Monthly Archives: September 2007

Early Test for Lung Cancer Developed

By Daniel J. DeNoon, WebMD Medical News
Reviewed by Louise Chang, MD

Sept. 18, 2007 — A new blood test promises to detect lung cancer at its earliest, most curable stages.

The test is under development by Panacea Pharmaceuticals, Gaithersburg, Md. It detects a recently discovered protein called HAAH. People with at least 20 different kinds of cancer — including lung cancer — have much higher than normal HAAH levels in their blood.

The test does not prove that a person has cancer. But it does identify people who need additional, more definitive tests, says Panacea research scientist Mark Semenuk.

“The important thing is that we can pick up even stage I lung cancer,” Semenuk tells WebMD. “To diagnose lung cancer really early provides the opportunity for curative treatment. Unfortunately, lung cancer does not cause symptoms until fairly late in the disease process.”

Semenuk presented studies of the new lung cancer test to this week’s American Association for Cancer Research second international conference on Molecular Diagnostics in Cancer Therapeutic Development, held Sept. 17-20 in Atlanta.

In their first study, Semenuk and colleagues obtained 160 blood samples from 160 patients at all four stages of lung cancer and from 93 people who did not have lung cancer.

The HAAH test was positive in 99% of the lung cancer samples but was nearly undetectable in people without cancer. This study allowed the researchers to set an HAAH cutoff level — 3 ng/mL (nanograms/milliliter) — that maximizes the number of cancers detected while minimizing the number of false-positive test results.

In a second study, the researchers tested how well the HAAH test could tell people with various stages of lung cancer from smokers without lung cancer. Previous blood tests for lung cancer have been unable to differentiate smokers — who are at very high risk of lung cancer — from patients with early-stage lung cancer.

The result: Average HAAH levels were about the same for patients at all four stages of lung cancer, ranging from 16 ng/mL to 22 ng/mL. Average HAAH levels for smokers not known to have cancer were zero. However, about 10% of the smokers tested positive for elevated HAAH levels.

“These results are very encouraging, because they point to those patients who are most likely to need further testing,” Semenuk says. “Elevated levels of HAAH cannot confirm whether a person has lung cancer, but can be used as a routine screening test for recommending further diagnostic evaluation. That is the way most cancer biomarker tests … are meant to work, and this may be one of the most effective to date.”

Panacea already offers the three versions of the HAAH test: LC Detect for lung cancer, PC Detect for prostate cancer, and TK Sense to test whether patients with chronic myelogenous leukemia respond to the drug Gleevec. Doctors can send specially prepared blood samples to the Panacea laboratory for testing. The cost of the lung cancer and prostate cancer tests is $125. The TK Sense test costs $500.

Semenuk says that the company is working on possible cancer treatments based on HAAH.

http://www.webmd.com

Smoking women get more acne!

Women who smoke have been found to be four times more likely to get acne than their non-smoking counterparts. In a study conducted on 1000 women between the ages of 25 and 50, 42% of smokers were found to have acne compared with only 10% of the non-smokers in the group.

This ‘smokers’ acne’ is characterised by blocked pores and large blackheads but less inflamed spots than normal acne.

Smokers who had suffered from acne in their teens were found to be 4 times more likely to suffer from this smoker’s acne.

Dr Bruno Capitanio, one of the study’s authors, said:

“Our study demonstrates that NIA affects a high percentage of women, and is especially high among smokers. Recognizing this form of acne is fundamental to providing correct information about the effects of tobacco on the skin.

Dr Colin Holden, President of the British Association of Dermatologists, said:

Dermatologists have long associated smoking with premature ageing of the skin, wrinkles and a leathery complexion.

However, scientists are now increasingly linking the habit with acne. For people who suffered acne as teenagers, the probability of also suffering acne in adulthood is four times higher in smokers than non-smokers. This suggests that smoking could be a major contributing factor for adult acne if you are already predisposed to the disorder.

This study also shows an interesting link between a specific type of acne and smoking. All of these findings will hopefully provide people with an extra incentive to quit.

About 70 per cent of smokers say that they want to stop smoking, but most believe they are unable to. However, around half of all smokers eventually manage to give up.

Smoking ban at home could come in future

by Rhodri Clark, Western Mail

PARENTS could be banned from smoking in their homes to protect their children’s health, following the success of the smoking ban in public places, legal experts have claimed.

But such a ban may not happen for many years, because society is not yet ready for such a draconian step, they admit.

One legal option would rest on the human rights of children, whose health is damaged more by passive smoking than adults’.

However, human rights rulings usually balance the rights of two sets of people, and one legal expert said judges would currently come down in favour of an adult’s right to smoke in their home rather than the child’s right to breathe clean air.

The ban on smoking in public places across Britain appears to have improved health already.

On Monday it emerged that heart-attack admissions to Scottish hospitals had dropped 17% in the first year of Scotland’s smoking ban.

Researchers also said a national evaluation found a 39% reduction in secondhand smoke exposure in 11-year-olds and in adult non-smokers.

There was no evidence yet of smoking shifting from public places into homes.

But the British Medical Association says five million children in the UK are exposed to secondhand smoke in their homes. Those children are at higher risk of:

Cot death;

Asthma attacks;

Respiratory symptoms;

Impaired breathing, as children and adults;

Middle-ear disease, which can be fatal.

They may also be at greater risk than other children of becoming asthmatic in the first place and of developing childhood cancer.

Scottish research shows that even education is impaired, since children who live with smokers are 44% to 77% more likely to miss school than other children.

Prof Nigel Lowe, deputy head of Cardiff Law School, said smoking in homes could be addressed through smaller steps, such as smoke-free homes being a condition of fostering and adoption.

“The big leap will have to wait until the little leaps have been made,” said Prof Lowe, an expert in child law.

“Who would have predicted 20 or 30 years ago that we couldn’t smoke on trains or planes or in public places?

“The next logical step would be to protect the children, but I think we’re quite a long way from that.

“I could see that it could happen. No current judge, I would predict, in England or Wales would be prepared to make that huge jump yet. But I wouldn’t rule it out forever.

“The thing about human rights which always gets us into problem areas is that you’ve always got to balance it against other people’s rights.”

While some might argue that a child’s rights were infringed by smoking in the home, others would argue that adults have the right to respect for their private family lives. The ban on smoking in public places was premised on workers’ rights to a smoke-free workplace. Workers can choose their workplace, while children do not choose their parents or homes.

But Prof Lowe said, “There’s a material difference between what you do in your own house and what you do outside.”

Wendy Hopkins, a specialist family lawyer in South Wales, said it was premature for family law to proscribe smoking in the home.

“Those are areas in which family law could go. There’s no doubt that children living in a household where there’s a heavy smoker are much more at risk.”

If one parent smoked, the family courts might take that into account when deciding on who had custody of children, she added.

Dr Tony Calland, who chairs the BMA’s Welsh council, said the arguments against smoking in children’s homes were as strong as those against smoking in workplaces, but he did not believe further legislation should be passed.

“It’s the principle that’s the important thing – that you shouldn’t poison anyone, including your own children.

“What will happen in time, and I think is already happening, is that smoking is becoming socially unacceptable.

“That will become the driver. It’s a social evolution process, rather than being told by the Government or police or BMA that you mustn’t smoke.”

Chantix – an 8 in 10 failure rate or worse?

by John R. Polito

Saturday, December 16, 2006

Ten links at Pfizer’s “My Time to Quit” website (www.mytimetoquit.com) transport visitors to
its Chantix website. If it truly is time for them to quit, it’s unlikely that Chantix is the answer.

Pfizer markets varenicline as Chantix in the U.S. and Champix in Europe. On September 29, 2006 its press release boasted that “after one year, approximately one-in-five patients who received the 12-week course of varenicline remained smoke-free.”

What we do not know is whether Chantix’s modest 1 in 5 success rate is attributable to the effects of Chantix, to the 16 clinical counseling sessions participants received, to the use of nicotine replacement therapy (NRT) following 12 weeks of Chantix use, or to the fact that more than 1,000 hard to treat smokers who would likely have generated substantially higher failure rates were denied participation. What we do know is that Pfizer’s clinical Chantix studies were not blind as claimed.

Understandably, Pfizer wants to assign full credit for the results from its five varenicline studies to Chantix. Understandably, it wants smokers to believe that, as in its clinical studies, 1 in 5 who purchase Chantix will succeed. But if cessation pharmacology study history teaches any lesson it is that clinical studies are engineered for victory. Unless real-world users can find a way to duplicate study engineering they should expect to experience dramatically lower success rates.

Pfizer’s five clinical trials of varenicline were published in July and August 2006. Three are comparable in that they involved a 12-week treatment period using 1mg of varenicline twice daily. The study headed by Gonzales produced a 21.9% one year Chantix quit smoking rate, in Oncken the rate was 22.4% and in Jorenby 23% – an average of 22%.

But these rates were achieved under highly artificial clinic study conditions. Pfizer spared no expense in creating one of the most intense clinic quitting experiences in any smoking cessation study ever. Real-world quitters, alone with their Chantix pills, or even participating in Pfizer’s GetQuit support plan, will be fighting under entirely different battlefield conditions.

Varenicline study participants received a free 12-week supply of Chantix, were reimbursed travel expenses associated with visiting their health provider to obtain it, attended 16 clinic visits involving one-on-one sessions lasting up to 10 minutes, with counselors trained in motivation and coping skills development, and received 8 follow-up telephone support calls from their provider.

The Impact of Motivation, Counseling and Support

How much of Chantix’s 22% one-year quitting rate is due to Chantix and how much attributable to the 26 times in the Jorenby study that participants spent quality one-on-one time with their Chantix provider, either in person or over the telephone?

Evidence tables in the June 2000 U.S. Tobacco Cessation Guideline combine and average similar smoking cessation studies and provide estimated six-month abstinence rates for a host of quitting methods and conditions. For purposes of comparison, varenicline’s six-month rates were an identical 29.7% in both the Gonzales and Jorenby studies and involved up to 160 minutes of counseling time (10 minutes x 16 sessions) plus an additional 8 telephone calls of unknown duration.

Table 13 of the U.S. Guideline examines the impact of program contact time on cessation rates. It combines 16 different study arms and concludes that programs involving 91 to 300 minutes of total contact time should be expected to generate an average six-month quit smoking rate of 28.4%.

The only way smokers will ever know how much of varenicline’s 29.7% six-month rate should actually be credited to Chantix is for Pfizer to design and conduct studies which make varenicline stand on its own, without substantial contacts, counseling or ongoing support. Such studies were conducted when the nicotine patch and gum went from being prescription quitting aids to over-the-counter products.

A 2002 study by NRT pharmaceutical industry consultants combined and averaged the seven over-the-counter nicotine patch and gum studies and found that just 7% were still not smoking at six-months – a 93% six-month relapse rate. Although a well-kept industry secret, the one-year OTC NRT rate is likely a bit less than 5%. Yes, a 95% failure rate and near 100% failure for second time users.

Contrasting Early NRT Studies

Compare the over-the-counter patch and gum’s approximately 5% one-year rate with rates generated in early nicotine gum studies which, like Pfizer’s Chantix studies, were often loaded with education, counseling and support elements.

Varenicline’s 22% one-year rate is actually lower than the 1976 nicotine gum study headed by Russell in which 23% were still not smoking at one year. It also fails to measure up to the 1980 Raw study which produced a whopping 38% one-year rate, to the 1982 Jarvis study’s 31%, the 1983 Schneider study with 30%, the 1984 Hialmarson study at 29%, the 1986 Daughton study at 31%, the 1987 Kornitzer study at 32%, or the 1989 Tonnesen study which boasted a 44% one-year quit smoking rate.

Diverse Study Site Evidence

Online FDA varenicline documents raise serious concerns that factors other than Chantix or Chantix impacted performance. The Medical Review shows striking contrasts at a number of study sites in four week continuous quitting rates (CQR) during the final weeks of varenicline treatment, weeks 9 to 12.

At the University of Massachusetts Medical School, 46% of the 22 member placebo group were still not smoking at 12 weeks compared to 50% for the 22 member varenicline group. Hardly an impressive victory. New York’s Medical and Behavioral Health Research witnessed 35% of the 17 member placebo group still smoke-free at 12 weeks compared to only 6% of the 16 member varenicline group.

Did counseling sessions at these study sites place greater emphasis on front-end quitting tips such as the importance of stabilizing blood sugar, overcoming time distortion, handling alcohol, understanding elevated blood serum caffeine levels, and recognizing emotional loss? Would doing so have allowed a far greater percentage of placebo group members to successfully navigate the up to three days needed to rid their body of all nicotine and endure the worst of withdrawal?

Did sites generating dismal placebo group rates fail to counsel participants on the fact the reason they could skip meals while still smoking and not experience wild blood sugar swings is because nicotine was their spoon, with each puff pumping stored fats and sugars into their bloodstream?

Were placebo group counseling concerns totally ignored at Tulane University where 0% of 8 placebo group members were still not smoking at 12 weeks, in San Francisco where 0% of 10 survived, in central Kentucky with 0% of 12, and at the University of Mississippi with 0% of 9? What possible explanation is there for the tremendous diversity in 12-week quitting rates among Chantix users? In Brooklyn only 18% of 12 varenicline users were still smoke-free at 12 weeks, at New York’s Central Park just 6% of 16 remained quit, and in Jackson, Mississippi only 14% of 15 were still healing.

On the flip side, Chantix users did amazingly well at the University of Nebraska where 67% of 18 users were still free at 12 weeks, at Newport Beach, California where 64% of 28 remained quit, at Palo Alto with 69% of 13, and the Mayo Clinic with an amazing 81% of 21 users were still standing.

Did counselors at some sites strongly encourage Chantix users to endure and persevere through medication side effects while counselors at other sites were not as persistent? Adverse events among the 692 varenicline users in the two identical studies (Jorenby and Gonzales) included 199 participants reporting nausea, 51 reporting flatulence, 50 with constipation, 81 reporting abnormal dreams, and 36 reporting sleep disorders. Did symptoms contribute to researcher awareness of participant group assignment and failure of the study’s blind?

Were counselors at some clinical sites – such as the Mayo Clinic – better trained than others? Were their backgrounds primarily in pharmacology cessation counseling or in behavioral cessation counseling? How will Pfizer’s boast of a 1 in 5 Chantix one-year success rate be affected by the fact that almost all real-world quitters will use it without the benefit of sixteen one-on-one counseling sessions?

Nicotine Replacement Therapy Use During Chantix Studies

The brain’s dopamine pathways not only produce a neurochemical “aaahhh” reward sensation surrounding species survival events such as eating, drinking, reproduction and accomplishment but also generate powerful and salient reinforcing memories that ensure we return for more.

But by happenstance the nicotine molecule fits the brain’s nicotinic type acetylcholine receptors responsible for generating dopamine. Chronic nicotine use causes the brain to fight back and attempt to diminish nicotine’s impact by growing or activating millions of extra acetylcholine receptors in at least eleven different brain regions – a process known as up-regulation.

The larger receptor playing field creates a tolerance cycle of escalation in which the smoker often must gradually use more nicotine in order to overcome additional brain up-regulation and de-sensitization. Any attempt to quit using nicotine will briefly leave the dependent user de-sensitized during the brief period of time needed for the brain to down-regulate and restore natural receptor counts.

The theory behind NRT was that it allowed dopamine flow to continue while buying the smoker time to extinguish psychological nicotine feeding cues and conditioning. Its downfall has been that, outside of extremely supportive clinical studies, few quitters have the self-discipline and motivational stamina needed to engage in a lengthy period of gradual stepped-down withdrawal on their own.

Dismal real-world NRT success rates have resulted in the industry actually blaming quitters for not using it properly. But proper use often results in the quitter getting hooked on the cure. In 2004 GlaxoSmithKline consultants noted that nearly 40% of nicotine gum users are dependent upon it, or, as the consultants like to put it, they’ve become “persistent users.”

A May 2005 study found that varenicline causes alpha4 beta2 type acetylcholine receptors to produce 30 – 60% of the dopamine flow that nicotine would produce if sitting on the same receptor site. Not only does this raise ongoing nicotine-type dependency concerns, which Pfizer asserts only impact about 3% of users, but concerns over permitting NRT use during varenicline studies once the 12-week treatment period was complete.

Although Pfizer’s studies acknowledge keeping records of nicotine use during the 40-week post-treatment monitoring period, that data has not yet been made part of the public record at the FDA. As stated in the Oncken study, “During the follow-up period, use of nicotine replacement therapy did not disqualify subjects from being considered abstinent.”

The obvious question becomes, what percentage of the 1 in 5 of Chantix users reported as have successfully quit for one year were still chemically dependent upon nicotine? In that almost all varenicline users will purchase Chantix with the goal and dream of breaking nicotine’s grip upon their mind and life, do they have a right to know the actual percentage that Pfizer counted as success stories, who were in reality still solidly hooked?

Excluded Smokers

Chantix’s real-world performance rates are likely to be further eroded by the fact that a substantial percentage of difficult to treat smokers applied to participate in each study but were denied. In Gonzales 1,843 smokers were screened and 458 were excluded (25%), in Oncken 980 were screened and 333 excluded (34%), and in Jorenby 1,413 were screened and 386 excluded (27%).

Excluded from participation were those suffering from cardiovascular disease, alcohol abuse, major depression, panic disorder, systolic blood pressure greater than 150 or diastolic pressure greater than 95, a history of cancer, a body mass index (calculated as weight in kilograms divided by height in meters squared) of less than 15 or higher than 38; weight less than 45kg, those with a “clinically significant medical disease,” those over age 75 or younger than age 18, those smoking fewer than 10 cigarettes per day, and those known to have recently relapsed during NRT or Zyban/Wellbutrin quitting attempts.

Most within these groups reflect populations that have historically been extremely challenging to assist in quitting, including youth who often smoke fewer than ten per day. Real-world conditions will not bar them from using varenicline.

Their use of Chantix has not yet been studied and we have no idea how their status and conditions will impact outcome. What we do know is that their exclusion from Pfizer’s studies has likely resulted in a significant overstatement of varenicline’s true one-year effectiveness.

FDA Must Demand Solid Science

Will the U.S. Food and Drug Administration (FDA) continue to allow pharmaceutical companies to design and conduct chemical studies guaranteed to produce clinical efficacy but which result in approval of products that in real-world use perform no better than quitting without them?

The FDA knew or should have known that both NRT and varenicline studies were not blind as claimed, and that resulting odds ratio victories have little or no foundation in science. Instead of exposing known blinding failures they remain quiet and allow horribly flawed science to be used to exploit the dreams of smokers dying to break free.

Nicotine is a psychoactive chemical producing a powerful dopamine/adrenaline high. Those addicted to it are dependent upon prolonged dopamine aaahhh” reward sensations accompanied by central nervous system stimulation. It gets the heart pounding faster, their senses perked, their fingers and toes growing cold, and energizes the addict as nicotine causes the release of stored fats and sugars into the bloodstream.

Smokers who have attempted quitting know what their withdrawal syndrome feels like – a rising tide of anxiety which breeds irritability, impatience, anger and depression. They joined NRT and varenicline clinical studies after being promised the “chance” of receiving free medicine, which they hoped would diminish their withdrawal syndrome.

Pfizer’s studies indicate that eighty to ninety percent of varenicline study participants had attempted quitting at least once previously and failed. In both NRT and varenicline studies, the expectations of withdrawal syndrome reduction were frustrated by assignment to the placebo group, or fulfilled by assignment to the active group, with the arrival of nicotine or varenicline in the brain.

A June 2004 study by Mooney reviewed 73 allegedly double-blind NRT studies and declared that the limited number of studies assessing blindness were not generally blind as claimed in that “subjects accurately judged treatment assignment at a rate significantly above chance.”

Mooney warned researchers that, “to determine the prevalence of failure, clinical trials of NRT should uniformly test the integrity of study blinds. Moreover, if blindness failure is observed, subsequent efforts should be made to determine if blindness failure is related to study outcome and, if so, to provide an estimate of treatment outcome adjusted for blindness bias. Without these methods and analyses, the validity of NRT clinical trial results could be questioned.”

Were blinding studies conducted in association with any of Pfizer’s five varenicline studies? If so, the results have not yet been made public. Using Mooney’s warning, smokers have legitimate reason to question the core validity and integrity of Pfizer’s five studies.

The blinding analysis in a 2005 study by Dar found that 3.3 times as many placebo group members correctly guessed that they had received placebo (54.5%) as guess nicotine (16.4%). Although the Dar study focused on smoking reduction, Tonnesen’s 1993 nicotine inhaler quitting study produced strikingly similar placebo group findings with 3.8 times as many in the placebo group correctly guessed placebo (58%) as guessed nicotine (15%). Among inhaler users, Tonnesen found that 3.5 times as many correctly guessed inhaler (46%) as guessed placebo (13%), while 42% on active and 27% on placebo did not know which treatment they had received.

The FDA knew that placebo group expectations and frustrations in NRT studies are identical to those experienced in varenicline studies. They sought some degree of reduction in their withdrawal syndrome and none occurred. It was no secret to Pfizer that roughly 80% of the placebo group would relapse within two weeks, handing the active group victory by default.

Smokers join clinical studies in hopes of receiving promised medications that result in withdrawal symptom reduction. Their expectations differ from the 80 to 90% of annual quitters who attempt quitting cold turkey, who fully expect to sense and navigate withdrawal.

It is an important distinction because government authorities continue to turn their heads while Pfizer proclaims to smokers that its nicotine replacement products competed against and defeated cold turkey quitters. Those wanting to quit cold turkey were never invited to clinical NRT studies. The representation is false and extremely deceptive.

Although it may be impossible to randomize alternative expectations of fully enduring or dramatically diminishing physical nicotine withdrawal, the pharmaceutical industry can and should recruit and fully serve both expectations from the same general population when conducting clinical studies. Subgroups with similar traits could then be compared and odds-ratio victories would at last have some validity. If education or counseling is to be included we must accept the variance that its intensity, duration, focus and content should be tailored to each group’s differing cessation needs.

But pharmaceutical industry financed studies will likely never pit “real” cold turkey quitters against those wanting to sense a diminished withdawal syndrome as the expected results would likely destroy more than one golden goose.

WhyQuit looks forward to the day when it can at last report that a new quitting product truly is effective in real-world use. On that day we will become the product’s most vocal advocate. All preliminary evidence to date suggests that Chantix isn’t it.

XXX

No Copyright – This Article is Public Domain

John R. Polito is solely responsible for the content of this article.
Any factual error will be immediately corrected upon receipt of credible authority

NHS Should not treat smokers according to Tories

Failing to follow a healthy lifestyle could lead to free NHS treatment being denied under the Tory plans.

Patients would be handed “NHS Health Miles Cards” allowing them to earn reward points for losing weight, giving up smoking, receiving immunisations or attending regular health screenings.

Like a supermarket loyalty card, the points could be redeemed as discounts on gym membership and fresh fruit and vegetables, or even give priority for other public services – such as jumping the queue for council housing.

But heavy smokers, the obese and binge drinkers who were a drain on the NHS could be denied some routine treatments such as hip replacements until they cleaned up their act.

Those who abused the system – by calling an ambulance when a trip to the GP would be sufficient, or telephoning out of hours with needless queries – could also be penalised.

The report calls for a greater emphasis on the “citizen’s responsibility” to be healthy and says no one should expect taxpayers to fund their unhealthy lifestyles.

Yet while the Health Miles Card would award points for giving up smoking and losing weight, it could penalise those who are already fit and well because they would receive no benefits under the scheme.

Also, the NHS already demands that obese patients lose weight before receiving hip replacements.

And any moves to impose compulsory cards on patients would provoke a backlash from civil liberties groups.

The Dorrell report also calls for a consultation on raising the smoking age to 18 and for shops to be stripped of their licences if they sell tobacco and alcohol to minors.

It proposes a fully-trained nurse to be made available to every school to offer advice on sexual health – but Tory officials stressed they would not be offering children contraceptives.

Ministers should divert more attention and funding to public health epidemics which are costing the NHS billions a year, the report says.

Smokeless Tobacco Not a Safe Alternative for Cigarettes

By Charles H. Weaver, MD
August 27, 2007

According to the results of a study published in Cancer Epidemiology Biomarkers & Prevention, urine levels of a potent carcinogen found in tobacco appear to be at least as high in users of smokeless tobacco as in cigarette smokers.

Smokeless tobacco refers to chewing tobacco and snuff. Both these types of smokeless tobacco contain cancer-causing agents, and users of smokeless tobacco have an increased risk of oral cancer. Oral cancer includes cancers of the lip, tongue, cheeks, gums, and the floor and roof of the mouth.

Because smokeless tobacco does not involve exposure to the harmful components of tobacco smoke, some have suggested that it may be less harmful than cigarettes.

To evaluate this claim, researchers assessed levels of a strong carcinogen (cancer-causing agent)—known as NNK—in 420 cigarette smokers and 182 users of smokeless tobacco. All study participants were seeking treatment for tobacco dependence.

NNK exposure was assessed by measuring NNK metabolites (total NNAL) in urine. The researchers also assessed levels of cotinine—a marker of nicotine exposure.

Urine NNAL and cotinine levels were higher in users of smokeless tobacco than in cigarette smokers.

While the processing of NNK by the body may differ between users of smokeless tobacco and cigarette smokers, the researchers state that these results “indicate that exposure to NNK is at least comparable in smokeless tobacco users and smokers.”

The researchers conclude: “These findings do not support the use of smokeless tobacco as a safe substitute for smoking.”

Reference: Hecht SS, Carmella SG, Murphy SE et al. Similar exposure to a tobacco-specific carcinogen in smokeless tobacco users and cigarette smokers. Cancer Epidemiology Biomarkers & Prevention. 2007;16:1567-72.

Fire at car-storage facility linked to teenagers’ cigar

SIDNEY — Teenagers who carelessly smoked a cigar sparked a fire that leveled a century-old building Friday night, officials said, destroying an inventory of classic-car parts and dealing a business its second major blow in 14 months.

But firefighters were able to save nine automobiles and a number of mechanics’ tools from the parts and service center of Whitaker & Sons Inc. Buick Chevrolet, said James Olmstead, Delaware County’s deputy fire coordinator. “Some of them were driven out, and some of them were pushed out, but all the cars on the ground floor were saved,” Olmstead said.

They were not, however, able to save the four-story business, a former silk mill a local family has owned for generations. Nor were they able to save 1920s- and ’30s-era car parts stored on upper floors, he said. Two boys discarded a cigar in a cardboard box in an enclosed ramp to the business Friday, triggering a blaze that burned for 35 to 40 minutes before it was reported at 5:58 p.m., Olmstead said.

No injuries were reported.

Chemicals used in the auto-repair business fueled the flames, which shot from windows into the evening. Demolition of the building took about four hours after the fire was extinguished; firefighters were on the scene until 6:30 a.m. Saturday.

The boys, a 14-year-old and a 15-year-old whose names were not released, face charges of reckless endangerment and criminal mischief. They admitted smoking near the business before the blaze, Olmstead said.

The business was heavily damaged in the June 2006 floods, he said, meaning many tools inside the business Friday had replaced those lost a year earlier.

Scottish smoking ban has improved public health.

There has been a significant improvement in public health according to the most recent research carried out in Scotland.

Comparisons of heart attack rates at nine hospitals showed a 17% drop in the number of heart attack victims since March 2006 when the smoking in public places ban was implemented.

The research also suggest that the air quality found in pubs is now as good as that outside.

The report also states there has been a reduction of 40% in the number of adults exposed to second-hand tobacco smoke (also known as environmental tobacco smoke)

The main findings of the study were;

  • The ban has reduced second hand smoke exposure in both children and adult.
  • Among primary school children, levels of a by-product of nicotine fell by more than a third (39%) following the ban.
  • In adults, cotinine (a metabolite of nicotine) levels fell by almost half (49%) in non-smokers from non-smoking households.
  • Non-smokers living in smoking households continued to have high levels of second hand smoke exposure in the home.
  • And the authors suggest that further action is urgently required to support smoking households to implement smoke-free homes and cars.

The scientific research is based on routine health data, as well as research projects undertaken by government scientists and Scottish universities into the effects of the smoking ban.

The Scottish deputy chief medical officer, Professor Peter Donnelly, said the results were proof that the ban had produced major health gains.

Professor Jill Pell, who headed the research team which made the findings, said:

“The primary aim of smoking bans is to protect non-smokers from the effects of passive smoking.

But Scottish publicans claim that many of the benefits could have been achieved without a ban and complain that bar sales have declined because of it.

Jill Pell said

“Previous studies have not been able to confirm whether or not that has been achieved. What we were able to show is that among people who are non-smokers there was a 20% reduction in heart attack admissions. This [research] confirms that the legislation has been effective in helping non-smokers.”

After the Scotland banned smoking in enclosed public spaces, Wales and Northern Ireland followed suit in April 2007 and England did the same in July 2007.

Is this 1984?

Smoking has become such a hated pass time that in the UK, hospital managers are telling patients off for smoking in hospital grounds – which strictly speaking isn’t illegal. Here is an article I found from the Observer…

Nick Cohen, Sunday August 19, 2007
The Observer

Last week, a young NHS psychiatrist, who blogs under the pseudonym Shiny Happy Person, described how she ‘was just taking five minutes out, enjoying the sunshine in the surprisingly pleasant grounds of my new hospital, when the flowerbed spoke to me’.

She went on to reassure her readers: ‘No, I’m not neuroleptic-deficient. Other people heard it too. One moment, all was quiet and the next a disembodied voice was bellowing from somewhere in the vicinity of the begonias. Strictly speaking, it wasn’t actually addressing me and I know this because it said, “This is a no-smoking area. Please put your cigarette out. A member of staff has been informed.” I gave up smoking six weeks ago. But, really, how Orwellian is that?


‘The smokers looked understandably alarmed, glanced furtively around and then scarpered. I can’t help questioning the wisdom of installing a talking flowerbed to tell people off in the grounds of a psychiatric hospital, of all places.’One of the many difficulties in reporting on the NHS is that doctors cannot speak freely about the idiocies of their managers. Threats of dismissal mean I can’t identify the junior psychiatrist or say where she works. But it is on the record that hospitals have banned smoking and some, such as the University Hospitals Coventry and Warwickshire Trust, have put smoke alarms outdoors to catch patients who nip outside for a quick fag.

The makers of a new generation of alarms say their trade doesn’t stop with the NHS. They are doing good business with local authorities, drug rehabilitation centres and government departments. Their Cig-Arrete (geddit?) detector provides ‘a visual and audible re-enforcement of your commitment to creating a smoke-free environment’.

Sensors pick up the whiff of illicit smoke and a voice cries: ‘This is a no- smoking area. Please extinguish your cigarette. A member of staff has been contacted.’ Which sounds very like what Shiny Happy Person said she heard.

You might think there’s nothing wrong with alarms blaring out threats when smoking is the biggest cause of preventable death. But then it’s not illegal to smoke in hospital grounds or any other open space. NHS managers are going way beyond the law and not thinking about the likely effects on the mentally ill of having flowerbeds shout at them when they do it.

Their hectoring is hardly novel. Last week, we had example after example of British bureaucrats, grown fat on extra powers and extra funds, using an ever-more audacious authoritarianism to hide their manifold shortcomings.

As psychiatric patients were fleeing from talking begonias, the Metropolitan Police threatened to use anti-terrorist legislation against climate-change protesters at Heathrow, even though the demonstrators were not, in fact, terrorists. A few days earlier, the West Midlands Police and Crown Prosecution Service had referred Channel 4 to the media regulator, Ofcom, for exposing Islamists who preached hatred of unbelievers and called for homosexuals ‘to be thrown off mountains’.

As Joanne Cash, a distinguished libel lawyer, said at a meeting in defence of the programme makers, the police and CPS have ‘no power and no jurisdiction’ to censor investigative journalism. ‘They have overstepped their powers into the realm of freedom of expression.’

Meanwhile, the Chief Constable of Cheshire, Peter Fahy, gave the clearest sign yet that drinking was replacing smoking as the vice the 21st century can’t tolerate. He responded to the arrest of four teenagers for the alleged murder of Garry Newlove by calling for the legal age for drinking alcohol to be raised to 21. Three of the accused are under 18 and were, allegedly, drinking before the killing.

But the accusation that they had broken an existing law his officers failed to enforce did not deter Mr Fahy from demanding a new law and, indeed, the overturning of the basic principle of English law. ‘At the moment, you can drink anywhere you like unless the local authority has designated that you can’t drink in that area,’ he continued. ‘I would like to see the emphasis changed and that we say drinking in public is not permitted apart from in those areas where a local authority says, “Yes, in this particular park, this particular location, people can drink.”‘

It is alarming to realise that a chief constable charged with upholding the law has no respect for the 800-year-old common law principle that any act which isn’t specifically illegal is legal. He and others want to turn it on its head so that all acts are illegal except those the authorities specifically say are legal.

The alternative would have been to promise to break up gangs and remove the licences of pubs and shops that sold to underage drinkers. But that would require hard police work and the sending of more criminals into an overcrowded prison system that doesn’t want more prisoners.

The seduction of authoritarianism is that it is easier, much easier, to install screaming smoke detectors than persuade patients to stop smoking; to shoot the messengers rather than investigate totalitarian religion; to stop law-abiding people from drinking or protesting rather than take action against teenage gangs or real terrorists.

I suspect the overbearing streak in government is going to get worse. As Labour’s public spending increases slow down, the incentive to lash out will grow among institutions such as the NHS and the police which need to conceal how much public money they have wasted.

More insidious is the notion that people can be forced to be good. If you are a puritan, you can believe we would be a happier society if cigarettes and alcohol had never been invented. If you can close your eyes and sink into the daydreams that there is no need to protest about climate change or that sexist, racist and homophobic preachers are the invention of the media, you will be happier still.

Any assault on freedom becomes justifiable if it will help lead us to a clean-living, conflict-free, multicultural Utopia. The shrieking from the flowerbeds is only going to get louder.