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New Guidelines Challenge All Clinicians to Help Smokers Quit

June 27, 2000

Health care professionals have new evidence and tools to help patients quit using tobacco, according to a report issued by the U.S. Public Health Service (PHS). A private-sector panel of smoking cessation experts convened by the federal government challenged all clinicians, insurance plans, purchasers, and medical school officials to use the evidence in the new guideline to make treating tobacco dependence a top priority.

President Clinton has issued a memorandum directing executive departments and agencies to encourage federal employees to stop smoking, to promote greater use of available smoking cessation programs, and to review current federal tobacco cessation programs in light of these new guidelines.

The PHS guideline, "Treating Tobacco Use and Dependence: A Clinical Practice Guideline," contains evidence-based information about first-line pharmacologic therapies (bupropion SR, as well as nicotine gum, patches, inhalers, and nasal sprays) and second-line therapies (clonidine and nortriptyline). It also highlights new evidence about how telephone counseling can help patients quit.

"There has never been a better time for health professionals to help their patients break free from the deadly chronic disease we know as tobacco addiction," said David A. Satcher, MD, Assistant Secretary for Health/Surgeon General. "Starting today, every doctor, nurse, health plan, purchaser, and medical school in America should make treating tobacco dependence a top priority."

The guideline is aimed at practicing clinicians. Studies have shown that more than 25 percent of U.S. adults smoke and that 70 percent of them would like to quit. Of those smokers who try to quit, those who have the support of their physician or other health care provider are the most successful.

"Anyone who uses tobacco and is committed to quitting needs to know that tobacco dependence is a chronic disease that, like high blood pressure or diabetes, frequently requires treatment over time to get it controlled," said Michael C. Fiore, MD, MPH, chair of the guideline panel and director of the Center for Tobacco Research and Intervention at the University of Wisconsin Medical School in Madison. "In my view, a doctor isn't providing an appropriate standard of care for his or her patients if he or she doesn't ask two key questions — 'Do you smoke?' and 'Do you want to quit?' — and then work with that individual to make it happen."

Data show that only half of the smokers who see a doctor have ever been urged to quit, even though smoking is the single greatest preventable cause of illness and premature death in the United States. People who smoke are at increased risk of heart disease, cancer, and other smoking-related illnesses that contribute to more than 430,000 deaths a year. Nationwide, medical care costs attributable to smoking (or smoking-related disease) have been estimated by the Centers for Disease Control and Prevention (CDC) to be more than $50 billion annually. In addition, the CDC estimate the value of lost earnings and loss of productivity to be at least another $47 billion a year.

The guideline concludes that tobacco dependence treatments are both clinically effective and cost-effective relative to other medical and disease prevention interventions. The guideline urges health care insurers and purchasers to include, as a covered benefit, the counseling and pharmacotherapeutic treatments identified as effective in the guideline and to pay clinicians for providing tobacco dependence treatment, just as they do for treating other chronic conditions.

The tobacco cessation guideline was developed by a consortium convened by the U.S. Public Health Service that includes: The Centers for Disease Control and Prevention; the National Cancer Institute; the National Institute on Drug Abuse; the National Heart, Lung, and Blood Institute; the Agency for Healthcare Research and Quality; the Robert Wood Johnson Foundation; and the University of Wisconsin Medical School's Center for Tobacco Research and Intervention. It builds on a smoking cessation guideline first issued by the government in 1996. In addition, more than 100 organizations are supporting this effort.

An article by Dr. Fiore that presents the findings of the updated guideline appears in the June 28 issue of the Journal of the American Medical Association.


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