Not only does the health of former smokers DRAMATICALLY improve after quitting, but people who stop smoking get a boost in their quality of life, new research finds. Continue reading
Here’s a new study that may some real good news for smokers wanting to quit. Tabex (cytisine), a drug “developed in Bulgaria during the Soviet era, shows promise for helping millions of smokers cheaply and safely kick the habit,” according to a study published in the New England Journal of Medicine. Continue reading
If you could do four things to dramatically reduce your risk of brain shrinkage (especially that caused by dementia, vascular dementia, Alzheimer’s disease, or stroke), would that be of interest to you? Continue reading
Congrats to the new Surgeon General, for taking an even stronger stand on tobacco in her recent report, “How Tobacco Smoke Causes Disease.: The Los Angeles Times and Orlando Sentinel write that the report has found that “ANY exposure” to tobacco smoke can cause immediate damage to the human body.
“There is NO safe level of exposure to cigarette smoke,” Surgeon General Regina Benjamin said.
“Inhaling even the SMALLEST amount of tobacco smoke can also damage your DNA, which can lead to cancer.”
The report also finds almost NO difference between being a light smoker and a heavy smoker.
“That’s because of the inflammatory processes occur at very, very low doses,” said cardiologist Dr. Stanton Glantz.
The AP notes that the report “is the 30th issued by the nation’s surgeons general to warn the public about tobacco’s risks,” but “is unusual because it devotes more than 700 pages to detail the biology of how cigarette smoke accomplishes its dirty deeds — including the latest genetic findings to help explain why some people become more addicted than others, and why some smokers develop tobacco-caused disease faster than others.”
CNN says that the report “links smoking directly to 13 different cancers including esophagus, trachea, stomach, pancreas, kidney, bladder, cervix and acute myeloid leukemia.”
It also “ties smoking to more than a dozen chronic diseases like stroke, blindness, periodontitis, heart disease, pneumonia; reproductive problems like diminishing fertility; chronic obstructive pulmonary disease (COPD), asthma and other respiratory illnesses.”
The Washington Post “Checkup” blog reports that Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, called the report “a stark reminder of how lethal and addictive smoking truly is.”
With the news that CT scans — or computerized tomography — can prevent lung cancer deaths, smokers and ex-smokers may wonder whether they should ask for a screening. USA TODAY did a nice job in asking experts for their advice:
Q: How could a lung cancer screening help save lives?
A: Like a mammogram, CT scans can find tumors when they’re small and potentially curable, says the National Cancer Institute (NCI), which funded the $250 million study. Today, most lung cancers aren’t found until people develop symptoms, such as a coughing or shortness of breath. At that point, the cancers are usually incurable.
Q: Should everyone get a lung cancer screening?
A: No. There is a risk of harm associated with the scans, so a patient’s benefits must outweigh the risks.
Q: What study is this all referring to?
A: STUDY: CT scans can reduce lung cancer deaths by 20%. The study only included people at high risk of lung cancer — those ages 55 to 74 who were current or former heavy smokers, says Otis Brawley, chief medical officer of the American Cancer Society, who wasn’t involved in the trial. Everyone in the study had smoked the equivalent of one pack a day for 30 years.
It’s not known whether screenings might help light smokers or those who’ve never smoked, Brawley says.
Q: Are screening CT scans safe?
A: That depends on the patient, Brawley says. For people at high risk of lung cancer, like those in the study, the benefits outweigh the risks. Screening for lung cancer with CT scans reduced lung cancer deaths by 20% during the eight-year study, and cut overall deaths by 7%.
Even so, CT scans still have their risks.
First, they expose patients to radiation, which can itself cause lung cancer, especially in people who have already damaged their cells through smoking, says David Brenner, a professor at Columbia University not involved in the trial.
CT screenings also cause a lot of “false alarms,” in which patients are needlessly worried because of suspicious results on a scan, Brawley says. In the study, about 25% of patients screened with CT scans needed some sort of follow-up, says Harold Varmus, director of the NCI.
In some cases, patients simply had a second scan. But in others, patients needed invasive tests to rule out cancer. Removing a chunk of lung tissue for a biopsy is risky and can be painful, the NCI says. Biopsies can cause collapsed lungs, bleeding and infection.
Some patients with suspicious CT results need a larger operation, in which surgeons open the chest, the NCI says. The operation can cause nerve damage and is especially risky in people with heart conditions or other ailments that are common in older smokers and ex-smokers.
CT scans may detect slow-growing lung tumors that would have never posed a threat, Varmus says.
And CT scans can find lumps and bumps outside the lungs that, on closer inspection, turn out to be harmless, the institute says.
Q: What are radiation’s risks?
A: If half of the USA’s 36 million current and former smokers ages 50 to 74 were to get annual CT screenings until age 75, radiation-related cancers could kill up to 94,000 people, Brenner says. But the screenings could be expected to prevent 380,000 deaths from lung cancer, he says.
The CT scans used in the study provide about 3 millisieverts of radiation, says Denise Aberle, a leader of the study. That’s about the same as from a mammogram.
Q: Can people sign up to get one of these scans today?
A: Maybe. Most hospitals can perform screenings with CT scans, says Bruce Johnson of Boston’s Dana-Farber Cancer Institute.
Although insurance plans don’t pay for lung cancer screening, some people might choose to pay the $300 out-of-pocket cost, Varmus says. Insurance plans generally do pay for diagnostic CT scans, which are used when patients already have other signs of lung cancer.
Johnson notes that screening for lung cancer involves more than one procedure. Hospitals need to be prepared to follow up on patients with suspicious results, performing more tests to confirm or rule out cancer.
For the study, researchers from Kaiser Permanente “evaluated the records of 21,123 men and women in midlife and continued following them, on average, for 23 years.” They found that, “compared with non-smokers, those who had smoked two packs of cigarettes a day increased their risk of developing Alzheimer’s by more than 157% and had a 172% higher risk of developing vascular dementia — the second most common form of dementia after Alzheimer’s.”
The Wall Street Journal reports that smokers who did not smoke so heavily still faced an increased risk for dementia. For example, even smokers who smoked just half a pack of cigarettes daily still had a 37% increased risk for Alzheimer’s.
Bloomberg News points out the public health implications of the study, noting that “about 46 million Americans ages 18 or older are cigarette smokers, according to the US Centers for Disease Control and Prevention.”
The study’s lead author explained that “smoking causes higher levels of inflammation in the body and affects how blood clots.”
In addition, “smokers are … more likely to have strokes, high blood pressure, and cerebrovascular disease — a malady of the blood vessels, particularly the arteries that supply the brain — which are all risk factors for dementia, she said.”
According to the CNN’s “The Chart” blog, people “who smoked between one and two packs had a 44 percent heightened risk, compared to non-smokers.”
However, “this could be an underestimation, because some smokers who would have developed dementia died before diagnosis, said Kenneth Hepburn, associate dean for research at the Emory University School of Nursing, who was not involved in the study.”
What’s more, “the reported risk of dementia among heavy smokers is also likely an underestimation because many of those people will die before they’re old enough to develop dementia, he said.”
“Former smokers and people who smoked less than half a pack a day did not appear to be at increased risk of Alzheimer’s or vascular dementia,” HealthDay reported.
Still, “the associations between smoking and dementia did not change, even after adjusting for race or gender, high blood pressure, high cholesterol, or heart attack, stroke or weight,” the study authors added.
All of this is just another reason for all of you who smoke to talk to your personal physician ASAP about stopping ASAP.
It is generally understood that being inactive, eating poorly, smoking, and drinking too much are bad – very bad – for your health. Now, a newly published study assesses and quantifies those behaviors. In short, “combine all of the above and you’ll end up seeming 12 years older than people your age who do none of the above.”
“Overall, 314 people studied had all four unhealthy behaviors.” That is, they smoked tobacco, had “more than three alcoholic drinks per day for men and more than two daily for women,” attained “less than two hours of physical activity per week; and” ate “fruits and vegetables fewer than three times daily.”
As a result, they “were 3.49 times more likely to die over the course of the study than their countrymen (and women) who practiced clean living,” the Los Angeles Times “Booster Shots” reported.
“That included a 3.14 times greater risk of death from cardiovascular disease; a 3.35 times greater risk of death from cancer; and a 4.29 times greater risk of death form any other cause.”
Conversely, “96% of those with healthy behaviors were alive at the end of the study, compared with 85% of those with the worst health habits,” according to the data in the Archives of Internal Medicine.
Lead investigator Elisabeth Kvaavik, PhD, of the University of Oslo, also pointed out that “also having, for instance, two poor and two healthy behaviors, doubles the risk of dying compared to having only healthy behaviors,” the CNN blog “Paging Dr. Gupta” reported.
Still, “modestly changing behaviors can have a big health impact.”
In fact, such modifications “‘are likely to have a considerable impact at both the individual and population level,’ the study authors write,” according to a report from Medscape.
Thus, “developing more efficacious methods by which to promote healthy diets and lifestyles across the population should be an important priority of public health policy.”
More than that, it shoud be an important priority for you and your family.
When I wrote my book, SuperSized Kids: How to protect your child from the obesity threat, I predicted that if the obesity epidemic was not stemmed, that this generation of U.S. children would be the first in history to have a shorter life expectancy than their parent. Now, new population-level predictions show the importance of tackling obesity for the nation’s health. In other words, the gains we are making in improved life expectancy from lower smoking rates, especially over the next decade, will be offset by a great degree by reductions in life expectancy based on the rise in obesity.
This report, from MedPage, tells us that if obesity and smoking rates had held steady, the average 18-year-old would have seen a 2.98-year increase in life expectancy over a 15-year period. At least according to a report by Susan T. Stewart, PhD, of Harvard and the private nonprofit National Bureau of Economic Research in Cambridge, Mass., and colleagues.
But a 48% rise in obesity overrode the expected gain from a 20% reduction in smoking rates seen over the past 15 years, the researchers reported in a study in the Dec. 3 New England Journal of Medicine.
Bottom line: a predicted net impact of 0.71 fewer life-years through 2020 — one quarter of the anticipated increase.
Overall, life expectancy isn’t expected to fall over the next decade, the researchers cautioned. Instead, their estimates suggest that “life expectancy will continue to rise but less rapidly than it otherwise would.”
Still, the findings should be a wake-up call for policymakers and physicians, Stewart said in an interview.
“We know that the effects of obesity are not quite as intense as the effects of smoking, but obesity is more widespread,” she said. “It was a little discouraging to see that obesity was winning.”
“But if we were to put the same kind of effort into addressing obesity as we have fairly successfully put into addressing smoking, then perhaps we could have the same kind of positive effects for the future,” she added.
The researchers forecast life expectancy and quality-adjusted life expectancy for a representative 18-year-old for each year from 2005 through 2020.
Since both obesity and smoking impact quality of life, the researchers also estimated quality-adjusted life expectancy using 2003 Medical Expenditure Panel Survey data.
Four iterations of the National Health Interview Survey from 1978 through 2006 revealed an average 1.4% decrease in smoking rates per year in the 15 years prior to 2005.
But Body Mass Index (BMI) trends based on National Health and Nutrition Examination Surveys (NHANES) from 1971 through 2006 showed an average 0.5% increase per year over the 15 years before 2005.
Assuming a continuation of past trends for the next 15 years, 21% of current smokers would quit by 2020, the researchers estimated.
Based on this factor alone, life expectancy for the typical 18-year-old would increase 0.31 years, with an extra 0.41 years of quality-adjusted life expectancy.
But over the same time frame, the normal weight population would drop by 35% in the U.S. with an estimated 45% of Americans expected to be obese by 2020.
The impact of this change alone would reduce life expectancy by 1.02 years and quality-adjusted life expectancy by 1.32 years.
Thus the net effect of the two risk factors together would be a 0.71-year reduction in life expectancy and 0.91-year drop in quality-adjusted life expectancy relative to the trend.
This same pattern was forecast for every year from 2005 to 2020, with the disproportionate effects of obesity becoming even more pronounced over time.
Even in sensitivity analyses based on more rapid declines in smoking and slower rises in obesity, the effects of obesity exceeded those of smoking on life expectancy.
The trends could be expected to have less absolute impact for older adults, who have fewer years of remaining life expectancy, Stewart said.
However, the results might underestimate the impact of obesity on youth, considering that earlier onset leaves more time for risks such as diabetes to arise, she said.
“Though perhaps not achievable,” completely eliminating both smoking and obesity would increase life expectancy by 3.76 years while quality-adjusted life expectancy would rise by 5.16, the researchers wrote.
They cautioned that these population-level forecasts do not apply at the individual level to smokers who quit or people who lose weight.
Nevertheless, “even modest weight loss and reductions in smoking at the individual level can have substantial effects on population health,” they concluded.
Nicotine patches and gum seem to be safe and effective in pregnant women, according to a new study.
Such patches and gum have been shown to help non-pregnant adults stop smoking, study co-author Dr. Geeta K. Swamy told Reuters Health. However, women and their physicians have been uncertain about their safety and effectiveness during pregnancy.
Reuters Health reports Dr. Swamy, from Duke University Medical Center in Durham, North Carolina, and colleagues took another look at data on pregnant smokers who had participated in a study comparing psychological treatments with nicotine patches or gum to help them quit.
Adding nicotine patches or gum tripled the number of women who quit, from 8 percent to 24 percent.
However, almost a third, 31%, of the women who used the patch or gum had pregnancy complications, compared to 17% of the women who did not use it. And, there was a much higher risk of such complications in black women, in those with complications in previous pregnancies, and in those using painkillers. However, the use of the patch did not seem to have a direct effect, the researchers noted.
Based on the findings, although the patch is not “absolutely safe,” the researchers believe it may still be worth using in heavy smokers, given the known association between smoking and bad pregnancy outcomes, particularly premature birth and low birth weight, they conclude.
The editors of the journal wrote that this study was “an important reanalysis of a randomized trial that compared cognitive therapy with cognitive therapy and nicotine replacement therapy to reduce smoking in pregnancy” and revealed “it is unlikely that the nicotine replacement therapy was associated with adverse outcomes.”
Nevertheless, we may not know for sure until the “Smoking, Nicotine, and Pregnancy trial,” which is a large-scale randomized trial of nicotine replacement therapy during pregnancy that is being conducted in the United Kingdom, is published. It will likely provide useful insight into any potential safety concerns because it will follow the offspring up to 2 years of age.
In the meantime, I consider smoking in pregnancy to be much more likely to harm a woman or her baby than using a nicotine replacement therapy to stop smoking. In addition, carrying an unborn baby is often a motive for women to stop smoking.
And, stopping smoking is health at any time!
MedScape is reporting “An important head-to-head study of smoking cessation therapies shows that combination treatment with a nicotine patch plus lozenge almost doubles the rate of abstinence at 6 months compared with placebo, new research suggests.”
“This is the first time that a head-to-head study has been done looking at all the different smoking cessation pharmacotherapies, and it’s also one of the first times that combination therapies have been looked at in a large sample,” said lead author Megan E. Piper, PhD, assistant professor, Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison.
“When you get a 40% quit rate at 6 months in a group, that’s really promising for smokers who are trying so hard to quit.”
The study was published in the November issue of the Archives of General Psychiatry and included 1504 adults who smoked an average of 10 or more cigarettes a day for at least the past 6 months and were randomly assigned to 1 of 6 interventions:
- bupropion SR (sustained release; Zyban, GlaxoSmithKline), 150 mg twice daily for 1 week before a target quit date and 8 weeks after the quit date;
- nicotine lozenge (2 or 4 mg) for 12 weeks after the quit date;
- nicotine patch (24-hour, 21, 14, and 7 mg titrated down during 8 weeks after quitting;
- nicotine patch plus nicotine lozenge;
- bupropion SR plus nicotine lozenge; or
- placebo (1 matched to each of the 5 treatments).
Patients also received six 10- to 20-minute individual counseling sessions, with the first 2 sessions scheduled before quitting.
The protocol included 3 in-person baseline sessions, during which researchers collected relevant medical history and vital signs measurements and carried out a carbon monoxide breath test. The last baseline visit took place between 8 and 15 days before the quit date.
Patients had study visits on their quit day and at 1, 2, 4, and 8 weeks postquit, during which vital signs, adverse events, and smoking status were recorded.
Measures of Success
The researchers looked at several measures of cessation success including being able to quit for 1 week after the designated quit date; being abstinent for at least 1 day during the first week of an attempt to quit; the time to first lapse, defined as the first cigarette smoked after quitting; and the time to relapse, defined as smoking on 7 consecutive days after the quit date.
During treatment, the patch, bupropion plus lozenge, and patch plus lozenge were all significantly more efficacious than placebo, but at 6 months, or 4 months after the end of treatment, only the patch plus lozenge remained efficacious.
The carbon monoxide–confirmed abstinence rates at 6 months were 40.1% for the patch plus lozenge, 34.4% for the patch alone, 33.5% for the lozenge alone, 33.2% for bupropion plus lozenge, 31.8% for bupropion alone, and 22.2% for placebo;
The odds ratio at 6 months was highest (OR, 2.34) in the combination patch plus lozenge group, followed by the patch alone (OR, 1.83), lozenge alone (OR, 1.76), bupropion plus lozenge (OR, 1.74), and bupropion alone (OR, 1.63) compared with placebo.
This patch/lozenge combination came out ahead in a number of other measurements. It, along with the patch alone, was the most effective at helping patients stay abstinent for at least 1 day during the first week of an attempt to quit. In addition, the combination tended to produce more positive outcomes than other treatments on days to lapse and days to relapse.
Safe and Well Tolerated
All the interventions appeared safe and well tolerated. Only 4 of 1504 participants withdrew from the study for medication-related reasons.
People who had tried to quit before this study were evenly distributed in the various treatment groups, so the success rate was not a result of it just being the right time to quit for subjects.
“Let’s say everyone was going to quit if it was their sixth time, but we randomly dispersed all the people who were at their sixth time across all the different treatment conditions, so that shouldn’t have too much of an impact in terms of comparing the conditions,” said Dr. Piper.
Successfully quitting after several failed attempts could at least partially be attributed to “skill building,” she said. “Some of it is just learning the triggers, learning what you can and can’t do and still be able to stay smoke free, and learning how to cope with withdrawal over time.”
The authors speculate that the patch/lozenge combination might produce an additive effect. “When you put a patch on, it’s steadily putting nicotine into your blood, and so it’s generally taking the edge off some of your withdrawal all the time,” said Dr. Piper. “But some people have times when they always have a cigarette — after a meal or when stressed at work, for example. These people can use the lozenge instead of going for a cigarette in those moments of intense craving.”
Dr. Piper believes that the counseling sessions played an important role in successful smoking cessation. Some healthcare providers provide such counseling, but smokers across the country can also access a national quit line (1-800-QUITNOW) that provides over-the-phone coaching. “And if you’re interested in face-to-face counseling, they will help you locate clinics or groups or classes in your area.”
All the treatment interventions used in the study, except for bupropion, are available without prescription, and most are covered by health insurance plans, said Dr. Piper.
Varenicline Not Included
It is unfortunate that the study did not include varenicline (Chantix, Pfizer), commented Alexander Glassman, MD, head of clinical psychopharmacology at New York State Psychiatric Institute and professor of psychiatry, Columbia University, New York City.
“Studies show that this drug used alone is superior to bupropion, although these studies excluded patients with depression and schizophrenia, many of whom smoke,” he said.
As for recent concerns about the safety of this drug, Dr. Glassman said reports during phase 4 (postmarketing) evaluation are “notoriously unreliable.”
This new comparison study reinforces the notion that combination therapies are superior to single therapies, said Dr. Glassman, who runs a smoking cessation research clinic and has done research on smoking and depression. He noted that although the patch plus lozenge was superior to other treatments, the other combination used in the study — bupropion plus lozenge — also fared well.
After reading the study, Dr. Glassman will consider using the lozenge more often in his practice. “The authors convincingly showed that the lozenge can work just as well as bupropion as an add-on treatment or as a combination treatment,” he said.
The lozenge is a relative newcomer to the smoking cessation scene and may not be as well known or as commonly used as the patch, he said. The lozenge is better than nicotine gum, as the release of nicotine is controlled and not dependent on chewing method.
Dr. Glassman stressed that not all smoking cessation tools work for everyone. “Some people have trouble with the lozenge — they get nauseated — and some people will feel jumpy and not sleep well on the bupropion.”
In my latest book, 10 Essentials of Happy, Healthy People, I teach people how to utilize these ten essentials that are necessary to live a happy and highly healthy life. Under The Essential of Self-Care, teach what I call “The 10 Commandments of Preventive Medicine. Here’s the seventh installment of this ten-part series. Continue reading
Tobacco users who think it’s safer to dip snuff or chew tobacco than smoke are dead wrong, researchers say. A study has found that taking one pinch of smokeless tobacco delivers the same amount of polycyclic aromatic hydrocarbons (PAHs) as smoking five cigarettes.
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What an interesting new study. It concludes that to dramatically reduce your healthcare costs, to lengthen your life, to improve the quality of your life, and, in short, to have a happier and more highly healthy life, you need to “only” do four things.
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