June 2, 2008

Lend an ear to quit smoking forever

IF YOU are an incorrigible smoker, but secretly long to give up your addiction, then lend an ear. Auriculotherapy (ear acupuncture) is back in fashion as an anti-smoking aid.

Saturday is World No Tobacco Day, and the World Health Organisation says smoking is still the leading preventable cause of death globally, causing one in 10 deaths among adults, mostly men. In SA, government efforts to reduce smoking appear to be working. Cigarette sales have dropped by 33% in the past decade and 77% of adults dont smoke.

For those who cant help puffing, experts say nows the time to look at new approaches to cessation aids.

Ear acupuncture is enjoying a resurgence in popularity, but it is not exactly new. Medical texts show it was documented in Nei Jing, or Huang Ti Nei Jing (Canon of Medicine) in full, the earliest extant Chinese medical text, compiled during the period known as the Age of War (500 BC).

It was popularised in the West by French neurologist Dr Paul Nogier in the 50s. So successful was Nogier at appropriating the ancient Eastern wisdom, that he became widely known as the father of auriculotherapy.

Auriculotherapy is defined as a therapeutic intervention to stimulate specific acupuncture points on the ear. Traditional acupuncturists use needles. Modern methods include laser probes, magnetic balls and stainless-steel coils. Treatment usually lasts about 30 minutes.

In 1996, the US Food and Drug Administration approved the use of acupuncture needles by licensed practitioners. By law, disposable needles must be used to prevent infection and disease transmission.

Ear acupuncture as an anti- smoking aid came to SA in the hands of another Frenchman, orthopaedic surgeon Dr Victor Bran, who trained in Nogiers method in Lyon. Bran emigrated to SA and practised the method for more than 30 years.
He retired last year. Randburg, Johannesburg GP Dr Gavin Zipp trained with Bran, and now offers the treatment. He says it is unique as it removes the nicotine craving and deals with the usual withdrawal symptoms, and has no adverse side effects. He claims a 95% success rate after just one treatment if patients have a firm resolve to stop smoking, and are aware of and deal with habits and associations related to smoking.

Needle-phobes need have no fear. Zipp uses stainless-steel coils from China. The coils are currently the most effective available treatment option, and cause minimal, if any, discomfort.

Dr Ella Jardine is a Johannesburg medical doctor and acupuncturist who studied Chinese traditional medicine at Shanghai University in China. She has used acupuncture as an anti-smoking aid for years. For optimum results, she treats the whole body, not just the ears. She uses smaller, flatter, needles in the ear and replaces them with natural seeds left in after treatment. Pressing the seeds when patients feel the urge to smoke helps them cope, Jardine says.

In China, traditional medicine doctors recommend a treatment every second day for 10 sessions. Jardine gives one treatment and leaves it up to patients to decide if they need more.

Dr Yussuf Saloojee, executive director of the National Council Against Smoking, says virtually every smoker benefits from stopping smoking, regardless of age, disease state, or years of smoking. For most people, stopping smoking is not a tortured impossible process 10% find it very easy; for the majority (80%) it is somewhere between easy and difficult; for 10% it is very, very hard.

He says ear acupuncture is not generally considered an effective treatment. He cites a US Cochrane review of 24 trials comparing active acupuncture with sham acupuncture (using needles at points supposedly incorrect for the condition). The review found no consistent evidence that active acupuncture or related techniques increased cessation success rates, but not enough evidence to dismiss the possibility of an effect greater than placebo.

Saloojee says behavioural counselling and pharmacotherapy are each effective, but the two together produce the most success.

Nicotine replacement therapy (in patch, gum, spray or inhaler form) doubles the chance of quitting. The therapy is safe in stable cardiac disease, but caution is needed in unstable, acute cardiovascular disease, pregnancy, or breast feeding, he says.

Saloojee says the latest anti-smoking drug, Varenicline (Champix), is probably the most effective single medicine for smoking cessation. It mimics, then blocks, nicotines actions in the brain and is thought to work by reducing the strength of the urge to smoke and relieving withdrawal symptoms. It often causes mild side effects (such as transient nausea), and there has been concern about depression and suicidal thoughts, but risks are low, he says, and adverse events are uncommon.

However, in the US last week, Reuters says hundreds of patients taking Chantix (as Champix is known in the US) have reported serious accidents, vision problems and heart trouble. US aviation regulators responded quickly, saying they would prohibit use of the drug by commercial and private pilots, and consumer advocates have called for stronger warnings on the drugs label.

The antidepressant, bupropion (Zyban), doubles quit rates when used with intensive behavioural support, Saloojee says. It is generally safe and well tolerated. Contraindication is an increased risk of seizures.

Scientists are developing radically new approaches for smoking cessation based on a better understanding of brain chemistry and the actions of nicotine, and these may prove more effective than current treatments, he says. In 2006, clinical trials on a vaccine against tobacco addiction began in the US. It works by preventing nicotine from reaching the brain.

The vaccine stimulates the immune system to produce antibodies to nicotine in the blood, says Saloojee. This stops or at least reduces the amount of nicotine reaching the brain.

Drugs of abuse such as nicotine or cocaine, contain small molecules which easily slip across the blood-brain barrier (this is essentially a filter that protects the brain from potentially damaging substances), he says.

With the vaccine, antibodies attach to nicotine in the blood and make the resulting complex too big to pass into the brain. The result: Smoking stops being pleasurable or calming and the drive to smoke is reduced. – MARIKA SBOROS


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