University of Pennsylvania researchers have identified what may be a more effective way to help people quit smoking. About 70 percent of smokers give up the daunting effort during the first week of trying.
The researchers, led by Caryn Lerman, a professort of psychiatry, divided 1,246 subjects into slow metabolizers of nicotine and normal metabolizers of the addictive chemical, based on the length of time it took for them to rid their bodies of the drug. The ratio of two metabolites, or byproducts, of the body’s processing of nicotine allows easy identification of the two groups. The metabolite is found in blood and saliva.
The results of the comparison showed that slow metabolizers did just as well on a nicotine patch or the drug varenicline (marketed as Chantix), a drug that works on the nicotine receptors in the brain. But the patch costs less and has fewer side-effects than varenicline (including nausea, difficulty sleeping and abnormal dreams), so the researchers concluded that slow metabolizers should be put on the patch.
Normal metabolizers of nicotine, meanwhile, had more success with varenicline because they tend to rid their systems of nicotine faster, limiting the effectiveness of the patch. Varenicline contains no nicotine.
“The slower metabolizers, they do very well with the patch. And they get no incremental benefit from varenicline,” Lerman said in an interview. “Why spend the money? Why have the side-effects?”
This may seem like common sense, but no one had ever tested it before, she said. And given how difficult it is to kick the habit, smokers need all the help they can get to succeed the first time they try, Lerman said.
“Each time somebody fails, it affects their self confidence,” Lerman said. “The trial and error approach is not optimal.”
Researchers did not test nicotine gum because it delivers a less consistent flow of nicotine to the user, she said. The patch, worn on the skin, delivers a steady flow of the drug, she said.
In some of the test groups, overall success rates were fairly low, Lerman noted, but the study was conducted during the Great Recession, a time when financial stress may have depressed the chances of succeeding for everyone, regardless of which approach was used.
The story reports that a large smoking cessation study found that some smokers respond better to a prescription pill, sold as Chantix, and other people respond just as well to a less-expensive patch. A new blood test can distinguish whether people fall into one of those groups. By testing people in advance of choosing a therapy, the researchers believe this could improve quit rates and be widely adopted.
While we applaud the instinct to inform readers about this important research, which hasn’t been widely covered by the mainstream media, we think the story had some holes that could have been addressed with minimal effort. Importantly, the story doesn’t adequately describe what kind of study this was, quantify the size of the benefits, or include a perspective from someone not involved in the study. Also, the cost of adding a test to measure each person’s blood before choosing a quitting therapy should have been acknowledged and addressed.
Look, we know this is a blog piece and many blog posts are meant to be (mandated to be?) shorter. But in more than 8 years, our project has tried to drive a stake in the ground proclaiming 10 important issues that consumers need to have addressed in order to make sense of health care claims. We include news blogs among the outlets that we hold to that standard.
Cost and effectiveness comparisons between widely used health therapies are rare and valuable. U.S. smoking rates have fallen, but there are still 42 million Americans who do smoke, including teenagers and young adults. Helping smokers choose a quitting method that’s more likely to be successful, or potentially cost less and have fewer side effects, would have tremendous benefits for individual smokers and the public health.
Applause for mentioning cost, but we would have liked some actual numbers. A 56-tablet bottle of Chantix, which is discussed in the story, costs around $250 this week according to an easy-to-use online price comparison tool. A direct comparison is not quite fair, since different smokers use these medications at different rates, but a possibly comparable amount of patches that provide medication through the skin is around $50. The story also could have asked the study author to estimate the potential savings in some way. In addition, the story does not acknowledge that adding a blood test to identify slow vs. normal metabolizers will add cost to smoking cessation efforts. How much is unclear.
Great to see a story addressing the effectiveness of pills vs. patches. Glad also to hear discussion of side effects. Loved this scientist’s comment: “The slower metabolizers, they do very well with the patch. And they get no incremental benefit from varenicline, Why spend the money? Why have the side-effects?”
But again, we were looking for actual numbers. What were the overall success rates, and how did the researchers define “success”? How much better did the normal metabolizers do on the pills compared with the slow metabolizers? How less frequent are side effects with the patch compared with pills? By providing numbers to demonstrate the advantages of each approach for different individuals, the story could have made clearer why this was such an important study.
The story notes that side effects of varenicline include nausea, difficulty sleeping, and abnormal dreams. It also acknowledges that there is harm in pursuing a therapy that does not work if the quitter is discouraged. Excerpt: “Each time somebody fails, it affects their self confidence,” Lerman said. “The trial and error approach is not optimal.” We’ll rate this borderline satisfactory, but ideally we would have liked to see some quantification of these side effects, especially since frequency of side effects is an important part of the rationale for choosing one approach over the other. Moreover, the story should have explored potential harms from the blood test used to classify nicotine metabolism. How accurate is it? And if the test is wrong, what does that mean for your chances of quitting successfully?
The study being reported on was a fairly large randomized controlled trial that included over 1,000 patients at different sites across the nation and took four years. It’s an important study. The story doesn’t give us enough detail about the research, and crucially did not explain that this was a randomized trial, which would signal to many readers that this a study capable of proving cause and effect. Another critical missing detail is that all participants received counseling in addition to nicotine replacement. Specifics about the subjects, such as their age, sex, duration and frequency of tobacco use, and socioeconomic status, could also affect how readers interpret the results.
The story did not exaggerate the dangers of smoking.
We appreciate that this story took the time to interview one of the study authors, who provided useful context. However, one other perspective, at least, would have been great and might have yielded many of the details we wish this story had included. In addition, the story could have mentioned that the medication used in the study was provided by Pfizer — a detail noted in this press release.
The study being reported on was a comparison of two popular smoking cessation aids, and the story also mentions nicotine gum. We’ll award a satisfactory, but wish that the story had mentioned counseling as an approach that’s also supported by strong evidence.
The therapies in the story are widely available, but the patch is available over the counter and varenicline requires a prescription, which certainly impacts access. The story didn’t mention this. In addition, the story doesn’t describe the availability of the screening test that separates smokers into “fast” and “slow” metabolizers. We could not tell if that is easy for any primary care physician to order.
The story includes a comment from the researcher that this was an obvious question to study, but “no one had done it.” Again, we would have liked for someone other than the author to agree and add credibility. However, the story’s description of the study’s novelty appears accurate.
The story clearly includes an interview and went beyond the news release.
See: http://www.uphs.upenn.edu/news/News_Releases/2015/01/lerman/
Systematic, Criteria-Driven
As always, encouraging news outlets covering medicine to practice journalism, not stenography. https://twitter.com/garyschwitzer/status/1267796903141539846
Thanks @garyschwitzer & @HealthNewsRevu
So helpful & rational as always:
"Often it is what journalists allow interviewees to say – unchallenged – that is most concerning" https://twitter.com/garyschwitzer/status/1267796903141539846
CBS @60Minutes promoted one hospital’s “promise of plasma” for #COVID19. Here are some things that you need to know about that story. https://www.healthnewsreview.org/2020/06/60-minutes-promotes-one-hospitals-promise-of-plasma/
Comments (4)
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paula hatfield
January 19, 2015 at 10:11 amoh please a way to make more money utilizing the addition of nicotine. I smoked for 40 years at a pack a day. I read the book “the easy way to quit smoking” by Allen Carr and quit within a week. It is all in your head people. It was easy quitting and I didn’t have to take other drugs for it. Why doesn’t CVS sell this book if they are so serious about helping people.
Lenny Bernstein
January 19, 2015 at 4:06 pmHey, I love your critiques and have learned something both times. Please keep looking at my posts. Small bits of self-defense: Some of the numbers you call for would confuse most people. We may have to just disagree on that one. I try to get an outsider’s perspective every time, but sometimes it’s just impossible–either when I’m writing on a Sunday for Monday a.m. or when I’m cranking out several posts in a day. Not an excuse, but just so you know. And when a test isn’t even yet available, or is still just in the experimental stage, it’s not worth the space or time to try to find out about cost. All that said, I really like what you’re doing here, please keep it up.
Lenny Bernstein
Washington Post
“To Your Health” blog
Twitter: @LennyMBernstein
Lenny Bernstein
January 21, 2015 at 1:22 pmThanks for the resources, Gary, I will check them out.
Lenny
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