Clopidogrel benefit greater in smokers --Rope benefit greater in those hanging on the side of a cliff

Well, Well, Well, what a headline.  I'm suprised that RJ Reynolds or Phillip Morris hasn't already dressed a cowboy in a Tuxedo and placed the following caption in an ad in VOGUE stating:    "smoking helps my blood thinner work better and it can work for you too".

Unfortunately, smoking still increases plaque rupture in the untreated portion of the blood vessel, and  increases stroke, cancer and COPD rates, but those facts will not make headlines, at least not in VOGUE cigarette ads.

The ability to rev up  Cyp1A2 by tobacco use is fascinating and a very helpful piece of information to spur other areas of research but I fear this fact will be mistranslated by the lay public.   The fact that smoking can affect  the metabolism of a compound is not new news.  In 2003, published in the Journal of Psychopharmacology, there  was a small study of 17 patients who demonstrated that the smoking group metabolized the antipsychotic zyprexa much more quickly........6x more quickly to be exact.  That study also demonstrated that females and nonsmokers have a marked reduction in clearance of this medication .   Smoking increases the metabolism of caffeine as well (thus the 2 pot per day habit that many smokers can tolerate whereas the rest of us would be begging adenosine in the ER for SVt after that much coffee).  It  also increases the metabolism of clozapine, flecanide, mexilitine, theophyllin, haldol and even  inderal while it  decreases the metabolism of xanax. (Hey, yet another advertising opportunity). Apparently, it's the polycyclic aromatic Hydrocarbons (PAH's) that induce the the CYP1A2 and it's these same PAH's that turn on certain genes that cause oxidation and increase cancer and inflammation.   

So, it won't be long until this information will reach the general public.  It's hard to translate it into a helpful way but I guarantee you that entities like the Blue Grass institute, pro tobacco lobbyists and "protectors" of the rights of smokers everywhere will be delighted to misinform and misinterpret it for our patients.

We can certainly explain this information in a true and helpful way to our patients, though it may  be difficult for some to understand and for others, it will be just another excuse to keep smoking after an intervention.

All I can say is,   If the rope and the Cliff illustration doesn't work, perhaps we can put on a Tuxedo and try again.

Melissa  

Your comments

	Clopidogrel benefit greater in smokers --Rope benefit greater in those hanging on the side of a cliff
	# 1 of 2	April 18, 2009 02:36 (EDT)
	Dr ghassan kiwan	no need to add to your concerns ,dear Melissa.. are we going tp prescribe 2 or 3 cigarettes per day for those who are on clopidogrel from now on??? I am concerned that this piece of information would be misinterpreted by patients as a false assurance and by others as an enouragement. smoking cessation clinics must increase their efforts to help smokers avoid this trap .the battle is not yet over...just started...
	# 2 of 2	April 23, 2009 07:41 (EDT)
	Melissa	I agree Dr. Ghassan.  However, I've been encouraged by the progress we've made locally in smoking deterrence with the slight increase in tax and several businesses going smoke free.......... until yesterday.  Spring finally came back to Kentucky with abundant sunshine, blooming daffodils and bunnies playing on lush green lawns.  As I stepped out of my car at the hospital, a gentle warm breeze was blowing and unfortunately,  carrying with it cigarette smoke from the smoking hutt erected technically "off campus" but within a stone's throw of our parking lot .   The nicotine addicts were out in full force, bless their hearts, sucking for dear life on the burning weed that they are convinced they cannot live without.  It was all I could do to keep from tackling some of them as they made their  death march from the back door to the smoking shelter.  Yes, we still  have lots of work to do .  In Metcalfe County Kentucky, a county adjacent to us, the smoking rates published there last month are around 47%. With every victory comes more responsiblity and the recognition of the need to do even more. Thanks for your post. Melissa

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