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Two new drugs — both oral, rather than injected — may soon be available to combat multiple sclerosis.
Three studies, all being published early online Jan. 20 in the New England Journal of Medicine, find that the new drugs — fingolimod and cladribine — reduce relapse rates in people with relapsing-remitting multiple sclerosis (MS). Both drugs work by altering the immune system response.
However, as is often the case with immune-suppressing medications, there are concerns about side effects, including an increased risk of serious infections and possibly, cancer.
“Oral drugs are what people with MS have been wishing for a long time. This is wonderful news for people with MS,” said Dr. John Richert, executive vice president of research and clinical programs for the National Multiple Sclerosis Society (NMSS). “The drugs appear to be quite effective, and at the moment, appear to have a reasonable risk-benefit ratio. However, it will be very important for people with MS and their physicians to remain vigilant and be on the lookout for side effects.”
All three studies were funded by the drug’s manufacturers — Novartis for fingolimod and Merck Serono for cladribine. Both manufacturers are currently pursuing U.S. Food and Drug Administration approval for their medications.
Multiple sclerosis is a chronic, potentially disabling illness that’s believed to be an autoimmune disorder. In MS, the body’s natural defense system mistakenly attacks the fatty substance that protects the nerves (myelin). About 400,000 Americans have multiple sclerosis, according to the NMSS.
The current treatments for MS are all injectable medications, which Richert said is sometimes a barrier for people to start early treatment. He said that treatments may be more successful if they’re started early in the course of the disease, so he’s hoping that having oral medications will help people start treatment sooner.
Two of the new studies focused on the oral medication called fingolimod. Both were phase 3 studies. One study included more than 1,000 people with relapsing-remitting MS. The study participants were randomly selected to receive a daily dose of 0.5 milligrams (mg), 1.25 mg or a placebo.
Annual relapse rates were less than 1 percent each year, but were 54 percent less for the lower dose of fingolimod and 60 percent for the higher dose. The study also found slower disease activity and progression.
In the second study on fingolimod, 1,153 people with relapsing-remitting MS were randomly assigned to receive a daily dose of 0.5 mg or 1.25 mg of fingolimod or a weekly dose of 30 micrograms of interferon beta-1a (Avonex) for one year. The annual relapse rate on either drug was less than 1 percent in this study as well. However, the people on fingolimod had up to a 52 percent lower relapse rate. This study found no significant differences in disease progression between the two treatments.
Both studies found that the lower dose of the drug was better tolerated. A small number of serious infections occurred, including two deaths from herpes infections in these studies. And, there appeared to be a higher incidence of cancer in people taking fingolimod.
Still, “the fact that fingolimod is given orally is a huge advantage,” said the lead author of the yearlong study, Dr. Jeffrey Cohen, director of experimental therapeutics at the Mellen MS Center at the Cleveland Clinic in Ohio. “It appears to be effective and is generally well-tolerated.”
The third study, also a phase 3 study, looked at the oral medication cladribine in comparison to placebo. In this study, more than 1,300 people with relapsing-remitting MS were randomly assigned to receive a cladribine dose of either 3.5 mg or 5.25 mg per kilogram of body weight or a placebo. During the second year of the study, those on cladribine were all given the lower dose.
As in the fingolimod studies, annual relapse rates were less than 1 percent. However, those on cladribine had relapse rates that were up to 58 percent lower. Disease activity and disability scores were also lower in the treatment groups.
Although the drug appeared to be generally well-tolerated, there were some serious side effects with cladribine as well, including serious herpes zoster infections. Herpes zoster is the virus that causes shingles, and there is a vaccine available for this virus. Whether getting the vaccine prior to treatment would lessen the risk of infection isn’t clear because it hasn’t been studied, said Richert. Cladribine was also associated with a potentially increased risk of cancer.
Another question that remains to be answered for both medications is whether or not they will increase the risk of a very serious brain infection known as progressive multifocal leukoencephalopathy (PML). It wasn’t discovered that the MS medication, natalizumab (Tysabri), caused a slight increase in the rate of these infections until the drug came to market. That’s because it’s such a rare side effect.
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If the U.S. swine flu epidemic isn’t over, it certainly looks as if it’s on its last legs. While federal health officials are not ready to declare the threat has passed and the outbreak has run its course, they did report Friday that for the fourth week in a row, no states had widespread flu activity. U.S. cases have been declining since late October.
One U.S. expert said the epidemic has “one foot in the grave,” and there are many reasons to believe there won’t be another wave later in the year.
For one thing, the virus has shown no signs of mutating. The vaccine against it is effective. And roughly half the people in the U.S. probably have some immunity because they were infected with it or got vaccinated.
The World Health Organization is witnessing an international decline as well, and is discussing criteria for declaring the pandemic over. Britain this week shut down its swine flu hot line, which was set up to diagnose cases and give out Tamiflu.
“Clearly, the last four weeks have been one of the quietest January flu seasons I can remember in my career,” said Michael Osterholm, a prominent expert on global flu outbreaks with the University of Minnesota.
Since its emergence last April, swine flu has caused an estimated 15,200 deaths worldwide, mostly in the U.S. — a much lower number than initially feared. The positive outcome is primarily because the virus didn’t mutate into a deadlier form.
Even so, experts have praised the actions of the U.S. and Mexican governments and scientists who quickly developed an effective vaccine.
Criticizing the government for its intense response would be like chastising officials for building dikes in New Orleans to withstand a Category 5 hurricane and then seeing only a Category 3 come ashore, Osterholm said.
“The government did not overreact,” said University of Michigan flu expert Dr. Arnold Monto, echoing Osterholm’s point.
Whether it will stay quiet for the rest of the winter is hard to say, but some experts are beginning to lean that way.
“If it’s not dead, it’s weakening fast. It’s got one foot in the grave,” said Dr. William Schaffner, a flu authority at Vanderbilt University.
A poll released Friday by the Harvard School of Public Health found that 44 percent of Americans believe the outbreak is over.
The Centers for Disease Control and Prevention released numbers Friday showing most states continued to have only occasional flu activity last week. However, only three states had absolutely no reports, and a CDC official cautioned that swine flu is still around and is likely to keep infecting people for weeks or months to come.
“We don’t seem to be seeing the disappearance of this virus,” said the official, Dr. Anne Schuchat.
Whether there will be another wave of swine flu — as was seen in the spring last year and again in the early fall — is a much harder question, she added.
Her comments reflect a raging debate among scientists. One expert told The Associated Press he thinks a spike in H1N1 cases is likely by May, though perhaps a smaller one than last fall. Another said he did not expect another spike. A third predicted another wave, but not until next fall at the earliest. A fourth refused to even guess.
An estimated 70 million Americans have been vaccinated against swine flu through a government campaign that started in October. Counting those who have already been infected and others who were vaccinated, perhaps 40 percent of the public has some immunity to the virus.
However, that means at least half of Americans don’t have immunity, and there are many places that have not been hit hard by swine flu yet, some experts noted.
Also, this is a global disease that can move quickly through air travel, and much of the rest of the world is not vaccinated, Osterholm pointed out.
Experts give health officials generally good marks for their handling of the pandemic, even with months of delays in the production of swine flu vaccine.
About 60 percent of the 1,400 adults in the Harvard poll said U.S. public health officials did a good or excellent job in dealing with the pandemic. More than half said the government devoted the right amount of attention to the outbreak.
The telephone survey was done in late January and had a margin of error of plus or minus 3.2 percentage points.
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Associated Press Medical Writer Maria Cheng contributed to this report from London.
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Elderly black Americans use fewer medications than whites and are more likely to skip taking their meds, a new study finds.
It included 100 black and 100 white patients, aged 60 and older, who were interviewed at the start of the study, and again six months and one year later.
Overall, whites used more medications, had more chronic medical conditions and used more physicians. Whites were more likely than blacks to have adequate health literacy skills (58 percent vs. 29 percent) and less likely to be unable to afford medications (12 percent vs. 28 percent).
The most common problems for both whites and blacks were: medication non-adherence (42 percent vs. 68 percent), under treatment (83 percent vs. 87 percent), suboptimal drug use (59 percent vs. 66 percent), and suboptimal dosing (48 percent vs. 56 percent).
The findings support previous research showing that elderly black patients have higher rates of medication non-adherence than whites. But, overall, medication-related problems are prevalent and persist in both races, the researchers said.
“Strategies to better measure the quality of medication use in older adults are needed, and efforts to improve the quality of medication use in older adults must account for potential differences in both the number and types of problems affecting whites and blacks,” concluded Dr. Mary Roth and her colleagues at the University of North Carolina at Chapel Hill.
The study was published online Dec. 11 in the Journal of General Internal Medicine.
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The new swine flu is scary, no doubt about it. But here’s the information you need to better understand the illness and the ways you can protect yourself and your family from infection.
Understanding the Swine Flu Virus
Human influenza, or the “flu,” is a viral infection that usually occurs seasonally and is transmitted between people. The viruses are categorized into two major types, A and B, and subtypes, named H and N. The current swine flu is a new type of influenza A virus, H1N1, which has not previously been seen. This strain is unusual in that it appears to be a cross between strains that infect swine, birds and human beings. While this new strain may yet present some surprises, we know a lot about how influenza is transmitted and how to slow or break that cycle.
The main way that influenza viruses are spread is person to person via the respiratory droplets of coughs and sneezes. The virus is transmitted when these infected droplets land on the mouth or nose of people nearby or when people touch respiratory droplets on another person or an object, and then they touch their mouth or nose or rub their eyes before washing their hands. Swine flu is not spread by eating pork or other food, and pigs pose little risk of viral transmission.
Protecting Yourself and Your Family from Infection
The bottom line of protecting yourself is to practice good hygiene and avoid coming into contact with the virus.
Keep your hands away from your face or wash them first. Stay away from crowds. Avoid contact with sick people if you can. If you can’t, wash your hands often with soap and water. Be sure to use a paper towel to turn off the faucet handles so as not to recontaminate your hands. The same paper towel precautionary measure applies to doorknobs. If you can’t wash your hands, use an alcohol-based hand sanitizer with at least 60 percent alcohol.
Cover your mouth when you cough and sneeze. Teach your family to do the same and to discard used tissues promptly. If no tissues are available, it is better to cough or sneeze into your sleeve than your hand. They should wash their hands immediately, before they contaminate other surfaces with infective secretions.
Keep ill family members away from others at home and stay at home unless medical care is needed. Masks are most effective when worn by infected people to prevent the spread of the virus, so if you are infected and you must go out, wear a mask to reduce the transmission of infected droplets to others. While masks are not effective against small viral particles that may be airborne, and airborne transmission may occur, large infective droplets are probably a major factor and the one that a mask can best protect against. Wear a mask if you are within six feet of an ill person. N-95 masks must fit tightly to work effectively. Don’t worry if you don’t have an N-95 or a fancy surgical mask. The key to prevention is to keep droplets away from your nose, mouth and eyes. You can use a cloth bandana or similar accessory to cover your nose and mouth. Change paper or cloth masks frequently. (In hospitals, N-95 masks are recommended because of higher exposure rates.)
Seek medical care promptly if you become ill with flu-like symptoms-fever, generalized aches, sore throat, cough, runny nose, vomiting, diarrhea and lethargy-especially if you are having trouble breathing. The antiviral medicines Tamiflu and Relenza are quite effective if taken within the first 48 hours of your symptoms’ appearance. If you are exposed to the new 2009H1N1 virus, you might also benefit from prophylactic antivirals to prevent infection, especially if you have underlying health problems. Check with your doctor.
Warning: Do not give aspirin (acetylsalicylic acid) to children or teenagers who have the flu; this can cause the serious and possibly fatal Reye’s syndrome. NSAIDS (nonsteroidal anti-inflamatory drugs) such as ibuprofen (Advil, Motrin), naproxen (Naprosyn, Midol) and acetominophen (Tylenol) are safe to administer for their symptomatic relief.
Remember, staying away from crowds and using good hygiene can help you prevent the contraction of many flu illnesses and give you some measure of reassurance during this flu outbreak.
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U.S. regulators see benefits to using an AstraZeneca Plc cholesterol drug in a vast new group of patients but will ask outside advisers to probe various safety issues, documents released on Friday said.
AstraZeneca wants permission to promote the Crestor drug, for preventing heart disease in people with normal cholesterol levels but other risk factors based on findings of a large study known as Jupiter.
A Food and Drug Administration reviewer, commenting on a higher number of diabetes cases reported with Crestor patients, said that, at the current time, the benefits seen in the Jupiter trial “outweigh the risk, but further clinical trials are needed to further define this benefit/risk ratio.”
The Jupiter trial “was relatively short in duration” and “therefore the long-term complications are unknown,” the reviewer said.
The reviewer also said the agency felt it was a “chance finding” that gastrointestinal-related deaths were higher in Crestor patients compared with a placebo.
The comments were included in documents the FDA released ahead of a meeting on Tuesday of a panel of outside advisers.
The advisory panel will be asked to comment on the diabetes and gastrointestinal findings before deciding whether to recommend approval for expanded use, according to a November 12 memo. The FDA also will seek input on a higher number of patients who reported a “confusional state” in the Crestor group, the memo said.
Barclays Capital analyst Brian Bourdot said he expects the advisory panel to support wider use of Crestor.
“Overall, the FDA review appears benign, with few safety concerns and little disagreement that Crestor shows a significant benefit” in the expanded group, Bourdot said in a note to clients.
The Jupiter study showed Crestor cut deaths, heart attacks and strokes in middle-aged people with healthy cholesterol, but elevated levels of C-reactive protein, which is associated with heart disease.
The FDA said it would ask the advisory panel to “keep in mind that an estimated 6 million middle-aged and older men and women in the United States” meet the criteria of people in the study.
AstraZeneca said in an analysis also released by the FDA that Crestor’s risks in the Jupiter study were “consistent with the known safety profile.” The company said potential side effects were outweighed by the benefits, including a 44 percent reduction in cardiovascular-related deaths, strokes, heart attacks and other problems.
An expanded label for Crestor would boost sales of the drug in the coming years, but industry analysts say the size of the opportunity is uncertain because of the looming arrival of generic versions of Pfizer Inc’s Lipitor in late 2011.
Gbola Amusa of UBS believes the Jupiter results could expand the overall statin market by 20 percent to 50 percent in volume terms, lifting AstraZeneca’s Crestor sales to some $8 billion in 2012 from $3.6 billion last year.
Others are more cautious, and the consensus forecast for 2012 is $6.75 billion, rising to $6.92 billion in 2013, according to Thomson Pharma.
AstraZeneca’s partner Shionogi & Co Ltd also sells Crestor in Japan and recorded $172 million in revenue from the drug in 2008.
The dramatic reduction in heart attack risk seen in Jupiter already has helped boost prescriptions for Crestor since details were unveiled in November last year.
The FDA will make the final decision on whether to allow AstraZeneca to promote Crestor more widely, but it usually follows panel recommendations.
Crestor is a key driver for AstraZeneca as other drugs go off patent, but its exclusivity through to 2016 is being challenged by generic manufacturers in a case due to go to trial in February 2010. AstraZeneca has requested a summary judgment ahead of the trial to eliminate the most significant issue in the case and is awaiting the judge’s decision.
AstraZeneca shares rose 0.9 percent to $45.77 in afternoon trading on the New York Stock Exchange.
(Reporting by Lisa Richwine and Ben Hirschler; editing by Gerald E. McCormick and Andre Grenon)
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The number of Americans with diabetes will nearly double over the next 25 years, rising from 23.7 million in 2009 to 44.1 million in 2034, according to a study by the University of Chicago.
In the same period, medical costs associated with treating the disease will triple from 113 billion dollars to 336 billion dollars, even without a rise in the incidence of obesity, according to the study published in the December issue of Diabetes Care.
“If we don’t change our diet and exercise habits or find new, more effective and less expensive ways to prevent and treat diabetes, we will find ourselves in a lot of trouble as a population,” said lead author Elbert Huang.
The study said its projections, despite being significantly higher than other recent estimates, may be too conservative because they assume the rate of diabetes and obesity, a risk factor for the disease, will remain stable.
In 1991, scientists projected that the number of Americans with diabetes would reach 11.6 million people in 2030, but some 20 years before that date the figure is already double that.
The study’s authors acknowledge that obesity rates have risen steadily in past years, but predict that they will level out over the next decade and then decline slightly from the current 30 percent level to around 27 percent in 2033.
The US health program Medicare, which provides health care for older Americans, spends some 45 billion dollars a year on diabetes treatment for 8.2 million people.
By 2034, the number of people with diabetes covered by the program is expected to rise to 14.6 million, according to the study, with associated costs rising to 171 billion dollars a year.
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ATLANTA – Let us give thanks — and pass the Purell.
Your family might be sharing more than turkey and pumpkin pie this Thanksgiving. Swine flu may also be on the table — and at crowded airports and shopping malls.
Just as the pandemic seems to be waning around the country, some health officials are worried that holiday gatherings could lead to more infections. So the government has launched a new travel-health campaign.
“It’s important to remember the things that everybody can do to stay healthy,” said Dr. Beth Bell of the Centers for Disease Control and Prevention.
Thanksgiving is typically followed by at least a modest bump in early seasonal flu cases, according to reports from the past few years. But this, of course, is not a typical year. Swine flu is a new virus that accounts for nearly all flu cases right now.
Despite weeks of declining infections, health officials are staying vigilant. The federal government is putting up posters in airports, seaports and border crossings in time for Thanksgiving. The campaign also includes advertisements with slogans such as “Stop, Wash & Go.”
The CDC urges people to travel only if they are well, get vaccinated against swine and seasonal flu, wash their hands often, and cover coughs and sneezes with a tissue or sleeve.
Some 33 million Americans are expected to hit the nation’s highways over the Thanksgiving holiday, a slight increase from last year. About 2.3 million more will travel by airplane.
The elbow-to-elbow conditions expected on many flights may pose more of an infection threat than a runny-nosed tike at the other end of a Thanksgiving dinner table. One CDC official even suggested asking that a sick passenger be moved to another part of a plane.
But that’s not likely to happen on a crowded airliner or bus, and it isn’t much of a solution anyway, said a few people waiting at Atlanta’s downtown Greyhound station on Tuesday morning.
“That’s just putting it next to somebody else,” said Judd Nelson, 39, waiting to start a two-day bus trip to Phoenix.
Nelson had not been vaccinated against swine flu, and he did not have any hand sanitizer. He was resigned to his fate if someone with swine flu happens to be aboard his bus.
“The way I look at it is, if I get it, I’m going to get it no matter what,” he said.
Swine flu has sickened an estimated 22 million Americans, hospitalized about 98,000 and killed 4,000 since it was first identified last April. It is similar to seasonal flu but poses a much bigger threat to children and young adults.
Usually, seasonal flu is just getting going in late November, and holiday get-togethers allow illness to jump from small pockets to other parts of the country. Swine flu, in contrast, has been widespread for months.
“It’s not like we expect to see a bunch of infected people going to uninfected cities and towns,” said Andrew Pekosz, a flu expert at Johns Hopkins University.
The swine flu pandemic hit in two waves: first in the spring, then a larger wave that started in the late summer.
For the past three weeks, fewer states have been reporting widespread cases. School closings have dropped to the point that there were none on Monday — the first time that’s happened since late August — though there were six on Tuesday, according to the U.S. Department of Education.
But there are still plenty of ill people — as many as during the peak of many regular flu seasons, CDC officials say.
Indeed, disease trackers are quick to say that flu is unpredictable. A variety of things could happen, including a third wave or a mutation that could make the virus more deadly or less susceptible to medicines.
“We really don’t know what the trajectory is going to be,” said Bell, a CDC epidemiologist who has been a leader in the agency’s swine flu response.
Seasonal flu usually emerges at this time of year, but some experts think swine flu will muscle aside the seasonal viruses. That probably will not be known until next month, said Dr. Richard Whitley, an infectious diseases specialist at the University of Alabama at Birmingham.
At New York’s Pennsylvania Station, Katie Almroth was waiting to board a train Tuesday with her 11-month-old daughter Anna, who’s been vaccinated for seasonal flu but not for swine flu. They were headed to Harrisburg, Pa., to visit relatives for Thanksgiving.
The 33-year-old nurse from Jersey City, N.J., said she was not worried about traveling during the swine flu pandemic, but felt more comfortable on a train than an airplane with her daughter.
“I must admit I did bring little wipes along,” said Almroth, showing the antiseptic wipes she had tossed in her bag with small bottles of hand sanitizer.
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MONDAY, Nov. 23 (HealthDay News) — Body weight and co-existing health problems don’t explain why black colon cancer patients have lower survival rates than whites, U.S. researchers say.
In an effort to determine why blacks have lower survival rates than whites for nearly all cancers, including colon cancers, investigators have explored a variety factors, such as differences in health care access, exposure to risk factors and tumor characteristics. However, the role these factors play in survival rate disparities remains unclear.
In the new study, researchers at the University of Alabama at Birmingham looked at how weight and comorbidity (the presence of other diseases in addition to colon cancer) affected colon cancer survival in 496 patients who had surgery for colon cancer between 1981 and 2002.
Black patients were 34 percent more likely than white patients to have died by 2008, according to the study published online Nov. 23 and in the Dec. 15 print issue of the journal Cancer.
Among patients with early-stage cancer, the risk of death from any cause was 2.2 times higher in those with a high level of comorbidity. Among patients with advanced cancer, being underweight was associated with an 87 percent increased risk of death. However, being overweight or obese reduced the risk of death by 42 percent among patients with stage IV colon cancer, the study authors noted.
These findings were the same regardless of race, which suggests that differences in weight or comorbidity don’t explain why black patients are more likely to die than white patients, the researchers concluded.
“Further efforts are needed to identify the basis for the survival difference by race for patients with colon cancer. A greater understanding of this complex issue may help eliminate the disparity,” research leader Upender Manne said in a news release from the journal’s publisher.
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WASHINGTON – Federal health officials said Tuesday a popular variety of heartburn medications can interfere with the blood thinner Plavix, a drug taken by millions of Americans to reduce risks of heart attack and stroke.
The Food and Drug Administration said the stomach-soothing drugs Prilosec and Nexium cut in half the blood-thinning effect of Plavix, known generically as clopidogrel.
Regulators said the key ingredient in the heartburn medications blocks an enzyme the body needs to break down Plavix, muting the drug’s full effect. Procter & Gamble’s Prilosec OTC is available over-the-counter, while AstraZeneca’s Nexium is only available with a prescription.
“Patients at risk for heart attacks or strokes who use clopidogrel to prevent blood clots will not get the full effect of this medicine,” the agency said in a statement.
Plavix is marketed by Sanofi-Aventis and Bristol-Myers Squibb. With global sales of $8.6 billion last year, it’s the world’s second-best selling drug behind Pfizer’s cholesterol drug Lipitor.
Because Plavix can upset the stomach, it is often prescribed with stomach acid-blocking drugs.
The FDA says patients who need to reduce their acid should take drugs from the H-2 blocker family, which include Johnson & Johnson’s Mylanta and Boehringer Ingelheim’s Zantac. FDA scientists say there is no evidence those drugs interfere with Plavix’s anti-blood clotting action.
Nexium and Prilosec are part of a class of drugs known as proton pump inhibitors, but FDA regulators said they don’t have enough information to say whether other drugs in that class shouldn’t be used with Plavix.
“There’s not enough data to tell us how those drugs interact with,” the enzyme that activates Plavix, said Mary Ross Southworth, FDA’s deputy director for safety of cardiovascular products. “There are ongoing studies looking at those other drugs.”
The FDA said the warnings on Plavix have been strengthened based on a 150-patient study submitted by Sanofi over the summer.
But some consumer advocates said the agency’s action fell short, arguing that regulators should have placed the information in a “black box” warning label, the most serious available.
“This information still has not risen to as prominent a level of warning as it should have,” said Dr. Sidney Wolfe, director of health research at the consumer advocacy group Public Citizen.
Information about the drug interaction between Plavix and other medications is not new. Researchers at pharmacy benefit manager Medco Health Solutions reported last year that taking Plavix with Nexium significantly increased patients’ chances of being hospitalized for a heart attack, stroke or chest pain.
In May, Sanofi and Bristol-Myers updated Plavix’s labeling to advise against using it in combination with certain heartburn drugs.
A Sanofi spokeswoman said Tuesday that the company has bolstered that language labeling.
“We’ve strengthened the label to say that these drugs should be avoided altogether, not just discouraged,” said Noelle Boyd, Sanofi’s senior communications director.
WBB Securities analyst Steven Brozak said the news would put pressure on Paris-based Sanofi and New York-based Bristol-Myers to provide more safety data on their best-selling product.
“This is going to create a chain reaction as patients start calling their physicians, and they are forced to make a spot decision on limited information,” said Brozak. “That’s not gonna help either company’s bottom line.”
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ATLANTA – Cigarette smoking rose slightly for the first time in almost 15 years, dashing health officials’ hopes that the U.S. smoking rate had moved permanently below 20 percent.
A little under 21 percent of U.S. adults said they smoked, according to a 2008 national survey by the U.S. Centers for Disease Control and Prevention. That’s up slightly from the year before, when just 19.8 percent said they were smokers. It also is the first increase in adult smoking since 1994, experts noted.
The increase was so small, it could be just a blip, so health officials and experts say smoking prevalence is flat, not rising. But they are unhappy.
“Clearly, we’ve hit a wall in reducing adult smoking,” said Vince Willmore, spokesman for the Campaign for Tobacco-Free Kids, a Washington, D.C.- based research and advocacy organization.
There’s a general perception that smoking is a fading public health danger. Feeding that perception are indoor smoking laws, cigarette taxes and Congress’ recent decision to allow the Food and Drug Administration to regulate tobacco.
But health officials believe gains have been undermined by cuts in state tobacco control campaigns. Some advocates believe tobacco companies are overcoming increasing obstacles.
Cigarette marketing has persisted and is effectively reaching kids and minorities with messages about flavored or menthol products, said Dr. Clyde Yancy, president of the American Heart Association.
The tobacco industry also has been discounting cigarettes to offset tax increases and keep smokes affordable, Willmore said.
Between 1997 and 2004, the average retail price of a pack of cigarettes — adjusted for inflation — jumped 63 percent, and adult smoking declined about 15 percent. Between 2004 and 2008, the price rose just 2 percent, while adult smoking declined by just about 1 percent, he said, citing industry sales data.
“There’s a clear correlation,” Willmore said.
Cigarette smoking is the leading preventable cause of death and illness in the United States, and is a cause of cancers, heart disease and other fatal conditions.
The adult smoking rate has been dropping, in starts and stops, since the mid-1960s when roughly 2 out of 5 U.S. adults smoked. Now it’s 1 in 5. However, federal health goals for the year 2010 had hoped to bring the rate down to close to 1 in 10.
Adult smoking hovered at about 21 percent from 2004 to 2006, then dropped a full percentage point in 2007, said Dr. Matthew McKenna, director of the CDC’s Office on Smoking and Health.
The 2007 drop gave CDC officials hope that U.S. smoking was plummeting again. “Now that appears to be a statistical aberration,” McKenna said.
The new survey’s results come from in-person interviews of nearly 22,000 U.S. adults.
The study was released Thursday, published in the CDC publication, Morbidity and Mortality Weekly Report.
Also on Thursday, the CDC released state-by-state results on smoking from a different survey, conducted by telephone, of more than 400,000 adults. West Virginia and Indiana had the highest smoking rates, at about 26 percent, but four other states — Kentucky, Missouri, Oklahoma and Tennessee — had rates about as high.
Utah had, by far, the lowest smoking rate, with only about 9 percent of Utah residents describing themselves as current smokers.
Many of the states that have the lowest smoking rates are those that have been the most aggressive about indoor smoking laws and about state taxes that drive up the cost of cigarettes, said Dr. Thomas Frieden, the CDC’s director.
Health officials are optimistic that more and more smokers will be discouraged from lighting up by escalating cigarette taxes, including a 62-cent federal tax that took effect in April. That may cause smoking to go down when the 2009 smoking data comes in, some advocates said.
Perhaps the recession will have an impact, too.
“In general, when people have less money, they smoke less,” Frieden said. “Time will tell.”
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