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New approaches to nicotine addiction mean a growing tobacco cessation market

Steve Gordon smoked four or five Parliament Ultra Lights while driving to the Bronx from Westchester County. He smoked a few more on the street. Then he crumpled up the remainder of the pack, threw it away and entered a hypnotist’s office.

That was on July 6, 2006, at 3:59 p.m., he said. He had been a smoker for 10 years. Since then, he hasn’t gone back.

“It’s awesome,” said Gordon, 34. “I’m able to run two miles straight without getting winded.”

For Gordon, hypnosis was the solution, but most smokers who try to quit fail repeatedly. Of the more than 45 million Americans who smoke, an estimated 28 million want to quit. With tobacco costing taxpayers an estimated $193 billion each year from healthcare costs and lost productivity, and most states passing laws that restrict or ban smoking, the pressure to kick the habit is on like never before.

All those would-be ex-smokers are also something else: a business opportunity for the pharmaceutical industry. While smokers like Gordon turn to novel alternatives to quitting cold turkey, researchers are looking for new drugs and new ways to improve anti-smoking aids.

Sales of anti-smoking tablets increased 24.8 percent in 2006, and anti-smoking gum sales increased 17.3 percent, according to Information Resources Inc., a marketing information company. And 2007 was a boom year for the smoking cessation industry, with revenues at $1.7 billion worldwide, a 37 percent increase from 2006, according to Visiongain, a pharmaceutical marketing information company.

Varenicline, a new drug treatment sold by Pfizer under the trade name Chantix (Champix outside the United States), generated $101 million in revenues in 2006, the year it was released, according to company reports. In 2007, that amount grew to $883 million.

But while anti-smoking entrepreneurs have unquestionably found a way to cash in on demand, there are still questions as to whether their products are any better than quitting cold turkey.

“They’re making a fortune off people,” said Joel Spitzer, a health consultant to the city of Evanston, Ill., and an advisor to WhyQuit.com, a site that encourages the cold-turkey approach. “They’re steering them away from best chance to quit.”

Spitzer believes the smoking cessation pills or patches keep people hooked on nicotine, rather than free them from addiction. It’s an addiction like heroin or alcohol, said Spitzer, who espouses the idea that to completely quit smoking, an addict can’t have even one puff.

Quitting alone is a difficult proposition. Among those who attempt to quit without aids, “quit rates are extremely modest,” said Douglas Jorenby, director of clinical services at the University of Wisconsin’s Center for Tobacco Research and Intervention, in Madison. After about a year, he said, only 5 percent remain off tobacco. “It’s a testament to how powerful that dependency is.”

Jorenby argues that products with nicotine do help as a step to successfully quitting. By changing the way nicotine is taken in, the habit of smoking a cigarette is disrupted. And with nicotine replacement, drugs like buproprion and varenicline and the addition of counseling, the severity of withdrawal is reduced.

While nicotine replacement therapy can be an effective way to drop the habit in the short term, it lacks long-term potency, Jorenby said. “A lot of people only use the medicine for a short period of time,” said. They think they have kicked the habit, and soon enough find themselves smoking again.

So far, tobacco cessation aids have only been marginally effective in helping smokers kick the habit, experts said. Nicotine replacement in the form of gums, patches and sprays, used with a prescription anti-depressant, have increased quitting success about twofold over those subjects given a placebo. But the overall quit rate remains low. The National Cancer Institute found that in 2006, only 8.6 percent of smokers 25 and older successfully quit for three months or more.

While alternative methods of quitting, from hypnotism to acupuncture, do help some quit, scientists are developing new medicinal ways to increase successful quit rates.

Pfizer’s Chantix approaches nicotine addiction in a different way than nicotine replacement. As a “partial agonist,” it produces a milder version of nicotine’s effects, but also blocks nicotine from attaching to the receptor.

“We really haven’t had something offering the combination of the agonist--withdrawal relief--with antagonist--blocking reward effects,” said Jorenby. “That seems to be rather unique.”

Spitzer has a problem with the drug, however. Chantix, he said, allows for slip-ups once in a while. That’s like telling a junky or alcoholic it’s OK to have just one more hit, he said. Spitzer’s message is simple: Don’t slip.

The federal Food and Drug Administration also raised alarms about Chantix when it released an advisory earlier this month saying it was “increasingly likely” that the drug was linked to 39 suicides and 491 reports of suicidal thoughts from users worldwide. Experts said 39 cases out of the nearly 5 million patients Pfizer says have taken Chantix is not enough to remove it from the market. Instead, the FDA asked Pfizer to include a label warning on the product, advising physicians and consumers of potential problems.

Some researchers are looking in completely different directions for solutions, said Wisconsin’s Jorenby. Three nicotine vaccines are in development, though all are several years away from being evaluated by the FDA. A vaccine “would be a paradigm shift for the field,” said Jorenby.

While some evidence suggests those who quit without the use of aids have greater success in staying smoke-free, experts said, for most, it’s far easier said than done. The American Cancer Society’s Quitline, based in Austin, Texas, tries to help smokers quit using whatever means available. “Our goal is to educate the caller on all of the options,” said Dawn Wiatrek, Quitline’s national director. “If you can rid nicotine from your life, you’re better off.”

That’s all Gordon wanted to do.

“I don’t feel that cigarettes control my life anymore,” he said.

E-mail: cr2379@columbia.edu