Drug for smokers to quit could be a drag on resources

Beijing’s municipal Legislative Affairs Office has released draft tobacco control legislation requiring medical institutions to provide “guidance and help” for smokers.

The draft, released for public consultation last week, echoes a controversial plan first outlined by Health Minister Chen Zhu in April that would see consultations with doctors on quitting smoking covered by basic medical insurance and the drugs involved in such treatment included in the essential drugs catalogue.

While many doctors and tobacco control advocates support the plan, saying that giving smokers professional help to quit will improve public health and cut the social cost of tobacco use, others question whether it is appropriate to extend limited basic medical insurance to cover such drugs.

The mainland is the world’s largest producer and consumer of tobacco, accounting for 40 per cent of cigarette sales. A Ministry of Health report in 2010 said there were more than 356 million smokers on the mainland and over a million smoking-related deaths every year.

Wang Hongzhi , a pharmaceutical industry specialist at management consultancy Allpku, said using drugs to treat smoking addiction was ineffective, as clinical trials showed the most effective drug was only 10 percentage points more effective than a placebo. Authorities in other countries had also linked such drugs to suicidal tendencies and cardiovascular diseases, he said.

And even though such drugs are covered by basic medical insurance in some countries, such as Australia, that did not necessarily mean Beijing should follow suit as the level of social security on the mainland was much lower, he said. The full course of treatment costs more than 4,000 yuan (HK$4,899), while the premium for basic medical insurance in rural areas is about 300 yuan a year, Wang said, adding that the reimbursement level for essential drugs in rural areas was only 50 per cent.

He said that including drugs used in treating smoking addiction in the essential drugs catalogue should not be a priority, given that the mainland only extended insurance coverage to serious diseases such as kidney failure and lung cancer in March.

“The point is you can’t quit smoking solely because of the drugs or willpower,” Wang said. “There are many other things that need to be addressed first, otherwise it is just not an efficient use of money.”

But Dr Xiao Dan , director of the smoking cessation clinic at Beijing’s Chaoyang Hospital, said that extending insurance coverage should be a top priority as it was cheaper to treat tobacco addiction than to treat the cardiovascular diseases that would otherwise develop.

Xiao said that some of her patients, after hearing that the first phase of drug treatment would cost them more than 2,100 yuan, would only accept one or two packets of drugs, or none at all, saying they would rely on willpower instead.

“Smoking addiction is a chronic ailment and drug treatment is a way of treating it,” she said. “The priority of basic medical insurance should be to focus on the burden on people’s health, and smoking is responsible for an enormous [burden].”

Xiao also said that helping smokers quit would be good news for the 740 million non-smokers on the mainland who had to put up with second-hand smoke.

Some tobacco control experts who support the idea, such as Professor Zhi Xiuyi , director of the Lung Cancer Treatment Centre at Capital Medical University, propose a gradual approach. He said pilot programmes should first be conducted in designated cities that already have hospital-based smoking-cessation clinics, had introduced bans on smoking in public places and had higher levels of social security.

That would let doctors identify patients suffering from serious addiction and those who should be treated with drugs. “Not all patients need to be treated with drugs, and we need to have trained, experienced doctors for that purpose,” Zhi said.

Jiang Yuan , deputy director of the tobacco control office at the Chinese Centre for Disease Control and Prevention, said extending basic medical insurance to cover smoking cessation was only a small part of tobacco control and should only be implemented after other measures, such as bans on smoking in public areas, were in place, otherwise patients would just start smoking again.

“Studies show tobacco prices, a ban on smoking in working areas and health warnings … are the three most effective measures to encourage people to quit,” she said. “We need to improve the general environment for tobacco control first.”

pinghui.zhuang@scmp.com