John Polito: Approved quitting products are not effective

[Vocalek]

Interesting essay, with some interesting links. John Polito runs the Why Quit web site. He believes that there is only one way to quit smoking: give up nicotine.

Dying Truths About Quitting Smoking Methods

I believe that the evidence that contradicts his belief lies in the research conducted on smokers who permanently switched to snus and the emerging research showing long-term quit (smoking) rates among those who have switched to e-cigarettes.

How long do you need to stay quit to consider your experience a success? The American Cancer Society says:

Only about 4% to 7% of people are able to quit smoking on any given attempt without medicines or other help.
Studies in medical journals have reported that about 25% of smokers who use medicines can stay smoke-free for over 6 months.

A word about quitting success rates

Is 6 months a good benchmark? I don't think so. I stayed nicotine-free for six of the most miserable months of my life and started smoking again as a conscious choice because I couldn't stand not being able to concentrate and remember. I wanted to smoke every day of that six months.

I recall reading somewhere that if you can make it to one year smoke-free, the odds are good that you will remain smoke-free. I went looking for some predictive numbers and found this from Taiwan:

The purpose of the current study was to evaluate the smoking cessation program with a 3-year follow-up review implemented at outpatient clinics, which were run by the Family Medicine Department in a medical center, with a total of 772 adult participants. The abstinence rates were 99.7%, 49.2%, 37.7%, 30.2%, and 22.7%, at the 1-, 3-, 6-, 12-, and 36-month points, respectively. The frequency of clinic visits is a major factor predicting long-term cessation. The results indicate the need to pursue implementation and evaluation of multidisciplinary interventions in smoking cessation clinics with a longer follow-up, including the promotion of compliance to increase clinic visits and prevent relapse.

Smoking cessation program in outpatient cli... [Eval Health Prof. 2010] - PubMed - NCBI

So could some mathmetician calculate the answer to this question: If you remain abstinent for one year, what are the odds you will still be abstinent at the 3-year mark?

Here is another long-term followup report:

Abstract

This study was based on a ten-year follow-up of smokers who had participated in a randomized controlled trial of a behavioral self-help program for smoking cessation. The original sample was made up of 200 smokers assigned at random to two treatment groups. Ten years later 93.5% (n=187) of the sample were successfully located (of the 13 not located, 6 had died), from whom information was obtained about their current state and the evolution of their smoking over the 10-year period. Reported abstinence at this follow-up was confirmed by carbon monoxide in expired air. Significant differences were found in the abstinence rates of the two groups at the follow-ups 1 year (14% vs. 28%) and 2 years (13% vs. 24%) after the end of the treatment. After 10 years 26% (n=52) of the total sample were abstinent. Over the ten-year period, 62.0% tried to give up smoking at some point, the mean figure for attempts being 1.3. According to the results of the 10-year follow-up, low nicotine dependence at pretreatment is a major factor predicting long-term cessation in smokers.

Abstinence from smoking ten years after partici... [Addict Behav. 2008] - PubMed - NCBI

So what should be done with those who have high nicotine dependence? Should the medical profession just throw up their hands and blame the problem on the victimes?

Doesn't it seem like a no-brainer to take those who have high nicotine dependence and provide them with less hazardous long-term nicotine maintenance products?


How can you tell you've made it?

You haven't truly given up the habit until you see yourself as a nonsmoker, the type of person who just doesn't see smoking as an option no matter what the situation. This transformation can take several months or longer. Most quitters say they feel pretty good if they can make it through a whole year without smoking. By then, they know there's no day of the year that absolutely requires a cigarette.

How long does it take to really kick the smoking habit? | BabyCenter

In contrast to my six agonizing months of nicotine abstinence, since switching to an e-cigarette, I have absolutely no desire to smoke. I can stand in the middle of a smoking area and have no urges to bum a cigarette. Anyone else experiencing this?

 

[ADV]

I can stand in the middle of a smoking area and have no urges to bum a cigarette. Anyone else experiencing this?

Yes. At work, I stand everyday in smoke post among smokers and I have no urges to bum cigarettes. It's funny (and I laugh internally what a relief that is, after 30 years of smoking, finally over for me.)

 

[pianoguy]

After 2+ years, the smell of cigarettes has no appeal whatsoever - it reeks. I never thought I would get to that point.

 

[dotma]

Well I have quit over a year SEVERAL times, and the urge sure didnt go away with me. True, after a while, I most often didnt think about it, but when i had a stressful situation come up, as always happens in life, they were my little pacifiers.

 

[Bill Godshall]

I've known John Polito for the past decade.

He's done an excellent job of exposing the scientific evidence that NRT products aren't very effective for smoking cessation, and exposing the conflicts of interest of drug industry funded researchers/lobbyists/health organizations that promote drug industry products as the only effective way of quitting smoking.

Unfortunately, since John vehemently opposes the use of nicotine (by anyone and everyone), he also opposes tobacco harm reduction products and policies.

 

[Thulium]

Smoking cessation program in outpatient cli... [Eval Health Prof. 2010] - PubMed - NCBI

So could some mathmetician calculate the answer to this question: If you remain abstinent for one year, what are the odds you will still be abstinent at the 3-year mark?

22.7 / 30.2 = 75.2% of those abstinent for one year who were still abstinent at the 3-year mark.

 

[rothenbj]

Read it wrong.

 

[rolygate]

The abstinence rates were ..... 22.7%, at the ..... 36-month points.....

The Taiwan result of 22.7% successful abstinence at 36 months must be the highest success rate ever measured for pharma-assisted quitters. An extraordinarily high figure.

The only methods normally seen as that efficient (or better, of course) are e-cigarettes, Snus and the Allen Carr method. One wonders what pharma products were used, and/or if there is some kind of social influence that raises the success rate.

 

[Bill Godshall]

And the studies that find NRT had a very low success rate are rarely submitted for publication and/or rarely published.

Clinical studies also introduce bias (as a clinical environment doesn't closely resemble the real world most smokers live in). Many/most clinical studies are conducted in large university hospitals with lots of doctors and nurses walking around with white coats (which scares and intimidates most people, especially smokers).

Also, NRT studies aren't blind (as they're touted as being), since most smokers in the treatment group (i.e. that receives the NRT) knows they are getting the nicotine, while most folks in the placebo group know that they didn't get the nicotine.

Could anyone imagine doing a study of alcoholics whereby half of them were assigned to drink a beverage containing alcohol and the other half assigned to drink a beverage with no alcohol. Most of the alcoholics would quickly realize if they were assigned to the treatment or placebo group, which unblinds the study.

 

[rolygate]

So, essentially, there is no such thing as a blind study where any kind of consumer stimulant or similar is concerned?

Therefore, it means that trials using a placebo group are invalid. Or it has to be noted that most will relapse and this has nothing to do with the product investigated in the trial. I assume.

 

[Ande]

I'm sure blind studies work for a lot of drugs. I've taken a lot of medical drugs and had no way, other than trust, to know whether the drugs I was given were real or not.

But alcoholics, smokers, and similar...we know the drug in question too well. I recognise nicotine consumption in a heartbeat, and can't be fooled by something without it.

I suppose that drugs like varenicline (I have no idea how its effects should feel) are still testable in "blind" trials.

But I have to admit that there's a pharma habit in here I don't care for. In testing a new drug for effectiveness (and FDA approval) why don't they have to show that it's better than other treatments already available? Right now, they only seem to be "showing" that smoking cessation treatments are "better than nothing."

And given the false assumption of a blind trial, they aren't really even showing that. NRTs, when used as directed, aren't even better than nothing.

Best,
Ande

 

[rothenbj]

The Taiwan result of 22.7% successful abstinence at 36 months must be the highest success rate ever measured for pharma-assisted quitters. An extraordinarily high figure.

The only methods normally seen as that efficient (or better, of course) are e-cigarettes, Snus and the Allen Carr method. One wonders what pharma products were used, and/or if there is some kind of social influence that raises the success rate.

I wish you could get the actual study rather than the extract. Those numbers just don't appear realistic, particularly for NRT products. Perhaps their percentages were based on only those still smoke free at each checkpoint. That would make the 1 year mark around 5% and the 3 year mark just 1%.

 

[Vocalek]

Well I have quit over a year SEVERAL times, and the urge sure didnt go away with me. True, after a while, I most often didnt think about it, but when i had a stressful situation come up, as always happens in life, they were my little pacifiers.

The loss of the urge to smoke was not an overnight thing for me, but many have reported that phenomenon.

I had to increase the nicotine strength I was using from 16-18 mg to 24 mg to tide me through problem times. Others have reported adding a different product, such as snus to completely overcome smoking urges. If you don't want to increase the nicotine strength of your liquid, you might look into using one of Star Scientific's dissolvable orb products (like a Nicorette lozenge, only much less expensive.) The Ariva obs deliver about 1 mg of nicotine each. The Stonewall orbs deliver about 4 mg of nicotine. They are sold where other smokeless tobacco products are sold. Cost is about $3.65 for 20 orbs.

 

[Ande]

In contrast to my six agonizing months of nicotine abstinence, since switching to an e-cigarette, I have absolutely no desire to smoke. I can stand in the middle of a smoking area and have no urges to bum a cigarette. Anyone else experiencing this?

My longest ever period of nicotine abstinence (since my mid-teens) was between nine months and a year. Sheer hell for me and those around me. Never a day passed that I didn't want a cigarette, many times. Never a day that I didn't ask myself, over and over, if there wasn't some way I could possible have just one. Lots of days it was so bad that I couldn't function well. Not too surprising that I eventually figured "what the hell." Life was so unhappy without smoking that I no longer cared if the cigarettes killed me. I started again, and frankly, I loved it.

I had given up on quitting.

Then I got an ecig (a few years later). Not to quit. Just to have something for times and places when I couldn't smoke and it was making me grouchy. And I quit.

I'm around smokers and smoking all the time. Couldn't care less. Don't want to smoke, not going to smoke. I play in a band sometimes, in smoky bars. Going to hang out with friends in a smoky bar tonight. Not going to smoke. Not going to want to.

BUT if anyone wants to take my PV away, they can do so over their own dead body.

Ande

 

[dagnagan]

I got an e-cigarette in Jan. 2009, thinking I might be able to give up cigarettes. My only motivation to quit was fear that I'd eventually be in some situation, like a hospitalization, where I'd be forced to quit cold turkey. I have some fairly strong opinions about the benefits of nicotine, especially the evidence of its effects on dementia, and I just wanted to find an alternative delivery system.

I wasn't really motivated enough to quit smoking though, so I just used the PV occasionally as a substitute in certain situations. Then one hot afternoon in August 2010 I found myself down to just six cigarettes. I didn't want to go out in the heat, so I started using the PV and putting off lighting a cigarette. By the next day I still had those six cigarettes and no desire to smoke them --after 52 years of smoking every day.

I am never tempted to smoke. I find the smell of smoke somewhat unpleasant in a confined area, but it doesn't really bother me. The only time I envy smokers in when I discover I've left the house without extra juice, and I can't stop at a convenience store to buy my nicotine.