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Controversy Over Revised ‘Quit Smoking’ Guidelines

Posted on: Thursday, 8 May 2008, 09:00 CDT

New guidelines established by federal government health officials recommend that doctors to use the drug Chantix to help smokers kick the habit. While the guidelines, published by the U.S. Public Health Service, do make mention of the drug’s association to depression and suicidal behavior, they conclude the popular medication is the most effective at helping people to quit smoking.

The move has created concern among some consumer advocates who warn the that the drug’s safety profile is incomplete.  Chantix, made by Pfizer and on the market since 2006, is still considered a relatively new medication.
 
The quit-smoking guidelines mention other options as well, and urge a combination approach that involves both medication and counseling. However, doctors are encouraged to talk to all smokers who want to quit about trying Chantix.

"It is somewhat better than other therapies; on the other hand, it appears to have more risk," Dr. Sidney Wolfe of the watchdog group Public Citizen told the Associated Press. "That part of the risk-benefit equation is missing, and it's changing rapidly."

The new guidelines’ strong Chantix recommendation has also become the lead author’s financial ties to Pfizer.   Dr. Michael Fiore, an expert on smoking and health issues and the lead author of the new guidelines, had been a consultant to the Pfizer.   And of the 24 panelists who authored the revised guidelines, three reported having "significant financial interests" in the pharmaceutical industry, including stock ownership and speaking fees.

Fiore said his ties to Pfizer were cut in 2005. 

But John Polito, a consumer advocate and smoking cessation educator who runs the WhyQuit.com Web site, says Fiore's Pfizer relationship still poses a conflict of interest, and called the revised guidelines "a sales pitch" for the drug industry.  Polito’s site advocates a “cold turkey” approach to quitting smoking.

Polito said the task force overlooked research that showed quitting cold turkey works, and that studies finding Chantix superior don't reflect how it's used "in the real world."

"People are quitting smoking to save their lives," Polito told the Associated Press, adding that if Chantix's risks outweigh its benefits, "then it's insane for people to risk their lives" by using it.

But Fiore said the new guidelines are based on an extensive examination of scientific evidence, and were reviewed by 90 independent experts and endorsed by 60 public health entities.  He reiterated that his past financial ties to the drug industry had not played a role in the review process.

"Independent reviewers of it came to the conclusion that this is a document that reflects the science, and that's what we were charged to do," Fiore said.

The guideline authors reviewed 83 studies and determined that Chantix helped one in three stay tobacco free for six months after quitting, compared with a nearly 14 percent abstinence rate for placebo pills.  The guidelines recommend a combination of "both counseling and medication should be provided to patients trying to quit smoking."

Medications alone have not been shown to be effective in certain groups, such as pregnant women, smokeless tobacco users, light smokers and adolescents, according to the guidelines.  The task force recommended that doctors consider obtaining psychiatric histories of patients before prescribing Chantix, and said they should also monitor patients for changes in mood and behavior while on the drug.

Lois Biener, a researcher of tobacco use and control efforts at the University of Massachusetts in Boston, told the AP that most people who quit smoking do not use smoking-cessation drugs.

“There's little evidence that these drugs are superior in the long run to quitting without help, and while a few studies have shown some benefit, it's way less than what is claimed" by medication advocates,” Biener said.

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On the Net:

Pfizer Inc.

Chantix Website

U.S. Public Health Service

Source: redOrbit Staff & Wire Reports

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