Dr. Chatterbox Answers His Critics

Chatterbox’s campaign to allow high schools to pass out nicotine patches to teen-age cigarette addicts (click here and here) has flummoxed a few readers. Doesn’t Chatterbox know that nicotine causes heart disease? (Click here, for example, to read John Doyle in “The Fray.”) In helping America’s youth dodge the bullet of lung cancer, isn’t Chatterbox pushing it into a cardiovascular line of fire?

Chatterbox is not a doctor, but he does play one on the Internet. The Food and Drug Administration’s 1996 press release announcing its over-the-counter approval for the nicotine patch advises:

Persons with significant heart disease or who take certain prescription medicines for depression or asthma should speak with their doctors before using the Nicotrol patch. Some people who use the Nicotrol patch will experience skin irritation or redness where the patch is placed on the skin.

But “speak with their doctors” is a well-known fudge. The label doesn’t actually say that nicotine patches have been shown to contribute to heart disease or even “significant” heart disease. What gives? Chatterbox put in a call to Dr. John Slade, an associate professor of medicine at the University of Medicine and Dentistry of New Jersey, who has studied nicotine extensively. (It’s long been Slade’s view that the government should force cigarette companies to come up with a safe cigarette. Chatterbox endorsed the idea in this 1997 article in U.S. News & World Report.) Is nicotine bad for the ticker? “Nicotine certainly has interesting effects on the heart,” Slade replied. When you stop smoking, your heart slows down a bit, and between cigarettes your blood pressure drops. But Slade emphasized that the quantity of nicotine rushing into your bloodstream when you use nicotine gum or a nicotine patch is much, much smaller than when you smoke a cigarette. With a cigarette, he said, the nicotine surges are in the neighborhood of 80 to 100 nanograms per milliliter of blood. With the gum or a patch, the nicotine surges are more like 15 to 20 nanograms per milliliter of blood. At those levels, Slade says, nicotine doesn’t appear to endanger the heart.

Slade referred Chatterbox to a 1996 study in Chest, the journal of the American College of Chest Physicians. (Click here for an abstract and also for a link that will give you the whole article for $5.) In a double-blind test, nearly 6,000 ex-smokers, aged 35 to 60, were tracked over five years to check for any side effects associated with nicotine gum. Among those who stayed off cigarettes, the nicotine-gum chewers actually had slightly fewer cardiovascular problems than the ones who quit cold turkey! Here’s how the study’s authors explained it:

There seemed to be a protective effect of [nicotine gum] use that dissipated over time. One way of speculating about this mechanism might be as follows. Quitting smoking is presumed physiologically stressful to some extent. [Nicotine gum] softens the transition from smoking to abstinence. Some people with borderline cardiovascular disease who quit without [nicotine gum] might then have observable events.

The only problems that nicotine gum appeared to cause were “jaw muscle ache and hiccups for men and belching for women.” The study concluded that nicotine gum “appears to be safe and unrelated to any cardiovascular illnesses or other serious side effects.” Cigarettes can kill you, but the nicotine in  gum or a patch is probably no more likely to give you a heart attack than the caffeine in a bottle of Coke.