Study: Less Smoking May Not Help           
                      By LAURAN NEERGAARD, AP Medical Writer 

                   WASHINGTON (AP) - Your New Year's resolution was to cut back on cigarettes
                   this year, hoping to lower those nasty health risks. Don't be too sure simply
                   smoking less will truly improve your health.

                   Cutting back versus completely quitting is a hot new debate among tobacco
                   specialists. Quit and your body starts healing. But when heavy smokers refuse to
                   quit, the theory is that helping them to smoke less surely is healthier than doing

                   A major drug company even is poised to sell Europeans nicotine inhalers to help
                   heavy smokers not quit but just drop below, say, a pack a day - very different than
                   how Americans use such medicines.

                   Now one of the first studies to test that theory suggests just cutting back instead of
                   quitting won't help your health.

                   It's a surprise finding and won't settle the controversy. But the Mayo Clinic's study -
                   which found levels of toxins in heavy smokers' bodies didn't decrease when they cut
                   smoking in half - is getting serious attention.

                   ``That's very important because what it means to the lay public is that if you reduce
                   (daily cigarettes), we're still not sure how much benefit you're going to get,'' says
                   John R. Hughes, a well-known University of Vermont smoking expert. ``So don't fool

                   About 48 million Americans smoke, an addiction that kills 400,000 each year.
                   Smoking causes heart disease, lung diseases like emphysema, and lung cancer,
                   and also increases people's risk of seven other cancers.

                   Quit smoking and those risks start dropping. Seventy percent of smokers say they
                   want to stop, but only about 35 percent try in any given year. It can take repeated
                   attempts to finally succeed.

                   Yet many smokers won't try to quit. Hence the ``harm reduction'' theory: if
                   hard-core smokers could go from, say, 40 cigarettes a day to 20 - helped by
                   long-term nicotine-replacement therapy - maybe they'd be somewhat healthier.

                   Or would it just deter them from ever quitting, without significant benefit?

                   Pharmacia Corp. is investing in the theory. Its studies say up to 30 percent of
                   smokers who refuse to quit cut their smoking in half by using nicotine inhalers,
                   nasal sprays, gum and under-the-tongue pills to curb cravings between cigarettes.

                   Here, nicotine replacement is approved only for short-term smoking cessation. But
                   Denmark in 1998 let Pharmacia market those products for smoking reduction, too.
                   The company says three more European countries just issued similar approvals,
                   which it will unveil early this year when it begins more widely marketing the
                   harm-reduction concept. (Nicotine patches, however, remain just for quitting
                   because they supply continuous nicotine.)

                   ``If they reduce the consumption significantly, then one will see a health benefit,''
                   says Pharmacia's global policy director David Graham.

                   But the Mayo Clinic study found no health benefit when hard-core smokers cut their
                   puffing in half.

                   The problem: People apparently smoked their remaining cigarettes harder, trying to
                   suck in more addictive nicotine from each one and consequently inhaling more

                   Dr. Richard Hurt recruited 23 people who smoked between 40 and 50 cigarettes
                   daily but refused to quit, to see if nicotine inhalers helped them cut back to 10
                   cigarettes a day.

                   Then he measured levels of two potent cancer-causing chemicals and two other
                   cigarette toxins - carbon monoxide and a byproduct of cyanide - in smokers'

                   On average, smokers cut their daily cigarette intake in half after three months of
                   trying, but only two got down to 10 a day. Weeks later, their smoking inched up

                   Only one cancer-causing toxin decreased slightly as smoking dropped. Yet those
                   chemicals dissipate within weeks when smokers quit completely.

                   Hughes cautions that larger studies must prove whether cutting back really could
                   help some people's health. Even if it doesn't cut cancer risk, Hughes suspects it
                   could be a confidence-building step for some smokers to eventually quit
                   completely, something he's studying.

                   But ``we know heavy smokers can quit cold-turkey'' if helped by the right dose of
                   nicotine patches and other medicines such as antidepression pills that fight the
                   smoking urge, Mayo's Hurt says.

                   So for now, he advises that New Year's resolution ought to be to quit, not just cut
                   back: ``Set a date and go for it.''
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