From a business perspective, the patch have been a huge success, breaking all previous records for a new prescription product. In seven months, the three currently available brands–Habitrol, sold by Ciba-Geigy; ProStep, by Lederle Laboratories, and Nicoderm, by Marion Merrell Dow–have raked in sales of $480 million, with $1 billion expected by the end of the year. Demand has been so intense that manufacturers can’t keep up with it–and a fourth brand, Nicotrol, made by Parke-Davis, will make its debut July 15.
The patch is designed to satisfy smokers’ nicotine craving while they get counseling for the social and psychological aspects of their habit. Each patch delivers a 24-hour supply of nicotine, although some users remove them at bedtime to avoid the side effect of insomnia. Others, like Kathy Lynch, 45, a Boston social worker who smoked two packs a day for 20 years, do the opposite. “I put it on at night, get up the next morning and don’t need a cigarette,” she says.
Some insurance plans cover part of the cost of nicotine patches, but many now won’t pay at all unless the patch user also enrolls in a smoking-cessation program–a cost they don’t reimburse. A few corporations have decided to eliminate the middleman. In Atlantic City, 600 workers–including blackjack and baccarat dealers–have signed up for a ProStep patch program bankrolled by Trump Taj Mahal Casino Resorts.
Both physicians and manufacturers warn against smoking while wearing the patch. But those who do claim that at least the patch helps them cut down. Diane Poupolo, 52, of Everett, Mass., was desperate. She had smoked two-and-a-half packs daily for 33 years and suffers from emphysema. She had failed with hypnosis, nicotine chewing gum and her own will power. So she entered a stop-smoking program at Boston’s Deaconess Hospital run by Dr. Joseph Zibrak. She’s been wearing the patch and–against Zibrak’s advice–smoking about six cigarettes a day since mid-February. “I have a nice, strong, healthy heart,” she says, “but maybe I’m taking a gamble.”
The U.S. Food and Drug Administration is now investigating whether the five reported heart attacks in patch users who smoked are in fact the result of the combination–or simply coincidental, since smokers are at increased risk for heart attacks anyway. “I’m very skeptical that nicotine patches are causing heart attacks, because smokers are a very unhealthy group as a whole,” says Dr. David Sacks, director of California’s Palo Alto Pulmonary Disease Prevention Center. In a study of 792 patients wearing the Habitrol patch, almost half continued to smoke and none had heart attacks. The makers of Nicoderm cite another study of 150 people with known heart disease. They wore the patch and also smoked, but suffered no heart attacks, either.
Each year nearly 20 million Americans try to quit smoking-and fewer than 10 percent succeed. Unless the patches are proven perilous, smokers will almost certainly continue to clamor for them. Yes, Virginia, there is a chance of success, but it’s still pretty slim. In a pre-market study, 935 smokers received the patch plus counseling–and six months later, 75 percent were puffing away again. Anyone got a light?
