"Smoking Cessation" By Allen Weiss, MD, MBA, President and CEO

Dr. ALlen Weiss, MD, MBA, FACP, FACR

March 1, 2009 - President Obama has either joined the 49% of Americans who have quit smoking over their lifetimes or he is in the process of doing so. This is wonderful news since we need a healthy President, and one who sets a good example. Despite the fact that millions of people have stopped smoking during the past several decades, it is still more common than one might think: 23.9% of men and 18.1% of women are presently addicted in America, according to the National Health Interview Survey (NHIS)2005, National Center for Health Statistics.

Cigarette smoking is responsible for one in five deaths in the U.S. today. According to the American Heart Association, 46 million people in America smoke, with more than 80% wanting to quit. Unfortunately, tobacco is as addictive as cocaine or heroin, making it exceedingly difficult to stop.

The harmful effects of smoking have been known since the mid 1950s when the link between smoking and lung cancer was statistically proven. Dr. Morton L. Levin of the Roswell Park Memorial Institute in Buffalo, NY a state cancer research-treatment center, made this connection. Subsequently, he boldly wrote to the presidents of seven leading tobacco companies suggesting that they voluntarily label all cigarette packaging with a warning that excessive smoking is dangerous to health. At that time it created a firestorm of controversy, with the tobacco companies defending their positions. I had the good fortune to work under Dr. Levin during the summer of 1965 in a National Summer Science program. Packages were finally labeled in 1964.

Smoking continues to be the leading cause of heart disease and preventable death in both men and women in America today. Smoking is also responsible for many lung diseases and many types of cancer.

Twelve percent of pregnant women still smoke, according to reports by the Federal Centers for Disease Control and Prevention. The epidemiology of smoking causing spontaneous abortions and premature births with the attendant problems, was elucidated by Dr. Marla Weiss and colleagues while working with the Department of Epidemiology at Columbia University. The results are detailed in “Smoking: A Risk Factor for Spontaneous Abortion,” published as the lead article in the New England Journal of Medicine on October 13, 1977.

Quitting smoking is a good goal because your risk for heart disease drops in half after one year of being tobacco-free. After 15 years of abstinence your risk returns to that of someone who never smoked. Stroke risk drops similarly. Men and women in their 30s who quit smoking can add five years and three years respectively to their lives.

How can a smoker join the 1.3 million people who stop every year? One very good method is using nicotine gum as a substitute. In fact, President Obama was seen chewing nicotine gum while campaigning. In a recent interview he said he would obey the prohibition of smoking in the White House that was instituted by Secretary of State Hillary Clinton when she was First Lady. The President reiterated his complete understanding of the advantages of smoking cessation.

Other nicotine replacement products include patches, nasal sprays and inhalers. The amount of nicotine-substitute needed depends on the degree of an individual's previous use of tobacco. With time, a motivated person gradually decreases his or her intake of the nicotine replacement until the addiction comes to an end?

Two drugs have also been used to aid the transition. Bupropion (Zyban) reduces craving and withdrawal symptoms. An antidepressant medication, it is thought to help people stop smoking by mimicking some of the effects of tobacco on brain tissue. Bupropion can be used together with nicotine replacement products; several studies indicate that the combination helps more smokers quit than either method by itself.

. Additionally, Buspirone (BuSpar) is a tranquilizer that appears to be effective in helping smokers deal with feelings of anxiety resulting from tobacco withdrawal.

Acupuncture and other alternatives have also been tried but studies have not confirmed these options to be any more effective than placebo.

So, to all our friends—and leaders—who were hooked on this bad habit, we wish you well in your admirable efforts to quit. Anything non-smokers can do to support those going through the ordeal of cessation we should be doing. Obviously, not starting in the first place is the best answer; having empathy and encouragement for those who do try to quit is the next best alternative.

Good luck to all, especially our President.


Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.