Nicotine Wars

It still puzzles me that we use an incredibly addictive drug, nicotine, to help smokers quit their habit. It's like we've given up and decided that Nicorette gum is to the smoking addiction as methadone is to a heroin addiction. To make matters worse, it now seems that the pharmaceutical industry, in its press to promote its products, wants to limit the verbage on the warning label on the smoking cessation drugs.

(WSJ) As evidence mounts that nicotine-laced stop-smoking aids are producing only limited gains, some critics are calling the products over-rated and over-promoted.

But some high-profile public-health experts say the problem may be over-regulation. They say that federal law requires nicotine gums, patches, lozenges and other products to carry so many warnings that smokers are reluctant to use them. Indeed, the warning literature on a package of nicotine gum is about 20 times lengthier than the warning on a package of cigarettes.

So tobacco researchers and policy makers are starting to argue that the federal Food and Drug Administration should tone down the warnings on pharmaceutical nicotine. At a day-long summit last week in Austin, Texas, entitled "The Case for More Flexible Regulatory Policy," public-health experts discussed a number of changes they may seek to current regulations. Among other possibilities, they say they may recommend relaxing the health cautions for pregnant women and eliminating the requirement that teenagers refrain from using over-the-counter nicotine products without the approval of a physician.

"A 17-year-old smoker of 25 cigarettes per day is doing the right thing to use nicotine gum," says Jonathan Foulds, a tobacco researcher at University of Medicine and Dentistry of New Jersey. "Why give him another hurdle to cross to get help?"

Over-regulation as the cause for lack of utilization? How about the methadone/heroin analogy? Maybe the reason people aren't using these meds is because they're expensive and people don't like taking drugs - especially one that is powerfully addictive. And there are even researchers who question the efficacy of these drugs to stop the smoking habit in the first place.

Recent studies of successful quitters have suggested that the significant benefits of nicotine products seen in randomized clinical trials may not apply in real-world conditions. Critics say the public-health experts who favor nicotine medicines are too financially tied to manufacturers to see the products' limitations. And use of nicotine by teens, pregnant women, heart-disease patients and smokers who haven't quit remains controversial.

"The use of nicotine, whose efficacy in treating nicotine addiction is controversial even in adults, must be strictly avoided in pregnancy, breastfeeding, childhood and adolescence," argues an editorial in the current Journal of Health Psychology, written by a group of eight researchers and antismoking advocates.

To think that people actually READ a warning label and that this is the sole cause of the lack of utilization of these smoking cessation drugs belittles any real analysis of human behaviour.

The reality? We have been incredibly successful in the US at educating our population about the effects of smoking and reducing the number of individuals who smoke. Smoking bans have also been remarkably effective. Why make us smoke this lame excuse for "limited gains" of achieving our goals of smoking cessation in the interest of making pharmaceutical companies more money? Maybe, just maybe, the real reason that smoking cessation aides are producing only limited gains (in sales) is because fewer people are smoking.