Nicotine replacement therapy is over-promoted since most ex-smokers quit unassisted

Health authorities should emphasize the positive message that the most successful method used by most ex-smokers is unassisted cessation, despite the promotion of cessation drugs by pharmaceutical companies and many tobacco control advocates.The dominant messages about smoking cessation contained in most tobacco control campaigns, which emphasize that serious attempts at quitting smoking must be pharmacologically or professionally mediated, are critiqued in an essay in this week's PLoS Medicine by Simon Chapman and Ross MacKenzie from the School of Public Health at the University of Sydney, Australia. This overemphasis on quit methods like nicotine replacement therapy (NRT) has led to the "medicalisation of smoking cessation," despite good evidence that the most successful method used by most ex-smokers is quitting "cold turkey" or reducing-then-quitting. Reviewing 511 studies published in 2007 and 2008 the authors report that studies repeatedly show that two-thirds to three-quarters of ex-smokers stop unaided and most ex-smokers report that cessation was less difficult than expected. The medicalisation of smoking cessation is fuelled by the extent and influence of pharmaceutical support for cessation intervention studies, say the authors. They cite a recent review of randomized controlled trials of nicotine replacement therapy (NRT) that found that 51% of industry-funded trials reported significant cessation effects, while only 22% of non-industry trials did. Many assisted cessation studies—but few if any unassisted cessation studies—involve researchers who declare support from a pharmaceutical company manufacturing cessation products.


The authors conclude that "public sector communicators should be encouraged to redress the overwhelming dominance of assisted cessation in public awareness, so that some balance can restored in smokers' minds regarding the contribution that assisted and unassisted smoking cessation approaches can make to helping them quit smoking."

=

Absolutely spot-on, but as we know, so-called NRT is just a way for the nicotine industry to make more money, and that nicotine industry now includes pharmaceuticals as well as tobacco companies.

Big Tobacco Claims that Smoking Reduces Risk of Alzheimer's is a Scam

Good to see that even if journalists can't be bothered to investigate the links between tobacco companies and so-called scientific research, then at least some scientists are doing so. This study, published in January in the Journal of Alzheimer’s Disease, is a meta-analysis of previous studies looking at the effects of smoking on the incidence of Alzheimer's disease. Big tobacco have made much of claims that smoking actually reduces the likelihood of developing Alzheimer's. So how much truth is there to this?

The University of California at San Francisco team reviewed 43 published studies from 1984 to 2007. Authors of a quarter of the studies had an affiliation with the tobacco industry. The UCSF team determined that the average risk of a smoker developing AD, based on studies without tobacco industry affiliation, was estimated to be 1.72, meaning that smoking nearly doubled the risk of AD. In contrast, the team found that studies authored by individuals with tobacco industry affiliations, showed a risk factor of 0.86, suggesting that smoking protects against AD. When all studies were considered together, the risk factor for developing AD from smoking was essentially neutral at a statistically insignificant 1.05.

Thus the tobacco-affiliated scientists came up with a risk factor of half the figure found by more independent studies. Shocked? This has been the standard practice of tobacco companies ever since the link was made with lung cancer: pay scientists to falsify results. Any scientific research that has financial consequences runs the risk of being tainted by vested interests. But joining the dots and finding the pattern takes time and research funding. One interesting thing is that the researchers discovered which scientists had links to tobacco companies after the publication of company documents that had previously been kept secret.

“We know that industry-sponsored research is more likely to reach conclusions favorable to the sponsor,” said Stanton A. Glantz, PhD, of the UCSF Department of Medicine and a study co-author. “Our findings point to the ongoing corrosive nature of tobacco industry funding and point to the need for academic institutions to decline tobacco industry funding to protect the research process.”

Smokers at risk from their own 'second-hand' smoke

It is well known that smokers damage their health by directly inhaling cigarette smoke. Now, research published in BioMed Central's open access journal Environmental Health has shown that they are at additional risk from breathing environmental tobacco smoke, contrary to the prevailing assumption that such risks would be negligible in comparison to those incurred by actually smoking. Maria Teresa Piccardo worked with a team of researchers from the National cancer Research Institute, Genoa, Italy, to study the exposure of newsagents in the city to harmful cigarette smoke. She said, "Newsagents were chosen because they work alone in small newsstands, meaning that any tobacco smoke in the air they breathe is strictly correlated to the number of cigarettes smoked by that newsagent. We studied the contribution environmental tobacco smoke made to carcinogen exposure in 15 active smokers."

The researchers found that environmental tobacco smoke may have a significant impact on smokers' health. For someone who smokes 14 cigarettes a day, their own second hand smoke resulted in exposure the equivalent of smoking an extra 2.6 cigarettes. According to Piccardo, "Both active and passive smoking contributions should always be considered in studies about health of active smokers."
-

=

Slightly bizarre piece of research. In Italy, newsstands are large cubicles with the vendor hiding inside, hence the idea that they would be breathing in their own second-hand smoke. It doesn't take a genius to figure that if second-hand smoke has a measurable effect then it would also have one on the first-hand smoker. I guess it never occurred to the researchers that these people were also inhaling second-hand exhaust fumes.

If your first cigarette gave you a buzz and you now smoke, blame a gene

Anyone who has ever tried smoking probably remembers that first cigarette vividly. For some, it brought a wave of nausea or a nasty coughing fit. For others, those first puffs also came with a rush of pleasure or "buzz." Now, a new study links those first experiences with smoking, and the likelihood that a person is currently a smoker, to a particular genetic variation. The finding may help explain the path that leads from that first cigarette to lifelong smoking.

The new finding also adds to growing suspicion surrounding the role of a particular nicotine-receptor gene in smoking-related behaviors and in lung cancer. The regular smokers in the study were far more likely than the never-smokers to have the less common rs16969968 form of the CHRNA5 gene, in which just one base-pair in the gene sequence was different from the more common form. This kind of genetic variation is called a single nucleotide polymorphism or SNP.

Smokers were also eight times as likely to report that their first cigarettes gave them a pleasurable buzz.

"It appears that for people who have a certain genetic makeup, the initial physical reaction to smoking can play a significant role in determining what happens next," says senior author and project leader, Ovide Pomerleau, a professor of psychiatry at the University of Michigan Medical School and founder of the U-M Nicotine Research Laboratory.

"If cigarette smoking is sustained, nicotine addiction can occur in a few days to a few months," he adds. "The finding of a genetic association with pleasurable early smoking experiences may help explain how people get addicted — and, of course, once addicted, many will keep smoking for the rest of their lives."

Year of the Lung 2010

Every year has various global themes and 2010 has been designated The Year of the Lung. A declaration was published back in December that highlights the main aims of the organisers.

Hundreds of millions of people struggle each year for life and breath due to lung diseases, including tuberculosis, asthma, pneumonia, influenza, lung cancer and chronic obstructive pulmonary disorder (COPD), and more than 10 million die.

Chronic respiratory diseases cause approximately 7% of all deaths worldwide and represent 4% of the global burden of disease.

Tobacco use remains legal, although it kills more than 5 million people each year, including 1.3 million who die of lung cancer, and it affects the health of hundreds of thousands of others who are exposed to its effects secondhand.

Although it will be the 3rd leading cause of death worldwide by 2020, COPD is frequently not diagnosed.

There are more disturbing statistics in the declaration; I just highlighted a few. But the Year of the Lung organisers are well aware that lung diseases are low on the list of politically sensitive health issues and that many people in the world live in highly polluted environments. I suspect these two facts are not unrelated.

The WHO Framework Convention on Tobacco Control is being implemented with expected slowness. I have long suspected that cigarette smoke was an easier target than controlling air pollution. As nicotine addicts are slowly tempted into smokeless products it will take many decades before authorities will admit that polluted cities (as well as agricultural pollutants in the countryside) are as much, if not more, to blame for the rise in respiratory diseases. Implementing a Clean Air Act in all the world's polluted cities will do more for people than paying for medicines after the event.

However, I shan't be holding my breath.

China Expands Smoking Ban to 7 Cities

Chinese authorities plan to expand smoking bans in indoor public places across 7 major provincial capitals. But the numbers just don't look too promising.

Smoking is a huge business in China: 2 trillion cigarettes are sold in the country every year. The country accounts for more than one-quarter of the world's 1.3 billion smokers, with about 60 percent of Chinese men and 3 percent of women indulging in the habit.

Taxes from tobacco sales topped 416 billion yuan ($61 billion) last year, up 26.2 percent from 2008, according to a report issued last week by the state tobacco industry regulator. Interest on government loans to the industry added another 97 billion yuan ($14 billion). [Yahoo]

A lot of this money is raised by the provinces rather than central government, making it even harder to curb cigarette sales. Stressed out local administrators will probably need a few extra packets now.

International Union Against Tuberculosis and Lung Disease

The mission of the International Union Against Tuberculosis and Lung Disease (The Union) is to bring innovation, expertise, solutions and support to address health challenges in low- and middle-income populations. With nearly 10,000 members and subscribers from 145 countries, The Union has its headquarters in Paris and regional and country offices serving the Africa, Asia Pacific, Europe, Latin America, Middle East, North America and South-East Asia regions. Its scientific departments focus on tuberculosis, HIV, lung health and non-communication diseases, tobacco control and research.

See aggregated blog news below for the latest news from The Union and link.