Is It OK to Harass the Smokers We Love?

By Scott Mowbray

When I was 11 years old, I drew skulls and warnings on my mother’s cigarettes and then slipped the cigarettes back in the pack. If I was hoping to embarrass her, it worked: She offered them to guests at an afternoon party, and I heard the details. It wasn’t as hilarious as I had imagined, apparently. That was 1971.
Recently I asked a few friends and acquaintances if they had similar stories and received anecdotes dating all the way back to the start of the modern assault on tobacco. One friend’s father, who was a D.C. lawyer representing a tobacco company in the mid-’60s, fired the client after being pestered by a uniquely positioned pressure group: his offspring. Now 81, he emailed to say he recalls that “firing Lorillard as a client was written up…in an article in The Wall Street Journal, ‘Daddy, Why Do You Represent a Cigarette Company?’”
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Quit-Smoking Drug May Raise Suicide Risk

(HealthDay News) -- There's increasing evidence that the smoking-cessation drug Chantix is linked to serious "neuropsychiatric" side effects, including agitation, depressed mood and even suicide, U.S. health officials said Friday.

The U.S. Food and Drug Administration has asked Chantix's manufacturer, Pfizer Inc., to make the warning about these potential problems more prominent on prescribing information and on the drug's label. The agency is also working with Pfizer to produce a Medication Guide for patients, officials said.

"We have become increasingly concerned as we have seen a number of compelling cases that truly look as if they are the result of exposure to the drug and not to other causes," Dr. Bob Rappaport, director of the FDA's Division of Anesthesia, Analgesia and Rheumatology Products, said during an afternoon teleconference.

"These cases involve abnormal behaviors, changes in mood, and suicidal ideation and suicide," Rappaport said.

The FDA knows of 491 cases of suicidal behavior associated with Chantix, said Dr. Celia Winchell, a team leader in the FDA's Division of Anesthesia, Analgesia and Rheumatology Products.
"Of these, 420 are from the United States," Winchell said. "There are 39 that involve completed suicides, 34 in the United States."

According to Pfizer, 5 million patients have taken Chantix, whose generic name is varenicline.
Friday's warning follows a Nov. 20 FDA statement that the agency was "evaluating post-marketing adverse event reports on Chantix related to changes in behavior, agitation, depressed mood, suicidal ideation, and actual suicidal behavior."

At that time, Pfizer said there had never been a cause-and-effect relationship shown between Chantix and these symptoms. The company also said that part of the problem may be due to nicotine withdrawal.

Last month, Pfizer agreed, after consulting with the FDA, to update packages of Chantix sold in the United States to more prominently display a warning that users should be monitored for suicidal behavior, depressed mood, and other mental health symptoms.

The FDA approved Chantix in May 2006 as a smoking-cessation drug. It acts in areas of the brain affected by nicotine and may ease withdrawal symptoms and block the effects of nicotine if users resume smoking.

On Friday, FDA officials advised patients to tell their doctor about any history of psychiatric illness before starting Chantix. The drug can cause current psychiatric illness to get worse even if it is under control. Chantix may also cause the recurrence of an old psychiatric illness, the officials warned.

Patients should also report changes in mood and behavior to their doctor. Symptoms to look out for include anxiety, nervousness, tension, depressed mood, unusual behaviors and thinking about or attempting suicide, the FDA officials said.

In most cases, these symptoms developed while taking Chantix, but they can also appear after stopping the drug, the officials noted.
"We are continuing with the review process over the next several months as we try to pin down to what extent these problems are being seen with Chantix," Rappaport said.

Vivid, unusual, or strange dreams may occur while taking the drug. Patients may also experience impaired ability to drive or operate heavy machinery, the officials said.

More information
For more on quitting smoking, visit Smokefree.gov.

Smokers' Infants Have High Nicotine Levels

(HealthDay News) -- In homes where at least one parent smokes, infants have 5.5 times higher levels of a nicotine toxin called cotinine in their urine than infants of nonsmokers, a British study finds.

Cotinine is created as the body tries to get rid of the nicotine in inhaled smoke.

The study of 104 12-week-old infants (71 with at least one parent who smoked and 33 with nonsmoking parents) also found that having a mother who smoked quadrupled urine cotinine levels. Having a father who smoked doubled cotinine levels in an infant's urine, the researchers found.

Sleeping with parents and lower-temperature rooms were also associated with increased cotinine levels in infants, said the study by researchers at the University of Leicester Medical School and Warwick University.

"Babies affected by smoke tend to come from poorer homes, which may have smaller rooms and inadequate heating," the study authors wrote. "Higher cotinine levels in colder times of year may be a reflection of the other key factors which influence exposure to passive smoking, such as poorer ventilation or a greater tendency for parents to smoke indoors in winter."

The researchers also noted that sleeping with a parent is a known risk factor for sudden infant death syndrome (SIDS). They suggest that one reason for this could be an infant's proximity to parents' clothing or other objects contaminated with smoke particles.

The findings were published online Tuesday ahead of print in the journal Archives of Disease in Childhood.

More information
The American Academy of Otolaryngology -- Head and Neck Surgery has more about children and secondhand smoke.

Nicotine May Help Spur Lung Cancer

FRIDAY, July 21 (HealthDay News) -- While the nicotine in tobacco and in nicotine-replacement patches and gums doesn't cause lung cancer, it may help it along, a new study finds.
"Nicotine can promote the growth of new blood vessels and new cells -- two things that are correlated with the progression of cancer -- and our study shows how this actually happens," said study co-author Srikumar P. Chellappan, an associate professor in the Drug Discovery Program with the H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, in Tampa.

The finding raises questions about the use by lung cancer patients of nicotine-containing interventions aimed at helping smokers quit, such as popular patches and gums.
Chellappan's team identified a key binding process taking place between nicotine and receptors found on cells lining the lung's air passages, and in lung cancer cells themselves. The bond between nicotine and these receptors provokes further lung cancer cell proliferation, the researchers report in the August issue of the Journal of Clinical Investigation.
The Florida group conducted their lab work on cancer cells taken from patients afflicted with non-small cell lung cancer (NSCLS).

According to the American Cancer Society, lung cancer accounts for 13 percent of all new cancers and is the leading cancer killer of American men and women. Non-small cell cancers comprise 85 percent of the nearly 175,000 new cases of lung cancer diagnosed in the United States each year.

But while tobacco smoke is the direct cause of eight out of 10 lung malignancies, nicotine -- the addictive chemical in tobacco -- does not have cancer-causing properties. The role, if any, of nicotine in lung cancer has long been the subject of debate.

In previous work, Chellapan found that nicotine exposure among lung cancer patients did appear to undermine chemotherapy's effectiveness in killing off cancer cells. Because so many patients use nicotine patches or gums to help them quit, this raise the troubling notion that these interventions might actually help encourage the disease.

In this study, Chellappan's focused on NSCLS cells and adjacent cells from the lung's air passages also known as bronchial cells. They exposed both cell types to nicotine in the test tube. The amount of nicotine used was the equivalent to what would typically be present in the bloodstream of a patient who smokes one pack of cigarettes a day.

In addition to binding with what are known as nicotinic acetylcholine receptors, the nicotine appeared to help create signaling pathways that promoted the cancer cell growth cycle. This growth activated and recruited other cell machinery known to stimulate tumor growth.
The researchers concluded that, in the test-tube setting, nicotine appears to go beyond simply protecting cancer cells as had been previously observed. Instead, it appears to promote cancer-cell proliferation and tumor progression.

"We found that a normal amount of nicotine that is typically present in the blood of smokers can really induce a proliferation of cancer cells, and we have identified some proteins in the cell that facilitate this proliferation," said Chellappan.

"So, smokers should be staying away from all products that contain nicotine," he cautioned. "Not just cigarettes -- anything. I can not say that this is just about smoking. This is about exposure to any nicotine. Even a patch to help quit smoking may not be the best idea."
Nevertheless, one expert is still on the fence when it comes to the risks and benefits for lung cancer patients in using nicotine-replacement therapies.

"You can't necessarily say whether nicotine-replacement therapy is a good or bad idea," said Dr. Norman H. Edelman, chief medical officer with the American Lung Association.
"My guess is that it's a good idea to engage in smoking cessation," he said. "Smoking cessation is a much healthier way to go rather than avoiding the nicotine in smoking-cessation therapies based on the theoretical risk shown in test tubes that nicotine can promote tumors."
Edelman emphasized, however, that the current study is "an important biologic finding" that will need to be followed up with research in animals and ultimately humans.

Two other major groups agreed. The U.S. National Cancer Institute's Web site states that "any potential risks of short-term use of nicotine-replacement therapy to stop smoking are far outweighed by the significant and known benefits that accrue to patients who stop smoking."
And the American Cancer Society's Web site notes that "numerous studies have shown that these products are safe and effective in helping smokers quit." Society experts also point out that the use of nicotine-replacement products, alongside in-person and phone counseling, can double a smoker's chances of successfully quitting.

More information
For more on cancer and nicotine, head to the U.S. National Cancer Institute.
Last reviewed: 07/21/2006 Last updated: 07/21/2006