The Cure that Didn't

This story does an especially good job of highlighting the cult of addiction. It's about Chantix - a prescription drug to help people quit smoking from Pfizer. According to the company's website, it works by targeting the same receptors that nicotine targets, providing a (presumably) non-addictive nicotine-like buzz while suppressing the symptoms of nicotine withdrawal.

Here's the comedy. From the Chantix website:

Some patients have reported changes in behavior, agitation, depressed mood, suicidal thinking or behavior when attempting to quit smoking while taking CHANTIX. If you experience any of these symptoms, or if your family or caregiver observes these symptoms, please tell your doctor immediately. Also tell your doctor about any history of depression or other mental health problems before taking CHANTIX, as these symptoms may worsen while taking CHANTIX. ... You may have trouble sleeping, vivid, unusual, or strange dreams while taking CHANTIX. You should use caution driving or operating machinery until you know how quitting smoking with CHANTIX may affect you.

And indeed, the link to the article (the first link) tells of how the FAA is now prohibiting pilots from using the drug because people have been having vision problems and heart trouble.

What we have here, in other words, is a "cure" that's worse than the disease. Not only that, but it doesn't seem to be too terribly effective. The Chantix website claims a 44% success rate, but - and here's the laugh - adds that "You may benefit from quit smoking support programs and/or counseling during your quit attempt." That's because, in fact, their trials included accompanying weekly counselling sessions. Oh, and it turns out it's not really as effective as 44%. Pfizer gets that rate by - get this - measuring cessation rates inside of 12 weeks. If you measure them any later than that, it's really only 23%. And if we recall that there were weekly counselling sessions during the 12-weeks of the trial, we have to admit we don't really know what portion is accounted for by the accompanying counselling aid. Now, when you consider that 9% of the people in the placebo group remained off cigarettes after 52 weeks, you might be tempted to conclude that the counselling alone accounts for 9%. But that's silly - because if the same counselling was administered to the placebo group it's likely to have been less effective (since the placebo group wasn't having their withdrawal symptoms artificially supressed, and since their 7 "free" days of smoking at the beginning - Chantix treatment starts you off with a "free" week during which the drug keeps nicotine from being effective - didn't include conditioning them to see cigarettes as just nasty-tasting without the nicotine buzz, then obviously their counselling sessions weren't tailored to their actual situation). If a different counselling session was administered, then we've introduced a rather serious confound and can't really trust the data at all.

So what we seem to have is an expensive way to probably not quit with rather serious side-effects. Wonderful. If that isn't unintentional self-parody, I don't know what qualifies.

Some people are amazingly weak. The bottom line is that nicotine addiction is a choice. Going to the store, putting money on the counter, purchasing a pack of cigarettes, putting one in your mouth and lighting up is a string of choices. Quitting smoking involves interrupting this chain at some point - a thing that anyone who is conscious of his own actions can do. When you fall off the wagon with smoking, it's because avoiding the withdrawal symptoms has become more important to you than giving up. That is the bottom line, and no drug that merely lessens your withdrawal symptoms changes the terms of the game. Until they come out with a drug that instantly alters your chemical makeup to remove the dependance altogether, some amount of willpower will be involved. The dismal success rates of these drugs owe to this: anyone who believes they can quit with "just a little push" from Chantix doesn't understand what willpower is. Willpower isn't "I will do this if it's easy." Willpower is just "I will do this."

To be clear, I'm not joining in the crazy cacophony of people who seem to think that the FDA should bar Chantix on grounds of insufficient effectiveness. I don't personally see the difference between legal cigarettes and legal Chantix, honestly. Pfizer, of course, needs to come clean about the results of its trials, but since as far as I can tell the information is out there on the internets for all of us to read, then consumers can make up their own minds whether it's worth it to them to try - just as they can make up their own minds whether it's worth it to them to smoke, in fact. No - I'm not calling for a ban on Chanrix. I'm just pointing out that Chantix and things like it are indisputably effective in at least one way: highlighting how silly the "quit smoking" industry is. Chantix reportedly made Pfizer $277million last quarter, and the recent 5% drop in prescription rates has sent the company's stock down 1.2%. Just stop to marvel at the concept: there's an almost $300million make-or-break-a-company market in peddling a painful and probably dangerous experience that is 77% likely to turn out to have been a failure a year later.

The following line from this About.com article sums up the situation nicely:

A drug that has the potential to help 22 out of every 100 people using it quit smoking is impressive indeed.

Since when does the "potential to help" a mere "22 out of every 100 people" rate as "impressive?" A fool and his money, as they say...