Ouch. People are taking sides in the Chantix debate, some who have pointedly penned this week that I am over my head writing about this subject and a failure to boot. Because I am attempting to distill the science in a way that is manageable for the rest of us, there is some small measure of disdain coming my way.
It didn't come during a particularly good week. I have been weepy this week, prone to welling up unexpectedly. Beyond some of the larger issues in my life and the lives of those who are dear to me, I have been sitting day by day in the Brentwood courtroom where the trial of the year is playing out. The macabre information streaming from there has been wiggling its way into my thoughts even after the day is done.
A week ago, I left the courtroom briefly, when the reality of what was being discussed hit me square, both in the tear ducts and the gut. I'd like to be able to compartmentalize, but it seems my lot to tend to the integrated opposite.
Science is uber-compartmentalized, which may be why one Chantix developer seems to be taking what I write personally. This is the same person I wrote of a while back and who has never given me his credentials or agreed to come on record. He e-mailed me that "you are writing about a subject that is way over your head. There certainly are nicotine receptors in the brain and that's where nicotine from tobacco binds and it's the same place that Chantix binds."
In homage to accuracy, I have read more and continue to maintain that there are no more nicotine receptors in the brain than there are Ben & Jerry's receptors. There are acetylcholine receptors, to which nicotine binds. I'm not quite sure where ice cream binds, but it must be somewhere.
This e-mailer pointed out the role of confounding variables, characterized patients as being able to "claim all sorts of things" and pegged the ISMP report as failing to pass scientific muster. All leading to a situation ripe to "inflame a scientifically ignorant public."
Seems I am the ignorant media and you are the ignorant public. It is my long held principle that anecdotal experience is valid. Perhaps the scientifically ignorant public counts on the scientifically gnostic to acknowledge real-world effects?
This person positing a role in the development of Chantix attached a report by Jonathan Foulds, a professor of public health in New Jersey, but not before reminding me that the lack of peer review in the ISMP report made "a big difference."
Dr. Fould's report was also not peer reviewed, since it was published in a blog on May 28. Read it online at www.healthline.com/blogs/smoking_cessation/.
Fould's concerns and conclusions are well stated. However, he calls three out of four methods of adverse drug event reporting voluntary and haphazard. These methods (direct reporting to the FDA by the public, health care professionals and lawyers) are subject to influences like drug novelty, frequency of use and media coverage. The fourth method is above those messy concerns. That method? Drug manufacturer reporting to the FDA of reports brought directly to it.
The primary concern that Fould states is that the ISMP report does not take in to account the massive number of Chantix prescriptions relative to the numbers of adverse events being reported. It does make sense that a drug prescribed in the millions (ka-ching) may logically result in higher numbers of adverse events.
Fould also points to the difficulty of teasing out the effects of Chantix versus the effects of nicotine withdrawal. Nicotine withdrawal is nasty, no doubt, but at least in my case history, quitting before Chantix never made me stay up for days on end, produce volumes of writing and fail to discern between sleep and waking states.
Just as there are people out there scratching their heads and wondering how the anti-Chantix people reach their conclusions, I remain puzzled how Fould can write his way to this statement; "It therefore remains unclear whether any of these serious adverse events were caused by varenicline (Chantix)."
Without information on funding pipelines, stock shares held or seats on boards of directors, it continues to look from this vantage point more like a case of market forces driving the drug harder than old-fashioned axe-less science.
Finally, this comment from the un-named scientist stung the most. "Remember, your activism could cost lives by preventing folks from quitting smoking."
My activism responds thusly: Quit. Quit now. Quit again. Keep trying. Quit any way you can. But if you decide to try Chantix, pay attention to how you feel and stop if it isn't normal for you.
Losing the battle. suzanne.danforth@gmail.com.
