Britain's independent health watchdog says for people who can't quit smoking cold turkey, it's OK to use nicotine products to help them cut down.
For years, Britain has encouraged people who wanted to kick the habit to simply stop, with various supports available, including counseling and nicotine products. But nicotine replacement therapies were not recommended for people who still wanted to cut down but not quit immediately.
But in advice issued Wednesday, the National Institute for Health and Care Excellence said people unable to give up cigarettes in a single attempt should switch to licensed nicotine products, including gum, sprays and patches to at least reduce how much they smoke. The advice doesn't recommend e-cigarettes, which aren't yet regulated in Britain. Recommendations made by NICE are typically adopted by the government.
"People smoke because of the nicotine, but they die because of the tar in tobacco," said Mike Kelly, director of NICE. When people smoke fewer cigarettes without using nicotine replacement therapies, they typically inhale more deeply and ingest more tar, he said. By using nicotine products such as gum or patches, they can smoke less without any acute withdrawal symptoms. Kelly said smokers were still encouraged to quit entirely but that this new advice gives them another option.
According to NICE's assessment of past research, nicotine replacement products can be safely used with cigarettes for at least five years. NICE advised heavy smokers that they may need more than one product if they do try to quit.
The agency also said nicotine replacement therapies can be used for as long as they curb the urge to smoke and in the long term to prevent relapses. About one in five people in the U.K. smoke, and tobacco is estimated to cost the health system nearly >3 billion ($4.6 billion) every year.
"Since tobacco is by far the most harmful available source of nicotine, switching to alternatives ... is the obvious healthier choice," John Britton, chairman of the Royal College of Physician's Tobacco Advisory Group, said in a statement. "This guidance has the potential to change millions of lives for the better."
In the U.S., the Food and Drug Administration advises people to use nicotine replacement therapies when they want to quit. The agency says the products should be used as part of an attempt to quit smoking and should not be used indefinitely.
? ai??????na","sans-serif";mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:"Times New Roman";color:#333333;mso-fareast-language:EN-GB'>A journal editorial says such devastating complications are rare, but that "the frequency and severity of complications ... is problematic" in the study and that the best way to treat patients with both obesity and diabetes "remains unknown."
A research review in the journal said more long-term evidence on risks and benefits is needed to determine if obesity surgery is an appropriate way to treat diabetes in patients who aren't severely obese — at least 100 pounds (45 kilograms) overweight.
More than 20 million Americans have Type 2 diabetes; most are overweight or obese. Diabetics face increased risks for heart disease and strokes, and poorly controlled diabetes can damage the kidneys, eyes and blood vessels.
About 160,000 people nationwide undergo various types of obesity surgery each year. Bypass surgery, the type studied, involves stapling the stomach to create a small pouch and attaching it to a lower part of the intestines.
The American Society for Metabolic & Bariatric Surgery says obesity surgery is safe and that the death rate is less than 1 percent, lower than for gallbladder and hip replacement surgery.
The study involved 120 patients at five hospitals in New York, Minnesota and Taiwan. All patients got medicines for diabetes, obesity, cholesterol and/or high blood pressure. They all were advised to cut calories and increase physical activity.
Sixty patients also had surgery, and the two groups were compared after one year.
The surgery group lost on average nearly 60 pounds (27 kilograms) and 75 percent lowered blood sugar levels to normal or near normal levels. The non-surgery group lost an average 17 pounds (7.7 kilograms) and just 30 percent reached the blood-sugar goal. The surgery group also needed less medication after the operation.
The researchers say the diabetes changes were likely due to the weight loss but that hormonal changes affecting blood sugar may have contributed.
The surgery group showed a trend toward having less high blood pressure and elevated cholesterol — both major risk factors for heart disease, although those between-group differences could have been due to chance.
Ikramuddin, the lead author, said the study results don't mean that all mildly obese diabetics should have obesity surgery, but that "in the correct patient, surgery might be an important thing to consider."