The Smoking Gum Health: The battle to help people get off cigarettes gets a boost with over-the-counter nicotine gum. But it's still a tough fight.

April 16, 1996|By Patricia Meisol | Patricia Meisol,SUN STAFF

Powerful stuff, the public war against smoking. State after state is suing tobacco companies to recoup the medical bills of smokers. President Clinton regularly rants about cigarette advertising geared to children. And tomorrow, a nicotine gum available for the past decade only by prescription goes on sale over the counter. But what about the private war? How's it going?

Sharon Gilden is a veteran of that war. The war against the short white stick she knows is dirty, smelly and makes her feel tired and crummy. The war against the instrument that brings an instant high, a momentary relief from pressure, companionship when she is alone.

She tried the nicotine patch. Counseling. Carrot sticks. Hard candy. Will she go for Nicorette gum, which comes with its own mantra: Chew Chew Park?

The 40-year-old secretary at Black & Decker Corp. has tried to quit seven times. The most recent effort was a couple of weeks ago.

"I am very successful in cutting down," says Ms. Gilden. "But I've not gotten to a point where I've totally knocked them out completely."

She is just the candidate SmithKline Beecham Consumer Healthcare hoped to reach when it sought permission from the Food and Drug Administration to sell its nicotine replacement gum in retail outlets. A switch from prescription to over-the-counter can double sales, even before the endorsement from a prominent health group, in this case the American Lung Association.

"It is easy to quit smoking when there's no pressure," says Ms. Gilden, who smokes a pack a day. But as a single parent with a full-time job, two teen-agers and a house, that's almost never. "It's always something," she says "and sometimes I smoke just to take a few minutes for myself."

Habits are strong.

"I have people who tell me their cars won't start unless they light up a cigarette," says Debra Southerland, a smoking and health consultant in Columbia who runs support groups for corporations and the American Lung Association.

The one word she never uses is what she calls the F word -- failure. (She quotes Mark Twain, who said, "Quitting smoking is easy. I've done it 1,000 times.") In fact, Ms. Southerland says she'd rather work with a person who has tried to quit three or four times because they are well on their way to getting there.

An introductory two-week supply of Nicorette complete with video instructions is expected to sell for $45 to $55. Subsequent supplies would cost $25 to $30.

Later this month, the FDA will also consider whether to allow over-the-counter sales of SmithKline's nicotine patch.

Should smokers run out and buy the gum? How does it compare with other methods of quitting? Which method is best?

Different methods work for different people for unexplained reasons. But most methods that cost money don't work for most people: hypnosis (unproven); acupuncture, (no); support groups (not statistically significant); electric shock (unproven and potentially hazardous); tranquilizers (effective for a few weeks at most). Those are the conclusions of an October analysis in the journal Archives of Internal Medicine.

The cheapest way to get people to stop smoking is to have doctors speak out against it. About 2 percent of people quit after a chat with their doctors. The finding is one reason a group of prominent researchers at the American Medical Association's annual conference next week on tobacco is expected to call on doctors to routinely advise patients against smoking. In other words, pound it into their heads at every turn.

Of all methods in the study -- which didn't include cold turkey -- the most effective is nicotine replacement therapy in the form of gum, patch or nasal spray, and it should be offered to anyone intent on quitting, the study found. Overall, nicotine replacement therapy is about 20 percent effective, according to the British medical journal That means one person in four or five people who try nicotine gum or the nicotine patch quit smoking.

For that one person, though, it is a life saver. Nicotine gum DTC increases the quit rate by 50 percent when accompanied by some form of counseling, says Joseph A. Adams, a Towson internist who sits on the board of the Smoke Free Maryland Coalition. He encourages his patients to use gum or the patch.

The highly addicted

"It is especially helpful for smokers who are highly addicted," Dr. Adams says. "It prevents physical withdrawal symptoms, so people are less likely to be irritable and have difficulty concentrating." Highly addicted smokers are those who go through two or three packs a day and take their first puff within 30 minutes of getting out of bed. Ms. Southerland says she has worked with people who smoked one pack a day and needed the patch. "It comes down to not wanting to suffer," she says.

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