Neil Perlman,MD, The Quit Doctor

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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 inappropriate.

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 smoking.

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.

Chest 2002;122:403-408


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