Fund butt-out aids, MDs tell provinces

A Canadian medical research journal is urging all provinces to follow the example of Quebec, Australia and the United Kingdom and fund smoking-cessation therapies.

An editorial in the Canadian Medical Association Journal says reducing smoking rates could save hundreds of thousands of lives while slashing tobacco-related health-care costs. The authors say studies have shown treatments plus counselling increase the likelihood of a person quitting and still abstaining one year later.

"In this instance, (the benefit) is pretty clear-cut," Dr. Paul Hébert, the journal's editor-in-chief and editorial co-author, said in an interview. "You have public health interventions, like tobacco-control programs, that are already in existence.

"They have been more or less successful. In fact, they've dropped smoking rates over the course of time. But they seem to be fixed at 19 per cent."

However, Manitoba Healthy Living Minister Jim Rondeau said Monday fully funding such remedies would be "prohibitively expensive."

Instead, he said, Manitoba will urge Ottawa at an upcoming federal-provincial health ministers conference in Newfoundland to work co-operatively with the provinces on smoking prevention and cessation.

In the past, Rondeau said, the province's medical advisers have rejected the idea of taxpayers paying for nicotine-replacement therapies. "Up to this point, the docs have said if people can afford to smoke then they can afford to quit," he said in an interview.

Rondeau said he is concerned that Ottawa last week cut support for a smokers' helpline, and he's looking for ways the province can maintain the service in Manitoba.

He's also open to pursuing a broad range of methods for tackling smoking, including recognizing those who quit and even offering "prizes" on a selective basis.

Only Quebec among Canadian provinces provides public funding for all smoking-cessation therapies, while the Yukon and Prince Edward Island reimburse for at least one product each. The CMAJ says Australia and the United Kingdom cover the cost of all smoking-cessation products, including prescription medications and over-the-counter nicotine-replacement aids.

The journal editorial says the high cost of quit-smoking products acts as a disincentive for many smokers even to try to kick the habit.

"Given the high cost of tobacco addiction and our inability to decrease the rates of smoking in Canada below 19 per cent in recent years, governments should complement population-level public health strategies against tobacco with a marked increase in investment in individual-level smoking-cessation programs," the authors write.

"An appropriate source of funding for this is obvious -- the substantial tax revenues collected with the sale of every tobacco product."

As well, the editorial says the cost of quit-smoking medications -- about $220 for every life-year gained -- will be less than the cost of medical interventions needed down the road for Canadians who don't quit smoking.

"I would suggest that in this instance, it's like a user fee," Hébert said.

Murray Gibson, executive director of Manitoba Tobacco Reduction Alliance, said paying for smoking-cessation remedies would help people quit. But blanket coverage may not be the most cost-effective way to accomplish it. It may be better to target low-income groups or groups with high smoking rates, such as aboriginal people, he said.

As well, not all people smoke because they are addicted to nicotine, Gibson said. There are social and psychological, as well as physical, reasons why people smoke, he said. So funding cessation drugs is "not a be all and an end all in itself."

Doctors -- especially in Manitoba -- can also do more to help their patients butt out, Gibson said. According to a 2008 Canadian Lung Association survey, Manitoba physicians were least likely to ask patients if they smoked or to provide advice on how to quit, he said.

-- with files from The Canadian Press, Postmedia News

larry.kusch@freepress.mb.ca

Republished from the Winnipeg Free Press print edition August 31, 2010 A5