I'm a little puzzled. I've read you're post "Money Medics and etc..." I reread my post to make sure I didn't mistake something. I said there are many examples of faulty thinking on the part of the FDA and you say offer information to the contrary in your post, but when I read over your post, I can't find anything about the FDA in it....and it was never my intention to state that the FDA is right to ban eciggs... I believe the opposite, really. It sounds as though our sentiments about the FDA are similar.
I'm sorry, my post was too brief to convey the correct meaning. For 'FDA', read 'MHRA' - the issues are the same in the UK.
We know that the rank and file scientists and researchers at the FDA make decisions that are overridden by senior management for political (i.e. money) reasons. We don't have the same information for MHRA staff as there haven't been any whistleblowers yet. The policies seem identical though: designed to benefit the industry, not public health.
.....I assure you that most doctors don't know anything about eciggs or their existence, so they couldn't know of their potential benefit to help their patients quit smoking.
This is a shame because if a doctor suggests the use of Swedish Snus (the genuine article, that is) as a smoking replacement, there is probably a better chance the patient might succeed than with pharmacotherapy. In Sweden, that approach has been incredibly successful and now 20% use Snus, 12% smoke. They reduced their smoking prevalence by 40% and now have the lowest prevalence in the developed world. Mortality is falling in parallel. More than 150 trials over 25 years show no statistically significant difference in health outcomes for Snus users and those who totally quit. There is a slight increase in risk for stroke over a non-smoker, but no increase in risk for heart disease or any kind of cancer (including oral cancer). It would seem possible that 10% or more might find Snus acceptable, which would be at least double the success rate for most pharmacotherapies.
E-cigarettes have a success rate ranging from 31% (1 trial with less than ideal conditions for uptake) to ~75% anecdotally. They have potential to change the whole landscape (see
Quotes).
The Allen Carr / Easyway organisation have claimed a 53% success rate for getting people off smoking, and apparently that was obtained in an approved trial and published in a peer-reviewed journal.
So if doctors did have this information, just like advising the consumption of low-fat foods, they could also suggest these solutions. It would be preferable in every possible way to pharmacotherapy.
Also, many prescribers, myself included don't receive any perks from pharmaceutical vendors. In Mass, we can't even get pens anymore
I'd take a guess that the majority of researchers, and those academics in healthcare with no main position, are funded either directly or indirectly by pharma. This creates a clear bias in the research and in opinion papers published. The propaganda published on behalf of the pharmaceutical industry by medics in their pay has created a great deal of ill feeling here, for researchers in particular, but there is some spillover for medics in general. This isn't helped by the habit of prescribing therapies that don't work, leading to a return to smoking.
Finally, I don't think there is an appreciation here about the pressure a prescriber is under from their patients to write a prescription. I can't tell you how many times I've said no to giving someone a medication that wasn't in their best interest, or at least recommended therapy in addition to a medication, which most folks don't want. Many people want a quick fix. Patients are also part of the problems.
Yes - I hadn't appreciated that.
To say that medical professionals wouldn't embrace a cure for smoking that didn't involve writing a prescription is suggesting they have poor ethics, which is far from the truth for most of us. I have to be honest that I'm offended to be put in that category.
My apologies - that para you quoted reads differently from how I imagined it when writing, on reading it again - so I've edited it. It refers to those with specific knowledge of these issues.
Perhaps I haven't appreciated the lack of knowledge about this area? I didn't mean to offend and will take another look at that article. There is no point in accusing people of something if they don't know the issues... Perhaps it's just that we are so mad at those who do know the score: anyone involved with health and smoking.
It's worth pointing out though that many of us feel doctors should not prescribe for smoking cessation. The success rate for pharmaceutical interventions is no higher than an average of 5%, apart from Chantix. This has a slightly higher success rate but has significant risks (two trials showing a 1 in 30 risk of a cardiac event, apart from the other issues). We know that doctors are given what are essentially false figures for the success rates for pharmacotherapies and wonder why they seem to swallow this kind of misinformation.
Why is it that some doctors say up to 80% of patients they see are there because of lifestyle choices, therefore lifestyle choices are logically the most important part of medicine, not just preventive medicine; but that doctors swallow the hogwash pharma feeds them, and seem to know little or nothing about harm reduction, which in the area of smoking saves orders of magnitude more lives. It's as if medics haven't heard of the Swedish Miracle, when smoking is the biggest health issue out there and so many lives could be saved.
I'll answer my own question: it's because the information available is to some extent controlled by pharma. Maybe you can understand why some of us hate them with a vengeance.
