As scientists reveal they're working on a vaccine to stop nicotine cravings, experts look at the future of quitting, and whether the new trend for electronic cigarettes could have an impact.
By Lisa Salmon
Smoking-related diseases are one of the biggest preventable causes of death in the world. Yet, despite the huge risks, most smokers find it tough or impossible to quit.
While 74% of Britain's 9.6 million smokers say they want to quit, and 40% try to do so every year, only 5-6% (about 200,000 people) actually succeed. Though numerous factors can come into play, one of the biggest reasons for this is the fact that nicotine is extremely addictive.
But hope may be on the distant horizon - scientists are working on a new vaccine that could stop people becoming addicted to nicotine in the first place, and thus remove the major barrier to kicking the habit.
The formula has been successfully tested on mice, but years of further tests are needed before it can be tried on humans.
Nevertheless, the American scientists who have created the vaccine, which is designed to make the liver continuously produce antibodies that gobble up nicotine before it reaches the brain and heart, are extremely hopeful about its potential.
"As far as we can see, the best way to treat chronic nicotine addiction from smoking is to have these Pacman-like antibodies on patrol, clearing the blood as needed before nicotine can have any biological effect," says the project's lead investigator Dr Ronald Crystal, a professor of genetic medicine at Weill Cornell Medical College in New York.
Dr Crystal says studies show that 70-80% of smokers who try to quit light up again within six months, but he points out: "While we have only tested mice to date, we are very hopeful that this kind of vaccine strategy can finally help the millions of smokers who have tried to stop, exhausting all the methods on the market today, but find their nicotine addiction to be strong enough to overcome current approaches.
"This novel vaccine may offer a much-needed solution."
Demand for help is certainly there, and if a 'magic solution' does become a reality, it could literally be world-changing. Reducing the rates of people needing treatment for smoking related conditions could certainly make a significant dent in NHS costs, for starters.
Right now, as well as going 'cold turkey' and trying to stop smoking without help, using the NHS Smokefree services, or trying nicotine replacement therapies (NRT) such as nicotine patches, gums, or tablets, increasing numbers of smokers are thought to be trying electronic cigarettes (e-cigarettes) in a bid to stop smoking real cigarettes.
These battery-operated devices - designed to simulate smoking by producing a vapour that 'feels' like the real thing, minus the health risks of tobacco - recently caused a bit of a frenzy, when one was mistaken as a bomb on a bus.
Police launched a full-scale emergency swoop on the Megabus travelling from Preston to London earlier this month [July], when somebody reported vapour seeping out of a passenger's bag, after spotting them pouring liquid into it.
The road was brought to a standstill and terrified passengers were made to evacuate the bus, in a scene resembling something from an action movie.
It turned out to be an innocent fake fag - they're liquid-activated.
E-cigarettes have actually been around for a while; they were patented in 2003, with the aim of being marketed as a healthier alternative to smoking real cigarettes because they don't expose smokers to the 4,000 chemicals present in tobacco smoke. However, they do still contain nicotine.
They're sold as a harm-reduction tool and aren't yet regulated in the UK and, unlike some other nicotine replacement therapies, aren't classed as a medical product by the UK's Medicine and Healthcare products Regulatory Agency (MHRA).
Currently, there's little evidence on their safety or effectiveness as a 'quitting aid'.
This could change, though.
A small Boston University study by Michael Siegel, published last year, found that of 222 respondents who used e-cigarettes, 31% were abstaining from smoking real cigarettes six months later.
Many (66.8%) reported a reduction in the number of cigarettes they smoked, and almost half (48.8%) reported not smoking real cigarettes for a period of time.
Those respondents using e-cigarettes more than 20 times a day had a quit rate of 70%, and of those who weren't smoking after six months, more than a third were no longer using e-cigarettes or any nicotine-containing products.
Amanda Sandford, research manager for the public health charity Action On Smoking And Health (ASH), says: "E-cigs certainly have the potential to reduce harm for smokers who are unable, or not ready to quit, but want to continue to use nicotine.
"However, there's no clear evidence yet that e-cigarettes are effective as a quitting aid, although some smokers are using them as a springboard to quitting."
Professor John Britton, director of the UK Centre for Tobacco Control Studies, describes e-cigarettes as a "potentially extremely useful, very important development".
He points out that they provide smokers with a cigarette substitute which is similar enough to the real thing to be a behavioural substitute.
"There's nothing wrong with nicotine use," he explains.
"What's wrong is smoking tobacco to get the nicotine.
"E-cigarettes stop the use of tobacco for nicotine, but you don't stop all the behaviour that goes with it.
"That drug-rewarding behaviour is part of the reason people smoke, and you're substituting it with something that at best is a safe form of nicotine which therefore carries trivial, if any, risk for the smoker, and could be an extremely good thing."
However, he points out that the downside of e-cigarettes is that they're currently unregulated and vary enormously in their quality, content and ability to deliver nicotine.
He hopes that within the year the MHRA will have issued guidance that requires minimum standards for such products.
The MHRA confirms it's looking to license e-cigarettes as a health-promoting product in the future.
"The fact that so many people use e-cigarettes demonstrates that there's a desire among smokers to switch to something less hazardous. But we don't have the minimum standards on e-cigarettes' safety, purity and performance that any of us would like."
As far as a nicotine vaccine is concerned, Britton says several have been unsuccessfully tested in the past, and while the success of the latest vaccine on mice is a sign of promise, he believes the biggest treatment opportunity is to provide smokers with alternative sources of nicotine.
"I see e-cigarettes as the first generation of a potentially huge market for such sources," he says.
"If we accept that the great majority of smokers don't want to smoke and want help to quit, but can't or aren't ready to do so, it's in their interests that they should be able to walk into a shop and be able to buy alternative products that give them a hit but don't kill them."
Stopping smoking facts
Action on Smoking and Health (ASH) says:
:: An ASH study found 74% of British smokers said they wanted to quit.
:: Approximately half of all smokers make at least one attempt to stop in a given year.
:: Smokers who seek professional help to quit roughly double their chances of quitting.
:: After the age of 35-40 years, for every year of continued smoking a person loses three months of life expectancy.
:: Within 24 hours of stopping smoking, carbon monoxide and nicotine are eliminated from the body.
:: In a year, the risk of a heart attack reduces by half compared to that of a smoker, although it takes 15 years for heart attack risk to fall to the same level as someone who's never smoked.
:: After 10 years the risk of lung cancer falls to about half that of a smoker.
:: For advice on quitting smoking, contact NHS Smokefree on 0800 0224 332 or visit smokefree.nhs.uk