As an occasional smoker, yet one who never was 'addicted', smoking cessation has always been a curiosity to me.
Behind Antismoking Policy, Influence of Drug Industry - WSJ.com
Michael Fiore is in charge of revising federal guidelines on how to get smokers to quit. He also runs an academic research center funded in part by drug companies that make quit-smoking aids, and he personally has received tens of thousands of dollars in speaking and consulting fees from those companies.Conflict of interest? No, says Dr. Fiore
Really? Seems like the definition of a conflict of interest changes depending upon whether one gets paid or not. From where I sit (slouch), Dr. Fiore is full of shite, and pharmaceutical industry cash, which is nearly the same thing.
Now debate is growing about that evidence, and about who should be entrusted to interpret it. Some public-health officials say industry-funded doctors are ignoring other studies that suggest cold turkey is just as effective or even superior to nicotine patches and other pharmaceuticals over the long run, not to mention cheaper.At stake is one of the most important issues in the nation's public-health policy. Cigarettes kill an estimated 440,000 Americans a year. Helping America's 45 million smokers kick the addiction could save untold numbers of people.
The Public Health Service, part of the Department of Health and Human Services, issued guidelines in 2000 calling for smokers to use nicotine patches, gums and other pharmaceutical aids to quit, with a few exceptions such as pregnant women. Dr. Fiore, a University of Wisconsin professor of medicine, headed the 18-member panel that created those guidelines. He and at least eight others on it had ties to the makers of stop-smoking products.
Those opposed to urging medication on most quitters note that cold turkey is the method used by the vast majority of former smokers. They fear the federal government's campaign could discourage potential quitters who don't want to spend money on quitting aids or don't like the idea of treating their nicotine addiction with more nicotine.
“To imply that medications are the only way is inappropriate,” says Lois Biener, a senior research fellow at the University of Massachusetts at Boston who has surveyed former smokers in her state. “Most people don't want them. Most of the people who do quit successfully do so without them.”
Tags: corruption, /Pharmaceuticals
David Blumenthal, director of the Institute for Health Policy at Massachusetts General Hospital, questions the government's choice of Dr. Fiore. “The chairman of the committee should be unquestionably impartial,” says Dr. Blumenthal, who has published extensively on conflicts of interest.Pharmaceutical companies make several products to help smokers quit. Some give a nicotine fix without a cigarette, such as GlaxoSmithKline PLC's Nicorette gum and nicotine-laced Commit lozenges. Nicotine, the addictive agent in cigarettes, is considered benign relative to the carcinogens in cigarettes. Bupropion, an antidepressant, and Pfizer Inc.'s Chantix -- both pills available only by prescription -- aim to reduce cravings without using nicotine.
Many clinical trials have randomly assigned smokers to take one of these products or a placebo. Such randomized trials are considered the gold standard in many medical fields, and they have consistently shown that nicotine-replacement therapy or other medicine confers a benefit.
But these trials have limitations. They tend to compare quitters who wanted medication and got it with those who wanted medication and didn't get it -- which is a different group from quitters ready to try going cold turkey. Also, clinical trials tend to attract highly motivated quitters who may not represent the population as a whole. Even the placebo group in these trials often boasts double the success rate of the population of quitters generally.
Studies of quitters outside clinical trials have shown no consistent advantage for medicine over cold turkey, the pharmaceutical industry's primary competitor. An unpublished National Cancer Institute survey of 8,200 people who tried quitting found that at three months, users of the nicotine patch and users of bupropion remained abstinent at higher rates than did users of no medication. But at nine months, the no-medication group held an advantage over every category of stop-smoking medicine. The study was presented at a world tobacco conference last summer.
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As the federal government weighs the data in making new recommendations, many of its advisers are receiving money from companies with a stake in the outcome. Dr. Fiore holds a chair at Wisconsin that is funded by GlaxoSmithKline. He directs a tobacco research center that received nearly $1 million in funding from makers of quit-smoking medicine in 2004 and $400,000 in 2005. Between 1999 and 2004, Dr. Fiore personally pocketed $10,000 to $40,000 a year from the quitting-aid industry for honorariums and consulting work. He says he stopped such work in 2005.In the U.S. government's 2005 civil case against the tobacco industry, it chose Dr. Fiore as an expert witness. He was asked to estimate the damages owed to federal taxpayers as a result of smoking and to devise a plan for spending those damages. Dr. Fiore came up with an estimate of $130 billion, and a plan to spend about $5.2 billion a year of that mostly on counseling and medication -- a measure that could have doubled the size of the stop-smoking medicine market. (Later, the government reduced its request for damages to $10 billion.)
The American Cancer Society has allowed its logo to be placed on stop-smoking products in exchange for money. A Cancer Society spokesman defends that decision, crediting the pharmaceutical industry for bringing invaluable marketing muscle to the society's Great American Smokeout every November.
Those who advocate medication sometimes fail to disclose that they have financial ties to companies. In an article on Voice of America's Web site last year, Jack Henningfield, identified only as a smoking-cessation expert, urged smokers to “go to the consumer-friendly Web site that I like, which is www.quit.com.”
"It's easy to quit smoking. I've done it myself over a thousand times." ( Mark Twain)
I have quit many times. One time for six years. Just one cigarette led me back to the pleasure of puffing my life away. This last time, it'll be a year coming February 22, I know I must quit for real. I have asthma, acquired at a rock concert in 2000, when I wasn't smoking. Every tiime I stopped I went with a very expensive pharm. device for a few days and then cold turkey.
I strongly believe it's a powerful addiction, I hope research finds help for all.
I quit shortly after moving back to Chicago from Dallas. Going from $3 to $7 a pack overnight was the last straw. That and the fact that my new chainsmoking co-workers all look twice their age. It was much easier than I thought it would be. I wondered afterward if the difficulty of quitting might be partly a myth fed by tobacco companies to help potential quitters rationalize falling off the wagon.
Cold turkey has worked for the 2 most recently quitting friends I know. I'm always suspicious of the motives of pharmaceutical companies anyway.