Many more companies are helping employees stop smoking, the New York Times reported October 26. About one-third of those that employ at least 200 people pay for such programs, the Times reported. The proportion may be twice as high for the largest employers. The companies say the programs are a good investment. They cost much less than the extra medical care smokers often need.

By Howard LeWine, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

Two-thirds of the largest companies in America are motivating their employees to quit smoking with real perks.

The article in the New York Times points out how much money this can save. The average lifetime medical costs directly related to smoking are very high. Figures in the Times article suggest they are 16 times higher than the average cost of a stop smoking program. That includes both medicines and nicotine replacement.

Many companies are offering similar incentives to get employees to improve their health. They are paying for on-site exercise and fitness instruction, intensive programs to lose weight, and coaching to help people manage chronic diseases such as diabetes.

Companies wouldn't be doing this if it didn't help the bottom line. Most employers want to offer health benefits. But not having any control of rising insurance costs has become unacceptable. Managers look for ways to get the most out of each dollar spent, as they do with other parts of the business.

What Changes Can I Make Now?

Find out what health-enhancing incentives your employer offers. If you can think of anything that may help you and your fellow employees to improve your health, talk with your boss or human resources representative. See if what you want is available.

Even if the incentive isn't available now, your employer may be able to add it the next time the health insurance plan is renewed.

For smokers who want to quit, assistance is widely available. You have several aids that will help you stop.

Nicotine replacement now comes in five forms:

• Patches
• Gum
• Nasal spray
• Inhaler
• Lozenges

The newest medicine to help people stop smoking and stick with it is the oral drug varenicline (Chantix). It works two ways. It partly imitates the effects of nicotine, thereby cutting down craving and withdrawal symptoms. It also partially blocks the effect of nicotine, causing a smoker to get less of a reward.

The other widely used oral drug is bupropion (Zyban, Wellbutrin). Bupropion cuts the desire to smoke. The generic version is reasonably priced and works as well as the brand name products.

Both drugs should be started a week or two before your quit date.

What Can I Expect Looking to the Future?

At some point in the future, our political leaders will get it. Universal health coverage or consumer-driven health accounts will slow the rise in medical costs temporarily at best, but probably not by much and not for long.

Citizens need to be financially rewarded for adopting and sticking with healthy behaviors. This could be in the form of tax rebates or tax breaks.

It won't be easy to get agreement on the best and fairest way we should do this. But we can't wait any longer. We need to start investing today. We should directly fund healthy behaviors, rather than pay the much higher costs of treating diseases once they have occurred.