World’s Happiest Countries
No. 2: Switzerland
Population: 7.5 million
Life Expectancy: 80.5 years
GDP Per Capita: $32,300
Smack in the middle of Europe and surrounded by picture-postcard scenery, Switzerland ranks second among the world’s happiest countries. It has a low crime rate, good infrastructure, and a wealth of outdoor activities, from skiing in the Alps to boating on Lake Geneva. Home to the International Red Cross, the World Health Organization, and parts of the U.N., it’s not surprising that the Swiss devote a large portion of private and public money to health care — spending an average of $3,445 per person. It’s pretty peaceful, too: years of political neutrality have sheltered the Swiss from the conflicts of their neighbors.
No. 8: Bhutan
Population: 2.3 million
Life Expectancy: 55 years
GDP Per Capita: $1,400
Here’s a surprise: The small Asian nation of Bhutan ranks eighth in the world, despite relatively low life expectancy, a literacy rate of just 47%, and a very low GDP per capita. Why? Researchers credit an unusually strong sense of national identity. Plus, the country has beautiful scenery and a largely unspoiled culture, thanks to strict governmental limits on tourism, development, and immigration. Pretty counterintuitive, but Bhutan seems to have found a recipe for happiness.
No. 11: Ireland
Population: 4 million
Life Expectancy: 77.7 years
GDP Per Capita: $41,000
Once so poor that its citizens fled by the millions, the Celtic Tiger has enjoyed unprecedented economic growth over the past dozen years. Credit membership in the European Union and a can-do attitude has raised standards of living and even lured former immigrants back home. The excellent education system, open economy, and relaxed pace of life all contribute to the overall happiness of the Irish.
Working from Home: It’s in the Details
Traffic surrounding Microsoft headquarters in Redmond, Wash., has become so congested that Washington State Governor Chris Gregoire nearly missed a 9 a.m. speech at the company’s main campus one recent morning. Roads leading to the software maker simply weren’t designed to handle the 35,000 commuters who report for work there each day. The gridlock that greeted Gregoire was just the latest reminder that Microsoft needs to tackle its commuter crisis—and quick.
So Microsoft (MSFT) has embarked on a program aimed at getting more employees to work from home and other off-site locales, joining the growing ranks of companies to catch the virtual-workplace wave. About 14% of the U.S. workforce gets its job done at a home office more than two days per week, says Charlie Grantham, executive producer of consulting firm Work Design Collaborative. That’s up from 11% in 2004, and is set to grow to 17% by 2009.
Pros and Cons
Benefits of letting employees work from outside the office include keeping cars off the road, helping a company to bolster its green bona fides. But the practice can also foster employee retention, boost worker productivity, and slash real estate costs. At IBM (IBM), about 42% of the company’s 330,000 employees work on the road, from home, or at a client location, saving the computer company about $100 million in real estate-related expenses a year. VIPdesk, an employer of at-home customer-service reps, hangs onto 85% of its employees each year, compared with the 10% to 20% rate for traditional call centers, according to consulting firm IDC. And virtual workers are about 16% more productive than office workers, according to Grantham’s research.
For all the benefits of freeing workers from the office, drawbacks abound. First, not everyone wants to leave. Some fear they will step off the corporate ladder, while others need a busy environment to stay productive. Some managers are reluctant to scatter direct reports because keeping tabs on a virtual workforce can be harder than managing those close at hand. Some virtual workers can feel lonely, isolated, or deprived of vital training and mentoring. And communication breakdowns can impede innovation, trust, job satisfaction, and performance.
Obstacles like these have prompted IBM, Sun Microsystems (SUNW), and other companies to seek out a host of creative solutions to the problems that virtual work presents. Some turn to a combination of mobile devices, e-mail, instant messaging, and collaboration software to help colleagues stay in touch.
Some Are Reluctant
But experts say successful companies go a step further, adopting a whole virtual-worker ethos. “Management by objective is critical,” says Ann Bamesberger, vice-president of Open Work at Sun. “If you have to manage by monitoring, it’s not for you.” A number of companies including Deloitte & Touche, Ernst & Young, IBM, and Sun have also revamped office space to better accommodate virtual workers, providing everything from cubicles to conference rooms for employees who only occasionally stop in.
While many relish the chance to strike a better work-life balance by working from home, some are surprisingly resistant to being stationed outside the office. Of the approximately 25% of workers who could feasibly telecommute, less than half would do so more than two days a week, and 14% wouldn’t telecommute at all, according to a survey conducted by research firm Rockbridge Associates and the Center for Excellence in Service at the University of Maryland’s Robert H. Smith School of Business.
This reluctance may be fueled by fear that if they’re out of sight, they will be out of mind, too. About 61% of global executives say they think telecommuters are less likely to advance in their careers, compared with employees in a traditional office setting, according to a survey conducted by Futurestep, a subsidiary of Korn/Ferry International (KFY).
Communication Preferences
Even workers who are eager to telecommute encounter hurdles. Many managers simply don’t know how to manage a virtual workforce. “Projects fail, and companies assume that the workers can’t do the work,” says Colleen Garton, author of Managing without Walls. “But a high percentage of time, it’s the manager.” Over time, some employees begin to feel isolated, and virtual teams suffer from communication breakdown.
For virtual workers, there are plenty of ways to stay in touch, be it through e-mail, phone, or instant messaging. The trick, say experienced virtual workers, is helping managers know how employees like to communicate. When Kathleen Timiney worked at Groove Networks, a software maker acquired by Microsoft in 2005, she asked each team member how they preferred to communicate and posted those preferences where everyone could see them. “It’s not just superficial,” she says. “You have to support people in their style.”
IBM discovered that workers who spend three or more days without talking to a manager or colleagues start to feel disconnected. “Employees used to feel that IBM meant ‘I’m By Myself,’” says Dan Pelino, general manager for health care and life sciences at IBM. “We learned that it was important for managers to understand that people feel that way and to create new collaborative environments and to ask what they’re doing.” IBM teams use tools that provide customizable online team spaces, or portals that can be tailored to a specific project—complete with calendars, task lists, discussion forums, and document libraries.
Tools for the Virtual Craft
Other companies, including Microsoft, WebEx (WEBX), and Citrix (CTXS), also specialize in online conferencing and collaboration software that makes it easier for people in different locations to work together and conduct meetings. When Microsoft’s Timiney worked at Groove, the company set a policy that if even one person was operating virtually in a meeting, then everyone would sit in their offices and the entire meeting would be virtual. “Because there’s a big sensory difference in that experience, it made sure that everyone was on a level playing field,” she says.
Another way to bridge the physical distance is to provide a worker with the tools needed to stay connected to colleagues. For the virtual worker, a laptop, high-speed Internet access, and a personal digital assistant or mobile phone are de rigueur. But some companies go an extra mile to outfit virtual employees.
IBM provides a universal messaging service that lets executives give a single phone number to clients and colleagues. The service then forwards calls to wherever that executive might be located, be it at home, on cell phone, or in a so-called eMobility Center, one of the temporary offices set up by IBM in locations around the world. Patrick Boyle, director of health-care and life-sciences sales at IBM, spends about half his time traveling, working from taxis, airport lounges, planes, and coffee shops. He’s also a frequent user of eMobility centers and considers headsets an essential tool of the trade. Microsoft’s Timiney says a quality headset is her most important tool.
Temporary Office Space
Some virtual workers at Sun use the company’s line of workstations, called Sun Ray clients. Unlike conventional PCs, these devices contain no hard disk or operating system. Instead, all the software resides in the company’s servers. That means all information is automatically backed up and stored securely—and won’t be lost in the event the desktop is stolen or irreparably damaged. No software on the desktop also means fewer frustrating calls to tech support, says Larry Ciraulo, director of client computing services for Sun IT.
About five years ago, Sun realized that its offices were empty about half the time, as workers were out traveling or at meetings. So the company began encouraging workers to work from home and created a network of temporary offices, similar to IBM’s eMobility centers, that can be reserved ahead of time. Over the last five years, Sun has saved anywhere from $300 million to $500 million, mostly in real estate costs. Sun also offers consulting services to help other companies that want to create flexible workspaces.
IBM’s eMobility centers feature cubicles and conference rooms equipped with the usual easels and whiteboards. They boast cafes with wireless access, so workers can meet informally as well. IBM realized at one point, however, that it needed to redesign the conference rooms to include clear glass. “Virtual workers want people to see them when they come into the office,” says IBM’s Pelino.
New Hires: Presence Required
It’s one thing to ask a seasoned employee to work from home, but a virtual work environment can be tough on young workers who are trying to learn their jobs and often try to develop friendships at work. “I wouldn’t want a person to come into a virtual environment as a new employee—mentoring is absolutely critical with new hires,” says Sun’s Bamesberger.
Often, Bamesberger will require that a new employee work in the office for a period of time before going virtual. “I personally think that learning requires some exposure to other human beings,” she says. Similarly, Convergys (CVG) asks call-center workers to come into the office for training and the first month of work before they start working from home. The company now employs about 60,000 call-center workers, about 850 of whom work at home.
Sometimes virtual workers simply miss that informal advice that colleagues give in an office setting. At IBM, the company has tried to make sure virtual workers receive needed coaching and mentoring. That can range from a sales exec getting advice from a colleague before an important sales call to more formal events at the office, where senior executives run roundtables.
As Microsoft establishes a formal virtual-work program, the company will likely have no trouble with the technology part of the equation. “Nearly 100% of our people have at some time worked virtually,” says Lisa Brummel, senior vice-president of human resources at Microsoft. Indeed, the company makes many of the tools that virtual workers need. Yet, figuring out how to use that technology wisely in a virtual environment requires a bit more thought. Microsoft can just ask IBM’s Pelino, who cautions, “We learned from trial and error.” Until then, beware traffic jams in Redmond.
http://www.businessweek.com/technology/content/feb2007/tc20070212_457307.htm?chan=rss_topStories_ssi_5
The Devil Dials Prada on LG’s New Phone
When Apple (AAPL) unveiled its long-anticipated iPhone at the annual Macworld trade show in San Francisco in early January, few received the news with more apprehension than Cha Kang Heui. Cha, the chief mobile phone designer at LG Electronics, has high expectations for a new co-branded handset due out next month that was designed with a team from Italian fashion house Prada.
The iPhone has certainly generated industry-wide buzz. However, opinion is divided about what sort of sales impact the wireless phone, music and video player, and mobile Internet browsing device will make in a very crowded field already dominated by Nokia (NOK), Motorola (MOT), Samsung Electronics (SSNHY), Sony Ericsson, and LG when it’s launched in June (see BusinessWeek.com, 1/10/07, “The Future of Apple”).
Even so, LG execs believe the Prada Phone, which will go head-to-head with Apple’s iPhone in the high-end multimedia handset arena, is a game-changer. It boasts an elegant shape and design, graphic interface, and, of course, the Prada brand name that oozes high-fashion and luxury. “With or without the iPhone, our Prada phone and other models will give consumers a new experience,” declares Cha. “Users will come back to us as long as we give them emotional satisfaction with easy-to-use software interface or intuitive look and feel.”
Prada Price Tag
In a world awash with mobile phones, global manufacturers have now started to reach out to luxury brand purveyors to develop fashion phones that offer a way to charge more for a little panache—but also stand out. For instance, Motorola has teamed with the (RED) group, co-founded by U2 front man and activist Bono, to develop the Red Motorazr. Plus, Samsung and high-end Danish consumer-electronics firm, Bang & Olufsen jointly developed a high-end handset called the Serene.
LG will see what kind of fashion instincts it has when the Prada Phone goes on sale in Europe in February. The design may be minimalist, but not the functions—or the price.
The multimedia phone, which will fetch €600 ($780), is not so different from other high-tech handsets. You can play and download music, surf the Internet, deliver voice mail, and read Microsoft’s document files. It also doubles as an FM radio and comes with a 2-megapixel still and video camera. (Sales in Asia will begin in March, but LG is still negotiating with U.S. carriers for its U.S. debut)
Shift to Design Emphasis
The main difference from other phones is its radically simple appearance. Like Apple’s iPhone, it removed clustered buttons and the keypad to rely on graphic icons on a big touch screen. And when not in use, the glowing icons disappear to reveal the pure black face that highlights the Italian fashion house’s ubiquitous Prada logo.
LG is betting that the touch interface and the sleek design and status symbol allure will differentiate the handset from other ultra-slim, function-backed devices. That may not be easy. The thin-is-beautiful fad has been in motion since 2004, when Motorola scored big with its Razr lineup in 2004. “Phones have become a powerful accessory of consumers, and they seek expression of their personality with their accessories,” says Cha.
Still, LG has shown some design panache in the past, what with the incredible success of its “Chocolate” phone. The Korean company, the world’s No. 5 handset maker after Nokia, Motorola, Samsung Electronics, and Sony Ericsson, has sold some 7.5 million Chocolate phones since its global debut last May.
The phone also marked the company’s shift in emphasis—to design and user interface—from leading-edge features.
“Digital Workhorse”
The Chocolate, the best-selling model LG has ever introduced, has turned LG’s money-losing cell phone business around. The handset unit posted an operating profit of $148.2 million in the second half of 2006, against a loss of $36.5 million in the first six months. The phone, which was first offered at a retail price of about $400, has also boosted LG’s average selling price for its phones in Europe to $160 from below $110 at the beginning of last year.
Like the Prada phone, the Chocolate was designed to look like a black rectangular bar, not a phone. Its LCD screen, which sleeps when not in use, suddenly lights up when it slides open. “Customers are amused when a simple personal accessory item turns into a powerful digital workhorse with a gentle touch,” says Cha, who first introduced touch-sensitive navigation buttons for the Chocolate.
Now LG is poised to ship the Prada and another new phone overseas, capitalizing on the playful interaction with its phone users. “We are creating a new market,” says Chang Ma, a vice-president with LG’s mobile communications unit. “Design has become a good enough factor for consumers to choose their phones.”
User Experience?
Ma reckons the design similarity between the iPhone and the Prada underscores how rapidly the Korean company has made strides in dreaming up innovative products on par with the kind of branding and design smarts Apple lends to its products. “We are pretty confident that [our] consumer-focused design capability has reached Apple’s class,” he says.
Already, the Prada phone won Europe’s prestigious IF award in December for its excellence in design. The ultra-thin phone, the outcome of an eight-month joint effort between LG and Prada designers, will be sold in phone dealerships and Prada stores in Britain, France, Germany, and Italy starting in February. That’s four months before Apple will start offering the iPhone in the U.S.
LG is also launching another fashion phone in Europe—called the “Shine” phone. As the name suggests, its face and the back are finished with shiny stainless steel. The face of the slider phone is a glittering silver mirror which turns into an LCD screen when it slides open. The back is a clean stainless sheet housing only the lens of a 2-megapixel camera. The phone, which will be sold globally this year, will have a price tag similar to that of the Chocolate phone.
The shiny, rectangular phone has all the ingredients for becoming a head-turner, at least as far as its hardware appeal is concerned. The big question is if users will appreciate their experience with its software as well. That issue looms large particularly because Apple is moving into the business, with Jobs pledging to “reinvent the phone.
The Candy vs. the Apple
Korean electronics companies had learned a lesson with Apple’s iPod music player earlier this decade. The Koreans were years ahead in rolling out a MP3 music player only to be outgunned by Apple with its beautifully designed iPod and the software magic of iTunes. “We admire Apple’s excellence in user interface and software,” says Brian Sohn, head of LG’s investor relations. “We are watching Apple carefully, but Apple also has some catching up to do in its telecom network technologies.”
Analysts agree that although Apple has the potential to shake up the industry, it won’t pose a major threat to large phone makers in the short term. Apple hopes to garner 1% of the global handset market by 2008, a goal that would mean sales of 10 million phones. That’s a number LG is expected to achieve with its Chocolate phone alone from one year of its global sales. LG, which sold 64 million handsets in 2006, aims to ship 78 million units this year.
With the success of its Chocolate phone, LG is no longer an obscure name among carriers, dealerships, or consumers in global markets. “The chances of LG hitting the sweet spot have certainly improved,” says Kevin Lee, telecom device analyst at Woori Investment & Securities in Seoul. If the Shine or Prada phone proves a hit model, LG could charge ahead in its campaign to move up in the fiercely competitive industry’s pecking order.
http://www.businessweek.com/globalbiz/content/jan2007/gb20070129_447358.htm
How to Cut Energy Costs: Buy efficient appliances, unplug your TV, and other tips for reducing your thirst for power
ENERGY efficiency has come a long way from flickering fluorescent lights.
Amid rising fuel prices and increasingly dire predictions about the effects of greenhouse gases, people are seeking ways to reduce their electricity usage and lower their bills. And they’re finding it easier than ever, thanks to a host of new products and services from utilities, government agencies and manufacturers.
The Environmental Protection Agency’s Energy Star program singles out numerous products that meet energy-efficiency criteria. Utilities across the country are offering programs to help customers cut costs. And there are lots of simple household improvements that can cut your power use and lower your bill.
Here’s a look at some of the top tips for cutting costs, from several electric utilities and the EPA.
BUY EFFICIENT PRODUCTS
One of the best ways to cut costs is to use energy-efficient appliances. And there’s a simple way to track down products that fit the bill: the EPA’s Energy Star designation. The label, which was introduced in 1992, now adorns a wide array of appliances that meet the agency’s efficiency standards, from dishwashers, refrigerators and flat-screen television sets to more-modest gadgets such as cordless phones and battery chargers.
Some Energy Star products have a higher upfront cost, but the EPA says the electricity savings over the life of the product typically offset the premium. According to the EPA, a home that uses only Energy Star products and appliances will use 30% less energy than a house equipped with standard products, saving the typical homeowner about $400 a year.
Consumers saved $12 billion on their utility bills in 2005 by buying Energy Star products, the agency says. That’s up from $5 billion in 2000. Greenhouse-gas reductions through the program in 2005 were the equivalent of the emissions from 23 million vehicles, up from 11 million vehicles in 2000.
TALK TO YOUR UTILITY
Most utilities in the U.S. offer a variety of energy-efficiency programs. The offerings often include free or low-cost audits of customers’ homes to determine their energy efficiency, as well as rebates for appliances that meet certain energy-efficiency criteria. (In many cases, that means Energy Star products.)
For instance, Minneapolis-based Xcel Energy Inc. offers home audits and rebates for appliances, as well as rebates for designated home improvements that boost energy efficiency. For new homes, Xcel will cover the cost of installing energy-efficient components that meet certain guidelines.
The utility has seen a significant increase in customer interest since natural-gas prices began climbing in late 2003, says Peter Narog, manager of consumer demand-side management marketing. “The past two years, we almost haven’t even had to promote the program,” he says.
Xcel’s program reduced customers’ natural-gas usage by 160 million cubic feet in 2006 — enough to meet the natural-gas needs of 160,000 average homes for four days — surpassing the utility’s goal of 124 million cubic feet.
Southern California Edison Co., meanwhile, offers rebates for Energy Star appliances and provides energy-efficiency audits. Customers can have the audits done in their home by a third party — usually at a cost of $150 to $300 — or they can do a more-basic online audit at the utility’s Web site. Southern California Edison also offers low- income customers a break: The utility will cover the cost of weatherizing their homes and installing certain energy-efficient appliances.
Customers’ interest in the plan grew after California’s 2000-2001 energy crisis, which resulted in rolling blackouts and skyrocketing electricity prices. “After the energy crisis, everyone got very excited about energy efficiency and really started to embrace it,” says Lynda Ziegler, Southern California Edison’s senior vice president of customer service. Californians are also interested in the environmental benefits of energy efficiency, she says.
Most utilities in Europe offer similar programs. The U.K.’s ScottishPower PLC, for instance, sends energy-efficiency messages and advice with all of its customer bills and statements, says Chris Brennan, energy-services marketing manager for the company. ScottishPower customers can call a free telephone number to receive energy-efficiency advice from trained advisers.
HOME IMPROVEMENTS
There are also a host of simple improvements you can make around the house to cut down on wasted power:
Unplug your TV. Home-entertainment systems are big energy hogs to begin with. But many of them have a feature that eats even more power: They remain in standby mode after you shut them off, continuing to draw electricity. Standby power is responsible for 5% to 10% of total electricity use in most homes and accounts for roughly 1% of global carbon-dioxide emissions, according to the International Energy Agency. “Many customers don’t realize that they spend more money to power DVD players when they’re turned off than when they’re in use,” says Penny McLean-Conner, vice president of customer care for Boston- based utility Nstar.
Nstar suggests that customers connect their electronic devices to power strips and turn off the strips when the devices are not in use — which guarantees the gadgets won’t go into standby mode. You could also simply unplug your devices after turning them off.
Change your bulbs. Compact fluorescent bulbs have been substantially improved over the years — no more flickering and humming — and they now can be screwed directly into most fixtures. The bulbs, which sell for about $3 apiece, last up to 10 times longer than incandescent bulbs and can save $30 or more in energy costs over a bulb’s lifetime.
Lower your thermostat to 68 degrees Fahrenheit. Industry experts say 68 degrees is the lowest indoor temperature that most people find comfortable. For each degree you lower your thermostat, you can save 3% on your heating bill, according to the Edison Electric Institute, the Washington, D.C., industry group for U.S. investor-owned utilities. Installing an Energy Star-qualified programmable thermostat can help, by lowering the temperature automatically at designated times, such as when you’re out of the house.
Turn down the temperature on your water heater to 120 degrees Fahrenheit, which is considered adequate or comfortable for most household needs. Lowering your water heater to 120 degrees from 150 degrees can lower your utility bill by $1.80 a month, according to Greenville Utilities, which provides electricity and other utility services to customers in Greenville, N.C., and surrounding areas. Another water-temperature tip: Wash your clothes in the coolest water possible. About 80% of the energy used to run your washer comes from heating the water.
Keep fireplace dampers closed to lessen heating and cooling loss. An open or poorly sealed damper can draw air up the chimney even when the fireplace isn’t in use, creating a net energy loss on an annual basis, according to Progress Energy Inc., a Raleigh, N.C., energy holding company.
Have your furnace maintained regularly by a professional, and keep your furnace filter and vents clean. Dirty furnace filters and vents cause the furnace to burn less efficiently, making it more difficult to heat your home.
Keep the curtains open in rooms with southern exposure during the winter and closed during the summer. In the Northern Hemisphere, south-facing windows receive the most intense light in both the summer and winter. Letting in that light in the winter will help keep your house warm; blocking it in the summer will help cool things off. In both cases, you’ll be able to use less power to keep your house comfortable.
Don’t run kitchen and bathroom exhaust fans for long periods. Exhaust fans will remove heated or air-conditioned air from your home if they run for more than 15 minutes after you’re done cooking or running the water, according to Gulf Power, a Pensacola, Fla., utility. You might also consider replacing your current fan to save on costs: Energy Star ventilation fans use 65% less energy on average than standard models.
Christine Buurma. Wall Street Journal. (Eastern edition). New York, N.Y.: Feb 12, 2007. pg. R.13
Nicotine Fix: Behind Antismoking Policy, Influence of Drug Industry;
Michael Fiore is in charge of revising federal guidelines on how to get smokers to quit. He also runs an academic research center funded in part by drug companies that make quit-smoking aids, and he personally has received tens of thousands of dollars in speaking and consulting fees from those companies.
Conflict of interest? No, says Dr. Fiore, who has consistently declared that doctors ought to use stop-smoking medicine. He says his opinion — reflected in current federal guidelines — is based on scientific evidence from hundreds of studies.
Now debate is growing about that evidence, and about who should be entrusted to interpret it. Some public-health officials say industry- funded doctors are ignoring other studies that suggest cold turkey is just as effective or even superior to nicotine patches and other pharmaceuticals over the long run, not to mention cheaper.
At stake is one of the most important issues in the nation’s public- health policy. Cigarettes kill an estimated 440,000 Americans a year. Helping America’s 45 million smokers kick the addiction could save untold numbers of people.
The Public Health Service, part of the Department of Health and Human Services, issued guidelines in 2000 calling for smokers to use nicotine patches, gums and other pharmaceutical aids to quit, with a few exceptions such as pregnant women. Dr. Fiore, a University of Wisconsin professor of medicine, headed the 18-member panel that created those guidelines. He and at least eight others on it had ties to the makers of stop-smoking products.
Those opposed to urging medication on most quitters note that cold turkey is the method used by the vast majority of former smokers. They fear the federal government’s campaign could discourage potential quitters who don’t want to spend money on quitting aids or don’t like the idea of treating their nicotine addiction with more nicotine.
“To imply that medications are the only way is inappropriate,” says Lois Biener, a senior research fellow at the University of Massachusetts at Boston who has surveyed former smokers in her state. “Most people don’t want them. Most of the people who do quit successfully do so without them.”
The panel is now working on a revision of the guidelines, scheduled for completion early next year. Dr. Fiore, an internist, is again chairman. He says this time only seven of 26 members have industry ties. Karen Migdail, a spokeswoman for the revision effort, says it involves so many voices that “it’s hard for one perspective to have an influence on the process.” She says Dr. Fiore is “one of the leading experts” in smoking cessation and well-suited to the job.
Dr. Fiore says his panel will give a fair hearing to all points of view on smoking cessation. He says the process is sufficiently collaborative to prevent bias, his or anyone else’s, from creeping into the final product. He notes that many of the studies questioning the effectiveness of stop-smoking medication arose after the publication of the 2000 guidelines. The panel will scrutinize them closely before reaching any conclusions, he says.
David Blumenthal, director of the Institute for Health Policy at Massachusetts General Hospital, questions the government’s choice of Dr. Fiore. “The chairman of the committee should be unquestionably impartial,” says Dr. Blumenthal, who has published extensively on conflicts of interest.
Pharmaceutical companies make several products to help smokers quit. Some give a nicotine fix without a cigarette, such as GlaxoSmithKline PLC’s Nicorette gum and nicotine-laced Commit lozenges. Nicotine, the addictive agent in cigarettes, is considered benign relative to the carcinogens in cigarettes. Bupropion, an antidepressant, and Pfizer Inc.’s Chantix — both pills available only by prescription — aim to reduce cravings without using nicotine.
Many clinical trials have randomly assigned smokers to take one of these products or a placebo. Such randomized trials are considered the gold standard in many medical fields, and they have consistently shown that nicotine-replacement therapy or other medicine confers a benefit.
But these trials have limitations. They tend to compare quitters who wanted medication and got it with those who wanted medication and didn’t get it — which is a different group from quitters ready to try going cold turkey. Also, clinical trials tend to attract highly motivated quitters who may not represent the population as a whole. Even the placebo group in these trials often boasts double the success rate of the population of quitters generally.
Studies of quitters outside clinical trials have shown no consistent advantage for medicine over cold turkey, the pharmaceutical industry’s primary competitor. An unpublished National Cancer Institute survey of 8,200 people who tried quitting found that at three months, users of the nicotine patch and users of bupropion remained abstinent at higher rates than did users of no medication. But at nine months, the no- medication group held an advantage over every category of stop-smoking medicine. The study was presented at a world tobacco conference last summer.
Similar so-called population studies — which review results of people who already quit or tried to, rather than prospectively randomizing subjects into groups — have also suggested that cold- turkey quitting can compete with medication in real-world situations. These studies, in California, Massachusetts and Australia, have their own limitations. One is that they depend on people to remember what they did rather than monitoring them in a controlled experiment.
Kenneth Strahs, GlaxoSmithKline’s vice president of smoking-control research and development, notes that his company’s products won approval from regulators at the Food and Drug Administration who demand randomized clinical trials. “The FDA does not conclude either safety or efficacy based on retrospective population studies,” says Dr. Strahs. Smoking-control products account for a small fraction of the company’s revenue.
The researcher who raised the first serious questions about nicotine-replacement therapy says it may fall into a rarely discussed gap between efficacy in clinical trials and effectiveness in the real world. Greater use of medication is not “associated with any increase in successful quitting in the population,” says John Pierce, a University of California, San Diego, professor of medicine who was lead author of a 2002 Journal of the American Medical Association article finding no superior benefit from over-the-counter nicotine substitutes in California.
“If we’re going to be intellectually honest, we have to be willing to examine the issue of whether current users [of medication] are obtaining long-term rates of abstinence that are higher than anyone else,” says Kenneth Warner, a tobacco researcher and dean of the University of Michigan School of Public Health. “That’s going to be very hard for people to do in the smoking-cessation community,” because belief in the value of medication runs so deep, he adds.
All sides in the debate agree that intervention by doctors and other health-care providers to confront smokers can be effective in encouraging quitting. Dr. Fiore says the primary goal of the guidelines is to spur such intervention, and he says they have been successful in sharply raising the proportion of doctors who discuss smoking with their patients. Also undisputed is that behavioral support, whether from professional therapists or quit-line counselors, can be valuable.
As the federal government weighs the data in making new recommendations, many of its advisers are receiving money from companies with a stake in the outcome. Dr. Fiore holds a chair at Wisconsin that is funded by GlaxoSmithKline. He directs a tobacco research center that received nearly $1 million in funding from makers of quit-smoking medicine in 2004 and $400,000 in 2005. Between 1999 and 2004, Dr. Fiore personally pocketed $10,000 to $40,000 a year from the quitting-aid industry for honorariums and consulting work. He says he stopped such work in 2005.
In the U.S. government’s 2005 civil case against the tobacco industry, it chose Dr. Fiore as an expert witness. He was asked to estimate the damages owed to federal taxpayers as a result of smoking and to devise a plan for spending those damages. Dr. Fiore came up with an estimate of $130 billion, and a plan to spend about $5.2 billion a year of that mostly on counseling and medication — a measure that could have doubled the size of the stop-smoking medicine market. (Later, the government reduced its request for damages to $10 billion.)
The American Cancer Society has allowed its logo to be placed on stop-smoking products in exchange for money. A Cancer Society spokesman defends that decision, crediting the pharmaceutical industry for bringing invaluable marketing muscle to the society’s Great American Smokeout every November.
Those who advocate medication sometimes fail to disclose that they have financial ties to companies. In an article on Voice of America’s Web site last year, Jack Henningfield, identified only as a smoking- cessation expert, urged smokers to “go to the consumer-friendly Web site that I like, which is www.quit.com.”
Dr. Henningfield is a principal of Pinney Associates, a consulting firm whose largest client is GlaxoSmithKline, operator of the quit.com site. Other articles citing Dr. Henningfield’s views on smoking have identified him as a professor at Johns Hopkins School of Medicine without mentioning the GlaxoSmithKline connection. Dr. Henningfield, who holds a doctorate in psychology, is an adjunct professor at Johns Hopkins. He says only 10% of his income comes from Hopkins.
Dr. Henningfield says he always tells journalists about his financial ties to industry. But in an interview with The Wall Street Journal last summer, Dr. Henningfield promoted the use of stop-smoking medicine without volunteering any information about those ties. He says he thought GlaxoSmithKline’s public-relations firm had already provided the information.
In an least two medical-journal articles that Dr. Fiore wrote or co- wrote promoting the use of stop-smoking medicine, no mention was made of his financial ties to the makers of those treatments. Dr. Fiore says the editors of those journals may have ignored his disclosure or he may have failed to provide it. If the latter, “I am sorry about that,” he says, adding that those are two of more than 150 medical- journal articles he has published.
Dr. Fiore and other members of the Society for Research on Nicotine and Tobacco refuse to accept any funds from the tobacco industry, even unrestricted research grants. Smoking-control activists say there’s a big difference between tobacco companies, which they say engaged in scientific deceit for a half-century, and drug makers that are trying to help smokers quit. Reflecting the view of many in the antitobacco camp, Harry Lando, a University of Minnesota nicotine researcher, says, “I view the pharmaceutical industry as our ally.”
After the federal panel with industry-funded scientists came out with its guidelines in 2000, a campaign against cold turkey took root. The Web site of the highest-ranking physician in America — the surgeon general — calls it a “myth” that cold turkey is the best way to quit. In November 2006, during the week of the Great American Smokeout, doctors around the country participated in a campaign called, “Don’t Go Cold Turkey.” The creator of the campaign was GlaxoSmithKline.
The how-to-quit Web site of the federal Centers for Disease Control and Prevention rejected a request from John Polito, an ex-smoker in Mount Pleasant, S.C., to include a link to his Web site, WhyQuit.com, which advocates cold-turkey quitting. In a 2002 letter explaining the rejection, the agency told Mr. Polito that drug therapy has been shown to double quit rates.
In an interview, CDC epidemiologist Corinne Husten says the real reason for the rejection is that the CDC doesn’t recommend private Web sites. However, the CDC site long included a link to GlaxoSmithKline’s quit.com site. Asked about that, Dr. Husten says, “Some things have gotten on the [CDC] Web site that shouldn’t be there.” (After the interview, the CDC removed the quit.com link.)
Pressure may be growing for doctors to follow the federal guidelines. An article in the December issue of the journal Tobacco Control argued that failure to follow the guidelines could be deemed medical malpractice.
Some health officials don’t go along with the federal government’s tilt against cold turkey. The state of California’s help-line for smokers presents cold turkey as an equally viable option to medication. “The effectiveness of pharmaceutical aids has been proven short-term; long-term, it’s still in debate,” says Hao Tang, a research scientist with the state department of health services. California has succeeded in reducing its smoking rate to 14%, six percentage points below the national average.
After three decades of smoking, Linda Holstein quit nearly three years ago using a nicotine patch as well as nicotine gum, which on occasion she still pops into her mouth. Elated at being free from cigarettes, Ms. Holstein, a Minneapolis attorney, says, “The gum helped very much.”
Others say ingesting medicinal nicotine prolonged withdrawal, leading them ultimately back to cigarettes. During the 20 years that Tanya Blakey, a Georgia teacher, smoked two packs a day, she tried to quit countless times using nicotine-replacement therapy. “Every time I stopped using the NRT, I was smoking again within two or three days,” says Ms. Blakey. This week she is celebrating two years without a cigarette, this time having used no medication.
Kevin Helliker. Wall Street Journal. (Eastern edition). New York, N.Y.: Feb 8, 2007. pg. A.1
