Clinic Patients: Santa Claus
House: Let me guess... inflammatory bowel.
Santa: Wow, yeah. Is it that bad?
House: Yes. It's also written on your chart. Bloody diarrhea, gas, pain... took sulfasalazine, but it didn't work -
Santa: No, then I -
House: Next tried steroid enemas, oral corticosteroids, 5-ASAs, 6-mercaptopurine... I'm impressed.
Santa: By my medical history?
House: By how well your last doctor charted.
Santa: It's one thing to have to go to the bathroom every hour, but when the kids sit on my lap, it's... The store sent me home, they're gonna fire me. Can't you put me back on 5-ASA? Maybe it'll work this time?
House: Not likely. I'm giving you a prescription. It's cheap, which is good because your insurance company won't pay for it. [He gives Santa a prescription, who puts on his glasses to read it.]
Santa: [tries to read House's writing] Cojorius?
House: Cigarettes. One twice a day, no more, no less. Studies have shown that cigarette smoking is one of the most effective ways to control inflammatory bowel, plus it's been established that you look 30% cooler.
Santa: Are you kidding me?
House: About the looking cooler, yeah. The rest is true.
Santa: Isn't it addictive and dangerous?
House: Pretty much all the drugs I prescribe are addictive and dangerous. The difference with this one is that it's completely legal. [He turns to leave.] Merry Christmas.
What does the evidence say?
"Certain lifestyle factors also play a role in inflammatory bowel disease. Smoking may be associated with an increased risk of Crohn's disease, especially postoperative recurrence. In contrast, smoking is associated with a decreased risk of ulcerative colitis, and nicotine patches apparently have some benefit in patients with active disease. However, nicotine patches do not help maintain remission of ulcerative colitis." -- American Family Physician
"Ulcerative colitis is largely a disease of nonsmokers, and patients with ulcerative colitis who are exsmokers have usually acquired the disease within a few years after they stopped smoking. Patients who smoke intermittently often experience improvement in their colitis symptoms during the periods when they are smoking. Treatment with transdermal nicotine patches and mesalamine (5-aminosalicylic acid) has a beneficial effect on active colitis." -- Thomas GA, Rhodes J, Mani V, Williams GT, Newcombe RG, Russell MA, et al. Transdermal nicotine as maintenance therapy for ulcerative colitis. N Engl J Med 1995;332:988-92.
What does this mean?
If Santa were a former smoker, this advice may be medically relevant specifically in terms of the ulcerative colitis. As a general rule though, most medications don't cause 85% of all lung cancers. Nicotine patches, however, don't cause lung cancer and can be beneficial for active colitis. And if Santa really was a heavy smoker, nicotine patches might even be cheaper!
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