Monday, January 12, 2015

Why are Anti-Smoking Groups Recommending a Smoking Cessation Drug That Has Been Linked to Hundreds of Sudden Deaths?

Numerous health and anti-smoking groups continue to recommend the use of a smoking cessation drug, despite the fact that this drug has been linked with hundreds of sudden deaths.

The drug is Chantix, and the sudden deaths were suicides.

The Vancouver Sun revealed this Saturday that in Canada over the past seven years, Chantix has been linked to 30 suicides, 44 deaths, and more than 1,300 episodes of suicidal ideation or suicide attempts, depression, and aggressive behavior.

According to the article: "Numbers on the deaths and other side-effects come from a Health Canada database where doctors, pharmacists and drug companies report bad side-effects experienced by patients taking pharmaceuticals. But Health Canada admits on its website that side-effects are under-reported, and experts say the database could represent as little as one per cent of the patients who suffer complications.
“A small proportion of the adverse reactions that have occurred on this drug in Canada would be in the adverse reaction database. Essentially it is spontaneous, voluntary reporting,” said Barbara Mintzes, a pharmaceutical drug expert at the University of B.C."

"Even the incomplete numbers, though, are a concern, she said. When someone taking an anti-depressant attempts suicide, it’s initially not clear whether that’s caused by the pre-existing depression or the drug; but in the case of Champix, people are taking the drug to stop smoking — not for a mental health condition. “You are looking at a lot of deaths, suicides and attempted suicides, and suicidal ideation in a population that you would have no reason to think would be otherwise at high risk of suicide,” said Mintzes, an associate professor in the Faculty of Medicine’s School of Population and Public Health."

The article also revealed that in 2012, the British Columbia ministry of health fired eight scientists who were doing research on Chantix. Also that year, the health ministry cancelled an independent review of Chantix, allegedly because it didn't want the serious adverse effects associated with this drug to go public. A leaked email written by the co-director of the health ministry's drug evaluation unit stated:

"We’ve decided to keep (the review of) smoking cessation in-house, sorry about that. It’s getting political and we aren’t sure anyone wants to see a published evaluation."

The Rest of the Story

Imagine that there were reports linking the use of electronic cigarettes to hundreds of sudden deaths. Unquestionably, health and anti-smoking groups would be calling for the removal of e-cigarettes from the market. At very least, they would not be recommending the use of e-cigarettes for smoking cessation. How then can these groups recommend the use of Chantix?

This reveals the hypocrisy and bias of these anti-smoking groups. They recommend that smokers use Chantix, despite its having been linked with hundreds of sudden deaths, but they discourage smokers from using e-cigarettes, which have so far not been linked to any serious adverse health effects.

Moreover, there is a black box warning on Chantix which alerts patients to the potential for serious health effects, including suicidal ideation and suicide attempts. Given that warning, how can these anti-smoking groups continue to recommend the use of the drug?

It isn't this recommendation alone that troubles me. It is the hypocrisy of the anti-smoking groups. If e-cigarettes were linked to even a fraction of the sudden deaths to which Chantix has been linked, there is no way that these groups would be recommending the use of e-cigarettes.

Whether Chantix is causally linked to suicide is not relevant to my point because if e-cigarettes were linked - by anecdotal reports - to sudden deaths, even without definitive evidence of a clear causal connection, anti-smoking groups would not be recommending the use of this smoking cessation device. But under precisely the same conditions, they are recommending the use of Chantix.

I believe there are three major reasons for the hypocrisy and bias that we see being displayed.

First, there is a strong ideology in the anti-smoking movement against anything that even looks like smoking, regardless of the benefits and health effects of the product. Anti-smoking groups simply cannot recommend a behavior that looks like smoking, regardless of how many lives it might save.

Second, there is a strong pre-existing bias against electronic cigarettes. Anti-smoking groups have reached the pre-determined conclusion that e-cigarettes are evil, and no amount of scientific evidence of the net public health benefits of these products will cause the groups to change their mind.

Third, most of the major anti-smoking groups receive significant funding from Big Pharma, and Pfizer - the maker of Chantix - is a major donor to these groups. This creates an obstacle to anti-smoking groups publicizing the potential dangers of Chantix because they don't what to bite the hand that feeds them. However, this financial conflict of interest is hardly ever disclosed when these groups make their public recommendations against the use of e-cigarettes and for the use of Chantix.

The apparent actions of the British Columbia health ministry are a rather extreme demonstration of these severe biases. But we must remember that even by merely discouraging the use of e-cigarettes, anti-smoking groups are causing public health harm because they are opposing a bona fide strategy for smoking cessation that helps many smokers who would not be able to quit using traditional methods.

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