American College of Physicians: Internal Medicine — Doctors for Adults ®

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From the June 1997 ACP Observer, copyright © 1997 by the American College of Physicians.

Nicotine

The article Research spurs new views of nicotine in the February issue of ACP Observer included interesting data on a few diseases that occur less frequently in smokers than in nonsmokers and information on possible therapeutic benefits of nicotine. Unfortunately, the article also contained important misstatements, such as suggesting that new research points to "certain beneficial effects of nicotine—and (raises) serious questions about smoking cessation efforts."

Nicotine can be administered as a single therapeutic agent, independent of a smoke delivery system such as a cigarette, and independent of the more than 4,000 substances found in cigarette smoke. The only individuals or groups raising questions about the value of smoking cessation efforts are those who benefit financially from the sale of tobacco products.

The article also seems to question whether nicotine is addictive. Nicotine use fulfills the primary criteria of drug addiction: compulsive use, psychoactive effects and drug-reinforced behavior. The use of tobacco products is a complex, learned behavior that is woven into the fiber of daily living and is linked to how smokers deal with their world.

Fortunately, effective smoking cessation therapy is available. A recent guideline from the Agency for Healthcare Policy and Research Practice concluded that three therapeutic modalities are effective: nicotine replacement therapy, social support through clinician-provided encouragement and assistance, and skills training on techniques to achieve and maintain smoking cessation.

I hope that the readers of ACP Observer remember that smoking is the most important cause of preventable disease, disability and death in developed countries. Clinicians play an extremely important role in helping their patients to quit smoking.

John H. Holbrook, FACP
Salt Lake City, Utah

Too many people are likely to make pro-nicotine arguments out of the ACP Observer article on nicotine. ACP continues to be involved in the scientific method and should have little tolerance for the type of conjectural, pseudo-science offered by Matthew M. Hine, MD.

We already live in an era of medical myth and meandering. We don't need the august ACP Observer adding fuel to the flames of fallacy.

J. Vance Fentress, FACP
Ardmore, Tenn.

I would have expected to see your article on nicotine in a tobacco journal, not in ACP Observer. Tobacco is a drug like cocaine, and possibly worse. The number of people that tobacco kills—as well as the millions of tobacco-related illnesses—is well documented in the literature.

Suresh S. Shah, FACP
Lockport, N.Y.

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