Quitting Tobacco: What Works and What Doesn't with Michael Fiore

WebMD Live Events Transcript

Dr. Michael C. Fiore, director of the Center for Tobacco Research and Intervention and a professor of medicine at the University of Wisconsin Medical School, will talk about the most -- and least -- effective means to quit smoking.

Event Date: 06/27/2000.

The opinions given by Dr. Fiore are his and his alone. If you have specific questions or are concerned about your health, please consult your personal physician. This event is for informational purposes only.

Moderator: Welcome to WebMD Live's World Watch and Health News Auditorium. Today we are discussing Quitting Tobacco: What Works and What Doesn't, with Michael C. Fiore, MD, MPH.

Fiore is the director of the Center for Tobacco Research and Intervention, and a professor of medicine at the University of Wisconsin Medical School. He is also the principal investigator on an NIH-funded Transdisciplinary Tobacco-Use Research Center (TTURC) grant, "Relapse: Linking Science and Practice." He formerly worked as a medical epidemiologist at the United States Office on Smoking and Health, where he contributed to a wide range of national research, educational and policy projects. He has also received training as an Epidemic Intelligence Service (EIS) Officer for the United States Centers for Disease Control (CDC). Dr. Fiore completed his undergraduate studies at Bowdoin College and received his medical degree from Northwestern University in Chicago.

Dr. Fiore, welcome to WebMD Live.

Dr. Fiore: Thanks for inviting me.

Moderator: Why should you quit smoking?

Dr. Fiore: Well, there's not a single health risk that poses the same concern as tobacco use in America today. If we take three smokers and line them up side by side, unfortunately one of those three are going to die prematurely from a disease directly related to their tobacco use, losing, on average, about 10 years of life. The reason to recommend smoking cessation is that virtually all of these health risks are reversible upon quitting. We know, for example, that tobacco use is one of the leading causes of heart attacks. Upon quitting smoking, within one year, your risk of a heart attack is decreased by 50%. Within five years, it returns to that of a person who's never smoked. In terms of cancer risk, it takes a bit longer,  Approximately 10-15 years to approach that of a "never smoker." We can now say with confidence that starting on the day you quit, you'll begin to feel better and the benefits of quitting will continue for the rest of your life. There's probably not a single more powerful health gift a person can give to themselves as successfully quitting smoking.

Moderator: Why do the negative effects of smoking "wear off" when you quit?

Dr. Fiore: Well, in fact, ALL of the negative effects don't wear off. Unfortunately, the actual lung damage that occurs in a person who develops emphysema, or what we now refer to as COPD (chronic obstructive pulmonary disease), is not reversible. But many of the effects result in changes that the body is able to recover from, and the changes in the cardiovascular system are one example of that.

Moderator: What is the first thing people need to do once they've decided to quit?

Dr. Fiore: Well, you've already emphasized the first thing, and that is to make a commitment to remove cigarettes from their lives. One struggle that many people who smoke experience is the misconception on the part of people who don't smoke that tobacco use is just some bad habit, and that if the person had enough willpower, they should be able to quit on their own. Once a person has made that commitment, based on the Public Health Service (PHS) guideline that was released today, the recommendation is to talk with your clinician. For most people, quitting is a difficult process. But, with the right counseling that a clinician can provide, as well as one of the right medicines that will blunt the painful withdrawal symptoms that smokers experience, you can markedly enhance your likelihood of successfully quitting.

Moderator: What are the symptoms of nicotine withdrawal?

Dr. Fiore: Nicotine withdrawal has a characteristic syndrome that most smokers can describe. It consists of a series of experiences such as irritability, difficulty concentrating, disturbed sleep, increased appetite, and a physical craving for cigarettes. These symptoms usually begin within a few hours to one to two days after quitting, and are greatest in the first week after quitting. For most people, they then begin to decline, but in some, they can continue for months. That actually is not clear -- why certain people have a more prolonged withdrawal syndrome than others. But, it may be related to the biochemistry that occurs in the brain of a person who smokes vs. a person who's trying to quit. We know, for example, that the brains of smokers are objectively different than those of non-smokers, particular in terms of a series of neurotransmitters (brain chemicals) that change in the brains of smokers. This can be related to why it's more difficult for some people to quit than others.

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