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Monday,August 18,1997
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Studies may reveal powers of nicotine
Duke researcher wants to make quitting possible
The Associated Press
Jed Rose of Duke University runs one of the country's leading laboratories designed to learn exactly how nicotine grips most of the nation's 46 million smokers. Government figures indicate that 419,000 people die annually from smoking-related illnesses.
DURHAM, N.C. — At a school in a city built on the country's appetite for cigarettes, a researcher is unlocking the secrets needed to wean smokers offtobacco.
The hows and whys of nicotine addiction intrigue the 45-year-old psychiatrist and motivate research at the Nicotine Research Center.
Rose works at an office just a short drive from the headquarters of cigarette maker Liggett Group and for a university founded on tobacco money.
"The basic question is why people want the things they want. Why do people really pursue them," Rose said. "I got hooked on nicotine research."
"He's absolutely at the forefront of using medication to help people quit smoking," said Jaylan Turkkan, chief of the behavioral sciences research branch at the National Institute on Drug Abuse in Rockville, Md.
His patients are tested as they use patches and inhalers to help stop the urge to smoke. Some experiments use resolution imaging of brain receptors to determine where nicotine spreads with each puff. Rose also is working on a promising patch-and-pill combination.
"The basic question is why people want the things they want. Why do people really pursue them."
Even with all the medicines and tests, most patients don't succeed. Ernie Smith of Raleigh started a cessation program in hopes of ending a 50-year habit. He made it to four weeks, until he and his wife separated.
Jed Rose
Duke University
At his weekly test, the retired IBM employee blows into the smoker's equivalent of a lie detector, a machine showing the amount of carbon monoxide in the lungs. He admits to smoking a few cigarettes a day.
"It's kind of hard to give up an old friend," a frustrated 65-year-old Smith told Rose.
If the tentative $368 billion tobacco settlement reached in June is approved and provides smokers with money for programs to kick the habit, the center's findings on nicotine and the smoking ritual will help determine ways to use the funding wisely.
"My worry is always that people make the false assumption that somehow we have the answers and that we have the treatment," Rose said.
The truth, Rose said, is that while much is known about nicotine, the active chemical that gives cigarettes their power is still a mystery.
Why can some people light up only occasionally while others never can seem to grind out that last butt?
"It's a hard habit to break," said grocery clerk Brian Tapp of Raleigh, dragging on a Basic cigarette while taking a break from his job. "I've tried the chewing gum, and that didn't work. And I've tried the patch, and that kept falling off, so I suit that, too."
Answers are discovered with patients like Tony Micale, a accountant who smoked his first cigarette at age 8. He and 400 others are part of a study combining nicotine patches and a medication called mecamylamine, which was designed as a blood pressure controller. The drug has shown promise in reducing the satisfaction of smoking.
Micale, 41, said he hasn't lit up since the therapy began last September.
The body absorbs nicotine through receptors in places like the brain and lungs. A nicotine patch provides that chemical to the receptors without the tar and smoke of cigarettes. And according to an earlier, smaller study, mecamylamine actually blocks receptors, thereby reducing the craving to light up.
The results are encouraging. Thirty-four percent of the nation's smokers try to quit each year, but only 2.5 percent succeed. Using the nicotine patch, the cessation rate is about 15 percent. Preliminary results show that with the patch-mecamylamine combination, the success rate climbs to 40 percent.
Rose hopes to win U.S. Food and Drug Administration approval for the combination in a year or two.
His research goes beyond chemicals to a study of the ritual of smoking.
"The typical run-of-the-mill smoker has had thousands and thousands of pairings between smoking a cigarette and getting some sort of pleasurable effect," Rose said. "And those pathways have been hammered over and over. But then you give them a patch. There's something that doesn't give him any of the taste and any of the rituals."
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