Transcription of Dr. Dora Anne Mills for the show Breathe #9
Dr. Lisa: This week we begin a segment which is sponsored by the University of New England, a very innovative school just down the street from us here in Portland, Maine. Our segment is called wellness innovations. We will be discussing events and things that are happening in the research and wellness world that we think will be of relevance and use to our listeners. Because this week is the week of the Great American Smoke Out, we thought that this was an appropriate place to begin.
We will be talking to Dr. Dora Mills coming up soon about smoking and lung cancer. On November 17th, 2011, right before Thanksgiving, people have a chance to actually stop smoking. We encourage people to take advantage of this Great American Smoke Out, there are many resources available to them on www.cancer.org. We also encourage people to go to their own physicians and find help when they need to, take the time to bring the importance of breathe back to your body in a very physical way and stop smoking.
We are sitting here today with Dr. Dora Ann Mills and Genevieve Morgan, our co-host, as we come in every week and start with our main guest. We are pretty thrilled to have Dr. Mills in studio. She has been doing great things for the state of Maine for the last 15 years and now she is doing even more great things in a slightly different capacity. I am going to let people know who are listening a little bit about your background. You were recently name the Vice President for Clinical Affairs at the University of England. Prior to that you were the director of the Maine CDC, which is the Center of Disease Control and Prevention under Governors Angus King and John Baldacci.
We know that you have done a lot with public health including reducing Maine’s rate of tobacco use, teen pregnancy, and childhood obesity. You have established numerous statewide partnerships with hospitals, agencies, and schools including Healthy Maine Partnerships which provide public health programs on a local level. You received your medical degree from the University of Vermont College of Medicine, which is my alma mater so hooray! and your Master of Public Health from Harvard University. You are quite an esteemed individual Dr. Mills.
Dr. Dora Mills: I don’t know about that but thank you very much for the introduction.
Dr. Lisa: This month is American Lung Cancer Awareness month I believe, and we have the Great American Smokeout coming up on November 17th. This is one of the reasons we thought it would be such a great idea to have you in to talk to us because as the director of the Maine Centers of Disease Control and Prevention, you know a lot about this.
Dr. Dora Mills: Unfortunately I do know a fair amount about lung cancer in terms of the statistics and it’s pretty grim. I actually think if you think for a minute, if you ask most women which cancer do more women die from than any other cancer, most of them are going to answer breast cancer, right? Yet, the tragedy is that it is not, it is actually lung cancer. Tragic diagnosis. Occasionally people can live longer, but most people who are diagnosed with lung cancer, very tragically end up dying from it.
Dr. Lisa: It is tragic. My grandfather actually died of lung cancer and it came on it seemed fairly suddenly. Not that anybody wants to have cancer but if you are going to have cancer, this is a hard one to die from. It really impacts you in a very negative way and most people don’t do well and they die fairly easy. It’s a hard thing to watch.
Dr. Dora Mills: Especially when you think about 90% of all lung cancers are preventable.
Dr. Lisa: That is what I wanted to ask, do you have the statistics of what percentage of lung cancer is directly associated with smoking and what is the statistic for secondhand smoke?
Dr. Dora Mills: Yeah it’s about 85-90% of lung cancers are due to tobacco. There is a little bit of a leeway there because there is also a percentage of lung cancer that is secondary to radon exposure. We have a lot of radon in Maine.
Dr. Lisa: Right, tell us why we have a lot of radon in Maine.
Dr. Dora Mills: Radon is a gas that’s emitted, primarily is found in granite, and of course you don’t have to go too far in Maine to realize that Maine is on one big bed of granite. We do end up having a lot of radon, especially in parts of Maine where you see a lot more granite than in other parts of Maine. Radon itself can cause lung cancer, or is associated with it, but radon coupled with tobacco smoke ends up increasing your chances of lung cancer by quite a lot. There is this overlap where you can’t say that all lung cancer is just only caused by tobacco, but there is a certain percentage that is associated with tobacco but also associated with radon, and then some is just radon alone. If you add radon to the formula then you are up usually over about 90% of lung cancer is due to either one. Of course radon is preventable in that if you test your house for it, which is required in Maine at the time of the sale, but you can do it any other time as well, then you detect it, and there are ways to ventilate it to get rid of it so that you are not exposed to it.
Dr. Lisa: There are a few other things that people can do if they know that there is radon in their house as well, when they have their showers going you are supposed to leave your door open a crack, you are not supposed to sit in the steam, that sort of thing.
Dr. Dora Mills: Yeah it is kind of more around ventilation, but you want to test your water and your air for it to see if you have it. Very often you don’t, but if you do, it is something that you can mitigate.
Dr. Lisa: We have talked about smoking. I pulled up a few statistics, smoking is responsible for 21% of deaths worldwide in high income countries. That is interesting. 52% of preventable deaths are from lung cancer.
Dr. Dora Mills: That is pretty astounding, isn’t it?
Dr. Lisa: Yeah. Smoking, that is big, the radon we have talked about, what other things contribute to problems with lungs and lung cancer specifically?
Dr. Dora Mills: Of course secondhand smoke you mentioned a few minutes ago and that absolutely is as well. We know that about 7 deaths due to smoking, one of them is due to secondhand smoke. That is reducing as we speak because of course our indoor air is getting clearer and clearer of secondhand smoke. Still we know that a number of people who do smoke, who are addicted to tobacco, do smoke in their homes. That is why one of the efforts over the years by a lot of people in public health has been at least, if you cannot quit, at least smoke outside, and getting our indoor public places smoke free, such as restaurants and all other work places.
We have been very successful in those endeavors here in Maine, very fortunately. Of course in other states, not so successfully. If somebody is smoking at home, their other family members and household members are exposed to the carcinogens that are in… the cancer causing chemicals and secondhand smoke. A lot of people don’t realize that the secondhand smoke actually has higher concentrations of cancer causing chemicals than the primarily inhaled smoke. The reason is cigarettes have a filter so some of those cancer causing chemicals are actually filtered out when you are inhaling a cigarette.
Dr. Lisa: That is so ironic that they are filtering it out so the person who is smoking doesn’t get the stuff but everybody around them does.
Dr. Dora Mills: Yeah, and you still get tremendous doses of it if you are smoking cigarettes yourself, but it is ironic as you say that the people around you may actually get a higher level of it than yourself, if you are smoking.
Dr. Lisa: Children, this is a big secondhand smoke problem for them. We have been talking about lung cancer because of lung cancer awareness month, but asthma and allergies, and lung problems in children have been on the rise as well.
Dr. Dora Mills: Absolutely. Secondhand smoke is really deleterious to children’s lungs. If you think about just even what lung tissue looks like, or you can imagine what it looks like if you haven’t seen it, lung tissue in anybody is a very sensitive tissue, it is not like your skin that is thick and a lot of things can bounce off from it. Lung tissue is very porous, it is like a very delicate sponge. When you are young, when you are a child, it is even more so, and it is very susceptible to the effects of pollutants, especially when you are a baby or a child. You can imagine if you throw cigarette smoke on top of that very delicate king of sponge like tissue when you are a child, it has very deleterious effects and what we see.
As you mentioned Dr. Lisa, is the fact that these children do have very high rates of asthma or more severe asthma than they would have otherwise, as well as ear infections, pneumonia, lung infections, and many other infections and diseases that you wouldn’t think they would necessarily have, like ear infections. It turns out that cigarettes thicken up all of their secretions so when they get a cold then their secretions are kind of thick, they don’t clear them as well, and then they’re more likely to get things like ear infections which happen when you have kind of sometimes when you have thick secretions building up in your ear and then the bacteria take hold.
Dr. Lisa: That is an interesting point. I have had a number of patients, thank goodness, over the years who have quit smoking and what I’ve noticed in my practice is that patients will quit smoking and then their lungs actually get worse for a time, it’s almost as if there’s some sort of purging that needs to take place.
When you were talking about secretions, that’s what reminded me of that, that all the patients that will come in they are like, “Dr. Lisa, you told me I should quit smoking, but I feel so much worse.” I am like, “You know what, you’ve just got to hang in there because your body is trying to get rid of something that it’s been dealing with for a really long time.” It’s this thick, hacking, disgusting, something that eventually does go away. People who are going to quit smoking on November 17th which is the Great American Smoke Out, or another day, just stay with it, your lungs are going to get better.
Genevieve: I’d love to hear you talk about that a little bit more Dr. Lisa and Dr. Mills. I have a couple of friends who are still smoking. They have tried and tried to quit. It’s just such an addiction, it’s very difficult. Can you both speak to that because you’ve treated it through Chinese medicine and there are other policies and programs that you have, so it is an interesting 2-way approach.
Dr. Dora Mills: The main thing I would say is don’t quit quitting. The average successful quitter has tried quitting 7 times before they’re successful. It doesn’t mean a lot of them aren’t successful on the first try or the second try, or the tenth try, but don’t quit quitting. Just because it doesn’t work for you once, don’t quit quitting. There are medications that are very effective. There are also some ways to increase your chances.
I would recommend people calling the Maine Tobacco Quit Line which has free consultation by phone, it’s anonymous, you can also get vouchers for free or low cost medications, quitting prescription medications, and they will stay in touch with you and help you through it. I can’t say it’s easy. We know some of the newer science data shows that nicotine is as addictive to the brain as heroin. I got protected because I have asthma. When I was a kid, a young adult, I never even thought about picking up a cigarette because I couldn’t inhale secondhand smoke so how could I inhale primary inhaled smoke?
I feel very fortunate but I know that I have a lot of friends and acquaintances over the years that did pick up a cigarette and it’s very highly addictive. They didn’t want to keep smoking, it was very tough, but many of them have successfully quit as well.
Dr. Lisa: We have been talking about smoking, we’ve been talking about radon, lung cancer, a little bit about asthma, let’s talk about some of the other air quality issues maybe. What about outdoor and indoor quality in Maine, what can you say about that?
Dr. Dora Mills: Unfortunately Maine does have both issues, major indoor and outdoor quality issues. Outdoor air quality issues we have, you wouldn’t think so … You look around at our landscape and it’s so beautiful and picturesque and pristine and yet we have major air pollution issues and outdoor air pollution issues. The main reasons is that we are kind of on the tailpipe of the country. Picture a map of the United States and look at those arrows of the jet stream, they generally come across the United States, across the Midwest, and then it makes this left hand turn going up north, right across the northeast. There are a fair amount of pollutants that get carried along, get picked up by the jet stream, and then as the jet stream hits the cold air of the northeast, ie Maine …
Dr. Lisa: Right, we are pretty cold up here. Especially at the end of November
Dr. Dora Mills: Right. Those pollutants actually precipitate out and cause more air pollution here than you would see, say in Connecticut or in southern parts of the south and Midwest. Particularly when you look at the pollutants from the states in the Midwest that have a lot of coal producing plants, or use coal as fuel, they emit a lot of pollutants that then get carried here. That is also one reason why we have of course when you combine high heat in the summertime, we end up having of course a lot of high ozone days, more than you would think being in Maine.
Dr. Lisa: Can you talk about that? What is that? What does a high ozone day mean for people?
Dr. Dora Mills: What these high pollutants mean in our outdoor air is that we do have high asthma rates. Maine has the highest asthma rates in the country. It is probably for a number of reasons, but one of the main reasons is because we have high levels of air pollution. We end up having a very high proportion of people in Maine, about 1 in 6 adults in Maine have asthma, for instance. That is about the same with our children.
Asthma is one of the few chronic diseases actually is higher rates in children than in adults. It’s a chronic disease that we see in adults and children. We have very high rates of asthma. For people who are asthmatic, the outdoor air pollution makes their asthma much worse. If you had asthma and you lived in a state with cleaner air, you would be less severely affected by it than the fact that …
Dr. Lisa: We would do well to have as clean an indoor air quality and outdoor air quality as possible, whether it is from smoking or otherwise. This show is about breathing and so far I feel a little overwhelmed because of all of this sort of bad news, but I know there is good news. You are going to tell us a little bit about the positive health trends that are going on in the state of Maine.
Dr. Dora Mills: There absolutely is great news. When you think about 20 years ago and how much indoor air pollution we had due to cigarette smoke and indoor wood stove smoke and yet most of that is really done away with now in terms of, all indoor public places in Maine are smoke-free … Restaurants, even bars, and any workplace is smoke free. Then there’s wood stoves that most of them have been replaced in the last 23 years.
We’ve got great news and we are seeing the effects that our lung cancer rates are actually starting to stabilize and even come down, it is great news. People are generally much more aware that if they are addicted and they are unable to quit right now, then at least to keep it away from other people. You do see that, people are generally very cognizant of taking it outside or being careful.
Dr. Lisa: We even have people, and we haven’t talked about this that much as far as cars and car exhaust but we now have no idling zones in front of schools and in front of public buildings. When it’s cold people are less likely to sit in their car and just keep it running indefinitely.
Dr. Dora Mills: Absolutely.
Dr. Lisa: There are good things happening.
Dr. Dora Mills: Absolutely. We are much more aware of these things. That’s good. It’s making us all shift gears and change our behavior a bit and it’s making all of us healthier.
Dr. Lisa: Speaking of good, you are doing really good things over at the University of New England. I was over there visiting you the other day and you were telling me all of these amazing things that are happening. For a small university, you’re a powerhouse over there.
Dr. Dora Mills: Oh, it is a really exciting place to be. University of New England is our largest educator of health providers in Maine. That is, if you ask health professionals in Maine where they got their education, more of them got their education at UNE, or University of New England, than any other university. It is an exciting place to be, it is a university where an undergraduate campus and medical school is located in Biddeford Maine, on a spectacular oceanfront campus.
Dr. Lisa: It’s beautiful, I can’t believe it’s a college campus.
Dr. Dora Mills: Oh it’s absolutely beautiful. In Portland, on Stevens Avenue on the old Westbrook College Campus, is also a beautiful campus where the most of the other graduate schools of health professions reside. Brand new Pharmacy school that is absolutely stunning there, that is right on Stevens Avenue. Opened up two and a half years ago. We are just completing the dental school, which opens up in 21 months or so in 2013. We have a nursing school, nurse anesthetist school, physician assistant school, masters of social workers school, masters of public health program, and a dental hygiene school. I am going to miss one but occupational therapy, physical therapy …
Dr. Lisa: And that is just in the medical school within the health sciences.
Dr. Dora Mills: That is in the graduate school for health professions located in Portland. We have 11, will be soon when the dental school opens up, 11 graduate degrees in health professions. 10 of those located in Portland on Stevens Avenue on this beautiful campus. The other, the medical school and the undergraduate school and then other graduate schools in sciences like neuroscience are located in Biddeford. It’s a vibrant place to be, I am very excited. If you know of any kids who are thinking about college or you, yourself, are thinking about graduate school, look us up at UNE on the web. It is a great place to be, very innovative university.
Dr. Lisa: Wow. We will also provide a link to the University of New England. I have been there, I have visited there, it’s an amazing place, we have actually done some work with them. I am 100% behind what you are doing now.
Dr. Dora Mills: Great. Thank you very much. I should mention, a lot of our courses, too, are offered online as well. That is another thing to consider. You can be anywhere in Maine, or anywhere else, and obtain a masters in public health. We have an accredited masters of public health program that you can obtain entirely online.
Genevieve: That’s great.
Dr. Lisa: Yeah, this is exciting stuff. I know we had to talk about the breathing, the smoking, and the air, and all of this that is something we still need to think about. We don’t want to scare people, but it is out there, so we needed to talk about all that …
Genevieve: When is the smoke out date?
Dr. Lisa: The Great American Smoke Out is November 17th, we will make sure people are aware of that.
Dr. Dora Mills: Thursday before Thanksgiving.
Dr. Lisa: Yes, Thursday before Thanksgiving.
Dr. Dora Mills: Okay, all you smokers out there, November 17th.
Genevieve: Smoke your turkey, not your lungs.
Dr. Lisa: There you go. There are things you can do about air quality, there are things you can do about health education. Dr. Mills, you have been working on all of these things for a number of years …
Dr. Dora Mills: As you have too!
Dr. Lisa: Thank you for coming in.
Dr. Dora Mills: Thank you so much for having me.
Dr. Lisa: We appreciate the time you spent with us. We look forward to all the wonderful things you’re going to do at the University of New England.
Dr. Dora Mills: Thank you.