US: Barack Obama signs historic smoking bill

President Barack Obama has signed into law a bill giving the government historic powers to curb cigarette makers, declaring the move emblematic of the change he is bringing to Washington. Mr Obama affixed his signature to the measure with a nod to his own struggles to kick the habit, and lamented the fact that 1,000 people under the age of 18 become regular smokers every day, courting a range of grave health risks.

"I know, I was one of these teenagers, and so I know how difficult it can be to break this habit when it's been with you for a long time," he said. "I also know that kids today don't just start smoking for no reason – they're aggressively targeted as customers by the tobacco industry. They're exposed to a constant and insidious barrage of advertising where they live, where they learn, and where they play."

The law grants the Food and Drug Administration (FDA), a regulatory body, the authority to ban flavourings added to some tobacco products and require tough new warning labels, in a bid to lessen tobacco use among young people. Mr Obama argued that the bill's passage was just the latest sign that he was living up to his promise to forge fundamental political reform.

"When I ran for president, I did so because I believed that, despite the power of the status quo and the influence of special interests, it was possible for us to bring change to Washington," he said. "And today, despite decades of lobbying and advertising by the tobacco industry, we passed a law to help protect the next generation of Americans from growing up with a deadly habit that so many of our generation have lived with."

Under the new law, the FDA will create a new Center for Tobacco Products to oversee the science-based regulation of tobacco products in the United States. It bans cigarettes dominantly flavoured with candy, fruit and spice by October this year, and forces tobacco firms and importers to submit information to the FDA about ingredients and additives in tobacco products. The measure places strict limits on tobacco advertising in publications with a significant teenage readership, and bans the use of words like "mild" or "light" in advertisements that make tobacco products seem safer.

The FDA will now be required to enforce a rule banning all outdoor tobacco advertising within 1,000 feet of schools and playgrounds, and the bill ends all tobacco-brand sponsorship of sport and entertainment events. Under the measure, tobacco companies must disclose to the FDA the ingredients in their products, and allow the agency to require changes to protect public health, though not to reduce nicotine content to zero or ban a class of tobacco products.

Larger and more specific health warnings will now have to cover the top third of the front and rear panels of tobacco product packages and the FDA will have the power to require graphic warning labels that cover half of the front and rear panels. The bill was backed by health groups like the American Cancer Society, the American Heart Association and the American Lung Association for its curbs on smoking, the number one cause of preventable death in the United States.

Source: The Telegraph, 22 June 2009
Link: http://tiny.cc/CCoL6

NHS hospitals to pilot proactive approach to smoking cessation

The Department of Health will this week launch a new proactive smoking cessation pilot scheme at 35 hospitals in England. The aim is to increase the number of patients receiving ‘effective and timely stop smoking advice when in hospital’.

Hospitals in the pilot scheme will have to identify every smoker admitted and ensure they are offered support to quit, with care pathways for brief interventions and referrals to NHS Stop Smoking Services. A ‘hospital champion’ to act as a link person for all stop smoking activity must also be appointed.

If referrals to NHS Stop Smoking Services are successfully increased, the approach will be rolled out to further hospitals in November or December. The pilot builds on evidence, a Cochrane Review published in 2007, that stop smoking programmes that begin during a hospital stay and include follow-up support for at least one month after discharge are effective.

A similar programme to identify and treat all smokers admitted to the University of Ottawa Heart Institute, in Canada, between April 2003 and March 2004 found that 44% of smokers identified at admission were smokefree six months later. If rolled out nationally, the scheme would be the world’s first national standardisation of stop smoking interventions in secondary care. The pilot is due to be launched at the UK National Smoking Cessation Conference in London.

Source: Nursing Times, 23 June 2009
Link: http://tiny.cc/q1CoT

Pill to make smokers forget their craving

A blood pressure pill might help people quit smoking. Researchers believe that the beta blocker drug works on certain brain chemicals and effectively deletes some of the memories associated with the habit. It is these memories which help drive the craving and lead to thousands of would-be quitters relapsing.

There are an estimated 10 million smokers in the UK — around a quarter of men smoke, which is just slightly more than the number of women who do. While 70 percent try to give up each year, only 5 to 15% manage to do so for more than 12 months.  One of the most popular aids for quitting smoking is nicotine replacement therapy (NRT), which comes in the form of gum, patches, lozenges or inhalers. NRT works by releasing nicotine steadily into the bloodstream at much lower levels than in a cigarette, and without the tar, carbon monoxide and other poisonous chemicals found in tobacco smoke.

However, while NRT tackles the physically addictive nature of smoking, it might not tackle the desire or craving to smoke. The new treatment, known as memory reconsolidation blockade, targets this craving and could be used in conjunction with nicotine replacement therapy. Smoking, along with many drug addictions, triggers an increased release of the brain chemical dopamine, a neurotransmitter that is involved in controlling movement, emotional response, the ability to experience pleasure and pain, and short-term memory.

One of the latest theories on addiction is that this high level of dopamine tricks the brain into thinking the addictive substance is important to it. When the memory of that addictive substance is triggered - by an environmental cue such as holding a glass of wine or drinking coffee - this produces a positive emotional response. This, in turn, leads to a craving for the substance.

Scientists have for some time been investigating the idea that blood pressure pills - beta blockers - can affect aspects of memory. According to a University of Maryland report, one of the potential side-effects of beta blockers is memory loss. One theory is that some beta blockers interfere with the chemical norepinephrine, which is involved in the brain's natural 'filing system'. Every time we recall a memory it is changed a little, which means it then has to be 're-filed'. Beta blocker drugs somehow interfere with this process, although not obliterating the memory itself, just the emotional response it provokes.

Previous studies on animals have shown that those given injections of a beta blocker were less likely to recall being afraid of certain things. In the trial at Massachusetts General Hospital, smokers who have smoked at least ten cigarettes a day for the past three months are being given the beta blocker propranolol. The study, which involves 50 smokers, includes a smoking cessation phase, where the men and women will be given nicotine patches, and a relapse prevention phase where they will be assigned to receive either propranolol or a placebo once a week for six weeks. During this time, they will regularly be exposed to their own personal environmental smoking triggers.

'It is a very exciting concept,' says Dr Paul Kenny of the Scripps Research Institute, a leading researcher in the field. 'The theory is that it blocks or erases memories associated with smoking. There is much incentive to discover and develop novel and efficient therapies for the treatment of tobacco addiction.'

Dr Ken Checinski, consultant psychiatrist and senior lecturer in addictive behaviour at St George's, University of London, said: 'It is always exciting to have novel variants of inducing behaviour change. This is a promising approach and we should watch for the results with interest. It will not be a "magic bullet", as smoking behaviours have multiple causes. However, if smokers with cue-related craving are targeted, this might be a particularly powerful method.'

Source: The Daily Mail, 23 June 2009
Link: http://tiny.cc/ybRPp