Drug companies want to treat smoking as a chronic disease

Throwing in the Towel

Smokers, you might as well give up now and admit that your chances of quitting your nicotine addiction are dismal at best. The most you can reasonably hope for is to replace your addiction with a lifetime commitment to smoking cessation drugs.

That’s the basic message in a “perspective” article published last month in the Annals of Internal Medicine. The title of the article: “The Case for Treating Tobacco Dependence as a Chronic Disease.”

Who in the world would make such a case? I’m glad you asked.

First shot across the bow

The four authors of the article are all affiliated with Robert Wood Johnson Medical School in New Jersey. And their connect-the-dots proposal goes like this:

1) Most smokers want to quit, but even when using smoking cessation drugs they often find quitting impossible, resigning themselves to a lifetime of smoking
2) Smoking is the leading cause of preventable deaths in the U.S., but it’s still regarded as a bad habit
3) Tobacco dependence is the equivalent of a disease, such as diabetes, because both prompt chronic, life-threatening diseases and complicate existing diseases
4) Diabetes treatments are well covered by health insurance
5) Smoking cessation drugs should be covered in the same way

The authors note that long-term use of smoking cessation drugs is considered “off-label,” but if a patient requires long-term use, then “treatment should be continued, encouraged, and reimbursed.”

In other words: Let’s start thinking of smoking cessation drugs as long-term therapies. And let’s get them covered by health insurance so smokers will be inclined to use them long-term. And finally, let’s sell a boatload of drugs.

Ready for the kicker? Two of the four authors are consultants to GlaxoSmithKline, Pfizer, and Novartis – companies that make a variety of high profile smoking cessation products, including Nicorette gum, Nicoderm patches, Commit nicotine lozenges, Chantix, and Zyban.

Conflict of interest? Absolutely not. The interests of the authors appear to be in perfect harmony with the interests of the drug companies they’re affiliated with.

Dazed and confused

Since this article appears to be the first shot across the bow in what we can expect will be a full-blown campaign to establish smoking as a chronic disease, this would be a good time to note that the side effects of two of the drugs mentioned above are nearly as bad as the side effects from inhaling cigarette smoke into your lungs every day.

I first told you about Pfizer’s Chantix in 2006. Common side effects listed on the Chantix web site include nausea, constipation, gas, and vomiting. But that just gets things started. Side effects listed as “frequent,” include diarrhea, gingivitis, chest pain, back pain, dizziness, anxiety, depression, emotional disorder, polyuria (excessive urination), menstrual disorder, and hypertension.

More recently, FDA officials issued a warning about “reports of suicidal thoughts and aggressive and erratic behavior in patients who have taken Chantix.” According to the agency, many of these patients may also experience “depressed mood, suicidal ideation, and changes in emotion and behavior within days to weeks of initiating Chantix treatment.”

Like Chantix, GlaxoSmithKline’s Zyban is a smoking cessation drug that doesn’t replace nicotine, and it comes with some similar warnings. The Zyban information flyer states: “Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior.”

Zyban also has a little secret that most users of the drug are probably not aware of. The active ingredient is the same active ingredient used in Wellbutrin, an antidepressant. Side effects? You bet’cha! Anxiety, dizziness, skin rash, agitation, ringing in the ears, stomach painjust to name a few.

You can find information about three effective smoking cessation therapies that don’t require drugs in the e-Alert “Smoke Gets In Your Eyes” (11/8/07). And each of these therapies is intended for “cessation” – not lifetime use.

Sources:
“The Case for Treating Tobacco Dependence as a Chronic Disease” Annals of Internal Medicine, Vol. 148, No. 7, 4/1/08, annals.org
“Alzheimer’s: Vitamin for Longer Life” Ivanhoe Newswire, 4/16/08, ivanhoe.com