The last few days have been big news day for smokers. Four big stories!
- Three studies, funded by governments in the US and Europe, were published yesterday in the journals Nature and Nature Genetics. They suggest that genetic markers may be responsible for tobacco addiction and lung cancer. More on the implications of this below the fold.
- Obama on Hardball's College Tour gave us a new language to speak to kids about smoking and quitting. More below the fold.
- The Congress approved legislation enabling the FDA to regulate tobacco products. More below the fold.
- On May 7, the updated federal clinical practice guidelines for treating tobacco dependence will be released. More below the fold.
Anyone who has studied the subject of smoking knows that tobacco is estimated to be associated with approximately 430,000 deaths every single year in the US. To put this figure in perspective, this is equivalent to about FOUR 9/11's every single day, 365 days a year (4 X 3000 X 365), year after year after year. Smoking is the leading cause of death in the US.
For many smokers, as Barack Obama admitted on Chris Matthew's College Tour last night on MSNBC, quitting smoking is very hard. In fact, most smokers make at least 4 serious quit attempts before they successfully quit for good. And some just fail over and over again. The US Anti-Smoking campaigns and laws have been incredibly effective in reducing smoking rates in the US population. The percentage of the population that smokes has dropped by more than half since the 1965 Surgeon General's first report on the health effects of smoking.
For some smokers, quitting is as easy as just stopping cold turkey. In fact, that is how most smokers have quit. But for other smokers, quitting tobacco is the hardest thing they have ever tried to do. On May 17, 1988, nearly 19 years ago, Surgeon General C. Edward Koop issued a 618- page report on addictions in which he said "cigarettes are as addictive as heroin and cocaine." I know this challenge first hand in my own family. I think my brother in law has tried to quit seriously dozens of times, only to eventually relapse. He has now switched to chew tobacco (which may cause mouth or tongue cancer) but at least his lungs are getting a break from the harmful carcinogens in the tobacco smoke. The problem for many is that scientists have not understood why quitting is so much more difficult for some people than it is for others.
Story 1. Genes, Tobacco Addiction and Lung Cancer
Yesterday we may have been given a glimpse into the answer of why some people seem more addicted to nicotine than others. Yesterday, three separate research studies were published in n the journals Nature 1 and Nature Genetics2. The research studies surveyed genetic markers in more than 35,000 people in Europe, Canada and the US. They found that either one specific gene or three closely related genes are associated with a higher risk of lung cancer and with heavier smoking and a more difficult time quitting (greater addiction to tobacco).
"This is kind of a double-whammy gene," said Christopher Amos, an epidemiology professor at the M. D. Anderson Cancer Centre in Houston and author of one of the studies. "It also makes you more likely to be dependent on smoking."
This research suggests that smokers who inherit the genetic variations from both parents have an 80% greater likelihood of being diagnosed with lung cancer than smokers without the variants. Smokers with these genes light up two extra cigarettes every day on average and have a much harder time quitting than smokers without these genes.
The researchers found that the genetic variations are genes that encode nicotine receptors on cells. Researchers suggest that their findings could explain chain smoking, nicotine addiction, and lung cancer that cannot be traced to environmental factors or brain biology. The findings have potentially huge implications for finding gene therapies to help those most addicted to nicotine to quit. They also suggest greater compassion for those who try again and again to quit without success.
Story 2. Obama and His Anti Smoking Message
Yesterday, Chris Matthews hosted Senator Barack Obama as part of his College Tour on Hardball on MSNBC. Chris asked Obama about how hard it was to quit smoking cigarettes. The link to the clip is below. Obama admitted that quitting was hard and that he had relapsed several times. He said he is trying to rely on nicotine gum to temper his addiction while quitting smoking. Perhaps Obama's difficulty in quitting suggests that he may have some of these genes that make it especially hard for him to quit?
I particularly loved Senator Obama's most effective tool in helping him stay off cigarettes. It is his wife, Michelle, who announced on 60 Minutes, "If you see Barack with a cigarette,, let me know!" Talk about accountability!
But my favorite part was his advice to the few smokers in the audience who were brave enough to stand up and admit they were smokers. He said,
"You guys need to get it straight! You guys need to get on the case!"
And the thousands of 20-somethings seemed to understand immediately what he was saying. Perhaps this is the message that the cessation advocates should be using on young people to encourage them to quit. Heck, why not make this part of the clip a new anti-smoking message?
Barack talked eloquently about why it is important for him not to smoke. He wants to set a good example for the young people of America. He wants to stay healthy as President and wants the American people to follow his example. He wants to live long enough to give his two daughters away at their weddings and he wants to see his grandchildren. His advice, in general, to the college students was "Don't Start." Hopefully someone from the American Cancer Society, American Lung Association or National Cancer Institute will pick up the ball and help make our next President the best cheerleader and example for improving public health that we have ever had.
Interestingly, Obama not only cares about his health but has the strongest provisions for protecting the public health in his health care reform proposal than any other candidate who has been running for President in the last year. This is one of the great strengths of Obama's health care reform plan. He understands that the health care system alone only can explain about 10% of the variation in the health status of the American people. Most of the public's health is a function of behaviors, environment, and genes. This is why it is so critical to have an effective public health system that supports the medical care system. Most Americans probably don't realize that of the trillion dollars we spend on health care each year, only about 1% is for population based prevention efforts. No wonder we spend more than twice than any other country on medical care and yet perform so poorly on basic public health measures.
The part of the clip on smoking is about 7 minutes into the clip.Obama on smoking link
Story 3. The Congress approved legislation giving the FDA authority to regulate tobacco product.
source
The House Commerce Committee approved a bill Wednesday that would give the Food and Drug Administration sweeping regulatory authority over the tobacco industry.
The Senate bill would severely curtail tobacco marketing, emphasize health warnings on tobacco products, ban many flavored cigarettes, and prohibit labeling of cigarettes as "light" or "low tar." Dozens of health groups have supported the bill as potentially life-saving.
Opposition to the bill comes from the Bush Administration (surprise, surprise), Senators of tobacco growing states, and Reynolds American (which used to be RJR).
The tobacco bill has been endorsed by the cigarette maker Philip Morris, and some people have criticized it as a compromise that does not go far enough.
Statements supporting the vote were issued by Senator Kennedy of Massachusetts, who sponsored the Senate version of the bill; the American Academy of Pediatrics; and the American Cancer Society.
While one senator has threatened to filibuster the bill when it goes to the floor for a vote, the President has not yet indicated he would veto the bill. HIs argument with the regulation is that the FDA is already too overloaded and can't possible take on the regulation of another industry.
However, this bill, if enacted and signed, would represent a significant shift in federal policy towards the tobacco industry, enabling the FDA to regulate advertising and additives, disclose the contents of products, and set standards for removing and reducing the harmful ingredients. The bill would also require that research findings are made public, companies be prohibited from making health claims, and bigger and stronger warning labels on tobacco products.
The bill would create a center within the F.D.A specifically for tobacco regulation financed by industry fees projected to exceed $5 billion over the next 10 years.
Please let your representatives in Congress know that you support this bill (S. 625 ).
Story 4. New Clinincal Practice Guidelines for Treating Tobacco Use and Dependence
Eight years ago, in 2000, The US Public Health Service (PHS) and the Department of Health and Human Services (DHHS) released a clinical practice guideline that summarized the research evidence to date of the efficacy and effectiveness of approaches and treatments for those who use or are dependent on tobacco products. The original guideline, released 12 years ago, in 1996, summarized 3,000 relevant research papers and the 2000 guideline update included an additional 3,000 research papers. The 2008 guideline review included an additional 2,700 research papers for a total of 8,700 research papers addressing tobacco use and dependence and the treatments for reducing both. This is an extraordinary evidnce base.
On May 7, the PHS/DHHS will release the updated 2008 guideline at the AMA in Chicago. On hand for this event will be the CEO and Executive President of the AMA, Dr. Michael Maves, the Director of the Agency for Healthcare Research and Quality, Dr. Carolyn Clancy, the Chair of the Guidelines Update Panel, Dr. Michael Fiore, The President of the AMA, Dr. Ron Davis, and the former US Surgeon General, Dr. C. Everrett Koop.
If you work in the health care system or for a health insurance plan or for an employer, I would urge you to make sure that the medical director or benefits manager is aware of these new guidelines and recommendations. Research has found that organizations that are familiar with the guidelines are much more likely to adopt its recommendations and specifically to provide insurance coverage for recommended treatments, than organizations that are not.
There are still huge gaps in access to coverage for effective smoking cessation medications and counseling services. But there has also been lots of progress. Medicare Part D that covers prescription drugs covers Chantrix and Zyaban (two non-nicotine replacement drugs). All but 10 state Medicaid programs cover medications or counseling. And most health pans cover medication or counseling. And all 50 states offer free telephone quit lines where you can get telephone counseling that is just as effective as individual or group counseling.
If past experience is any guide, the release of these new clinical treatment guidelines should usher in a new wave of recognition of the need to increase access to effective smoking cessation treatments and reduce financial barriers and other barriers to their use.
Combined, these four stories represent the opportunity for significant advances in helping Americans, most of whom started in their early teens, to quit using tobacco and reclaim more control over their health. Most smokes want to quit. We need to help them using the best information available.