March/April 2008

the Zen of Science

By MARC RINGEL, MD

Quitting smoking?
Try a team approach: you, your doctor, and maybe a little help from the pharmacist.

New cure's a real Kick

Cancer of the nose was first recognized as an affliction of tobacco smokers by John Hill of London in 1761; cancer of the mouth was likewise indicted a few years later, in 1787, by Percival Pott. It took more than 100 years--with the popularity of inhaling and the invention of x-rays that could distinguish lung cancer from tuberculosis--before tobacco was implicated in lung cancer in the German medical literature. Thereafter, the pace of progress of medical knowledge about the evils of smoking grew exponentially. Other cancers, including those of the larynx and bladder, as well as chronic bronchitis, emphysema, and a huge jump in risk of heart attack and stroke were added to the list of tobacco’s ill-effects. Smoking was even found to increase the incidence of stomach ulcers.

Still, it wasn’t until the 1998 Tobacco Settlement, when the tobacco companies agreed to fork over $206 billion to 46 states in compensation for the cost of caring for people made sick by tobacco products, that the industry finally admitted that their business might just be doing harm to Americans’ health. I decided to start this piece with a very abbreviated history of smoking and health because it’s a more interesting way to introduce the topic than with yet another litany of disease statistics, or with one more harangue about giving up the evil weed. If I thought scaring or nagging you to quit would work, I’d do it. But it doesn’t work. So instead I’ll give the small percentage of you who do smoke (I presume it’s a small percentage) some concrete how-to advice.

Earlier in my life, I was an addicted cigarette smoker. I’m glad I was, because having been a nicotine fiend myself gives me a whole lot more compassion for people who are struggling to kick their tobacco habit. Nicotine is a highly addictive substance. And
the whole context of smoking--the social connections, the thing you do with your hands, the satisfying deep breathing--make it profoundly difficult to give up. Which is why I do everything I can, non-judgmentally, to help my patients and friends beat their addiction.

If you’re not ready to quit for whatever reason—too much stress, an alcohol addiction you need to control first, other significant life events—it’s okay to wait until you have the energy to devote to your personal stopsmoking campaign. Following are a couple of solid suggestions to help smokers who are ready to quit.

First, there’s the Colorado QuitLine and Colorado QuitNet, set up with Tobacco Settlement funds. If you call or contact them via their website, they will counsel you, check up on you, send you educational materials and even provide you with nicotine patches. It’s all free. And it works. Call 800 QUIT NOW (800-784-8669) and/or email them at www.co.quitnet.com to get started.

Second, there’s a new drug, varenicline (brand name Chantix) that works by blocking nicotine receptors in the brain. The smoker takes the drug every day, tapering up to the full dose of two pills a day in about a week, which is set as the quit date. Several of my patients have stopped smoking without even waiting a week, saying their desire to smoke just went away as soon as they took their first dose of varenicline. I’ve never seen anything like it.

Now for the bad news. Varenicline costs about $120 a month. And you’re supposed to take it for three to six months, which comes to 360 to $720.

Now the worse news. Most insurance does not cover the cost of the product because:
a) smoking cessation, like other preventive measures, does not pay in the turbulent healthcare market since, by the time the insurer realizes savings for having a healthier patient, that person is likely to be off its rolls and

b) when faced with a new service, the reflex answer by health insurance companies about whether they’ll cover it tends to be “no,” because the less they pay out the more they make.

But look at it like this. I just called my neighborhood 7-11 to find that they charge $3.09 to $5.15 for a pack of cigarettes, which means about $90 to $150 a month for a pack-a-day habit. So the cost of varenicline is around what the average smoker spends on his addiction. And if he quits, at the end of three or six months, he doesn’t need the drug any more, nor does he have to feed his tobacco jones. So from then on he gets to keep all that money he used to spend on smokes.

If you’re a smoker who wants to quit, talk to your health professional about it. One British study published years ago showed that if a general practitioner merely told each smoking patient that he ought to quit and handed him a pamphlet, 4 percent did quit over the course of a year. That’s a lot of bang for nearly zero bucks. These days there’s a whole lot more we can do to help you stop smoking, in a package tailored to fit any budget.

Marc Ringel, MD, is a family practitioner and writer based in Greeley, Colorado.