Smoking Cessation

Dave Winer quit smoking last week.  I Didn't even know he smoked.  He's right.  Most physicians haven't smoked.  We don't know first hand how hard it is to quit.  We do know how important it is.   James Prochaska has written about how people change.  He's written "academic" books too .. but this one is better.  It looks at how real people change unhealthful behaviors.   Dave's additction, of course, is not unusual.  When I counsel patients on smoking cessation, the very first question I ask is "are you interested in quitting?'  If the answer is "no." .. I let them know that I will be here when they are interested.  If they are interested, I do offer nicotine replacement of some kind.  At frist, I was hesitant to use the nicotine inhalers .. seemed too much like cigarettes .. but I've had so many patients use them to quit that I am actually an avid prescriber of them now.   And of course Buproprion absolutely helps.  There's very good data on this.   The cool thing is that other antidepressants can help with smoking cessation .. even the very inxpensive ones like nortriptyline.  But we won't see much on TV about these alternatives, since the pharmaceutical industry has no incentive to sell it.  Nortriptyline is generic and costs about 10 cents a tablet.