By Suzanne Danforth
May 29, 2008 6:00 AM
It's been a big week for Chantix, reader. The kind that makes we want to jump on and shape the story, but since one source of my income flows from on demand writing (it's not pretty, but it pays) and the other doesn't come from a benevolent editorial source with health benefits, I have to make do with making the case once, here, on one Thursday morning of many.
Early last week I received a Chantix e-mail. The same day the FAA banned the drug for pilots and air traffic controllers. Each story was triggered by a report of the ISMP, the Institute for Safe Medical Practices, a non-profit in Pennsylvania that stands alone in the country in its mission of safe medication use. The day after, the Wall Street Journal reported that an arm of the Department of Transportation, the Federal Motor Carrier Safety Administration advised medical practitioners not to qualify "anyone currently using this medication for commercial motor vehicle licenses."
The ISMP report demonstrated "a wide spectrum of injuries, including serious accidents and falls, potentially lethal cardiac rhythm disturbances, severe skin reactions, acute myocardial infarction, seizures, diabetes, psychosis, aggression and suicide."
The back story behind this week's move by leaders in the trucking and aviation industries to ban Chantix in their workers is threefold. In the most recent quarter alone, more serious adverse event reports were made regarding Chantix than any other drug on the market. Any drug at all, regardless of market share or numbers of prescriptions sold.
Those reports, which the FDA publishes to the public, were analyzed by the ISMP in a pilot program meant to track drug risks. Their data are strong, because of the high numbers of people taking Chantix (much higher than Pfizer's clinical trials that brought the drug to market), and the real-world circumstances. They are not without limitation, however, including that the numbers cannot point to causality as sufficient to answer all the safety questions.
Even so, the ISMP concluded their report by noting "concern about the use of varenicline (Chantix) by persons in settings where the risk of accident is high."
The third aspect of the story is that the legal community is on it. Kristian Rasmussen is an attorney working the legal angle of the more nefarious effects of the compound in question. From his Alabama practice, Rasmussen said last week that "It is clear that Chantix is dangerous and evidence suggests that Pfizer has known the risk for a long time."
Rasmussen is the co-author of several legal articles showing that the base compound in Chantix, cytosine, has been prescribed for years in Europe for tobacco cessation. As far back as 1972, there are cases linking cytosine to suicide, both attempted and successful.
Rasmussen called the magnitude of the evidence mounting against Chantix alarming and noted that Pfizer, as its manufacturer, has been attempting to "hide this information since the release of the drug on the open market in 2006."
Just how can one drug be responsible for so many systemic reactions, from suicidal impulses to heart attack to diabetes? Some of the theories being advanced are complicated, but sensible. Because of the nature of medical literature, these theories are coming well in advance of peer-reviewed journal articles.
In the meantime, we'll just have to use our common sense. Chantix works on certain receptors in the brain and nervous system that are responsible for pleasure. These are the little brainiacs that move you unconsciously toward a pack of cigarettes, and which release all kinds of warm fuzzy chemicals into your system when you do light up. These are not nicotine receptors, no such thing in the brain world, they are pleasure receptors. Chantix is an inhibitor; it blocks those receptors so you crave the pleasure of nicotine less, and if you do smoke it blocks the resulting warm fuzzy chemicals and sense of satisfaction. Nothing gets downstream to one of my favorite brain systems, the meso-limbic dopamine system. Forget all the fancy talk, just remember that pleasure, reinforcement and reward are the watch words.
As humans, we derive reinforcement and reward from countless acts ranging from organic to physiological to actual interactions out in the world. Chantix may be blocking a system that allows all kinds of pleasure and reward, whether it comes from kissing your kid or smelling a flower or smoking tobacco.
This makes the simple explanation seductive; why wouldn't the world turn gray and dispiriting? But how to account for aggression, psychosis, heart attacks, diabetes? This is more difficult, but perhaps we walk a delicate balance in our inner lives that exerts cascades of influence on a variety of bodily systems, all relating in some way back to pleasure, reward and reinforcement.
It might really be, after all, about pleasure in all its forms; sybaritic delight, Utilitarianism and Epicureanism.
What's your pleasure? Visit www.ismp.org/docs/vareniclinestudy.asp for the ISMP report. suzanne.danforth@gmail.com .
Quitting: Long Drives and Personal Trials
I have been faced with a novel challenge this week in my quest, journey, desire and intention to quit smoking. It is called "being in the car." I need to "be in the car" on a fairly regular basis right now because of work.
The good news is that it is real, live writing-type work. The bad news is that it is for writing-type pay and it takes me 27 miles to and from my house each morning and evening. It is during these miles that I am having trouble forgetting that I don't smoke on long drives anymore.
The fight starts quickly between the nail biting, pen-cap crunching, gum-chewing confident self and the knocked-off-center-at-the-improbability-of it-all self. One of these selves sometimes has cigarettes on her or stops to get some. Can you guess which one?
It is a small personal trial in the big scheme of things, but I was dismayed to realize that I haven't quite broken the car habit.
The patch is still my friend, it can be found in various places on my body, in case you are looking. But it seems to forget it has a job to do once I get in the car and am faced with the very long drive to or home from the courthouse.
For a smoker, to "be in the car" means to be in a solitary place in which to light up. This became such an ingrained habit that I used to light up between home and Pic 'n' Pay (a shamefully short distance to either drive or smoke).
Smoking and driving got to be habitual, ingrained, reflexive.
For a long time now I have not had to rely on my car to transport me very far. There were a few long drives between here and there, but mostly I stayed put enough to walk where I needed to go.
With my recent move back to Portsmouth I anticipated working mostly from home, walking to get groceries, have fun and exercise the dog. I did not anticipate getting this temporary work.
Until now, I was sure I had broken the car habit. I stopped equating my car keys with a butt and I was able to get in my car, zoom off and not even miss the little ... sticks, a name I use in the interest of keeping this column censor friendly. "Sticks" is not the first word that comes to mind, but I can't print the first word that comes to mind here, or even the second.
I really want to use those words, though, because "being in the car" is a danger zone. Evidently I broke the car habit because I wasn't really driving anywhere. Couldn't the gods have seen clear to visit me with one more year of not really driving anywhere, so I could really truly break the habit?
Once I arrive, I'm fine; I have a job to do. Never mind that the subject matter is mass market, true crime, burn barrels and horrifying details; it's a job, it pays and I focus on it. During breaks, I can walk the grounds, enjoy the spring breezes, eat my brown bag lunch, gaze at the pond and forget I am a smoker.
Twists of fate, no matter how small, bite one on the butt. It has to do in part with expectations. I have high expectations, too high, of myself and others and I have worked to rein them in. Even so, I have circuitously learned that it is the expectations you don't know you have that really hurt.
I remember the first time I had an expectation that was not fulfilled. My mother's friend, a former nun, was in need of a room at my (private women's) college, where she had lived many years prior. Her husband was next door in Beth Israel with a heart attack. He was a former priest. They met. They loved each other and left their respective orders to try and navigate the world of relationship. The administration said no, she could not stay there.
Naively, until it occurred, it was an expectation I didn't know I had.
He recovered. And she did OK too, although they did not ultimately make it as a couple.
All I can come up with for an explanation of my current situation is that the gods work in mysterious way. We are each visited with situations we could never anticipate, and that we don't want but that present themselves to us nonetheless.
If the gods had not seen fit to offer up the surprises of this job, I doubt the patch would be suffering this type of amnesia.
Perhaps my new job and its personal attendant trials are meant to desensitize me?
It's the best I can come up with.
What's the best you can come up with? suzanne.danforth@gmail.com.
Quitting: Stories of Portsmouth
I am back in town for the time being and there are so many stories begging to be told.
First is that nicotine patch co-inventor Murray Jarvik died on May 8. I would like to give him a special thank you, because the back story of the patch shows a true scientist at work. When Jarvik and his partner could not get approval for human trials of the patch, they tried it on themselves to gather data. What they found is that the patch mimicked the bodily changes in a person who smokes a cigarette. Jarvik's work helped to prove that nicotine is all by itself an addictive substance.
Boy is it. I'm gathering my own data right now, but am finding that of everything I have tried in the past eight months, the patch is far and away the best method for me. More about that next week, there is too much going on to focus just on smoking.
Portsmouth-isms comprise another story. How about that report of Gary Dodds coming out the front door of the Cutts Mansion breathlessly bidding hello to the city attorney on his walk home, whilst state police waited for him out back? Like MasterCard: Priceless.
Dogs are a story too, and you know my position on dogs. They sully my bed at night, keep me company during the day and don't understand why local restaurants don't offer "hund-wasser." That would be "hound water" for those of us stateside. Many businesses (including restaurants) in Europe routinely offer water for the four-legged companions of the patrons. My understanding (never investigated on first-person basis) is that in Europe, your dog is welcome wherever you are welcome.
Dogs (and by default their owners) aren't so welcome right now in many parts of the Port City. No to Prescott Park, no to fields where we bury our dead, at least until June 1, no to Creek Farm, where island denizens are trying to encourage a mainland ecosystem for study and no to New Hampshire beaches, except before 8 a.m. and after 6 p.m. I hear that Seapoint beach wants to welcome only dogs with a Kittery license. The beach regulations posted online don't support that, but it might be in the works. Thank goodness for the outer reaches of Peirce Island.
I guess I am glad for the relative lack of restriction; in the western part of Massachusetts, I would only walk in the cemetery across the street when my friend was able. We would bring the three dogs and the plan was that if anyone gave us question, she would pull off her hat and explain she was looking for a plot. Some days, it was the only place we could go, verboten though it was.
Dogs need to walk, to run, to play. That can't always happen on leash. Are we responsible at all for having domesticated them? How do we fill their need to socialize, to play, to shake it out, if we face ever-shrinking places to let them off leash?
Finally, there is the story of not having enough pre-bought oil in the tank, a la Simply Green Biofuels versus Rye Fuel. Beyond the fact that there is enough material to keep a reporter deep in stories on all aspects of the energy beat, we just have to be happy with the story of the day as it comes to light by way of the most insistent and disgruntled voice. Mr. Murdoch, why isn't there enough money to finance decent community journalism?
I will just have to be happy telling my smoking story. Natch; telling my not-smoking story. The patch continues to be my friend. I would like to take credit for the idea of making the patch a fashion statement, but I can't.
One reader (Kathleen of the good humor from Maine) suggested carrying around a permanent marker and inviting people to decorate it, a la a tattoo. I really liked that idea, and if the darn thing didn't have to be rotated along my body on a day to day basis, I would take up that suggestion. It would be easy to invite people to decorate it on the days when the patch is on a distal limb, a tad racy when I have to place it on other body parts.
I found out the hard way that the patch needs to be rotated. It irritates the skin if it is placed in just one area. (Yes, the box does state that, if you read far enough). Is this an argument for the gum? Or the lozenge? Perhaps, but I am not ready to move on to either of those in serious way.
The patch is doing the job. When I work it, it works.
What's your story? suzanne.danforth@gmail.com.
Quitting: Patch up those excuses
Nicotine, nicotinic receptors, agonists, pleasure centers, dopamine, Chantix, ecchh. I'm sick of it all. For a good two months now, I have had no pleasure, none, from the nasty little weed sticks my body and my mind crave so unrelentingly.
Even though it is warmer and I can take it outside, mister, for every pleasurable bit of the action I used to derive, there is now the famous equal and opposite reaction. A break became an interruption. The yummy taste became ashy. The quiescence that followed a cigarette became shameful. Because I have been smoking less, when I did smoke it gave me a headache.
Yes, my tenses are all mixed up. Past, present, do I, don't I? We'll get to that. Let me say first that it is probably a good thing that I write in both the present and the past about my nicotine habit. The literature indicates this means I am changing. Finally! It's about time. I've been whining about this publicly since last July, dissecting the journey, casting about for topics, impugning science, scientists, brain chemistry, pharmaceutical companies, you name it.
Could it be that the rubber is hitting the road? I hope so.
Many months ago, my sister gave me a couple of boxes of "the patch," a square little thing to slap on the body somewhere that delivers a steady dose of the core drug. The boxes languished in the cabinet, became dusty and lonely. In the meantime, I tried Chantix, gum, cold turkey, cutting down and bumming only. I even tried not trying, hoping that my desire to quit might magically allow me to eschew without the pain of quitting.
Success remained elusive.
Chantix, as you know, made me nuts. The other tactics didn't make me crazy, but they didn't quite work, either. I don't know what made me wake up recently and dig out those boxes, rather than reach for a butt. I'd like to say it was purposeful, goal directed, lofty. It was none of those things.
I had two dosages to choose from, 21 mg or 14 mg. There is program to follow, but since I haven't followed a norm since Pa fell off the bus, I decided simply to put on the stronger patch.
Lo and behold. The day passed and I didn't smoke. In some ways, it was like the early days of Chantix, before it took deep hold of my brain. I forgot about smoking. I didn't look for butts, crave butts, lament lack of butts or have to slap myself upside the head and remind myself I wanted to be a non-smoker. I just. Didn't. Smoke.
Buoyed by this success, and blighted by my own personality, on day two, I chose a 14 mg patch. Enter mild irritation, seductive thoughts of smoking, motor restlessness. But, I still didn't smoke.
Until.
You can insert whatever works for you here. Until ...; the addiction came roaring back, until ...; life intruded. Until ...; the siren call from the pretty mint green package became too hard to ignore. Until ...; whatever. Excuses all.
On day four, I peeled off the patch and waited enough time to believe I wouldn't have a stroke from double dosing nicotine and I smoked. Have I mentioned there was no pleasure?
There was purpose, to be sure. I smoked for three long days, enough to get me through another transition. Round about hour 12 of smoking, I knew I would get back to the patch as soon as I possibly could. I knew that desire was sufficient. There was something gritty about knowing that I was going to put that patch back on, as soon as I was over the hump.
One could argue that I should have just put it on and not waited for the right moment. One could also argue that there are plenty of high bridges around. The knowledge that I was going to put the damn thing back on was sufficient. There was a quality to it that meant business. I knew that there would always be a reason not to put the patch on, a social gathering, a deep crave. But I also knew that I was reaching a point where that was not going to be good enough.
So, last night, during my typical two hours up in the middle of the night, I rooted out the patches once again. I don't smoke during my nightly wakefulness, never have. I figured that putting the patch on would allow me to wake up in the morning and not be faced first thing with a craving.
I take nothing back about what I think and have written about Chantix, let that be said. It remains, in my opinion, imperfect, poorly studied and dangerous enough to be taken off market.
I chose the 21 mg patch. Wish me luck, light, and the courage of my conviction.
It's time to spring clean up dog poop in the South Cemetery! May 10, 8:30 a.m. See you there. suzannedanforth@gmail.com.
Come for a Walk with Me
Walk with me, reader. I have become a walker, much to my surprise. I don't walk to reduce my carbon footprint (a lovely side-effect nonetheless), lose weight (still waiting for that to happen) or accomplish tasks. I walk to amble, meander, and meet the occasional toddler who just learned to walk themselves, yesterday.
I'll tell you straight up that I am not smoking, so there may be some irritability, some snappishness. Truly, I'm not. Any moody storms will be quick and sure to pass, not to worry, because I am the beneficiary of an efficient nicotine delivery system. It is located on my left arm in the form of a patch. How is that going, you want to know? In time. In time, I'll tell you.
It's not that I want to make you wait (I'm not one of those who delights in some perverse way at holding out, not me at all) rather, I want to protect and nurture this new feeling of drawing in, holding close, not choosing or deciding on an outcome before the scene has even had a chance to play itself out.
So we'll walk and admire the canvas of greens put before us in spring, sniff earth smells, and hurl a stick to water for a while to watch the young dog's muscle and joy when she dives in after it. My whole life I have walked only to get from point A to point B. Same with the telephone. Hello? What time are we meeting? See you then, I have to go now.
I have lived, on reflection, to get from point A to point B. How very American. How un-Zen. Such a lot I have missed focused straight ahead, straining to influence, impress, solicit imprimatur. Although there is something seductive about the scoffer-type, the one who says, to hell with that and you, this is my house and you are a guest, I don't want to exchange my type of chip for that type of chip.
You know I harbor a secret desire to write, string just the right word here with that one there and build a story that opens the curtain for a glimpse of the mystery. One that explains, inadequately and perhaps just for a moment, the ambiguity of love. I do write, you say? Well, yes. I do write, it's why you know anything at all about me, isn't it reader?
But I tell no stories, I weave no threads of truth into a canvas that, unfurled, narrates a picture map of life. I pick book after book off my shelves that do just that thing, I read fiction with highlighter in hand, notebook at my side, to re-read, re-write, marvel at word pairings, word symmetry, word progression.
I get that same feeling sometimes reading the non-fiction in the New York Times or the New Yorker, but it's not non-fiction I yearn to put on paper. Some local writers summon me too: Trevor Bartlett can turn a revealing phrase, Gina Carbone can make me sit through a movie (trust me, that's a big one) and Heather Mackenzie makes me wonder every week why she never tackles the question of sexually transmitted disease.
Dan Brown? Not so much. I'm envious of his bankroll, and the themes in his blockbuster are good on the face of it, but the transparent formula seems simply a mass-market version of my fifth grade discovery of Sidney Sheldon.
Lean in, I don't want to say this next too loudly, for fear of scaring off my continued attempts at writing. I think (I hope) there is a story in me. I handle my well-worn copies of "Art and Fear" (Bayles and Orland), "If You Want to Write" (Ueland) and "Sifting through the Madness for the Word, the Line, the Way" (Bukowski) and hope and wonder and write and wait.
I walk. Idleness, say all good writers who write about the craft, is the essential beginning. That toddler? The one who learned to walk yesterday? We offered her a flower from the garden, we labeled them, yellow, red, soft, tall, short. Each word a new universe.
Take my hand now, on our walk. Just for a minute, help me down this incline. I won't hold on too long, or too intensely. My hand I can pull back, my heart, I cannot.
Walk your fingers to the keyboard and e-mail suzanne.danforth@gmail.com.
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