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.
Subscribe to:
Posts (Atom)
