Electronic cigarettes are as effective as nicotine gum for smokers wanting to quit
MD-FM Thursday 12th September, 2013
Sarah: MD FM, Medical News from around the world with Peter Goodwin
PETER: Hello! And with me is Sarah Maxwell. Firstly, we report from the 2013 European Respiratory Society Annual Congress just held in Barcelona, and a study also reported in The Lancet
SARAH: It’s the first trial comparing electronic cigarettes with nicotine patches for helping smokers to quit. The researchers recruited over 600 smokers who wanted to quit smoking and randomized them to use e-cigarattes, patches or placebo e-cigarettes, ones without any nicotine in them. And all three methods turned out to be equivalent! But according to lead investigator Chris Bullen e-cigarettes could be a welcome option because they’re getting popular
Bullen 1: “One of the key features about this product is that people like using them. Millions of people are trying them so a large number of smokers are actually trying to quit who have perhaps never tried to quit before. It may be that the mass appeal could have a mass benefit”
SARAH: Professor Chris Bullen, Director of the National Institute for Health Innovation at The University of Auckland in New Zealand. And he was hopeful that electronic cigarettes could be a worthwhile addition to range of existing products, supplying nicotine to addicts, that are less harmful than smoking
Bullen 2 : “There is some suggestion that these might be a good harm-reduction product but we would have to be confident that reducing the number of cigarettes is a prelude to quitting. If it means that they need to use nicotine products for the rest of their life to avoid smoking again, I think you could say from a harm reduction perspective that’s a good thing. If it means that, what we found, where people were smoking and using e-cigarettes, and that goes on for many many years: that’s not good for them. Reducing the number of cigarettes smoked is good from a perspective of some conditions but from the perspective of having a mycocardial infarction or stroke even one cigarette is dangerous”
SARAH: Chris Bullen, from New Zealand.
PETER: And the Barcelona conference heard some strong views expressed by Professor Andrew Bush from Imperial College London: outrage at his own government’s failure to adopt plain packaging for cigarettes, a form of anti-smoking legislation trail-blazed by the Australian government which he believes has a proven track record in cutting smoking rates.
SARAH: Yes. Prof. Bush picked out findings just published in The European Lung White Book, that lung conditions are responsible for 1 in 10 of all deaths across Europe, and earnestly need out attention, including smoking prevention. He told MDFM another key message was that good lung function starts at birth, and babies who don’t have a good start can have poor lung function for the rest of their lives
Bush 1: “We’ve really got to focus our energies into making sure that children are born in the healthiest condition possible, and maintain that health, because by the time you’re six years old your lung function is set for the rest of your life. One of the things that is clear, that impacts on the baby’s lung health, are factors in the mother’s pregnancy: so high blood pressure in pregnancy diabetes in pregnancy use of antibiotics by the mother in pregnancy”
SARAH: Andrew Bush also said that bacterial flora can affect lung health in new-born children, positively or negatively, and that along with things like maternal smoking and hypertension, delivery by C-section could impair lung health as it could deny the baby access to the mother’s vaginal flora needed to stimulate immune systems.
Bush 2: “Obviously if a mother needs a caesarean section because that’s the only way to deliver the baby safely then clearly the caesarean section must be done. But we need to think that the caesarean section may have more profound effects than we thought and perhaps we need to think is the rise in caesarean section rate is necessarily a good thing?”
SARAH: Professor Andrew Bush from Imperial College in London.
PETER: Also from the ERS Congress, on a rapid diagnostic testing has decreased the waiting time for detecting drug resistant TB. Traditional methods of drug-susceptibility testing can take anywhere between 21 days to 3 months because you have to collect a sputum sample first and then do a culture. A new study from the USA of three different rapid tests, in over 1,000 patients from India, Moldova and South Africa, gave results quicker, in between five and 15 days which were the same as with standard testing, 95 per cent of the time for almost all the usual TB drugs.
PETER: How can you be sure your patient takes any medicine you’re prescribing? Adherence to preventive anti-HIV medication prescribed to the un-infected partners of patients with HIV/AIDS was the topic of a fascinating paper in PLOS Medicine.
SARAH: That’s right and according to the authors it helps explain why field trials of drug treatments can often have widely varying outcomes. The author Jessica Haberer told MDFM that they wanted to find out why the use of prophylactic anti-AIDS therapy wasn’t universally successful. So they set up a study in Kenya and Uganda in sero-discordant couples using a whole team of health workers to check up on adherence. And their hard work paid off
Haberer 1: “ They had very high adherence and the most exciting thing that we found in our study was that in the context of objectively measured high adherence we found 100 per cent efficacy with this drug. So there were 14 infections within the 1147 couples that we studied and all 14 of those were in people taking placebo”
SARAH: Dr Jessica Haberer from Harvard University an the Massachusetts General Hospital in Boston, USA. She reckons adherence is relevant in many areas of medicine and more attention needs to be given to it. And the secrets of success?
Haberer 2: “The best way to help support adherence is to ask your patients what the barriers may be and to help them think of solutions. I think physicians often make assumptions about what patients need and often that information comes best form them, so they may be able to identify a financial barrier, a transportation barrier, or something like depression and that will help you support them in that process and potentially bringing in other resources like family members of friends.”
SARAH: But on the efficacy of prophylactic HIV medication in the real world, London expert Richard Hayes wasn’t optimistic about the scope for ensuring the levels of adherence needed
Hayes : “That was quite an intensive intervention and I think, to me, the remaining question is still: If you rolled out this kind of intervention on a very large scale, if you tried to get people in the general population to use this approach, how could you practically ensure acceptable levels of adherence? Because this intervention they trialled was pretty intensive really, and it’s difficult to see whether that could be provided on a very large scale”
SARAH: Richard Hayes, Professor of Epidemiology and International Health at the London School of Hygiene and Tropical Medicine.
PETER: In the New England Journal of Medicine there’s a fascinating study of testosterone supplementation, that was conducted with the help of 400 healthy men in the United States, a country where prescriptions for testosterone jumped five hundred per cent in less than a decade:
SARAH: Yes, the Boston researchers suppressed natural androgen production in these volunteers and then compared the effects different levels of testosterone supplementation had on their body composition, strength and sexual function. Androgen deficiency was associated with decreases in lean mass, muscle size and strength; while the estrogen deficiency that goes along with low testosterone was associated with increases in body fat. Both androgen and estrogen were linked to sexual desire.
PETER: The big question though is, which men really need testosterone supplements? Hypogonadism is usually diagnosed on the basis of a level of testosterone two standard deviations below normal, but that’s just arbitrary!
SARAH: Yes and the whole point of this study was to find out what the clinical effect of using testosterone might be. As a result of their meticulous research the authors suggest that there could be a big application of androgen supplementation in older men to prevent frailty, fractures and the ability to live independently: but they urge that more specific studies need to be done to establish the parameters. BREVE 1 Sur fond musical
PETER: Finally, in brief
In research on Middle East respiratory syndrome coronavirus infection, a combination of ribavirin and interferon-alpha 2b stopped the virus from replicating in cell culture. In a second study, rhesus macaques with the infection (MERS-CoV) treated by the same two-drug regimen showed no breathing difficulties and only minimal X-ray evidence of pneumonia compared to untreated animals.
Among patients with diabetes, use of an outpatient electronic health record in an integrated healthcare delivery system was associated with modest reductions in emergency department visits and hospitalizations. That’s according to a study published in the JAMA, which also found that there wasn’t any change in rates of visits to the doctor’s office.
That's all from MDFM for now. Sarah Maxwell and I will be back with more next week, so until then, from me Peter Goodwin, goodbye.