Tag: smoking

A twisty career path to improve care for smokers

When Jason Melehani, MD, PhD, grew up in a small town in the Sierra Nevada foothills, he didn’t know any scientists or doctors.

That all changed when he went to college at the University of California, Los Angeles and discovered the world of research. Now, Melehani is a resident in internal medicine at Stanford and his career path, twisty though it may seem, is headed to a future of helping people who have struggled with tobacco use.

At UCLA as a freshman, he joined a lab and began investigating an unusual parasite called Trypanosoma brucei that is transmitted via the bite of a tsetse fly to humans and cattle, causing an often fatal sleeping sickness in Saharan Africa.

“African sleeping sickness exclusively affects very impoverished regions of the world, so there wasn’t much interest from the pharmaceutical industry to develop medicines for this disease,” said Melehani. “A new therapy was recently approved, but it was spearheaded by a nonprofit initiative.”

This research experience inspired his career plan — with the ultimate goal of developing therapies for diseases affecting socioeconomically disadvantaged populations.

First, Melehani headed to the University of North Carolina, Chapel Hill, to earn both a medical degree and doctorate in pharmacology. This program included two years of preclinical medical courses, four years of research and two years of clinical training.  

After completing the MD-PhD program, Melehani took an unconventional approach.  

“Developing new treatments for patients is incredibly challenging especially from an academic lab. You can get things started, but there is a whole world of skills and people required to take things all the way to the clinic,” said Melehani. “I felt like I was experiencing only a thin sliver of the entire process in a research lab.”

To broaden his exposure, he next worked as a fellow at a venture capital firm in North Carolina focusing on healthcare and biotechnology.

“In seven months, I evaluated 500 companies and helped pick the most promising ones, which each received an investment of between half a million to eight million dollars,” said Melehani. “I worked with leaders of major healthcare organizations who valued my opinion despite my junior position. I learned a lot about how new drugs are developed and the role venture capital plays.”

The contacts and insights he gained through this venture capital training and a separate internship in the pharmaceutical industry will likely come in handy in the future when he is running his own academic research lab. “My hope is that this training will help me better select and position future discoveries so I can move them out of my lab to startup companies and ultimately to patients,” he said.

Even at Stanford, Melehani is making his own path. Melehani has applied to do fellowship training next year in both rheumatology and pulmonary medicine, which no one has done before in recent memory.

Melehani plans to research how smoking tobacco affects the immune system and leads to severe health consequences, such as chronic obstructive pulmonary disease, rheumatoid arthritis or heart disease.

“Smoking has disastrous immediate and long term effects on nearly every system in the body,” he said. “And it’s deeply tragic because 90% of people who smoke start before the age of 18 and it’s highly addictive. So even though 70% of people want to quit, the success rates are dismal — around 10%.”

The health impacts of smoking have been on Melehani’s mind for a long time. Many of his friends started smoking in high school. He was exposed to a lot of patients in North Carolina who were smokers. And now at Stanford, he sees many patients who are former smokers and dealing with a wide range of health problems.

Smoking fits his goal of addressing a major socioeconomic health problem— the highest rates of smoking in the United States are in the poorest areas with the lowest education rates. And these are the people who don’t have the resources to face the disastrous health consequences that result, he said.

Melehani hopes to tackle this problem by running his own lab at Stanford, doing fundamental research into how the immune system is affected by cigarette smoke and turning that research into meaningful changes in medical care for his patients.

For now, he is focusing on his patients and getting through his night shifts in the intensive care unit.

Photo of Jason Melehani by Margarita Gallardo

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine

Stanford study shows the power of eco-friendly packaging for cigarettes

My eyes are drawn to eco-friendly packaging when I shop for groceries. It is how I pick my laundry detergent, dish soap and many other products from the litany of options. But I’ve learned to double-check whether these items are actually better for the environment, because there are a lot of misleading labels.

Companies know that pro-environmental marketing works. A new Stanford study shows it is even effective for cigarettes.

The researchers surveyed over 900 adults on their perception of two major cigarette brands: Pall Mall and Natural American Spirit. Pall Mall is marketed as a discount brand, while Natural American Spirit is marketed as environmentally friendly. For instance, the Natural American Spirit’s “Respect the Earth” campaign advertises a “zero-waste-to-landfill” facility and uses a logo with three tobacco leaves that mimics the recycling symbol.

The study participants were a mixture of current smokers, former smokers and people who have never smoked. All three groups consistently ranked Natural American Spirit cigarettes as being healthier and better for the environment than the Pall Mall cigarettes.

“Ecofriendly and natural food products are seen as safer for health,” said the study lead author Anna Epperson, PhD, a postdoctoral fellow with the Stanford Prevention Research Center, in a recent Stanford news release. “That couldn’t be farther from the truth when it comes to cigarettes.”

Both brands are actually manufactured by the same company, Reynolds American. And they have the same health impacts, including a significantly higher risk of heart disease, cancer and chronic obstructive pulmonary disease. They are also commonly discarded, resulting in toxic chemicals leaching into the soil and water supplies.

 “All commercially available cigarettes will kill more than half of long-term users if smoked as intended. Marketing language that obscures these health harms, even indirectly through questionable pro-environment claims, ought to be prohibited,” the study authors concluded.

This warning may be particularly important to the San Francisco Bay Area and other pro-environment and pro-health regions, where Natural American Spirit cigarettes are especially popular according to Epperson.

Photo by webyourlife

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Nicotine patches and medications aren’t enough to quit smoking, a study finds

Photo by HansMartinPaul

I’ve watched family members and friends struggle to quit smoking, using nicotine patches and prescription medications. For many, it continues to be an ongoing battle.

This struggle is common, according to a new study from the University of California, San Diego that shows using smoking cessation drugs alone may not improve your chances of successfully quitting. The researchers studied two patient groups — comparing patients who used medication aids to ones that did not — to evaluate the effectiveness of three frontline smoking cessation drugs. To learn more, I spoke with the lead author Eric Leas, PhD, who conducted the research as a graduate student at UC San Diego and is now a postdoc at Stanford School of Medicine.

What inspired you to study the effectiveness of smoking cessation drugs?

“There is a major public health need for smoking cessation aids. Tobacco use remains the primary cause of cancer and cancer mortality in the United States and quitting smoking is so difficult for many smokers. I have several close family members and friends who have had debilitating disease caused by smoking and who struggled for many years to quit.

Several randomized trials have shown that some pharmaceutical smoking cessation aids can double quit rates. However, in the early 2000s, post-market surveillance studies of these cessation aids suggested that the population effectiveness did not match the randomized trial results. This was a major surprise to the medical field and met with some opposition. A criticism of these surveillance studies was that the same individual factors that make quitting difficult are also related to self-selected use of pharmaceutical aids when trying to quit. For instance, heavier smokers are more likely to use a cessation aid and also less likely to successfully quit. In social science and medicine this bias is known as ‘confounding.’”

Why did you study two “matched” patient groups?

“In our analysis, we attempted to address confounding variables using a method known as ‘matching.’ The goal of matching is to make study comparison groups similar with respect to potential confounders. In addition to cigarette consumption, we matched sociodemographics such as age, sex, race-ethnicity and education; smoking characteristics such as previous quit history and nicotine dependence; self-efficacy in quitting and having a smoke-free home.”

What did your study find?

“Even after matching, we found no evidence that the pharmaceutical aids improved the likelihood of successful quitting. While understandable, this finding is disappointing considering the need for successful cessation aids.

One possible explanation is that in many of the cessation randomized trials, smokers received the drugs in combination with intensive behavioral support. This support is not typically provided in the population. Prescribing behavioral support along with these drugs may be needed — as our results suggest that administering the drugs on their own is not working.”

What are you working on now?

“In collaboration with other professors at the School of Medicine and Stanford Business School, I am currently extending this work by studying how different groups of smokers respond to smoking cessation treatments, with the goal of developing tailored treatment plans.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Using history as a guide to end tobacco addiction

Photo courtesy of Robert Proctor

The public’s opinion of tobacco use has dramatically changed over time. Gone are the days when cigarette companies advertise using slogans like “fresh as mountain air” or “more doctors smoke Camels than any other cigarette.” We now know that cigarettes cause blindness and tuberculosis, among many other conditions, and are highly addictive.

But in the era of nicotine e-cigarettes that are touted as cool and harmless, have we really changed our ways? I spoke with Robert Proctor, PhD, a professor of history at Stanford, to learn about his work.

What inspired you to research the history of cigarette design?

“Cigarettes are the world’s leading preventable cause of death, killing about 6 million people worldwide every year.  A physician might hope to heal a thousand or perhaps ten thousand people over a career, but what if we could save these 6 million people annually?  It was this hope of saving lives that led to my exploring how cigarettes have been designed, and how they might be stopped.”

Where do you find your research materials?

“The Legacy Tobacco Documents Library is a real treasure.  I use it to explore the industry’s myriad secret projects — like Project Subculture Urban Marketing, a secret Reynolds campaign from the 1990s to target gays and the homeless in San Francisco.  I also use it to find out what they’ve been adding to cigarettes—like diammonium phosphate, a free-basing agent used to boost the potency of the nicotine molecule. I also use it to find out who has been working for the industry, as grantees or expert witnesses. Historically that included dozens of Stanford professors, but I don’t know any still working in that capacity today.”

What do you think about the FDA’s plan to reduce nicotine in cigarettes?

“As I explained in a recent op-ed for the New York Times, the Food and Drug Administration will try to mandate the reduction of nicotine in cigarettes to a sub-addictive level. However, they will encounter ferocious resistance from the industry, which sees nicotine as the indispensable ingredient of their business. For beginning smokers, nicotine is actually a negative in the smoking experience. Once addicted, most smokers regret having started. It will be crucial for the FDA to reduce nicotine sufficiently to make sure new users don’t become addicted. De-nicotinization is easy. Multiple techniques are available to achieve this, including genetic technologies and some of the same techniques used to de-caffeinate coffee.”

Have you also studied e-cigarettes?

“I have studied e-cigarettes but not as intensively. Many of the same techniques once used to market traditional cigarettes have been revived for e-cigarettes and other vaping devices, as Robert Jackler, MD, and his colleagues have shown so beautifully. E-cigarettes may help some smokers quit, but they are more likely to renormalize smoking and act as gateways to regular cigarettes. They also serve as bridge products to keep smokers from quitting nicotine entirely, which is why the big cigarette makers have all launched new vaping devices.”

What more can be done?

“Physicians often know the right thing to do, but may not have the power to make that happen — that is medical impotence.  A third of all cancer deaths, for example, are caused by cigarettes. Just knowing that, though, isn’t enough to do any good, since there are powerful forces dedicated to making sure we keep pulling smoke into our lungs. Much more could be done to solve such problems — the new age minima for purchasing cigarettes should help. I also believe we need to explore what I call ‘the causes of causes.’  Cigarette smoking causes disease, but what causes cigarette smoking?  Too often we end with the individual, rather than going upstream to the source of the problem in the first place. Stop the manufacture of cigarettes, for example, and you stop having to yank out tumors from lungs or putting people on oxygen. We need more upstream thinking in the practice of medicine.

We also need to think more about health in our own community. For instance, Stanford got a failing grade from the Santa Clara County Public Health Department in 2011 as the most cigarette-friendly campus in the Bay area — for allowing the sale and use of cigarettes on campus.  We did finally manage get the sale of cigarettes in the student union stopped, after years of painful protest.”

 

Editor’s note: Stanford has a smoke-free environment policy that prohibits smoking in all buildings, facilities, vehicles, covered walkways and during indoor or outdoor athletic events. Smoking has been banned on the School of Medicine campus for a decade. 

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

 

What you need to know about e-cigarettes

 

Photo by 1503849
Photo by 1503849

E-cigarettes are extremely popular with millions of middle and high school students across the United States. Kids love the flavors — like strawberry, bubble gum, chocolate cake and cotton candy — and blowing vapor into rings. And, they are inundated with ads that tout e-cigarettes as cool, harmless alternatives to cigarettes.

But, not surprisingly, e-cigarettes aren’t really safe. A recent University of California news story outlines ten important facts about e-cigarettes, including how they can harm your health.

One of the biggest health concerns is that e-cigarettes contain nicotine, which is addictive and can lead to the use of traditional cigarettes. “A lot of kids who take up [nicotine-free] vaping are at low risk for smoking, but once they start using e-cigarettes, they are three to four times more likely to start using cigarettes,” said Stanton Glantz, PhD, a tobacco researcher at the University of California, San Francisco, in the article.

In addition, e-cigarettes can contain other harmful ingredients, including:

  • Ultrafine particles that can trigger inflammatory problems and lead to heart and lung disease
  • Toxic flavorings that are linked to serious lung disease
  • Volatile organic compounds
  • Heavy metals, such as nickel, tin and lead

Stanford’s Bonnie Halpern-Felsher, PhD, a developmental psychologist who has studied tobacco use, also commented in the piece:

“Youth are definitely using e-cigarettes because they think they are cool… Adolescents and young adults don’t know a lot about e-cigarettes. They think it’s just water or water vapor. They don’t understand it’s an aerosol. They don’t understand that e-cigarettes can have nicotine. They don’t understand that flavorants themselves can be harmful.”

Furthermore, when e-cigarette users exhale the mainstream vapor containing these toxins, they can cause secondhand health effects.

The article discusses other hazards as well, including the possibility of battery explosion, and the products’ mixed record on helping smokers quit. It concluded with a call for more research to better understand the long-term health effects of e-cigarettes.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Great American Smokeout: Time to Quit

photo of cigarette stubs in ashtray
Photograph courtesy of olumi_day via a Creative Commons license.

Smoking used to be portrayed as being glamorous in advertisements and movies. In old films, actors constantly smoked cigarettes and a tough guy usually had one hanging out the side of his mouth. It’s debatable whether smoking still makes you look cool though, especially since there are fewer and fewer public places you’re even allowed to smoke. Plus we now better understand the health risks of tobacco products.

Tobacco use is the single largest preventable cause of disease and premature death in the United States, but nearly 44 million Americans still smoke cigarettes – 1 in every 5 adults. There are also 14 million cigar smokers and 2 million pipe smokers.

Tobacco use is not quite as widespread in California, where just over 1 in every 7 adults smokes cigarettes. In the past year, 61 percent of these smokers attempted to quit.

There are many good reasons to quit smoking, and health concerns usually top the list. Half of all smokers who keep smoking die from a smoking-related illness, including lung cancer, other types of cancer, heart attack, stroke, or lung disease. Women who smoke are also more likely to miscarry or have a baby with a low birth-weight.

There are both immediate and long-term health benefits when smokers quit. After quitting for:

  • 20 minutes, your heart rate and blood pressure drop.
  • 12 hours, the carbon monoxide level in your blood drops to normal.
  • 2 weeks – 3 months, your circulation improves and lung function increases.
  • 1 – 9 months, your coughing and shortness of breath decrease.
  • 1 year, your risk of heart disease due to smoking cuts in half.
  • 5 years, your risk of various cancers (mouth, throat, esophagus, and bladder) is cut in half.
  • 15 years, your risk of heart disease is the same as a non-smoker.

Cigarettes are also expensive. You can use a savings calculator to see how much money you would save if you quit smoking. For example, a pack of cigarettes costs $6.77 on average in California. If you smoke a half pack (10 cigarettes) per day, this adds up $24 per week or $1220 per year.

Of course, the nicotine in tobacco is very addictive so quitting can be difficult, but the chance of success is increased with help. There are many treatment options used to help smokers quit and many of these treatments are covered by health insurance.

The most effective quitting method is a combination of counseling, social support and the use of cessation medication. The most common form of counseling is through telephone-quit lines, which provide free support and advice from an experienced cessation counselor. The counselor can provide a personalized quit plan, self-help materials, the latest information on cessation medications, and social support. For instance, 1-800-QUIT-NOW is a free national counseling service. Many clinics and hospitals also have counselors and support groups that you can meet with face-to-face. Counseling and support groups are also available online.

There are a variety of cessation medications that are available either over the counter or with a prescription. Nicotine replacement therapies deliver nicotine to help reduce the severity of nicotine withdrawal symptoms. The nicotine dose is gradually reduced over time. Nicotine gum, lozenges and patches can be purchased over the counter, whereas nicotine inhalers or nasal sprays require a doctor’s prescription.

Bupropioin SR (Wellbutrin or Zyban) is a non-nicotine prescription medication that acts on the chemicals in the brain that are related to nicotine craving. It can be used alone or with nicotine replacement products. Verenicline (Chantix) is a non-nicotine prescription medication that blocks the effects of nicotine, so it should not be used in combination with nicotine replacement products.

It is important for smokers to speak with their doctor and/or a cessation counselor to make a personalized quit plan that is right for them. And this week is a good time to get started, just in time to take part in the Great American Smokeout on November 21. Smokers across the nation will use this Thursday to make a quit plan, or plan in advance and quit smoking.

The Great American Smokeout happens every year on the third Thursday of November. It started in California back in 1976 when nearly 1 million smokers quit for the day, then the American Cancer Society expanded the program nationwide the following year. It has drawn attention to the deaths and chronic diseases caused by smoking, resulting in laws that ban smoking in restaurants and other public places.

The Great American Smokeout is celebrated with rallies, parades, stunts, quit programs, and “cold turkey” menu items. For instance, the community is invited to receive up-to-date cessation information, resources and giveaways at UCSF Medical Center’s Great American Smokeout event from 9-10 am and 12-1 pm on the Parnassus, Laurel Heights, Mission Bay and Mount Zion campuses. UC Berkeley is also celebrating the event with a “cold turkey” give-away – get a free cold turkey sandwich in exchange for a pack of cigarettes from 11 am – 2 pm at Sproul plaza.

This is a repost of my KQED Science blog.

Hope for an anti-Nicotine Vaccine

Photograph courtesy of Ianier67 via Creative Commons.

A friend once told me that it was 100 times harder for him to quit smoking cigarettes than to quit drinking alcohol. He was successful and hasn’t smoked a cigarette for over 10 years, but he’s a lucky minority. I have several other friends who still struggle with smoking cigarettes – willpower, counseling, exercising, nicotine replacement patches and antidepressants like Zyban haven’t been enough.

Clearly nicotine is highly addictive. About 45 million people in the U.S. smoke cigarettes, even though cigarette smoking leads to 1 of every 5 deaths each year. In a National Health Interview Survey, over half of the smokers reported trying to quit in the past year without success.

In the future, these smokers may get a vaccine to help protect them from nicotine addiction.

Researchers from Weill Cornell Medical College and Scripps Research Institute have developed a new vaccine that may treat nicotine addiction, by blocking the pleasurable sensations that nicotine creates in the brain. Dr. Ronald Crystal and his colleagues have demonstrated that they can prevent nicotine from reaching the brain in mice using a single injection of vaccine. If these findings are confirmed in people, this vaccine could be an effective therapy to help prevent nicotine addiction.

For more information about this research, check out my KQED Quest blog.

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