Camus photograph censorship bid fails

Photographic impression of Albert Camus by Cartier-Bresson has been allowed to remain on display in spite of campaign by French Green party activists.

Smoking still a part of life in France

Funny how life can be so different in two countries separated only by the English Channel. In Andrew Lansley's England smoking is no longer a part of life. In France, defiance of the smoking ban has been reported widely in Paris. The French non-smoking organisation Droits des Non-fumeurs describes the volume of complaints about smoking violations as 'colossal'.

Some more reasons that smoking is not likely to disappear any time soon are discussed here.

Champix and the heart

A number of media stories concern reports that Champix may be responsible for an elevated risk of heart attacks. The Mail, the Express, the Independent, Medical News Today and others including the Scotsman all carry the story. The increased risk is said to be 72 per cent, which while being around three times greater than the alleged risk of secondary smoke exposure causing lung cancer or heart disease is still not conclusive.

Alone among these stories, the Scotsman makes no mention of the injuries associated with Champix. Not everyone is affected by them, but many disturbing after-effects have been reported, some of which have led to suicide – enough to make many users and their friends call for the drug to be banned.  There are also reports that adverse incidents were reported through 'improper channels' (and here) in order to cover them up.

Study author Singh said: "I think our new research shifts the risk–benefit profile of varenicline. People should be concerned. They don't need Chantix to quit and this is another reason to consider avoiding Chantix altogether." Champix's history has been enough to get the drug withdrawn in France. It didn't need an inconclusive study on heart troubles to conclude that Champix could well be more trouble than it's worth.

Interestingly Medical News Today also states this:

Varenicline has been shown to modestly increase the chances of a successful quit attempt, compared to unassisted smoking cessation attempts. But overall, the majority of smokers who quit do so without any pharmaceutical assistance at all.

Surely this is a cue for a stop to ridiculous claims like this? and thousands of pounds of public money poured into smoking cessation aids, when most quitters don't need them.

Yet another problem with Champix (cardiovascular)

Reports today indicate slightly raised risks of cardiovascular problems. A recent trial of patients with cardiovascular disease showed patients taking Champix were slightly more likely to experience heart problems than those taking a placebo.

Written warnings accompanying the drug will warn patients of this risk and Pfizer will be required by the FDA to carry out further studies in order to establish the risk more clearly.

The risk is said to be 'small' – that will surprise no one! What beats me is why anyone will take it for such a limited outcome:

An independent randomized trial of 700 smokers with cardiovascular disease who were treated with Chantix or a placebo showed that Chantix was effective in helping patients quit smoking for as long as one year. [emphasis added]

Other problems are by now well documented:

Chantix has been associated with agitation, depression and suicidal thoughts, and, in clinical trials, linked with nightmares. Psychiatric symptoms have occurred in people without a history of mental illness and have worsened in people who already had mental illness. [emphasis added]

 To this, we can add an apparent cover up of adverse incidents involving Champix.

Federal Food and Drug Administration officials acknowledged that they asked Pfizer to resubmit thousands of records after realizing that the company was sending required reports in an inappropriate format that could not be added to the agency’s Adverse Events Reporting System, or AERS.

The French Health Minister has recently delisted Champix as a publicly funded drug. I put the point to the local NHS trust in Scotland, putting the point that the French Minister had banned the drug and requesting its withdrawal by NHS Lothian. Their reply follows:

The Scottish Government does not advise upon the licensing and safety of medicines since this is not a devolved power for the Scottish Government. As such, they are would not be in a position to withdraw this medicine from use across Scotland . The Medicines and Healthcare products Regulatory Agency (MHRA) is the UK organisation responsible for the licensing of medicines and monitoring of the safety of these medicines. Information on this organisation and its activities to ensure public safety with medicines can be found at http://www.mhra.gov.uk/index.htm 

The MHRA has had varenicline under intensive surveillance for the last couple of years to ensure that the benefit to patients continues to outweigh any potential risks. They work in collaboration with the international drug safety monitoring network to ensure safety of medicines. A copy of an article writtten for their publication the Drug Safety Update on this can be seen at http://www.mhra.gov.uk/Safetyinformatio ... /CON087722 . They encourage all healthcare professionals and patients to be vigilant in reporting any suspected side effects with this medicine. Patients and healthcare professionals can report any suspected reactions for medicines at http://yellowcard.mhra.gov.uk/

At present there has not been any indication given by the MHRA that varenicline should not be used; but continued monitoring of safety is ongoing. Therefore it remains licensed for use within the UK . Prescribers have been made aware of the risk; and should be taking this into consideration when deciding if the potential benefit to the patient before prescribing for a patient. There is no move currently to discontinue use of the medicine in appropriate patients that are likely to recive benefit. If, however, there is additional warnings issued from the MHRA of safety concerns (or indeed recommend withdrawal from use), then NHS Lothian and all other Health Boards across Scotland would then comply.

I hope this information is of use to you.

Yours sincerely

Melinda Cuthbert

Lead Pharmacist Lothian Medicines Information Service/Yellow Card Centre Scotland, Pharmacy Department, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA

Clearly MHRA needs to be notified of public concern. It is extraordinary that a drug with such effects is recommended, subsidised, to the general public, especially people with a psychiatric history, when even those without such a history are disturbed by it.  ASH Scotland's most recent update (scroll down this link) on Champix and mental health says:

Clinical trials during drug development excluded patients with active psychiatric illnesses leaving the risks associated with varenicline use in this patient population unknown. A review of the evidence in Expert Opinion on Drug Safety has concluded that although the risk of potential neuropsychiatric events is evident through voluntary reporting systems and reported cases in the literature, multiple studies and case reports support the use of varenicline in the mental health population. 

As often, I take a diametrically opposing view.

Champix off the approved list in France: risks outweigh benefits

They kept this one quiet. (Or have I been asleep for a week?) Hat tip Chris Holmes.

The pill, called Champix in Europe and Chantix in the U.S. but known generically as varenicline, has been tied to everything from violent rages to suicidal thoughts. Reported side effects of Chantix have led to hundreds of lawsuits nationwide, including one filed last month in Pennsylvania following a 2009 murder-suicide.

French health Minister Xavier Bertrand said Tuesday he decided to remove the drug from a list of approved treatments available for reimbursement through his country’s social security funds because of questions about its safety.

About bloody time. Well done the French Health Minister. Some recent history is also included in this report:

In another controversy surrounding the drug, the U.S. Food and Drug Administration announced late last week that Pfizer had been asked last year to resubmit thousands of reports on adverse events related to Chantix, a request that came after it was revealed the company had not sent the information through proper channels.

The adverse-event information had been sent as a periodic safety summary rather than as a report required within 15 days for unexpected or fatal events, the FDA said.

I could comment but time is short today. Chris has already said what had to be said (comment 5):

Medical authorities the world over CLAIM to have the best interests of patients at heart. They CLAIM to be approaching these problems logically and scientifically.

Therefore it should be standard practice everywhere to try all safe methods FIRST, and only proceed to methods that involve any risk at all if none of the safe methods work. It is an absolute no-brainer. Hypnotherapy, acupuncture and the Allen Carr approach (which is a mild form of hypnotherapy anyway) have all proven themselves to be more effective in the long term than any of the meds, and they all involve NO RISK.

Why are they not being used as a priority to avoid damage to patients? Because of the massive lobbying power of global drug giants and their immoral influence over politicians and medical authorities.

It’s corruption, and it is killing people. Think I’m exaggerating, calling this sort of thing corruption? Check this out: GlaxoSmithKline have just revealed how much cash they lavished on Australian doctors and other medical personnel last year alone: over two million dollars, of which $371,659 was just to go on merry junkets to conferences abroad. In the age of the internet, none of this is necessary but it certainly makes people feel important, doesn’t it? Would YOU like an all-expenses paid trip to Vienna? But that’s nothing: in the same period GSK spent a staggering $96,000,000 on doctors in the USA (link here). Why? Because money talks.

But so do smokers! Spread the word, don’t risk the slimy meds. Even Pfizer can’t force their drugs down your throat. Doctors, I keep telling you: you’ll miss your credibility when it’s finally gone forever. You are signing it away with your own prescriptions pads with dodgy drugs like Champix, every working day of your lives.

BUT HOORAY FOR THE FRENCH HEALTH MINISTER! Monsieur Xavier Bertrand, I salute you! Bravo!

He's right. Champix is a drug that is being used to treat something that is far from being universally recognised as a sickness: the desire to give up smoking. And it's not only not the safest option, it's got a known track record (and I don't mean in getting people off tobacco). So let's stop spending our 'health' money on it.

Citibank predicts that smoking will cease

Citibank predicts that smoking in the UK will expire by 2050 in the UK. It produces a table with data based on national smoking rates across several countries:

	% of the population that smokes	Citi's earliest prediction for end of smoking
Australia	17	2030
Belgium	20	2051
Canada	18	2040
Finland	21	2093
France	25	2118
Germany	23	2280
Greece	40	2231
Iceland	16	2033
Italy	23	2091
Japan	24	2054
Netherlands	28	2048
New Zealand	18	2058
Norway	21	2042
Spain	26	2056
Sweden	15	2028
United Kingdom	21	2040
United States	21	2046

I find it interesting that two countries that have announced that they will eradicate smoking in the medium term, Finland and New Zealand, according to this table, won't actually achieve it until relatively late: New Zealand in 2058, and Finland in 2193. Netherlands (where there has been a huge backlash to the recent smoking restrictions) kicks the habit in 2048, but France carries on till 2118, 70 years later, and the Greeks for more than a century after that.

The predictions are based on fifty years' decline in smoking rates, and reports stress that 'if this continues', smoking will die out by the dates indicated.

If this causes any jitters in the stock market I doubt they will last. Ireland's smoking rate appears to have increased again after a short-term decline following their ban in 2004, and Scotland is failing to meet targets.