DR. HOOK-Chantix: Singing the no-smoking song

My life is so not glamorous. Because I have such a small practice, I usually can't afford to have outside help. But now we're hiring a nurse practitioner, and we've been hauling things all over, hammering away, dusting behind corners that haven't seen light since 1904, yadda yadda yadda. 

Things could be worse– like having tea with Pat Robertson– but no one told me I would be lying under a dusty desk today to wire up equipment in addition to seeing patients. By the way, I even iron at home. (I'm going to write a book called Ironing is Happiness: Smooth Away the Wrinkles in Your Life. John Grisham, eat your heart out!)  

Brad Pitt = Glamour. Dr. Hong = Hauling boxes and doing laundry. 

Anyway, I have some patients who think smoking is glamorous. I don't get it. When I see Nicole Kidman bathed in tobacco smoke, I need to wear an oxygen mask! I inhaled a cigarette once in college to see what the attraction was, and I coughed up my left lung.

Smoking is so bad for you! Whitney Houston said, "Crack is wack," but I say, "Tobacco is cracko!" Hmmm, let me revisit this. Cigarette smoking is the #1 preventable cause of illness and early death. In the US, about 438,000 deaths per year are attributable to smoking. Sure, we all have to die of something, but I would prefer to die of old age without suffering from a stroke, a weak heart, and poor circulation in my legs (especially since my left lung is still back at college).

Forty-one percent of smokers try to quit every year, but only about 10 percent who try to quit succeed for good. Most smokers fail to quit within the first few weeks because they become absolute raving witches, and I don't mean as in Endora.  

Some people are able to quit smoking by going cold turkey (vs. warm chicken – where do these expressions come from?). I counsel all my patients who smoke to give up the habit/addiction. Cutting down to five or fewer cigarettes is a great way to prepare to quit, but I have quite a few patients who will run over their grandmother before cutting down to five cigarettes a day. 

One lady said to me, "Honey, I'd give up a good man before I'd give up my cigarettes."

While the celebrated chair of UVA's department of psychiatric medicine, Dr. Bankole Johnson, is investigating several new drugs to help people stop smoking, several meds are already here.

Bupropion has proved useful in helping people quit, but there's a risk of seizure on the medication. (If it's not one thing it's another.) Nicotine patches, gums, etc. all help reduce craving and withdrawal effects like irritability, headaches, and hunger.

Chantix is the newest kid on the block. This medicine is an alpha-4, beta-2 nicotinic acetylcholine receptor partial agonist. (I realize no one knows what that means.) Nicotine binds to this receptor in the brain and causes a nice soothing brain chemical called dopamine to be secreted. Dopamine dopes you up to feel good. 

Chantix binds to this receptor about 50 percent as much as nicotine, so the person sorta has the feelings of nicotine in the system. Additionally, Chantix stops a smoking buzz because Chantix is already sitting on the alpha-4, beta-2...you know the rest.  

Should smokers who want to quit start singing Hallelujah? Well, the drug is four times more effective than placebo and two times more effective than bupropion after 12 weeks of therapy. But it isn't a cure-all. I guess nothing really ever is.  But it's a start and might save some lives. And I'm not just blowing smoke.

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