Participants in the International Pharmaceutical Federation Congress were able to take part in a forum on smoking cessation on August 29. A report follows
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| Terry Maguire: MRC-funded study |
Mr Peter Anderson (consultant in public health and a former World Health Organisation
regional adviser for a tobacco free Europe) said that 1.2 billion adults smoked.
Pharmacists needed to emphasise the health gains of quitting and seek political
support. Half of all smokers would die from tobacco-
related disease: half in middle age and half in old age. There were benefits
for all ages of stopping smoking and those benefits were greater the younger
people were when they stopped. Adults could be encouraged to quit by increasing
taxation. The World Bank had estimated that a 10 per cent increase in tax decreased
smoking by 4 per cent in low income countries. Increasing the size of warning
labels on cigarette packets was also effective. In Canada, 50 per cent of the
packet was now covered with warnings.
Mr Anderson told the forum that the WHO had set up an international framework
convention on tobacco control and its first meeting had been in October, 1999.
It had produced a series of general commitments to encourage action at a local
level, eg, increasing the number and size of warning labels and putting controls
on smuggling. Thirty per cent of all cigarettes traded were now smuggled. This
amounted to 60 billion cigarettes per year in the European Union, resulting
in a lost revenue of around m6bn. He stated that the tobacco industry was the
major perpetrator of this illegal trade. The details of the WHO initiative were
accessible on the internet at http://
tobacco.who.int.
Mr Anderson said that in 1977 there had been a major conspiracy by the tobacco
industry called “Operation Berkshire”. Its purpose had been to provoke
controversy over smoking and disease and to reassure smokers. The tobacco industry
put its own consultants into the WHO. One of these executives, Peter Tollinson
had said: “The poorest nations in the world are interested in basic public
health and not in the more exotic foray of WHO into the public health issues
of the modern industrialised world.”
He called for nicotine replacement therapy (NRT) to be more widely available
as, after all, it was the safest mode of nicotine delivery and the most restricted.
NRT should be available for temporary abstinence and there should be no fear
about people using it long term.
Pharmacists “key”
Ms Eeva TerÄsalmi (vice-president, Finnish Pharmacy Association, and task
manager, Europharm forum for pharmacists against smoking) said that pharmacists
were key, because NRT was largely a non-
prescription product and their contact with smokers was greater than that of
any other health care professional. She called for professional organisations
to support the creation of national tobacco policies to support the pharmacist’s
role in tobacco control by creating models and developing guidance, and to support
and encourage pharmacists in their active role in helping those who were giving
up smoking. She said it would be short-sighted to stop NRT being a medicine
and that that would play into the hands of the tobacco manufacturers. She quoted
Swedish Match AB and Gum Tech International Inc which were setting up a joint
venture to manufacture non-tobacco nicotine-containing products. She emphasised
how dangerous this might be.
Ms Terasalmi went on to mention two Europharm studies. One was a survey about
pharmacists’ smoking status and attitudes and the second was a research
project on the effectiveness of local co-operation in smoking cessation. Europharm
forum had produced educational material to support these initiatives.
Biggest epidemic
Dr Martin Raw (independent consultant and honorary senior lecture at King’s
College London) said that tobacco use was not common at the beginning of the
20th century but had become widespread with the introduction of the cigarette-making
machine. Use rose steeply during the 1914-18 war followed by a sharp rise in
deaths from lung cancer 30 to 40 years later.
Smoking he said was the biggest epidemic the human race had ever known. It was
now accepted as an addiction. Less than a quarter of attempts to stop were sustained
for more than one week and less than 3 per cent lasted more than six months.
He said that pharmacists should assess advice, assist and arrange follow-up,
refer to a specialist service and recommend NRT. Smokers should be encouraged
to use NRT, as it would more than double their chances of quitting. Dr Raw added
that smoking cessation was a far more cost-effective intervention than using
statins. Eighty-five per cent of people who should be given statins were smokers
aged over 50 who would fall below the risk level for statins if they stopped
smoking.
He said that NRT should be available to smokers through all health care systems
and welcomed the British Governments’ recent statements on making NRT available
on NHS prescription. He mentioned a new web base resource (Treattobacco.net)
which he was involved in developing along with the Society for Research in Nicotine,
the WHO, the US Centers for Disease Control, the Cochrane Centre and the World
Bank. The web resource was not yet available but would include executive summaries,
references, reviews articles and teaching tools. It would be free to all users.
Mr Jerome Reinstein (World Self-Medication Industry) said that nicotine was
not harmful and should be widely available. He said that in some poor countries
the cost of keeping a tobacco habit going could amount to 30 per cent of an
individual's income. He also said that NRT was a lot more expensive than cigarettes
in developing countries and this issue needed to be addressed. He agreed that
pharmacists were important because of their accessibility.
Dr Terry Maguire (director, Northern Ireland Centre for Pharmacy Postgraduate
Education and Training) talked about the results of an Medical Research Council-funded
study that he had carried out with colleagues at Queens University of Belfast.
Of 484 people enrolled in the study, 265 received the “Pharmacy Action
on Smoking” intervention and 219 had acted as controls receiving ad hoc
advice about smoking cessation. Twelve months’ abstinence, as confirmed
by urinary cotinine measurements, was 14.3 per cent for the PAS group and 2.7
per cent for controls. This was a significant difference.
Barriers
Qualitative research had examined the barriers to the use of the PAS model,
which included time, remuneration and clients’ motivation. Twenty-six pharmacies
had enrolled the 484 smokers; 60 pharmacies had enrolled no one. Pharmacist
attitudes to smoking cessation and its relevance to their practice were paramount
in the success of the project, said Dr Maguire. The original PAS model did not
take the cycle of change into account and targeted all smokers. Smoking Challenge
2000, which superseded PAS, took into account the cycle of change and only those
who were in the preparation or action stages were offered NRT. Those in precontemplation
were given brief advice and those in contemplation were given a brief motivational
interview. Smoking Challenge 2000 was an excellent model and was good for business.
Pharmacists could use it effectively within the time constraints of a busy pharmacy,
Dr Maguire concluded.