Monday, 6 July 2009

Giving Up Can Be Murder

Suicide is not the intended effect of giving up smoking. Nor is committing the perfect murder.

No smoking

My apologies for the long post. I felt that some background was needed, but there is a serious point at the end which I have not seen documented anywhere else.

Champix (or Chantix in the USA) is the trade name of varenicline. It is intended as an aid to stopping smoking, and is available on the NHS. Of course like any medical treatment it has side effects. Could those side effects lead to serious violence?

With the authoritarian stamp of the smoking ban and other government pressure there are a lot of people trying to give up smoking. There is also an increasing medicalisation of attempts to give up. Every other advert on our local radio station seems to be for the Stop Smoking Service. Fortunately Pirate FM rarely manages to finish an advert without interrupting it with the start (or even the middle) of another. Has anti-smoking political pressure allowed an unsafe drug on the market?

Varenicline is the first drug to be licensed to help stop smoking that doesn’t contain nicotine. The manufacturer, Pfizer, quotes that after twelve weeks of treatment with Champix or an inert placebo four times as many of those taking Champix are still not smoking. The figures at twelve weeks are 44% of those taking the real drug not smoking and 11% of those on the placebo. This is better than none-medical methods or nicotine-replacement therapy (NRT).

Here is where I follow Pfizer’s publicity off the path of good science, because they don’t quote figures that I can find, and I am quoting non-specifics without being able to provide a reference, as I heard this on Radio 4 some days ago. I looked in the NICE Report (National Institute for Clinical Excellence) and they have blanked out the figures.

Pfizer boasts about rates of success giving up at 12 weeks, and these are better than NRT. The problem is that giving up for 3 months does not provide great health benefits. The suggestion I heard on the radio, although the figures are redacted from the table 5, page 32 of the NICE report (lovely word, redacted; has a ring of dishonesty about it) was that at twelve months the success of Champix was almost identical to NRT, certainly within the statistical errors of the trials.

So we have a drug that is as effective as NRT. I have never smoked, but from friends I am aware that NRT can be unpleasant and quitting can be difficult, so an alternative is surely welcome, is it not? Well let us look again at the side effects.

Side effects listed as common include dizziness and hypertension, either of which can themselves be dangerous in some circumstances. However that is within the normal range of side effects of many medicines. Also listed as a common side effect is ‘emotional disorder’. The point made on Radio 4 and in the side effects link was that this can go as far as depressed moods and suicidal ‘ideation’, i.e. feeling down and having thoughts about suicide, a combination that seems to me rather dangerous.

So far this is an accepted, documented problem. Careful monitoring and warnings to patients to see a doctor or stop taking the medication at the first sign of depression or suicidal thoughts can deal with this. What about the undocumented effects? Could Champix lead to murder?

There is nothing I can find in the literature beyond warnings of ‘behavioural changes, depression, or suicidal ideation’. Even these do not get a mention in Pfizer’s adverts, although warnings against operating machinery do and all the information is on the website.

I think that “I wanted to kill ’im”, to quote a friend who was taking Champix, goes a bit beyond the usual understanding of ‘behavioural changes’. A mild and pleasant young lady, very fond of her lover, was driven to thoughts about killing him, and a desire to do so.

Of course this is more bad science, anecdotal evidence, but as I do not have the authority or capacity to do better science it will have to do. This friend had never had such thoughts before taking Champix, nor has she since giving up in fright. She was on no other medication likely to have this effect, and had no expectation of a reaction that might cause a placebo effect. Champix warnings do suggest psychological changes, and the friend said that she suffered others, being in a daze much of the time. In fact she attributes her giving up entirely to forgetting to smoke, such was the influence of the drug (of course that means the drug succeeded, as an addict would be unlikely to forget even then).

So what if my friend had killed her lover? Beyond the distress to her and others, she would have been given a life sentence, as this is not an acknowledged side effect. Her life would have been ruined. What if she had not been a pleasant person in love with her paramour, and clever enough to recognise the responsibility of the drug for her thoughts? What if such feelings are induced in a self-centred, unintelligent but otherwise harmless person? Thousands of them smoke. Will any be induced to murder?

As more is known about the drug, and this effect, if real, is documented the drug becomes a serious danger. What is to stop any smoker bored of someone close to them from starting a course of Champix, then in cold blood murdering that person? In court the murderer breaks down in remorse, blaming the medication. Manslaughter while the balance of mind disturbed milord, now given up the medication, no longer a threat. Free to go. So we are where I hinted that we would reach; the perfect murder.

Fortunately my other half cannot take Champix, due to her job, so I am safe!

Update: Mark (whose profile indicates he is interested in "smoking cessation") confirms in the comments that both Champix and NRT have overall success around 7%. Also in the comments generalsn has a link to a brief article on a financial website which does mention FDA concerns over violence in people taking the drug.

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Mark Barrus (888) 865 -1870 said...

NRT and Chantix have a 7% effective rate

generalsn1234567 said...

Since these bans are all about health, sign makers should be required to put the Chantix and Zyban warning on all of the “No smoking” signs to prevent suicides and lawsuits by forcefully coercing people into using a dangerous product.

Richard Dale said...

Thanks for that, generalsn. That link has the first comment I have seen on possible violence. Quite worrying to consider the decision a court would have to make if someone using the drug had been violent.

Thanks for that confirmation, Mark.

Aubrey Blumsohn said...


There are already plenty of relevant coirt cases. SSRI antidepressants are known to precipitate suicidal and homicidal ideation (and these data were hidden by the companies concerned). There are many cases of homicide where this has been a likely contributing factor (or often the only factor).

These drugs also feature in many school shootings in the US.

The courts don't deal with difficult things very well.



Richard Dale said...

Thanks Aubrey. I have been lucky enough to avoid almost all prescription medication, so have never really had to think about side effects. That is worrying.

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