Doctors debate use of gum to fight nicotine addiction

MUMBAI: Smokers in the city are being wooed by a new antidote—nicotine-based chewing gums. But the gum, the country''s first nicotine replacement therapy (NRT) that has been in the market for about a week, has divided the medical fraternity.
Some doctors welcome it as it could effectively bring down tobacco addiction,while others believe the gutkha-flavoured gum could be abused by persons who have been looking for alternatives ever since gutkha was banned.
The manufacturers, Ceejay Healthcare, point out that NRT chewing gums have been around for over a decade. Proprietor Praful Patel says that NRT gums have been clinically tested for over 20 years. "We only have introduced a taste that is in keeping with our ethnic makeup," he says.
A visit to the city''s only smoking cessation clinic shows, however, that quitting- -even with psychological and medicinal support—isn''t easy.
The Qit Tobacco Clinic which is part of the preventive oncology department at Tata Memorial Hospital, Parel, gets about three new nicotine addicts every day. But only few first-timers return to the clinic.
In fact, only 26 of the 120 addicts who came to the clinic in the period since May 31, 2002, managed to quit the habit, says the clinic''s medical social worker Parishi Majumdar.
About 6.3 lakh Indians die because of tobacco use every year. Yet smokers, it seems, would rather give up anti-tobacco therapy than their "injurious to health" habit.
This has also been underlined by the lukewarm reception to the smoking cessation pill, bupropion hydrochloride, that was introduced a couple of years ago. The pill, a prescription drug, is being sold under brand names by various pharmaceutical companies. "The sales have not been up to our expectation," admits an official of one of the companies.
The Quit Tobacco Clinic has been distributing for free the bupropion pillsever since it started receiving financial support from the World Health Organisation last year. Yet only eight addicts came forward to use it successfully, says Dr Nilesh Ingole of the clinic.
So, will therapy-wary smokers be game for nicotine-based chewing gums? Ceejay Healthcare''s president Carter Ward isn''t worried about being stonewalled by smokers. "We have sold over seven lakh pouches in less than a week and we still have to go beyond Bandra," he says.
The gum, containing nicotine polacrix, has been cleared by the state Food and Drug Authority as an over-the-counter drug. According to Dr P.C.Gupta, senior research scientist at Tata Institute of Fundamental Research who has worked in the field of tobacco addiction, "The chewing gums contain barely 2 mg of nicotine and have been documented to help chain smokers overcome the withdrawal symptoms."
But not all are convinced. Dr Surendra Shastri, head of department of preventive oncology at Tata Memorial, says it''s quite possible that a smoker gives up his heavy nicotine dose for the chewing gum instead. Another oncologist who doesn''t want to be named points out that gutkha addicts could get addicted to the gum.
Although the American Lung Association rates NRT chewing gum as an effective way of giving up tobacco addiction, it cautions against its use for more than three months at a stretch. There are also restrictions such as cutting down on beverages.
Alka Kapadia of Cancer Patients Aid Association, which holds over 20 lectures every month to highlight the ill-effects of tobacco, points out given the carcinogenic nature of the addiction, any product that could help should be given a chance. "One is sceptical, but excited," she says.