ASH Daily News for 01 August 2008

Smoking interferes with treatment for bipolar mania

Research shows that cigarette smoking is associated with worse treatment outcomes in acutely manic patients with bipolar disorder.

Investigator, Felicity Ng of the University of Melbourne and colleagues comment: "Rather than allowing the passive acceptance of smoking as a prevalent lifestyle habit among patients with mental illness to continue, clinicians could adopt an alternative stance that views smoking as a comorbid condition requiring active intervention."

Around one third of patients with bipolar disorder are smokers and the odds ratios for nicotine dependence are estimated to be 3.9 and 3.5 for bipolar I and II disorders, respectively, in comparison with the general population.

Studies have shown that lifetime history of smoking is significantly related to earlier onset of the first depressive or manic episode, greater symptomatic severity, poorer functioning, and a lifetime history of suicide attempt, comorbid anxiety disorders and substance dependence.

"Despite existing literature investigating the relationship between smoking and bipolar disorder course, the impact of smoking on the efficacy of bipolar treatment has yet to be explored in the context of rigorous clinical trial data," Ng noted in the Journal of Affective Disorders.

In the current study, the researchers reviewed evidence from three randomized controlled trials of antipsychotics for acutely manic patients with bipolar disorder.

From a total of 807 patients, over half (n=467) were smokers.

When data from all three studies were pooled, non-smokers showed significantly greater improvements than smokers on both Young Mania Rating Scale and Clinical Global Impressions scale for bipolar disorder mania severity scores.

Notably, the impact of active smoking on treatment outcomes became apparent in the medium- to-long-term rather than in the first few weeks of treating acute mania.

The researchers note that nicotine, the primary psychoactive compound in tobacco smoke, acts as an agonist at nicotinic cholinergic receptors, mediating the widespread release of neurotransmitters such as dopamine, noradrenaline, serotonin, γ-aminobutyric acid (GABA) and glutamate.

Since antipsychotics act as serotonin and dopamine antagonists, smoking may interfere with their therapeutic action.

Regardless of the underlying mechanism Ng and colleagues advise: "For bipolar and depressive disorders, patients may benefit from being specifically counselled on the importance of addressing smoking as part of their mood disorder management."

Source: Medwire News, 01 August 2008
Link: http://tinyurl.com/5s4gx5

Few aware that smoking can cause bladder cancer

While most people know that smoking can cause lung cancer, a new study shows that few know that it is a major risk factor for bladder cancer -- even among people who have the disease.

In a research review published in the Journal of Urology, investigators found that in one recent study, just over one third of adults knew that smoking raises the risk of bladder cancer. In contrast, 98 percent correctly identified the habit as a risk factor for lung cancer.

What's more, a study of patients with early stage bladder cancer found that just 22 percent knew that smoking contributes to the disease.

All of this points to a serious shortcoming in patient education, according to Dr. Seth A. Strope and Dr. James E. Montie of the University of Michigan Health System in Ann Arbor.

"A big gap exists between patient knowledge and their actual risk," Strope said in a written statement.

Smoking is believed to be responsible for half of bladder cancer cases, so quitting could substantially reduce a smoker's risk of the disease and for those successfully treated for bladder cancer, quitting can reduce the chances of a recurrence.

One study Strope and Montie reviewed found that when smokers with bladder cancer quit after their diagnosis, they reduced their risk of recurrence by about 30 percent compared with patients who continued to smoke.

Despite this, the researchers found that many smokers, even those with bladder cancer, say their doctor never advised them to quit. In a government study of U.S. adults, only half of smokers with a physician said they had received advice to quit. And a UK study of bladder cancer patients found that only 7 percent said their urologist had told them to quit smoking.

"Our study suggests that physicians must do a much better job of communicating the risk to our patients, and directing them toward smoking cessation programs," Strope said.

Source: Reuters News, 30 July 2008
Link: http://tinyurl.com/555r3d

Canada: Big tobacco to pay $1.15 billion over contraband product.

Two of Canada's biggest tobacco companies will pay $1.15 billion in criminal and civil penalties after pleading guilty to customs charges related to contraband cigarettes and smuggling.

Under separate court settlements in Montreal and Toronto, Imperial Tobacco Canada Limited was fined $200 million and Rothmans Benson & Hedges $100 million as part of the criminal charges.

The companies will pay another $815 million in civil damages to the federal and provincial governments over the next 15 years.

In total, Ottawa will receive $575 million, with the provinces getting the rest of the $1.15 billion.

The companies pleaded guilty to "aiding persons to sell and be in possession of tobacco manufactured in Canada that was not packed and was not stamped in conformity with the Excise Act," the RCMP said.

Revenue Minister Gordon O'Connor hailed the settlement and the RCMP said the fines are the largest ever levied in Canada.

O'Connor said, "Today's announcement sends a clear message that governments right across Canada are united in their efforts to enforce Canada's tobacco tax laws and fight contraband tobacco in this country."

"Together the civil and criminal payments effectively ensure that no monetary benefit was realized as a result of these activities."

Garfield Mahood of the Non-Smokers Rights Association said while he welcomed the fines, justice escapes us because none of the executives who presided over the operation went to jail.

"There's no winners in this because the industry has addicted a whole bunch of young people who then became lifetime annuities for these companies. Over time the companies will financially benefit. And literally thousands of people will die in the future as a result of this crime."

Almost immediately following the announcement, Rothmans announced it will be acquired by Philip Morris International Inc. for $2 billion, or $30 per share in cash.

"We are pleased to have resolved this issue," said Imperial Tobacco president Benjamin Kemball. "Today's events give our business the stability it needs to move forward."

In a statement, RCMP assistant commissioner Mike Cabana said the guilty pleas bring to an end more than eight years of investigation by the force and the Excise sections in Ontario and Quebec.

The charges involved the shipment of contraband tobacco in Canada to locations in the U.S. and near the Canada-U.S. border between 1989 and 1994.

From there, it was distributed to smugglers or black-market distributors who brought it back into Canada for further illegal distribution.

The smuggling operations became so pervasive that it caused governments to roll back tobacco taxes, reducing the price of cigarettes to similar levels that existed in the U.S.

Rob Cunningham, an anti-smoking activist and author with the Canadian Cancer Society said, "That brought an end to smuggling, but it made cheap cigarettes available throughout Canada."

It set the stage for today's black marketing in cheap cigarettes. He said since taxes were hiked after 1999, independent manufacturers have taken up shop in several native reserves, most notably in Akwesasne, near Cornwall, Ont., and the Six Nations reserve near Brantford.

He said, "We now have a different problem today, and it's very significant and growing. But the actions of the tobacco companies 15 years ago did fuel a capacity for contraband networks to exist." 

Source: Canadian Press, 01 August 2008 
Link: http://tinyurl.com/5gavuu

Canada: NS: One year later, tobacco display ban is something to be grateful for

Think back to this time last year. Remember the large, colourful walls of tobacco displays and promotional items that tobacco companies provided to virtually every convenience store, supermarket, and gas station?

These point-of-sale (POS) advertising displays made tobacco use seem normal and appear safe. The result was a belief among youth that "everyone" smokes, which made it more likely they would try smoking.

Many countries, including Canada, have restricted or banned traditional forms of tobacco advertising. In response, tobacco companies made POS advertising one of their main marketing tools. POS advertising increases the amount of tobacco sold and the number of people who smoke. It also increases impulse buys by smokers and it is a significant trigger for ex-smokers to re-start.

The effects of POS advertising are backed up by research, but the best evidence that POS advertising works is the fact that, in 2005, Canadian tobacco companies paid over $100 million for the right to advertise cigarettes in retail stores. In 2001, this payment amount was $74 million.

Keeping tobacco products completely out of sight protects children and youth from starting to use tobacco, it makes it easier for people quitting smoking and for former smokers to stay smokefree. Since Aug. 1, 2007, most retailers in Nova Scotia have complied with the revised Tobacco Access Act by storing tobacco products out of sight and removing all tobacco promotional signs and products.

Tobacco use is the largest preventable cause of death and illness in Nova Scotia, causing over 1,700 deaths each year in the province. The nicotine in tobacco products is very addictive and is the main reason that most people continue to use tobacco. Tobacco is the only legal product that causes the death of one in two people who use it.

Tobacco retail displays increase the likelihood children and youth will start to smoke.

Studies have shown that children and teens who often visit stores with tobacco displays, or who recall seeing tobacco displays, are more likely to start smoking. POS advertising is associated with encouraging youth to try smoking by creating the belief that smoking is a normal behaviour. There is also evidence that this type of advertising influences youths’ intention to smoke in the future.

Tobacco retail displays trigger impulse buys and return to smoking for people who quit.

Almost 40 per cent of smokers who have tried to quit have had an urge to buy cigarettes as a result of seeing POS displays. An in-depth study showed that participants had an urge to smoke when they saw these displays.

Nova Scotia’s Tobacco Access Act does make an exception for tobacconists. A store that only sells tobacco, tobacco accessories and lottery tickets, all products that can only legally be sold to adults, may display tobacco products under the Act. Retailers therefore have the choice to continue selling other products and put the tobacco out of sight, or become tobacconists and be legally allowed to display tobacco.

Putting tobacco completely out of sight conveys a strong public message that tobacco products are neither safe nor desirable. Thank you to the retailers and legislators who made this possible in Nova Scotia.

Source: Nova Scotia News, 31 July 2008
Link: http://tinyurl.com/5ly6px

USA: House approves FDA regulation of tobacco

The U.S. House approved a bill to give the FDA power to regulate tobacco products and ban certain flavourings in cigarettes. 

The bill exempts menthol additives from the ban, a moved watched carefully by Greensboro-based Lorillard Inc. Lorillard has the most market share of any tobacco company in the menthol category. For the second quarter, the company's Newport brand accounted for 34.6 percent of the market, up almost a full point since the same period last year.

The bill does include a provision that calls for a scientific review of menthol in cigarettes. Critics have said flavorings, including menthol, are targeted at younger and African-American smokers.

In a statement, Lorillard said "the addition of a multibillion dollar a year industry for the FDA to oversee, when the agency is already struggling to fulfill its core mission, is misguided."

According to federal disclosure forms, Lorillard spent about $1.7 million lobbying lawmakers to oppose the bill through the first half of the year.

Reynolds American Inc., based in Winston-Salem, also opposes FDA regulation on tobacco. It has a smaller menthol market share than Lorillard, but the company is testing a product called "Camel Crush" which allows smokers to change a cigarette from regular to menthol by crushing a capsule in the filter. Reynolds said this week it plans to expand that product nationally by September.

Commonwealth Brands, which has a plant in Reidsville, produces menthol cigarettes under five of its six labels.

While the measured passed the House, industry watchers said the bill is unlikely to see action in the Senate until a new Congress begins its session after the first of next year.

Source: Bizjournals, 31 July 2008
Link: http://tinyurl.com/6nexgv