Respected doctor, your observations are as simple and straight forward as THE BIBLE is. Yes the depression, homicide, adultery are inborn for humans.majority of human beings deny this with the help of a scapegoat like chantix

Hi Dr. Melissa

There is another simple yet compelling issue not mentioned here. Australian research published this spring in the journal Public Library of Science Medicine suggests that UNaided smoking cessation methods (like stopping cigarettes cold turkey or gradually reducing before quitting) is actually the most successful way to quit smoking after all, despite Big Pharma’s pervasive marketing campaigns to convince both consumers and physicians alike that we need to buy their products if we really, really want to quit.

In fact, as with problem drinking, gambling, and narcotics use, population studies show consistently that up to three-quarters of smokers who permanently stop smoking do so without any form of assistance like Chantix - known as Champix here in Canada and in Europe (where, coincidentally, France has recently announced that it will no longer be paying for the drug because of the drug's  safety concerns)

It is not, however, in Big Pharma’s best interests to let smokers entertain concepts that are dangerous to their bottom line - like being able to quit smoking on our own.

Hey Carolyn and glad to hear from you. I ALWAYS advocate for the "cold turkey" approach, but by the time I see many of these patients again, they are on their second ACS admission  or have suffered another event and are still smoking. At that point, it gets to be even more of an urgent situation so we are compelled to offer. Also, I think there is some inherent bias built into the journal publication you sited because of course for the population of patients who have less of an addiction struggle, cold turkey is always going to be the "most successful" approach,  it's those folks  who've already flunked the "UNAided" approach who desperately need our help.  

With regard to the French government, I'd be far more concerned about the health of those who did not receive aid to discontinue smoking than giving any of them Champix.  When I spent some time there 10 years ago, I remarked that it's the only place I'd seen folks eat and smoke at the same time, fork in one hand, cigarette in the other. Smoking used to be pervasive there (not certain how they've fared in the last ten years), but I'd say the cost- prohibitive nature of the up- front loading of that population  with champix had far more to do with their decision. Just my 2. 

Thanks for your post. 

Melissa

I agree 100% with your assessment.  Of all of the agents that have been purported to be successful, Chantix is the most effective agent for the hard core smoker. 

When people have side effects, I have some success with continueing the patient on low dose (inititation) schedule for a longer period of time and gradually escalating to the full twice daily regimen.

When I saw the "warnings" about Chantix on the news, I chuckled.  Is Chantix a worse poison than smoking?  Silly news like this can only compound the denial that many smokers are in.  Every have that silly discussion with a patient who wants "vascular protection" (e.g. statins, ramipril, Vitamin X-Y-Z) even though they smoke?

 IS there any common sense left in medicine?

Thank you, thank you, thank you!!  Finally, some common sense.  How many examples do we have where meta-analyses of sparse data are later refuted by definitive trials? 

-folic acid & homocysteine

-IV magnesium for acute MI

-renal toxicity of natrecor

-class 1c anti-arrhythmics in acute MI

-GIK therapy for acute MI

Well, can you add varenicline to this list?  

 How many of these events were adjudicated true serious cardiovascular events (MACE; MI-stroke-CV death)?  Was a time-to-event analysis performed?  Were baseline imbalances adjusted for?  The answer to all 3 questions is, quite seriously, no.   

There is something seriously wrong with the FDA. Fortunately, our government will now cover a 12 week course of varenicline for anyone over 65 or on welfare. Hallelujah! 

Wished to add - quitting smoking on your own, in the absence of a vascular event/"teachable moment" - is like getting a heroin addict to quit using diacetylmorphine on their own.  Yes, most smokers still do quit on their own, but these data are from the pre-varenicline era (at least, prior to widespread use), and unfortunately many smokers continue to smoke even after suffering a heart attack, stroke or revascularization.  Blinded randomized trials definitely show that varenicline results in increased cessation versus advice to quit alone with or without nicotine replacement therapy, and even beats buproprion/Zyban.

Thank you for a great article. 

As a former smoker I can honestly say that my Champix/Chantix-aided cessation has been by far my easiest, not only for me, but for everyone who lives/works with me.

I have been willing to sacrifice sleep quality.  I did with every other attempt to stop smoking.

The nausea has helped to stop me from stacking on weight, and can be managed easily.

Not sure if the repeated sinus infections are linked but do not care.

I have stopped smoking for my longest period to date and could not be happier.

The real shame about the scare-mongering is that there are medical "professionals" pushing it along and getting published at the expense of people who are addicted to nicotine.  I'm sure the tobacco industry has nothing to do with it.....

In Australia we now have subsidised access to a total of 6 months of Champix (starter pack and 2 x 12 week courses). Whilst not free, the medication is significantly less than what I was spending on tobacco.

Thanks to all of you for your kind commentary. As a point of interest I saw a couple this week who are smoking 4 ppd between them. The very nice gentleman was forlorned that he could not afford his meds and he suffered from very poor dentition. He was shocked when I told him how he could afford all of these entities very easily.  He and his significant other are smoking $32,000 US worth of tobacco products every five years.  Chantix for six months $720.

I hope he will think about it.

Melissa

My conclusion, from many years' experience in tobacco control, is that different things work for different people.  I know a life-long 3-pack a day smoker who quit cold-turkey because, according to him, he decided (after a history of several short-term quits) that he'd finally 'had enough'.  A friend who is a light smoker has been unable quit unaided, but has finally done so with the aid of Champix.  I am not persuaded by the argument that there is some capitalist conspiracy to under-play unaided cessation, nor by the argument that 'most people who quit do so unaided'.  The fallacy in this is the embarrassingly low proportion of current smokers who quit in any given year -- saying that something was used successfully by 75% or even 90% of 3% is nothing to brag about. What about the other 50%-60% of smokers who say they would like to quit?  The pro cold-turkey argument is current being advocated by Simon Chapman in this commissioned article in the BMJ in the lead-up to the UN Summit on Non-Communicable Disease next month. See: http://bmj.com/cgi/content/full/bmj.d5008?ijkey=7GXlbpq39uvfd1Q&keytype=ref

Thanks Dacq for this link to the BMJ piece, which concludes: "In the West, despite at least two decades of industry promotions, despite armies of drug retailers, and despite increasing success in the lobbying of governments to subsidise cessation pharmacotherapy, most ex-smokers continue to quit unaided."  As always, my advice is to "follow the money".

As an ex-smoker (your basic worst nighmare) - I like to think (hopefully!) that smoking will one day go the way of the spittoon, once a socially acceptable fixture in hotel lobbies, banks, doctors' offices and virtually every large urban building in North America a century ago. Handy for people suffering from tuberculosis who would cough up phlegm. Went completely out of favour once spitting was identified as a serious public health hazard. Hardly ever see spittoons these days...

A friend recently quit smoking (2-packs a day x30 years) by following two simple steps recommended in a book (called something like The Easy Way to Quit Smoking).  The two simple steps?  #1 - start thinking of yourself as a non-smoker and #2 - stop moping about it.

It was so NOT worth the Risk. Yes my husband quit smoking after 8 weeks, but now mysteriuously, he has congestive heart failure. Is the risk really worth the odds? Will our children now lose their father because the risks were "downplayed" in the media?

Julia,

I extend my concern and sympathy to you and your family's plight in dealing with the illness of your loved one. However, for the first 15 years of my practice, congestive heart failure was the most common and most expensive diagnosis in the US which predates Chantix coming onto the American market by centuries.  Ischemic cardiomyopathy is the most common cause of CHF (artery blockage) followed by hypertension. I have never heard of seen a case of congestive heart failure that was explained by the utilization of smoking cessation medications of any type. To the contrary, if more patients utilized these tools, the prevalence of heart failure would be impacted favorably. I wish your husband the best of luck.  Fortunately, congestive failure is far more treatable in this era of medicine than ever before and I sincerely wish him well.

Melissa