Quit Before You Do

Doctors typically wait until smokers are ready to quit before prescribing pills to help them do it. But a new study has found that even for those who are not ready to stop smoking immediately, medicine taken over time can substantially improve their chances of eventually quitting.

Clinical practice guidelines have long advised doctors to have their patients set a precise quit date before prescribing medicine such as Chantix, the pills used to treat nicotine addiction that were examined in the study. The idea was that such medicine should not be prescribed for someone who is not serious about quitting. In some cases, insurance plans would not pay for the pills if no quit date had been set.

But in a study published in JAMA on Tuesday, researchers found that even for patients who wanted to stop smoking eventually, the pills were effective, opening the way to a much larger population of patients whom doctors could potentially treat.

David Abrams, executive director of the Schroeder Institute for Tobacco Research and Policy Studies, said studies of nicotine replacement therapy, such as patches and gum, had long shown that attempts to quit gradually over time are a good way to change lifetime habits. The current study appears to show the same for pills, he said.

“Sometimes serious addiction needs to be coaxed down the stairs one at a time, not thrown off the top floor,” said Dr. Abrams, who was not involved in the study.

The study was funded by Pfizer, the drug company that makes Chantix, a treatment that costs about $250 a month. Federal regulators require companies to conduct studies proving the effectiveness of such therapies, and monitor them closely. The practice is common for smoking cessation therapies, said Robert West, director of tobacco studies at University College London, who was among the study’s authors. If such studies were funded by the government, which sustains a lot of academic research, taxpayers would bear the burden for what the company would eventually profit from, he said.

Still, some researchers not involved in the study said the topic required more work.

“The approach taken here is a very reasonable one that appears to have been successful,” said Gary A. Giovino, a professor of health behavior at the State University of New York at Buffalo. “But the findings from one study do not make a fact. We need more studies, funded by someone other than the company that makes the product.”

Smoking is the largest cause of preventable death in the United States, killing more than 480,000 Americans a year. The smoking rate has declined substantially since the 1960s, but the pace of decline has slowed in recent years and health experts are trying to figure out how to get more smokers to quit.

About 1,500 patients at 61 clinics in the United States and abroad participated in continued…

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