What’s up Quit Doc?
Every month, Dr. Neil Perlman provides
synopses of recent smoking cessation articles and studies.
“Financial Ties and Conflicts of Interest Between Pharmaceutical
and Tobacco Companies”, by Bhavna Shamasunder, published in the Journal
of the American Medical Association, August 14, 2002.
An interesting article depicting how tobacco companies pressured
pharmaceutical companies to alter their advertisements and the smoking
cessation educational materials that accompanied heir smoking cessation
products. It details how Philip Morris successfully terminated the
publication of “The Smoking Cessation Newsletter”, a publication
designed to provide physicians with information and encouragement to
advise their patients to quit smoking. This newsletter was provided to
physicians in connection with Nicorette Gum. However, since the
manufacturer of the gum was Marion Merrell Dow, a subsidiary of Dow
Chemical, and Dow supplied Philip Morris with chemicals valued at 8
million dollars per year, the marketing campaign was drastically altered
to prevent losing that account.
The article also discusses how Philip Morris was able to pressure
CIBA-Geigy, the makers of Habitrol (nicotine patch) to tone down its
anti-smoking advertising campaign. Besides manufacturing medications,
CIBA-Geigy also had an agricultural division that supplied pesticides to
the tobacco companies. Bowing to the pressure from reduced pesticide
sales, CIBA’s “Smoke Buster” advertising program was terminated from
magazines, newspaper and television advertisements.
Finally, the article discusses how Procordia AB, a Swedish holding
company that encompassed the Swedish Tobacco Company, the Pinkerton
Tobacco Company, and the American Candy Company, and the pharmaceutical
companies Kabi Pharmaceutia AB and Pharmacia Leo conspired to use the
nicotine gum technology to make not only the nicotine gum for smoking
cessation but also a nicotine chewing gum to be used not for smoking
cessation, but in places where using chewing tobacco would be
The end result was a dramatic change in the marketing of these
products because of the tobacco companies influence.
Nicotine Lozenges are Effective for Smoking Cessation
Saul Shiffmma, PhD, of the University of Pittsburgh, used either two
strengths of a nicotine lozenge or a placebo with 1,818 smokers. At 6
weeks over 46% of both nicotine lozenge groups had quit, compared to
less than 30% of the placebo groups.
Archives of Internal Medicine (2002;162:1267-1276).
Smoking Increases Risk for Rheumatoid Arthritis
Kenneth G Saag, M.D. from the University of Alabama at Birmingham
followed 31,336 woman between the ages of 55 – 69 who had no history of
Rheumatoid Arthritis. He found that woman who smoked were twice as
likely as non-smokers to develop Rheumatoid Arthritis than woman who
never smoked. This increased risk resolved after ten years of quitting
American Journal of Medicine (2002; 112:465-471)
An inexpensive antidepressant nortriptyline doubles the quit rate
Dr. Celia Lidia da Costa and colleagues, from Camargo Cancer Hospital
in Sao Paulo, Brazil, studied the antidepressant “nortriptyline” with
144 chronic smokers. The subjects were randomized into two equal groups,
with half receiving 75 mg of the drug and the other half a placebo pill.
All of the subjects attended weekly support meetings. After 6 weeks of
therapy, the group given the medication had a smoking cessation rate of
55.9%, significantly higher than the 23.3% rate achieved in the placebo
group (p < 0.001). Light smokers and those who used nortriptyline were
more likely to be successful, with odds ratios of 3.1 and 4.1,
respectively, the authors note. Adverse effects possibly related to drug
use were mild and occurred with similar frequency in both study groups.
The effectiveness of nortriptyline is probably not due to its
antidepressive effects, because other antidepressants, with the
exception of bupropion, have not shown any efficacy in increasing
cessation rates. While both nortriptyline and bupropion (Zyban,
GlaxoSmithKlein) have shown efficacy in smoking cessation, nortriptyline
is considerably less expensive, with a month of medication costing less
then $10, versus $90 for Zyban.