in the worst scenarios that you can imagine, so it works for them, right? So it's going to be hard to tear that away from them, to take that away from them. It could also be helping with symptoms of PTSD, right? So it's been shown that people with certain mental health disorders like depression and PTSD are more likely than the regular public or regular veterans. I don't want to say regular veterans, but other veterans to be smoking and to continue smoking. All right. So what does nicotine do, right? So nicotine does release dopamine. It makes you, it brings up that good feeling. It can also block signals from stress hormones. So it can increase a positive feeling and also decrease the stress hormones. Nicotine has been shown in some places, there's observational evidence that show that there's some evidence that it's neuroprotective, that the research is still going on, but there's some information on that. And Vanderbilt Medical University University Medical Center, Vanderbilt University Medical Center, I think that's Tennessee. I've been doing a lot of studies on the benefits of nicotine and what it can do for you. Working on different things including concentration, memory, weight loss. There, there are people out there that are looking at nicotine and some even say it is the one of the most studied chemicals that are out there, right? So there's also a lot of misinformation out there, right? And we want to pay attention to that because even Vanderbilt University, when you go on to their website, they have to write on a big banner before they even talk about the stuff they're doing. Fact. Nicotine does not cause cancer. So even before anything, people have to bring up that fact. Let me just take a second and see what's going on. Let me see. I don't see anybody in the comments, but I see some things going on here. All right. All right let's keep going. I just want to make sure that I'm looking out and seeing. Who's out there? All right, so fact, nicotine does not cause cancer. Okay, so Vanderbilt Medical University has to put that front and center, trying to combat the misinformation. So when you go down and read the good things that nicotine could possibly do, or what they're studying that it could possibly help with, that you're not already have this bias in your mind, like what are these people talking about, right? We can go a little further and talk about what the VA says, right? So you can go down and download the VA's My Smoking Workbook. If you google mysmokingworkbook. pdf, it'll come up. It's like one of the second things that go in there. And they also say the same thing, right? They'll tell you that let me make this bigger for you, right? So nicotine does not cause cancer, right? But as the addictive chemicals in tobacco, that make it hard to stop smoking. Tobacco smoke has over 7, 000 chemicals, more than 70 of these cause cancer, etc. It's not the nicotine that causes cancer. It's everything else. And that's what even the VA wants you to, wants people to know. Alright when we talk about e cigarettes and vaping, right? It's a, an area that we can talk about that doesn't have the issues that combustible cigarettes have, right? Even the Surgeon General deems that substituting cigarettes substituting e cigarettes for cigarettes would be the best thing for you. And this was in 2016 we started having this conversation. If you go over to my My Twitter account. I posted that today. I posted a video a YouTube video of him actually talking about that He is very interested in making sure that the youth are protected But he also recognizes that as for adults smoking cessation can be greatly helped by Using the e cigarettes. I think I also know I can't Janine I can't remember that the name of The, the one that might be coming in, the Surgeon General that might be coming in. But five years ago she was interviewed during, the chaos of what was happening back there. And she even said, we know that that e cigarettes are good and helpful for smoking cessation, right? So she was able to say that even in a news broadcast that was talking about something else something negative, she was able to bring that out. and recognize that. So I hope that she carries that into her current position as well. So we, we know that these are facts, that these, that this information is not there, right? That this information is out there. So what can we get this, get with, get from this? Nicotine isn't the killer of 77 veteran brothers and sisters a day. It's combustible cigarettes. That's the killer. That's what we need to find the substitute. to help save lives. So what else do we know? So let's look at lung cancer where that's still, smoking is still the number one contributor to veteran lung cancer. All right, what we know is that we diagnose let me see if I can find this here. There it is. Yeah, we diagnose 7, 700 veterans with lung cancer each year. It's almost 8, 000. So almost 8, 000 veterans we diagnose with lung cancer each year. And then we also have 5, 000 dying each year from lung cancer. Isn't that crazy? Almost the same amount that we are diagnosing end up dying. And the rate of how quickly they die is pretty scary. It's 13 percent mortality rate within the first six months. It's crazy. So it, it is a huge issue. And we want to pay attention to all of the aspects of what we're talking about here. Because right now we're just focusing on lung cancer right now. However, I also mentioned that there's, plenty of people that are passing away from Chronic obstructive pulmonary disease and strokes and other cancers and heart related issues, right? It says one in four in the general population That have a cardiovascular event are dying from a cardiovascular event that is specifically associated with smoking And so we take that into the veterans With our veterans and we still have the same thing But we also might need to increase the amount that could possibly be dying from it because veterans smoke more smoke more often Get rid of that for a moment All right. Oh yeah. And there's been, research in 2024 the VA has been really trying to get out there and get in front of this lung cancer issue because obviously it's an issue, right? And how they're doing that is screening and making sure that people are getting screened. And right now when people are testing positive for lung cancer, right, 90 percent of those people that are testing positive have no symptoms. They just go and get screened, and they have no symptoms prior to it, but they have the eligibility for screening, which I'll go into in just one second. But think about that. 90 percent of veterans that end up with this lung cancer that could gradually go on to, you know, high mortality lung cancer are going to die, are going to end up having lung cancer with no symptoms. Um, so let's unpack that, right? So for the VA, you're eligible to get screened for lung cancer if you're between the ages of 50 and 80. Right. So automatically you might say, well, that's not me. That's, you know, older people who cares. Well, let's, let's keep pulling that apart, right? 50 to 80 is your eligibility, right? But in order to be eligible, you also have to have smoked a pack a day for 20 years or two packs a day for 10 years. And then we also add in the fact that you could have quit 15 years ago. So think about what they're saying. So at 50, you could have quit at 35 and have been smoking a pack a day for 20 years prior, or a pack a day for 10, or two packs a day for 10 years prior. That puts us into our 17 18 year old range. That puts us into the veterans that are coming back from Iraq and Afghanistan and, uh, the ones that, you know, we're sending over to the border now, you know, I mean this is, this is the current veteran age of, uh, the cohort now, right? So it's not just the people that are 50 to 80 that we're talking to. This is the people that are serving right now, right? We want to get out in front of it, and especially with that group between 18 and 25, because when we look at the numbers for veterans, and how many of them smoke, you know, that's like 21 percent global, right? And then if we look at the veterans that are in the VHA, it ends up being like 14, 13, 14%. However, of that 14, 13, 14%, 50 percent of those, actually 50. 2 percent of those. Half of them are from ages 18 to 25 of current smokers. So this half of age of 18 to 25, smoking a pack a day for 20 years, or two packs a day for 10 years, these are the people that are going to end up getting those screenings. And 98 percent of them aren't going to have any symptoms, and a bunch of them are going to come out with positive results. This is no joke, folks. This is serious. 77 a day. So we need to intervene now. We need to understand that this is an emergency and appreciate it for the emergency that it is. It's a crisis that we have 22 veterans a day dying of suicide. It's a crisis that we have 77 veterans a day dying of smoking related illness. Both of these things that we can have something to do that we need to motivate ourselves to do, right? But are we doing enough for the, the, the smokers for the 77 a day? So we know that we have these therapies, right? We have the VA that actually has, um, you know, a pretty good robust bunch of things that are out there, right? Um, that nobody really uses. Um, they say that 70% of veterans want to quit smoking, right? However, when we get into the process of it, it's only six to 14% that ever do quit over a year, right? So, you know, they, they, they might try to quit. They might, uh, end up in a, uh. in a treatment and then drop out of the treatment. Uh, they might quit for a little bit and then go right back on it. Right? So we're only looking at, like, after a year, 6 to 14 percent that actually quit of that 70 percent of veterans that say they want to. And we're not even talking about the other 30 percent that said they didn't want to. Do we even talk about them? What does that even mean? Like, you know, that's 30%. That's a large number of veterans that say, Yeah, you know, I'm not interested in hearing about smoking cessation. Um, What's happening with them, you know, they're gonna end up one of those 77 veterans later on. We have to talk to them. We have to You know get in front of them and give them a positive messaging of what they can do. Also, just going back to those that It's like funny not funny at all Those veterans that were diagnosed with lung cancer in the VA. They don't quit either They continue smoking. Only like 11 percent that were screened for lung cancer, right? So 11 to 18 percent. 18 percent. Entered into treatment after that, after going into that. So of the smokers, 11% tried to quit. 18 percent went into treatment. It's pretty stark numbers, especially for people that already end up suffering from some type of lung issue. So we do know what we have, right. In terms of our are current treatments. We have nicotine replacement therapy. Those are our lozenges, those are our gum. I think they have inhaler stuff now. Patches, right? So all of these things are things that we have. We have medications Bupropion and Chantix. Those are the two medications we have currently. We have counseling. We have cognitive behavioral therapy and we have ACT, right? Act is acceptance and commitment therapy, right? So these are the big therapies that are that the VA uses. And then there's some, other programs that they have like a, a quick text line and a tele telephonic text line telephonic line that can help veterans when they're having cravings or something along those lines. So there's some stuff out there and again, those things are not successful. Right. Well, very limited success, right. So as we discussed a couple minutes ago, very limited. Success in that. And we can look at some other pieces of what's happening here in terms of veterans overall, right? So this is about the veterans that know about VA services. Smokeless Vets smokelessvets. org. Let me go ahead and put that up for you. Smokelessvets. org. There we go. Alright, smokelessvets. org. They found that they did a survey last fall, right? They found that 90 percent of veterans want to quit. But can't find methods that work for them, right? So again, these things that they've been trying, maybe with the VA, haven't been working for them. Only half of veterans polled knew that these VA resources even existed. And then 90 percent never even sought services to quit smoking. And this is kind of global, not necessarily everybody was already with the VA when Smokeless Vets did this last time. So, this is You know all the veterans that responded so we can encourage veterans to get treatment But we also need to recognize that the current treatments are inadequate. They're not doing the job. All right, so let's start to look at What works right? So we go back to e cigarettes and vaping right because as far back as the 2016 the current Surgeon General Recognized that e cigarettes can be helpful if smokers completely substitute one for the other The FDA agrees with this, right, they said it would be beneficial if smokers switched 100 percent to e cigarettes for the benefits. You don't want to dual, you don't want to use them both because that's, that's not great, don't do that. You want to just use e cigarettes switch over 100%, and that's supposed to be 95 percent of a healthier choice. And that's what we're looking at here, is tobacco harm reduction. What can we do for these veterans these thousands of veterans, that Can't find anything that works for them, right? That have been that 14 percent that, tried the the stuff and didn't work for them or rather, yeah, they tried the stuff and it didn't work for them. What can we do for these donors? What about that 30 percent that doesn't even want to quit? Right? That enjoys nicotine. That, it's like, you know, I do this as part of my routine. What are you going to do with those people? How are you going to help them help themselves? Right? So these are the reasons why we look at e cigarettes and vaping. We also have you know, Cochrane reviews, research, right? There's, I mean, it seems like most of the research out there right now is at odds with most of the news broadcasts out there right now. Right? Most of the research that you're going to see is all hey, smoking cessation or e cigarettes and vaping are very helpful in smoking cessation. We have Cochrane reviews that show that e cigarettes are more effective than nicotine replacement therapies. We have evidence from other countries that successfully utilize e cigarettes as a smoking cessation method. The Smokeless Vets survey found that 22 percent of veterans also know people, they know friends, they have family members, they have acquaintances that also quit smoking with e cigarettes. Vaping or e cigarettes. Alright? We know that it works. We know that people have seen it work, right? So despite what you might see in the broadcast and the news and major media, right? It's not what's going on here. So why are people more apt to use e cigarettes and vaping? Why does that work better? There's a lot of reasons that people come up with. One that seems very simple is that you're keeping the same ritual. in terms of smoking, right? You still have the the hand to mouth action. You still have the drag, the throat feel, right? So some people say that it's like smoking. And because it's like smoking, there's a psychological component that kind of increases the affinity for the person that's using the e cigarette or vaping or vape to use that. And then, you know, it's similar to smoking a cigarette. Right. So that's one of the big things. Also when available flavors can be helpful. So 26 percent of veterans found that if they are reported to smokeless vets, that if they smoked the e cigarettes or rather, sorry, if they were told more about the e cigarettes, if they understood the information behind them, that they would be more likely to consider them, but they're not getting that information, and that's the problem, right? That we have all these veterans that are suffering, dying at 77 a day, and we are not doing anything. We're not doing the the absolute best that we can. And again, we have other countries that serve as models for us. The UK, for example, concluded that, again, vaping and e cigarettes is 95 percent healthier. 95 percent healthier than smoking a combustible cigarette. 2019 alone, the UK had a study where there's 50, 000 people were able to quit through the use of vaping. The UK army and the UK navy don't allow smoking anymore, but they allow vaping, right? And it works. And like, have you ever heard of like the test retest thing? In terms of you give somebody a a mechanism, an intervention, and take it away and see what happens? We see it around here when we start banning vaping and cigarettes and e cigarettes. But when the UK sent their soldiers, deployed them into Oman, where vaping was banned at the time, when the e cigarettes weren't available, the use of combustible cigarettes rose 5%, and not only that, but the amount of smoking, right? Increased. So the rate of smoking more than 20 C cigarettes a day increased? Not a hundred percent, not 200%, but 270%. So this touches on the fact that when you remove the 95% healthier alternatives to combustible cigarettes, you're gonna increase the rates of smoking. It's, like, I don't understand the information's out there. So it's hard to believe that we're not all on that, on that bandwagon there. And we can also. Go back and kind of just touch on the 600 billion dollars that we use as a country for tobacco related illnesses and non tobacco related issues related to tobacco, non health issues related to tobacco, right? So if we look at the DOD, the DOD spends about, maybe more or less today, but 1. 8 billion dollars on tobacco related health And the VA spends about 2. 7 billion dollars, right? So this is a money thing. It's a life thing to me. But for the people that are, following Doge and be waste and abuse and all that, switching to vaping, which As we know, has killed nobody I mean tobacco vaping, nicotine vaping has killed nobody. Uh, when you look at the 480, 000 people that pass away and then nobody passes away from vaping. When you look at that, um, it's a no brainer, right? So, you know, how can we reduce deaths? How can we reduce, you know, Uh, money going out. How can we reduce these things? Well, we look at vaping. We make that part of our harm reduction conversation. We tell our doctors that we have our list of things that we have. We have medication, we have NRT, we have, um, uh, some, some behavioral health for you. Um, but one of the things I want you to do right now, right, is to go and get a, a legal vape, right? And I say legal vape because we don't know what's in some of these vapes that, that don't aren't FDA approved. Uh, so, that's why I say that, right? Try to stay with the things that we kind of have an idea of what's in them, right? So, you know, go get a legal vape, right? Go get a vape, and once you have that legal vape, throw away your pack of cigarettes, or your carton of cigarettes. What do you have? Right, that's the first thing that I want you to do when you go home, right? Start with that. Um, and then we still have all those other things that we're going to go through and, and work with you in order to get to where, get to the goal that you want to get to, which in tobacco harm reduction might not be complete abstinence. It might be, but it might not be. And, uh, you know, we, we, we have steps that we can take, right? So when you meet a goal. Right? Say maybe I want to cut that. I want, I don't want to smoke anymore. Right? So you met that goal. You're not smoking cigarettes anymore. Is there another goal? Right? So each step is another step that we can take further. But we got to take that first step and that first step is getting people off of combustible cigarettes. It is no joke. So what I'd like you to do, uh, as we move forward is to consider how you can help, right? What can you do? You can go to smokelessvet. org, right? They have a bunch of information in there and give you some ideas on, um, you know, who to talk to, you know, how to work with, uh, those in power, right? Speak power, speak to power, uh, in order to get some things done. But Contact your representatives. Contact your VHA, right? Your Veterans Health Administration, local to you. Talk to your doctors, talk to your providers. If you are a doctor, a provider, a therapist, right? Think about these things. Look up the research yourself. It's not hard to find. Google it go on to the VA has its own library go on the VA library It's all there. All right, and then if you're a member of the VFW or an American Legion consider this, right? And this is a conversation starter start a conversation with people in your your organization Talk to them about this how there's a 77 a day challenge right now. We need to cut this down This is no joke people are dying 7, 000 I'm sorry, 5, 000, 28, 000, there we go, 28, 000, 28, 000 people are dying a year of smoking. And it's all preventable. So what can we do, right? Have this conversation. Talk to them about vaping. Talk to them about, uh, e cigarettes. Talk to them about the research that's out there. The evidence from other countries. And then draft a resolution with them to take it national, right? Work with your local organizations and take it up. Try to take it national. Try to take it to your national organization. Those people that work with the senators and the, uh, congressmen, uh, and work with them in order to get this message out. to have them understand that working on tobacco harm reduction is saving 77 lives a day, 77 veteran lives a day. So that's what I'd like you to do. So I'm hoping that we can work on this together. Um, and again, you know, I'm going to try to do some of these lives, uh, as we move forward. So this has been doc V with call sign wizard, and I appreciate you and I appreciate the work that you do for vets. And I'm hoping that, uh, we'll continue the conversation. Thank you and have a great day.