Monday, August 31, 2009

Despite 98 Suicides and 188 Suicide Attempts Reported Among Chantix Users and No Deaths Reported for E-Cigarettes, FDA Would Rather You Use Chantix

An article in this week's issue of JAMA - the Journal of the American Medical Association - reports that the FDA has now acknowledged receiving 98 reports of suicides and 188 reports of suicide attempts that appear to be linked to Chantix use. In addition, the Agency has received reports of patients taking the drug being involved in motor vehicle crashes.

According to the article: "Although varenicline’s label had already indicated potential psychiatric risks, the agency has continued to receive reports of attempted and completed suicide in varenicline-treated patients, including some who had no history of psychiatric problems. An FDA analysis, released earlier this year, of varenicline adverse event reports submitted to the agency between May 2006 and November 2007 documented 19 suicides and 18 reports of suicidal behaviors, including 15 suicide attempts... But at a press briefing in July, Rosebraugh said that based on crude counts the agency now has reports of 98 suicides and 188 suicide attempts."

The article also notes that the FDA is requiring the makers of Chantix to conduct clinical studies to determine the incidence and severity of the adverse effects of Chantix: "To better understand the incidence of these adverse events and which patients may be at greatest risk, the FDA is requiring the manufacturers of both drugs to conduct additional randomized controlled trials. Unlike previous studies, these trials will include individuals with preexisting mental health conditions, who make up a disproportionate number of smokers."

The Rest of the Story

One almost wonders what the point of the FDA threatening to take electronic cigarettes off the market is. If Chantix has been studied and has been found to have likely caused 98 deaths and an additional 188 attempted suicides and it is allowed to remain on the market because smoking cessation is such an important goal, then what is the point of removing e-cigarettes from the market while studying its potential adverse effects? Suppose e-cigarettes were to be found to have caused 100 deaths. Would that warrant taking it off the market, since it - like Chantix - is helping people to quit smoking?

However, unlike Chantix - for which there were many immediate post-marketing reports of potential adverse effects, e-cigarettes have been on the market for more than 3 years and there have yet to be any severe adverse effects reported.

In other words, we know that people are dying from taking Chantix but we're going to allow it to remain on the market because it's helping people to quit smoking. We know that there is no evidence that anyone is dying from using electronic cigarettes, but we're going to take them off the market, even though they are helping people to quit smoking.

Sorry, but that just doesn't make any sense.

In the same way, it makes no sense for the FDA to allow Chantix to remain on the market while we conduct studies to determine the incidence and severity of its known deadly side effects, but to take e-cigarettes off the market while we conduct studies to determine whether it even has any adverse side effects.

More importantly perhaps, why are anti-smoking groups calling for the removal of e-cigarettes from the market when we are not aware of any documented severe adverse effects, yet they are not calling for the removal of Chantix from the market even though we know this drug is probably killing people?

One answer, I believe, is the heavy financial influence of the pharmaceutical industry. So far, every anti-smoking group which has called for the removal of e-cigarettes from the market has been found to be financially tied to Big Pharma. The Campaign for Tobacco-Free Kids, American Cancer Society, American Heart Association, American Lung Association, and Action on Smoking and Health have all received funding of some sort from the pharmaceutical industry. None of these groups, however, disclosed their financial conflicts of interest when they called for a ban on electronic cigarettes.

Thus, I believe that not only are the actions of these groups inappropriate, unsupported by science, harmful to the public's health, and heavily biased due to financial relationships, but these actions are also unethical because it is unscrupulous to advocate for a public policy like this without revealing such an important and relevant financial conflict of interest.

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