Linda Hyder Ferry: Dialogue with a physician for such a time as this

Jonathan Gallagher

Millions of people are slaves to nicotine. Addicted, afflicted, and helpless, they wish they had never started that first puff, and wish even more they could kick the habit and be free again. For such people as that and for such a time as ours, help may be on the way through the research of Linda Hyder Ferry, associate professor of medicine and public health at Loma Linda University, Loma Linda, California. Linda Ferry, M.D., M.P.H., is a doctor with a mission: to help people stop smoking. Her groundbreaking research has led to the development of bupropion (Zyban),* the first FDA-approved, non-addicting, nicotine-free, pharmacologic treatment for nicotine dependence. Ferry says of her work: “I believe this happened by God’s guidance. He gave me a persistent burden to do something about smoking.” A fifth-generation Seventh-day Adventist, Dr. Ferry graduated from Loma Linda University School of Medicine. She then took family practice residency at the University of Texas, after which she returned to Loma Linda University to obtain a Master’s degree in Public Health. She is married to David Ferry, chief of cardiology at the Loma Linda Veterans Affairs Medical Center. In 1997, Dr. Ferry established FIND: the Foundation for Innovations in Nicotine Dependence. This not-for-profit organization provides resource material and develops research that will assist those wishing to quit smoking and eliminate their nicotine dependence. You can access the foundation through the Internet at http://www.findhelp.com Or write to: P.O. Box 2001, Loma Linda, California 92354, U.S.A. Phone: (909) 777-3290 Fax: (909) 777-3281.E-mail: info@findhelp.com

So what led you to this dynamic mission to combat smoking?

My speciality is preventive medicine and public health. The Lord kept bringing me to a particular focus. “Linda,” He seemed to be saying, “your interest is in preventive medicine. And the most serious preventable health problem in the world is smoking. What are you doing about it?” I felt God wanted me to look critically at the problem of smoking and search for new answers. Once that focus settled, doors opened at the right time.

As a doctor, you could have specialized in many different areas. Why did you get involved with smoking issues?

Three reasons, perhaps. First, my Adventist perspective and belief in the health message. As I began working in public health, I recognized that if people could quit smoking then they could live healthier, enjoy life more, and be of better service to others.

Second, my job as medical director of the Addictions Treatment Unit at the Veterans Hospital in Loma Linda. My work was to treat patients with medical problems rising from their chemical addictions (e.g., alcohol, heroin, cocaine, amphetamines). But after discharge from recovery programs, they still walked out of the hospital with a packet of cigarettes in their pockets. I wondered, “If they could give up all kinds of ‘hard core’ addictive drugs, why can’t they give up nicotine?”

Thirdly, my responsibility as director of the preventive medicine residency at Loma Linda University. While designing a stop-smoking program, I came across some intriguing research. The first study indicated that people who try to quit smoking and fail are more likely to have a history of depression. The second was a survey of thousands of smokers that showed that almost one-third had depressive symptoms. Finally, a psychiatrist colleague mentioned that his patients, treated for depression and attention-deficit disorder with bupropion, reported that they did not crave coffee, chocolate, or smoking as they used to.

All these led me to think about anti-depressants as a possible aid to quit smoking.

So how did you start working on your idea?

In my first research attempt, I recruited my mother, a retired nurse, as my assistant. I had no funds to pay for one. The preventive medicine residents did all the work for free. I bought the medication and paid for the lab tests with a faculty seed grant from Loma Linda University. Once the pilot study was completed, bupropion manufacturers came forward with grants to develop the research program.

The result?

Tobacco smoking creates an addictive pattern in the brain, as nicotine controls the brain’s pleasure and reward center. Using bupropion changes this brain chemistry. In some people, bupropion decreases nicotine craving while they are still smoking, and within a week cigarettes may not taste good. Once a person quits smoking, bupropion stabilizes the chemical messengers in the brain where nicotine works, and decreases the nicotine withdrawal symptoms.

Why is the use of medication important? Why not stress having a strong will?

So often people say, “Why do you bother with giving people all these drugs? Giving up smoking is all in the head.” Yes, it’s all in the head, and it’s about chemistry. What nonsmokers don’t realize is that medication rearranges moods, affects the neuro-chemistry of smokers, and leaves them with a feeling of being normal.

What about those who say you should just pray?

Yes, you should pray! But in addition to prayer, there are other things you should do. Teach smokers about behavior modification skills and psychological preparation of what it’s like to live without becoming dependent on nicotine. After all, God created chemistry in our brains. He made moods and emotions. When harmful substances destroy the neuro-chemical balance of the brain so that it doesn’t work properly, why not give help to correct the problem? Especially when bupropion is not a substance that’s going to create a new addiction or problem.

So what exactly does nicotine do? What’s the real killer?

Nicotine in itself is not necessarily what kills people. It is what keeps the brain hooked so you keep using tobacco. It’s the 4,800 tobacco combustion products that kill you. Thirty percent of all heart disease is related to smoking, and that’s our number one killer in the United States. Between 85 and 90 percent of lung cancer is due to smoking. Probably 30 percent of all cancer is due to smoking. Chronic obstructive lung disease is another killer. A pulmonology friend told me recently that she’d be out of business if people stopped smoking! Tobacco is also responsible for many vascular diseases, another major killer. Thus tobacco accounts for killing 434,000 people every year in the U.S., and the majority are dying 10 to 30 years prematurely.

So where are we right now? Aren’t fewer people smoking?

Cigarette smoking really accelerated in the 1920s and 1930s. The figures continued to rise during World War II, with soldiers being given free cigarettes. After the war, smoking reached a high point when more than 50 percent of people in the U.S. smoked.

The first warning against smoking came in 1964, when the U.S. Surgeon General indicted tobacco as a health hazard. Since then, smoking has declined by 1 to 2 percent every year. But from 1994, the decline seems to have stopped and smoking has plateaued at around 25 percent of the U.S. population.

Is quitting smoking just a matter of going to your doctor and getting a prescription for Zyban?

Treating addictive behaviors is not achieved just by altering brain chemistry, though that is important. Addiction is like a triangle, and neuro-chemical dependency is just one of the three sides. The other two sides—helping people change their behavior and dealing with reasons for psychological dependence—are also essential. Then, of course, there is the spiritual side. In my stop-smoking classes, I emphasize using all the resources, including the spiritual, to beat the addiction.

How did you get into this helping profession, into what is clearly a ministry for you?

I grew up as an only child. I was fortunate in having Christian parents. From as far back as I can remember, my father read to me every night. My favorite Bible story was Queen Esther. By the time I could read for myself I had asked for it so many times that my father had it memorized. I was deeply molded by that story of a little girl who had nothing to hope for in the future. God put her in a place where she was instrumental in saving the lives of thousands of her people.

That story fascinated me all my life, especially the phrase when Mordecai says to Esther, “How do you know but that you came to the kingdom for such a time as this?” And if you turn your back and don’t do the hard thing, God will find someone else.

When the Lord brought me to public health practice, He kept saying to me, “Linda, the most serious health problem today is smoking. What are you going to do about it?” I simply prayed: “I don’t know what to do, Lord. Please guide me. It seems as if there’s hardly anything I could do that would really make a difference. But I’ll keep following where You lead.” God did make a difference in my life.

What has been the most fulfilling aspect of your work?

To stand with my mother, my volunteer nurse in the initial research, in front of a large audience and be recognized as being instrumental in bringing this new treatment to where it is today. To think of all those who will be saved from premature death, and how much healthier America can be. To serve God in such a rewarding ministry.

Interview by Jonathan Gallagher. Jonathan Gallagher is the news director of the General Conference of Seventh-day Adventists.

*When the interview was conducted, bupropion was not yet available outside the United States.