Treatments for nicotine addiction should be a top priority
Sadly, priorities for investment in clinical trials are directed at treatment of diseases caused by continued tobacco use, rather than addressing the root cause of the diseases: nicotine addiction. Moreover, clinical trials for smoking cessation and treatment of nicotine addiction are not even within the top 25 therapeutic categories in development by the drug industry; anticancer treatments are the first priority. 3 174 pharmacotherapy trials were done for smoking cessation compared with 1490 for lung cancer.
The small number of trials for smoking cessation does not correspond to absence of demand. Many smokers would try to quit smoking if effective and inexpensive approaches were available. Of 45·3 million US adult smokers, 43·5% had tried to quit in the past 12 months, and 80% of those who attempted to quit on their own, without pharmacological or behavioural therapies, relapsed within the first month, with only 3% still abstinent at 6 months.
Despite enormous efforts to find treatments for lung cancer, the 5-year survival rate has increased from 6% to only 14%, and incidence and mortality have increased 2·5-fold during the same period.8 Incorporation of tobacco dependence into a conceptual model of chronic disease will be of profound and immediate benefit to public health. Furthermore, research findings should be used to identify new molecular targets for nicotine addiction and biomarkers to predict treatment success.
