Edgar Allan Poe (1809-1849) Poe’s Death: Rabies, Alcohol or What?

 

 

1848 daguerreotype of Poe

The annual “historical clinicopathological conference,” sponsored by Maryland’s Department of Veterans Affairs and the University of Maryland, is a fun meet where doctors of various stripes discuss how this or that famous person met his end. The organizer is Dr. Philip Mackowiak. A chosen doctor, called the “discussant,” presents the facts of a case to an audience of doctors and students, then delivers his or her diagnosis. A general chin-wag ensues.

These days, “it’s become such a major production and everybody knows it’s a historical clinicopathological conference,” Mackowiak says. “The exercise now is to figure out who the person is and come up with a diagnosis.” Doctors are presented with a hypothetical patient and a description of the symptoms and are asked to render a diagnosis.

The following shows how this group of physicians diagnosed the death of America’s first great writer, Edgar Allan Poe:

Edgar Allan Poe did not die drunk in a gutter in Baltimore but rather had rabies, a new study suggests.

The researcher, Dr. R. Michael Benitez, a cardiologist who practices a block from Poe’s grave, says it is true that the writer was seen in a bar on Lombard Street in October 1849, delirious and possibly wearing somebody else’s soiled clothes. But Poe was not drunk, said Dr. Benitez, an assistant professor of medicine at the University of Maryland Medical Center. “I think Poe is much maligned in that respect,” he added. The great writer entered Washington College Hospital comatose, Dr. Benitez said, but by the next day was perspiring heavily, hallucinating and shouting at imaginary companions. The next day, he seemed better but could not remember falling ill. On his fourth day at the hospital, Poe again grew confused and belligerent, then quieted down and died. That is a classic case of rabies, the doctor said. His study is in the September issue of The Maryland Medical Journal.

In the brief period when he was calm and awake, Poe refused alcohol and could drink water only with great difficulty. Rabies victims frequently exhibit hydrophobia, or fear of water, because it is painful to swallow.   There is no evidence that a rabid animal had bitten Poe. About one-fourth of rabies victims reportedly cannot remember being bitten. After an infection, the symptoms can take up to a year to appear. But when the symptoms do appear, the disease is a swift and brutal killer. Most patients die in a few days.

Poe “had all the features of encephalitic rabies,” said Dr. Henry Wilde, who frequently treats rabies at Chulalongkorn University Hospital in Bangkok, Thailand. Although it has been well established that Poe died in the hospital, legend has it that he succumbed in the gutter, a victim of his debauched ways. The legend may have been fostered by his doctor, who in later years became a temperance advocate and changed the details to make an object lesson of Poe’s death. The curator of the Edgar Allan Poe House and Museum in Baltimore, Jeff Jerome, said that he had heard dozens of tales but that “almost everyone who has come forth with a theory has offered no proof.” Some versions have Poe unconscious under the steps of the Baltimore Museum before being taken to the hospital. Other accounts place him on planks between two barrels outside a tavern on Lombard Street. In most versions, Poe is wearing someone else’s clothes, having been robbed of his suit. Poe almost surely did not die of alcohol poisoning or withdrawal, Mr. Jerome said. The writer was so sensitive to alcohol that a glass of wine would make him violently ill for days. Poe may have had problems with alcohol as a younger man, Mr. Jerome said, but by the time he died at 40 he almost always avoided it.

Dr. Benitez, who worked on Poe’s case as part of this clinical pathologic conference. said that at first he did not know that he had been assigned Poe, because his patient was described only as “E. P., a writer from Richmond.” But by the time he was scheduled to present his findings a few weeks later, he had figured out the mystery.

Editor’s Note: Just to enrich your experience with History of Medicine, this week, take a listen to one of Poe’s greatest short stories.

The Tell Tale Heart by Edgar Allan Poe, narrated by James Mason

Five More Pharmaceutical Companies Join NIH Initiative to Speed Therapeutic Discovery

 

Five additional pharmaceutical companies have joined a National Institutes of Health-led effort to help in the research of promising new treatments. Funding and molecular compound information is available now for the initial phase of the recently unveiled Discovering New Therapeutic Uses for Existing Molecules program. This NIH-industry collaboration will match researchers with 58 compounds to test ideas for new therapeutic uses. Since the launch of the program last month, the total number of compounds the companies are making available has more than doubled.

 

Abbott, Bristol-Myers Squibb Company, GlaxoSmithKline, Janssen Pharmaceutical Research & Development, L.L.C., and Sanofi have joined Pfizer, AstraZeneca, and Eli Lilly and Company in this innovative approach to research.

 

The NIH’s new National Center for Advancing Translational Sciences (NCATS) created the Therapeutics Discovery program to help re-engineer the research pipeline. By crowdsourcing compounds that already have cleared several key steps in the development process, including safety testing in humans, scientists nationwide have the opportunity to contribute their expertise to advancing these resources for new disease therapies.

 

The eight participating companies will provide their compounds and related data, which were determined by the NIH to meet specific eligibility criteria. For example, each compound must have advanced to clinical studies but been unsuccessful in its original therapeutic indication or not pursued for business reasons. Preliminary information about the compounds, including mechanism of action, route of administration, and any limitations in use based on safety and tolerability, are available.

 

For the pilot phase of the program, in fiscal year 2013, NCATS will provide up to $20 million to fund two- to three-year staged, cooperative agreement research grants. If specific milestones are met, funded researchers will conduct pre-clinical validation and clinical feasibility studies in the first stage, and proof-of-concept clinical trials in the second stage, to test whether one of the compounds may be effective against a previously unexplored disease target. The pilot phase also is intended to test the utility of the newly created template agreements by reducing the negotiation time that otherwise could delay the research.

 

Researchers who are interested in NCATS’ Therapeutics Discovery funding must submit a pre-application in response to the NIH Funding Opportunity Announcement by Aug. 14, 2012. Applicants must include details about how they would explore specific hypotheses related to one of the compounds that might be useful in a specific disease area. The pre-applications will undergo review by external experts, and while no funding will be provided at this stage, successful applicants will be notified to submit a full application for fiscal year 2013 funding.

The Effects of Lowering LDL Cholesterol With Statin Therapy In People at Low Risk of Vascular Disease: Meta-Analysis of Individual Data From 27 Randomized Trials

 

Cholesterol Calculation: 1 mmol/l = 38.7 mg/dl

 

Statins reduce LDL cholesterol and prevent vascular events, but their net effects in people at low risk of vascular events remain uncertain. As a result, a study published in The Lancet, Early Online Publication (17 May 2012), evaluated, via a meta-analysis, individual participant data from 22 trials of statin versus control (n=134,537; mean LDL cholesterol difference 1.08 mmol/L (42 mg/dL); median follow-up 4.8 years) and five trials of more versus less statin (n=39,612; difference 0.51 mmol/L; 5.1 years).

 

Major vascular events were major coronary events (ie, non-fatal myocardial infarction or coronary death), strokes, or coronary revascularizations. Participants were separated into five categories of baseline 5-year major vascular event risk on control therapy (no statin or low-intensity statin) (<5%, >5% to <10%, >10% to <20%, >20% to <30%, >30%); in each, the rate ratio (RR) per 1.0 mmol/L LDL cholesterol reduction was estimated.

 

Results showed that reduction of LDL cholesterol with a statin reduced the risk of major vascular events (RR 0.79 per 1.0 mmol/L reduction), largely irrespective of age, gender, baseline LDL cholesterol or previous vascular disease, and of vascular and all-cause mortality. The proportional reduction in major vascular events was at least as big in the two lowest risk categories as in the higher risk categories, which reflected significant reductions in these two lowest risk categories in major coronary events (RR 0.57) and in coronary revascularizations (RR 0.52). For stroke, the reduction in risk in participants with 5-year risk of major vascular events lower than 10% (RR per 1.0 mmol/L LDL cholesterol reduction 0.76) was also similar to that seen in higher risk categories. In participants without a history of vascular disease, statins reduced the risks of vascular (RR per 1.0 mmol/L LDL cholesterol reduction 0.85) and all-cause mortality (RR 0.91), and the proportional reductions were similar by baseline risk. There was no evidence that reduction of LDL cholesterol with a statin increased cancer incidence, cancer mortality, or other non-vascular mortality.

 

According to the authors, in individuals with 5-year risk of major vascular events lower than 10%, each 1 mmol/L (39 mg/dL) reduction in LDL cholesterol produced an absolute reduction in major vascular events of about 11 per 1000 over 5 years. This benefit greatly exceeds any known hazards of statin therapy. Under present guidelines, such individuals would not typically be regarded as suitable for LDL-lowering statin therapy. The present report suggests, therefore, that these guidelines might need to be reconsidered.

Clinical Prediction of Fall Risk and White Matter Abnormalities: A Diffusion Tensor Imaging Study

 

The Tinetti scale is a simple clinical tool designed to predict risk of falling by focusing on gait and stance impairment in elderly persons. Gait impairment is also associated with white matter (WM) abnormalities. As a result, an article published in the Archives of Neurology (2012;69:733-738) was performed to test the hypothesis that elderly subjects at risk for falling, as determined by the Tinetti scale, have specific patterns of WM abnormalities on diffusion tensor imaging.

 

The study was performed in a community-based cohort of 125 homebound elderly individuals. The main outcome measure was dIffusion tensor imaging scans was the analysis of the location of WM abnormalities in subjects with Tinetti scale scores of 25 or higher (without risk of falls) and lower than 25 (with risk of falls). Multivariate linear least squares correlation analysis was performed to determine the association between Tinetti scale scores and local fractional anisotropy values on each skeletal voxel controlling for possible confounders.

 

Results showed that in subjects with risk of falls (Tinetti scale score <25), clusters of abnormal WM were seen in the medial frontal and parietal subcortical pathways, genu and splenium of corpus callosum, posterior cingulum, prefrontal and orbitofrontal pathways, and longitudinal pathways that connect frontal-parietal-temporal lobes. Among these abnormalities, those in medial frontal and parietal subcortical pathways correlated with Mini-Mental State Examination scores, while the other locations were unrelated to these scores.

 

According to the authors, elderly individuals at risk for falls as determined by the Tinetti scale have WM abnormalities in specific locations on diffusion tensor imaging, some of which correlate with cognitive function scores.

TARGET HEALTH excels in Regulatory Affairs. Each week we highlight new information in this challenging area.

 

Drug Shortages

 

What’s New on the FDA Drugs Site: June 13, 2012. Is there anything more to say?

EHRs – A Prescription for Pain Relief

 

 

By Mark L. Horn, MD, MPH, Chief Medical Officer, Target Health Inc.

 

A recent paper in the NEJM offers a welcome, interesting and potentially unifying explanation of the etiology of many common Electronic Health Records (EHRs) frustrations and happily provides an approach to address (at least) some of them. Perhaps what we need is a more diverse set of competitors and more creative regulation focused on facilitating interconnectivity and data access while bringing down costs. Ideally we’d have physicians and patients clamoring, and willing to pay for, truly innovative and cost effective EHR technology. One approach might be an EHR software targeted comparative effectiveness research (CER) initiative modeled on the patient focused outcomes research program assigned to the newly created Patient Centered Outcomes Research Institute (PCORI) by the Affordable Care Act (ACA).

 

Similar to, I suspect, many On-Target readers who have acquired familiarity with EHRs as either providers or patients, I’ve both experienced firsthand and heard secondhand about frustrations with these systems. The complaints are many and varied and include concerns about deficient capabilities, lack of ‘user-friendliness’, poor–or absent–communication among different systems (interoperability), unreliability, and expense.

 

According to a recently published paper by Kenneth Mandl and Isaac Kohane (NEJM 2012; 366:2240-42), medical information technology has actually regressed over time; initially ‘cutting edge’, the products have stagnated, especially in comparison to products available for other fields. These growing deficiencies have now reached the point where the technology physicians use in their professional lives lacks the sophistication and ease of use readily available among software applications used for many other purposes. They suggest (in a much truncated nutshell) that efforts by vendors to control data have restricted innovation and connectivity, damaging the market for innovative products and resulting in a suite of EHR products that has failed to capture for patients, physicians and the health care system the benefits of software advances, including the lower costs, available to them in (the authors’ term) their “civilian’ life”. The authors specifically note security processes, provider and patient communication, documentation tools, and the ability to perform sophisticated data analyses as areas where EHRs fail to incorporate the most powerful and available technologies.

 

Perhaps, given our readers’ collective interest in clinical development, we should add the ability to integrate physician and hospital generated clinical data with clinical trial data capture and analytic software to the list of potential opportunities. Compounding the frustration, the authors suggest that these superior technologies are likely available at costs below the price of EHR systems.

 

What is both interesting and ironic about this analysis is that physicians are often criticized for their failure to embrace technology; their seemingly slow and often grudging adaption of EHRs has been cited as evidence of this technological resistance. This criticism is perplexing since in other settings physicians are criticized for their overeager embrace of costly technologic interventions, among these advanced imaging techniques and robotic surgery. We may now have the seeds of a viable explanation. It may well be that physicians (and potentially patients as well) are more sophisticated than often assumed. As each cohort has gained experience with software products available for other purposes, perhaps they’ve discovered, relatively speaking, that EHRs often disappoint. Many available products lack critical functionality for interactivity, are excessively complex, difficult to use, and expensive.

 

Congress, Silicon Valley, and software developers everywhere, this is an interesting challenge for all.

 

2nd eSource Direct Data Entry Clinical Trial Completed Under a US IND

 

 

Target Health is pleased to announce that it has completed its second direct data entry (sSource) clinical trial under a US IND, using Target e*CRF® and Target e*CTR® (eClinical Trial Record).

 

Full enrollment will occur in a 3rd study within a month in a 6 center study with 120 randomized patients. Congratulations to a long list of the industry’s best career professionals, who happen to be permanently employed at Target Health Inc., for the following major accomplishments:

 

1.  The sites are very “happy” and asked us, “what has taken the Industry so long?”

2.  Monitoring visits dropped by 50%

3.  No protocol violations, as we performed daily central monitoring

4.  Only 3% of forms queried, and of these a total of less than 1% of forms were changed

5.  Site saved 70 hours of administrative time as they only entered the data once

6.  75% of all forms reviewed within the same day of the office visit

 

For more information about Target Health contact Warren Pearlson (212-681-2100 ext. 104). For additional information about software tools for paperless clinical trials, please also feel free to contact Dr. Jules T. Mitchel or Ms. Joyce Hays. The Target Health software tools are designed to partner with both CROs and Sponsors. Please visit the Target Health Website at www.targethealth.com

 

New York Hospitals Look to Combine, Forming a Giant

 

 

Will this hospital mega-merger make healthcare more or less 1) ___ for the average New Yorker?

 

Two of New York City’s biggest hospital systems reached agreement last Wednesday to pursue a merger that would shake up the way 2) ___ care is delivered, especially in Manhattan, where hospitals compete to serve some of the wealthiest neighborhoods in the world. The proposed merger would bring together NYU Langone Medical Center, a highly specialized academic medical center, and Continuum Health Partners, a network of several community-oriented hospitals, including Beth Israel and the two St. Luke’s-Roosevelt campuses. It would create one of the largest healthcare systems in the city, one that would have immense market power under the new 3) ___ health care system, and put pressure on independent medical practices, insurance companies and even rival medical schools, which may have to find other places to train their students.

 

The deal was outlined in a memorandum of understanding approved on Tuesday and Wednesday by the boards of both nonprofit organizations, and it is still subject to final confirmation by the boards. It would also need regulatory approval, and at least one patient advocacy group promised to challenge it. By strengthening its competitive advantage, a merged hospital system could limit options for 4) ___ and charge more for services, advocates fear. It would also have more power to negotiate higher rates with insurance companies, which might be passed on to consumers in the form of higher 5) ___.

 

The proposed merger comes amid a wave of health care consolidations around the country, driven by shrinking reimbursements from insurers and the government and by mandates of the federal health care law to operate more efficiently and at lower 6) ___. Hospitals are combining with other hospitals, doctor’s offices and even insurance companies as payment models shift from fee-for-service to a per-person rate in which providers are expected to manage most of a patient’s care, requiring coordination among doctors and facilities. “Economists have for some time now worried about the ceaseless consolidation on the supply side of the health care market, facing a much more splintered payment side with less market power,” Uwe E. Reinhardt, a health economist at Princeton University, said Wednesday.

 

The memorandum of understanding is essentially an agreement to share proprietary information, including financial, technology and personnel data, that would be needed to make a final decision to merge, most likely within six months. It is not binding, but it is a signal, as one hospital official said, that the proposal has gone beyond courtship to the engagement stage. In a joint statement on Wednesday evening, the boards said they would explore how their partnership “could create a fully integrated 7) ___ delivery system for the benefit of the people they serve, including underserved populations.” “Both entities expect,” it added, “that a successful partnership would achieve economies of scale that reduce health care costs while enhancing the 8) ___ of care and allowing for investment in new facilities.”

 

Any merger would have to be reviewed by the Federal Trade Commission, which would consider any antitrust implications, as well as by the State Health Department and the State Dormitory Authority, a financing and construction agency that carries some debt for Continuum. At least one trustee suggested that the 9) ___ would argue that their market share should be looked at in the context of New York City as a whole — perhaps even the nation — and not just Manhattan. “You have to be competitive,” the trustee said, speaking on the condition of anonymity because, he said, any public comment would be scrutinized by the regulatory agencies. “More and more of the reimbursement is going to be tied to lowering your costs, not raising your costs.”

 

The new organization would capture a huge swath of Manhattan, including some of its most affluent neighborhoods. It would be a formidable rival in the fight for patients and market share with the current behemoth among New York City hospital systems, New York-Presbyterian, which was created by a 1998 merger of what are now known as Columbia University and Weill Cornell Medical Centers. The hospital with perhaps the most to lose would be Mount Sinai Medical Center, like NYU an 10) ___ medical center, which would be geographically sandwiched between the two chains.

 

Officials said it was premature to predict that New York University Medical School would expand, but the merger could open up more hospital training slots for NYU medical students and cause Continuum’s current affiliates – Columbia University College of Physicians and Surgeons, Albert Einstein College of Medicine and New York Medical College – to lose some. Mergers often lead to the elimination of some specialty services that are 11) ___ among the combining hospitals. But officials at the hospitals, who spoke on the condition of anonymity because of confidentiality agreements, said the two organizations would deliver services more efficiently and would complement each other. They would bring in patients with a wider variety of ailments than either hospital does now.

 

But patient advocates may resist such a powerhouse. “That’s really too bad,” Judy Wessler, director of the Commission on the Public’s Health System, said of the decision to move forward. She said her group would ask regulators to reject the merger. Nisha Agarwal, deputy director of the Center for Popular Democracy, an advocacy group for low-income people, said she was “concerned about the antitrust implications and the impact on consumers,” but was not yet sure whether her group would file a legal challenge. Dr. Reinhardt said that while hospitals talked about synergy and public interest, the biggest impact of such a merger would be to give them more leverage with 12) ___ companies. But the insurance side has also been consolidating, he said, leading to a tug of war with hospitals. “So a hospital can literally tell an insurer you either take our prices or you take a walk, and that’s what’s happening,” he said. “Both sides always justify that, not on the basis of crude market power – we want more market power to get better prices – they always find some kind of high national purpose.”

 

 

ANSWERS: 1) expensive; 2) medical; 3) federal; 4) patients; 5) premiums; 6) cost; 7) healthcare; 8) quality; 9) hospitals; 10) academic; 11) duplicated; 12) insurance

Beth Israel Medical Center, Manhattan

 

Dazian Pavilion of the Petrie Division of Beth Israel Medical Center as seen from Stuyvesant Square in Manhattan

 

 

Beth Israel was incorporated in 1890 by a group of 40 Orthodox Jews on the Lower East Side each of whom paid 25 cents to set up a hospital serving New York’s Jewish immigrants, particularly newcomers. At the time New York’s hospitals would not treat patients who had been in the city less than a year. It initially opened a dispensary on the Lower East Side. In 1891 it opened a 20-bed hospital and in 1892 expanded again and moved into a 115-bed hospital in 1902.

 

In 1929 it moved into a 13-story, 500-bed building at its current location at the corner of Stuyvesant Square. It purchased its neighbor the Manhattan General Hospital in 1964 and renamed the complex Beth Israel Medical Center, located at First Avenue and 16th Street in Manhattan. By the 1980s it had long extended beyond its Jewish base. In 1988 it had the largest network of heroin-treatment clinics in the United States with 7,500 patients and 23 facilities. It acquired Doctors Hospital on the Upper East Side in the 1990s, renaming it Beth Israel Medical Center-Singer Division, and Kings Highway Hospital Center in 1995, renaming it Beth Israel Medical Center-Kings Highway Division.

 

In 2004, Beth Israel Medical Center closed the Singer Division and consolidated its Manhattan inpatient operations at the main hospital campus, called the Petrie Division, on First Avenue at 16th Street in Manhattan. As of 2010 Beth Israel Medical Center has residency training programs in nearly every major field of medicine including: Emergency Medicine, Internal Medicine, Surgery, ENT, Oral Maxillo-Facial Surgery, Radiology, Family Medicine, Dermatology, Obstetrics and Gynecology, Neurology, Ophthalmology, Pathology, Psychiatry, Podiatry, and Urology. Continuum Health Partners which owns Beth Israel provides resident trainees with subsidized housing and a competitive salary. In 2011 Huguette Clark died at the hospital at age 104. She left one million dollars to the hospital upon her death.

 

Huguette Marcelle Clark (June 9, 1906 – May 24, 2011) was an American heiress and philanthropist, who grew up in the 122 room mansion at Fifth Avenue and 77th Street, shown below.

 

Huguette M. Clark

 

 

The youngest daughter of former United States Senator and industrialist William A. Clark, she lived a reclusive life after 1930 and her activities were virtually unknown to the public. Upon her death in 2011, Clark left behind a vast fortune, most of which was donated to charity. Substantial sums were also left to her longtime nurse, her goddaughter, some employees and her attorney. Her accountant and her attorney are part of a criminal investigation concerning suspicions of mishandling Clark’s assets. Clark died at Beth Israel Medical Center, in New York City, two weeks short of her 105th birthday.

 

In recent years her eyesight had failed and her hearing was weak, and at times she had been unwilling to eat. She was moved in mid-April from her private room at Beth Israel Medical Center in New York up to its medical intensive care unit, then in mid-May to a room with hospice care. She had been living at the hospital under pseudonyms – the latest was Harriet Chase – in a guarded room with full-time private nurses. Her hospital room number didn’t even exist – outside her room on the 3rd floor, a card with the fake room number “1B” and the name “Chase” was taped over the actual room number. When she was moved to intensive care, room 1B was cleared of her belongings, and the card was removed. Huguette Clark has been almost entirely alone, aside from her private nurse and occasional visits by her accountant. One of her former attorneys represented her for 20 years without meeting her face to face, instead talking through a closed door. By all accounts of sound body and mind till nearly the end of her life, Mrs. Clark had lived, apparently by choice, cloistered in New York hospitals since the late 1980s. There, first in Doctors Hospital and later at Beth Israel, she was reported to have lived under a series of pseudonyms. The most recent, was Harriet Chase. In the hospitals, Mrs. Clark, whose given name is pronounced hyoo-GETT, was attended by round-the-clock private aides and surrounded by the fine French dolls she had collected since she was a girl. The collection was worth millions of dollars.

 

Even though Mrs. Clark had stunning Central Park views from 3 separate residences she owned at 907 Fifth Avenue, totaling 42 rooms, as well as multimillion-dollar estates in Connecticut and California, she chose to live her last many years in a hospital room at Beth Israel Medical Center. She was entombed on the morning of May 26, 2011, in the family mausoleum in section 85 of Woodlawn Cemetery, located in The Bronx, borough of New York City.

GENETICS

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Odds of Quitting Smoking Affected By Genetics

 

 

Sometimes we need to help people in spite of themselves. The reason is that unhealthy habits of individuals can affect the health of many others, which takes its toll not only on the health of each of us, but costs all of us more dollars in healthcare (editor’s note).

 

According to the Centers for Disease Control and Prevention, tobacco use is still the single most preventable cause of disease, disability, and death in the United States. Smoking or exposure to secondhand smoke results in more than 440,000 preventable deaths each year – about 1 in 5 U.S. deaths overall. Another 8.6 million live with a serious illness caused by smoking. Despite these well-documented health costs, over 46 million U.S. adults continue to smoke cigarettes.

 

According to an article published online in the American Journal of Psychiatry (30 May 2012), genetics can help determine whether a person is likely to quit smoking on his or her own or need medication to improve the chances of success. According to the authors, the study moves health care providers a step closer to one day providing more individualized treatment plans to help patients quit smoking.

 

The current study focused on specific variations in a cluster of nicotinic receptor genes, CHRNA5-CHRNA3-CHRNB4, which prior studies have shown to contribute to nicotine dependence and heavy smoking. Using data obtained from a previous study supported by the National Heart Lung and Blood Institute, it was shown that individuals carrying the high-risk form of this gene cluster reported a 2-year delay in the median quit age compared to those with the low-risk genes. This delay was attributable to a pattern of heavier smoking among those with the high risk gene cluster.

 

The authors then conducted a clinical trial, which confirmed that persons with the high-risk genes were more likely to fail in their quit attempts compared to those with the low-risk genes when treated with placebo. However, medications approved for nicotine cessation (such as nicotine replacement therapies or bupropion) increased the likelihood of abstinence in the high risk groups. Those with the highest risk had a three-fold increase in their odds of being abstinent at the end of active treatment compared to placebo, indicating that these medications may be particularly beneficial for this population.

 

According to the authors, it was found that the effects of smoking cessation medications depend on a person’s genes, and if smokers have the risk genes, they don’t quit easily on their own and will benefit greatly from the medications. The authors added that if smokers don’t have the risk genes, they are likely to quit successfully without the help of medications such as nicotine replacement or bupropion.

 

Go to the following websites for information on tobacco addiction, and tools and resources to help quit smoking.

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