New Jersey Monthly

 

 

At Last, Silencing the Voices

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Says Raymond: "She's come a long, long way. A lot of parents would have just dropped her [at a treatment facility] off and not done anything. But a lot of kids could go a lot further if they're given the opportunity."

A BITTER PILL. Robert Montalbano had tried plenty of ways to cut his pack-a-day smoking habit over the past 15 years, even trying hypnosis. But nothing worked. The Newark police officer says he simply enjoys the taste of cigarettes too much. "They were strong--filterless Camels," Montalbano says, as he warmly recalls his smoking days.

But now Montalbano is confident he's stopped for good thanks partly to a patent-pending lozenge that, when mixed with cigarette smoke, creates a noxious metallic taste in the smoker's mouth. "It's bitter, almost to the point of making you gag," says Montalbano.

The bitter pill was developed by Dr. Norman Hymowitz, a professor of clinical psychiatry at the UMDNJ-New Jersey Medical School. "Theoretically this works the same way that Antabuse therapy would work for an alcoholic," says Dr. Hymowitz. "If you take Antabuse and consume alcohol, you become sick. If people are truly motivated to stop smoking, this lozenge could be effective for them."

In a small pilot study with 50 smokers, including Montalbano, about 40 percent were able to kick the habit using the lozenge--more than twice the number who quit without it. The pill isn't available commercially yet, and more studies are needed to determine how effective the lozenge is in the long run. However, Dr. Hymowitz's findings mimic short-term studies for similar products that have been available in Europe for more than a decade.

The European products--which are in the form of chewing gum--contain about 6 milligrams of silver acetate, the substance that causes the cherry-tasting tablets to become distasteful. Dr. Hymowitz's tablet has only 2.5 milligrams of silver acetate. "We keep it far below the FDA guidelines because there are limits to how much silver acetate people can take without side effects," he says. "In lozenge form, the silver acetate lasts longer and is just as effective in producing the aversive taste."

That metallic taste occurs when a person smokes within two hours after consuming the tablet.

Patients in the study took six tablets a day for three weeks, leading up to the "quit day" they set for themselves. The tablet isn't a cure-all; rather, it's part of an overall program that includes recording every cigarette one smokes and pinpointing concrete reasons to quit. "The lozenge helped get me off cigarettes but I have a strong motivator for staying off--two small children," says Montalbano. "They're so small--one's eight and the other is four. I wouldn't want them to grow up without a father."

Along with that powerful motivation, Montalbano keeps lozenges in his car and his briefcase. "It's a strong reminder to keep from faltering," says Montalbano. "If I ever have the urge to smoke, I know I can pop one of these instead."

EARNING WARNING. A century ago, famed scientist Paul Ehrlich suggested that antibodies--proteins produced by the immune system to ward off viruses and other invaders--could be harnessed to pinpoint diseases. Somehow, Ehrlich hypothesized, scientists would learn to use antibodies as vehicles to carry cell-killing treatments directly to the site of an illness.

Today, his prediction is becoming reality. Scientists at the Princeton-based Cytogen Corp. has discovered a way to use antibodies to diagnose cancer, long before more traditional procedures could identify the killing disease.

Their procedure uses monoclonal antibodies, proteins in the immune system. These antibodies attach themselves to antigens, microscopic features that jut out from viruses, disease-causing bacteria, cancer cells and other substances that invade the body. Cytogen's artificial antibodies, of course, bind to only cancer sites.

The company's real breakthrough came when scientists discovered a way to piggyback a tiny amount of low-dose radioactive material to a monoclonal antibody without impeding the antibody's ability to find a tumor. The monoclonal antibody is then injected intravenously into the patient and, like a heat-seeking missile, binds to a tumor sight. Within a few days, a device called a gamma camera can take a "photography" of the body and determine if any radioactive material has remained, meaning it has adhered to a cancer cell.

The benefit of antibodies is their precision: An antibody will stick to only one specific antigen. Diagnostic techniques now used for cancer are much less precise. A computerized thermography scan, for example, can be used to look at a specific "slice" of the body and detect unusual masses in the tissues. But a CT scan alone would not be able to differentiate a tumor from, say, an abscess.

Because monoclonal antibodies bind only to diseased areas such as cancerous cells, physicians say they can provide new information that will affect treatment in 25 percent of cancer patients.

What's more, monoclonal antibodies have great potential to detect cancerous cells at an earlier stage. According to the American Cancer Society, the 156,000 people who will develop colorectal cancer have an 87 percent chance of surviving five years if their disease is detected before it spreads to other parts of the body. "The earlier we can diagnosis a cancer in a localized area, the more options we have for treatment and the greater likelihood we'll be successful," Dr. Gerald Murphy, chief medical officer of the American Cancer Society in Atlanta. "Hopefully this will pan out, and Cytogen has gone a long way to justifying this hope."

Last year, seven European countries gave approval to Cytogen products to detect ovarian cancer. This was the first time this long-ballyhooed technology was given regulatory approval anywhere in the world. In December, the FDA approved two Cytogen products -- used to detect ovarian and colorectal cancer -- for use in this country.

Cytogen is now going forward with the second phase of clinical trials for monoclonal antibodies that would be used to fulfill Ehrlich's dream of a "magic bullet": They deliver therapeutic materials directly to a cancer site. [Note to Jenny: While this development is interesting, it still is several years of testing from application, so I wouldn't play it any higher. Unlike chemotherapy, the cancer-killing substances would be directed only to diseased tissue, rather than to the healthy organ as well. "If we learn to target effectively, we could avoid all the well-know side effects of chemotherapy, such as nausea, hair loss, susceptibility to infections," says Dr. Thomas McKearn, president of Cytogen Corp. "The treatment wouldn't kill people anymore."

Like most new medical technology, the use of monoclonal antibodies will be cautious. The first wave of curative products aren't likely to appear before the end of the decade. However, Dr. McKearn notes that this targeting technology could, some day, be used to treat a host of debilitating conditions, such as rheumatoid arthritis and Alzheimer's Disease.

"Cytogen is a prototypical example of newer technology being moved from the bench to the bedside," says Dr. Murphy of the American Cancer Society. "I expect a lot of things from them. Cytogen is an example of why we're so optimistic about cancer research in general."

 

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