Pediatric Annals

Editorial Free

A Look at Telemedicine

Stanford T. Shulman, MD

A message from Pediatric Annals ’ Editor-in-Chief

Telemedicine appears again as the major topic for several papers in this issue of Pediatric Annals, having been featured last almost 5 years ago. This is appropriate, as this modality has been evolving very rapidly, and it will likely continue to do so. Especially — but not exclusively — in more sparsely populated regions, the delivery of medical care, including pediatric and some pediatric specialties, is increasingly taking advantage of innovative communication modalities. The articles presented here will be of substantial interest to the readership.

Effects of Smoking

This year marks the 50th anniversary of the Surgeon General’s landmark 1964 report that linked cigarette smoking to serious illness and premature death. This is a reminder to all of us who take care of children about the extreme importance of educating our older patients and their parents about the reality of smoking. Not only was the then newly suspected link to lung cancer highlighted in 1964, but also the connection to emphysema and cardiovascular diseases, including stroke and myocardial infarction.

This report helped to transform the U.S. from a place where airlines often handed out small packs of cigarettes to boarding passengers into a place with severe restrictions on cigarette advertising and warning labels on packages. The proportion of smokers in the population fell from about 50% (men) and 35% (women) to 18.1% of adults in 2012; however, the premature deaths of more than 400,000 Americans each year are still related to smoking.1

A currently controversial topic is the potential role of e-cigarettes in facilitating smoking cessation. The e-cigarettes vaporize nicotine without burning and presumably lack most or all of the negative health aspects of smoking; however, more research in this area is needed. Some believe that the expanded use of e-cigarettes may make the combusting of tobacco obsolete.2

The global health effects of smoking were addressed in an outstanding recent review.3 Three key messages for 21st-century smokers were presented, with solid statistical backup: First, in middle age, smokers have two to three times the mortality of similar non-smoking persons, leading to a 10-year reduction in life span. Second, many who die are still middle-aged individuals, and finally, stopping smoking at age 30, 40, or 50 years old for those who have been smoking since early adulthood adds 10, 9, and 6 years of life expectancy, respectively. So, smoking cessation works.

Globally, about 1.3 billion people now smoke, mostly in low- and middle-income countries, with about 6 trillion cigarettes smoked yearly. About half a billion children and adults younger than 35 already smoke (or will, according to current trends), and globally, relatively few will quit if current trends continue. Tobacco-related mortality increases slowly in a population as smoking uptake increases, since it takes 30 or more years to see the mortality effects; however, the consequences of stopping smoking are much more rapidly apparent.

Probably the most effective way to increase smoking cessation is to increase cigarette prices. Many countries, including the U.S., U.K., and especially France and South Africa, have used aggressive increases in cigarette taxes to increase the number of former smokers. Both the Lancet Commission on Investing in Health and the 2013 World Health Assembly have identified substantial increases in excise taxes on tobacco as the single most important intervention against non-communicable diseases. Achieving the World Health Organization’s target of a one-third decrease in smoking prevalence worldwide would prevent tens of millions of deaths during the next few decades and approximately 200 million deaths during the 21st century, overall, by helping smokers to quit and adolescents not to start. We should all continue to try to do our part effectively; our patients and their families will be far better off if we succeed.

This Month’s Stamps

Keeping with the anti-smoking theme, I have chosen four of my favorite stamps with an anti-smoking theme from among about 150 in my collection. These were issued by San Marino (the “facial ashtray”), Cape Verde (showing an apical myocardial infarct with its accompanying electrocardiogram with Q waves), Australia (with upset lungs threatening to strike), and Slovenia (the hand crumpling cigarettes).

Anti-smoking stamp issued by Cape Verde showing an apical myocardial infarct with its accompanying electrocardiogram with Q waves.Images courtesy of Stanford T. Shulman, MD.

Anti-smoking stamp issued by Cape Verde showing an apical myocardial infarct with its accompanying electrocardiogram with Q waves.Images courtesy of Stanford T. Shulman, MD.

Anti-smoking stamp issued by San Marino.

Anti-smoking stamp issued by San Marino.

Anti-smoking stamp issued by Australia.

Anti-smoking stamp issued by Australia.

Anti-smoking stamp issued by Slovenia.

Anti-smoking stamp issued by Slovenia.


  1. Nocera J. Down to the last cigarette?New York Times. January11, 2014:A19
  2. Abrams DB. Promise and peril of e-cigarettes: can disruptive technology make cigarettes obsolete?JAMA. 2014;311(2):135–136. doi:10.1001/jama.2013.285347 [CrossRef]
  3. Jha P, Peto R. Global effects of smoking, of quitting, and of taxing tobacco. N Engl J Med. 2014;370(1):60–68. doi:10.1056/NEJMra1308383 [CrossRef]


Pediatric Annals Editor-in-Chief Stanford T. Shulman, MD, is the Virginia H. Rogers Professor of Pediatric Infectious Diseases at Northwestern University Feinberg School of Medicine and Chief of the Division of Infectious Disease at the Ann & Robert H. Lurie Children’s Hospital, Chicago, IL.

Dr. Shulman is the recipient of the AAP 2011 Award for Lifetime Contribution to Infectious Disease Education.

An avid stamp collector, Dr. Shulman chooses relevant stamps from his personal collection to accompany his column each month.

Reach Dr. Shulman via email:


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