Dear Worried Wife,

YGBSM !!!  Having a PCP/neurologist refuse to prescribe oxygen therapy for your husband’s cluster headaches because he smokes is a bummer !!!  

I’ve searched the UK Department of Health archives at Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or and cannot find any policy that would prevent the prescription of Home Oxygen Therapy Services to a known smoker.   I’ve also read through the latest UK DoH Home Oxygen Therapy Service: Service Specification, and found nothing there on any policy like this either.  Having said this, it is clearly possible such a policy actually exists…  I just haven’t found it.   It’s also entirely possible this is a local policy.

What I did find (see link below on WHO Europe evidence based recommendations on the treatment of tobacco dependence) while searching this topic on the Internet, leads me to suspect your husband and far too many other cluster headache sufferers there in the UK who smoke may be getting screwed by one or more of big pharmaceutical firms, and these firms have no intention of giving any of them so much as a kiss…  

After reading the article in the link below, it doesn’t take too much stretch in imagination to think that it’s also possible that if such a policy does exist, it could be easily motivated by one of the oldest of human motivations…  greed.

Granted smoking is not healthful, and after perusing the Ministry of Health web sites it’s very clear there’s a major anti-smoking campaign underway within the Ministry of Health there in the UK and other government health organizations across Europe.  However, after digging a little further, there appears to be a much closer link between anti-smoking campaign, the policy (if it exists) that is apparently being used to deny your husband oxygen therapy because he smokes, and a major three-year project to come up with recommendations to support the anti-smoking campaign.  

As you go over this link and my analysis that follows, ask yourself the following question:

who stands to benefit monetarily from anti-smoking policies that effectively deny cluster headache sufferers the use of oxygen therapy because they smoke?

Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or

“WHO (World Health Organization) Europe evidence based recommendations on the treatment of tobacco dependence

M Raw1, P Anderson2, A Batra3, G Dubois4, P Harrington5, A Hirsch6, J Le Houezec7, A McNeill8, D Milner9, M Poetschke Langer10 and W Zatonski, Recommendations panel11”

ABSTRACT:

The following recommendations on the treatment of tobacco dependence have been written as an initiative of the World Health Organization European Partnership Project to Reduce Tobacco Dependence.

Keywords: tobacco dependence; recommendations; treatment; nicotine replacement therapy; buproprion

This was a three year project, funded largely by three pharmaceutical companies that manufacture treatment products for tobacco dependence, “

My analysis follows:

Products (and their manufacturers) recommended in the three-year WHO European Partnership project for the treatment of tobacco dependence include:

Nicotine replacement products available over-the-counter:
   Nicotine patch (NicoDerm CQ, Habitrol, others) made by (GlaxoSmithKline)
   Nicotine gum (Nicorette, Rite Aid) made by (GlaxoSmithKline)
   Nicotine lozenge (Commit) made by (GlaxoSmithKline)

Nicotine replacement products available by prescription:
   Nicotine nasal spray (Nicotrol NS), and
   Nicotine inhaler (Nicotrol Inhaler)… both made by (Pfizer)

Now let’s look at the Non-nicotine prescription medications recommended in this project that could easily form the basis of the UK MoH policy that denies oxygen therapy to cluster headache sufferers who smoke in favor of other medications to treat cluster headaches:

Zyban® (buproprion), Wellbutrin® SR and Wellbutrin® XL.  And the pharmaceutical manufacturer of these prescription medications is…   GlaxoSmithKline  and who makes Imitrex® (imigran) and Treximet®? BINGO!!!  You got it… (GlaxoSmithKline)

Varenicline (Chantix)  And the pharmaceutical manufacturer? (Pfizer)  and who makes Relpax® (eletriptan hydrobromide)? Another BINGO!!! … (Pfizer)

Clonidine (Catapres) And the pharmaceutical manufacturer?  [B](ALZA Corporation)  But…  ALZA makes the osmotically controlled oral system (OROS®), transdermal (D-TRANS®), and implantable (DUROS®) technologies found in many widely used pharmaceutical products, including Duragesic® (fentanyl) CII, NicoDerm® CQ® (nicotine)…

Given the fact that GlaxoSmithKline had total sales of  $34.4 Billion USD over the last 12 months and that their sales of Imitrex came to over $1 Billion USD in 2008, investing a few million pounds here and there to fund and bias a three year anti-smoking project that recommends the use of their medications by the UK MoH would appear to provide the potential for a handsome return on that investment…  

If you’ve connected the dots as I have…  It becomes obvious to even the least casual observer that if such an anti-smoking policy exists that’s being used to deny you husband oxygen therapy for his cluster headaches, it's more than likely the result of a carefully orchestrated money making scheme hatched by a noted pharmaceutical firm to have their medications prescribed more frequently as a result of that policy.  


The way I see it, your husband has several options:

1.      Get in touch with the folks at OUCH (UK) at Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or as it appears their Board of Directors is staying plugged into the latest UK MoH doings with respect to Cluster Headaches.  Perhaps as this has already been suggested, getting in touch with Helen (a.k.a. LeLimey) may be helpful.  I know she's got the answers and she can also be of assistance in pointing you to the right people within OUCH (UK) on this topic.

2.      Offer to start the anti-smoking therapy if his PCP/neurologist will also prescribe oxygen therapy at the same time.  Or…

3.      He can kindly inform his PCP/neurologist that if he or she refuses to prescribe him oxygen therapy as the first choice abortive for acute cluster headache attacks because he smokes, to please provide a copy of the policy that prevents the prescription of oxygen therapy to a known smoker.

4.      And, if such a policy is unavailable, your husband should request the PCP/neurologist provide the rationale for his or her refusal to prescribe oxygen therapy for his cluster headaches IN WRITING!  

5.      Email the Freedom of Information unit, Department of Health, 360C Skipton House, 80 London Road, London SE1 6LH  at: FreedomofInformation@dh.gsi.gov.uk and inquire as to any policy, provisions, or restrictions regarding the prescription of Home Oxygen Therapy Service to known smokers.


Take Care and I hope this helps.

V/R, Batch