Nicotine-Cessation Aids Questioned in Study

[EJH]

A couple years ago, my doctor prescribed Chantix because she felt it was imperative that I get off cigarettes. I'm positive that she prescribed it because it was the best available solution at the time. This was before all the bad stuff about the drug was becoming more widely known (to the general public anyways). Chantix did work for me, sort of and with a price. The vivid dreams I suffered were almost painful. I couldn't get any sleep and I thought I would go nuts from them. I didn't even make it through the starter pack.

As more and more evidence comes to light about the life-saving potential of vaping and evidence grows of the inadequacy of smoking cessation drugs, nicotine patches and nicotine gum, I believe that my doctor would have prescribed a vaping program for me if she knew then what she hopefully knows now (I've since moved away).

Does any one know if there are any doctors out there that have developed or are developing a vaping regimen for smoking cessation? It would be interesting to hear how one would work and how effective it is. Big Pharma must be shaking in their figurative boots at the thought that a cheap, non-patented method of smoking cessation might outsell their drugs that they spent billions to develop.

Kind of explains their motivation for trying to stomp out vaping before that happens...

 

[mostlyclassics]

I have to wonder if a study like this is intended to pave the way for approval of long-term NRT use.
Maybe we'll start seeing studies showing people using NRTs for longer periods of time have higher success rates?

One friend has been chomping on Nicorette for five years; another has been doing the moo-cow imitation for eight years.

 

[Vocalek]

The American Cancer Society has posted a response to this study. Notice the push for long-term use of NRTs which would be profitable for the ACS benefactor, GSK.

Home Page

Although I have to say that the ideas expressed in the last paragraph show promise (unless this is just another example of "New-Speak.")

The tobacco control field needs to stop acting as if it is involved in a zero-sum game and, instead, advocate for comprehensive tobacco control approaches that include BOTH individual and population based approaches - the data are very clear that this is what works and that it is cost-effective. Our advocacy activities should reflect that and not pit one approach against another.

 

[Ande]

From GSK's rebuttal:



Strange. Can anyone explain how I have remained abstinent from smoking for 2 years and 9 months despite NOT having broken my body's addiction to nicotine? I must be unique.

Not that unique.

At least, not in that way. I can think of a LOT of people in the same boat with you.

Ande

 

[ByStander1]

The American Cancer Society has posted a response to this study. Notice the push for long-term use of NRTs which would be profitable for the ACS benefactor, GSK.

Home Page

Although I have to say that the ideas expressed in the last paragraph show promise (unless this is just another example of "New-Speak.")

Wow. What's next? Their logo on the door of the tobacco shop reading "We Understand"

 

[wfx]

OMG. I just realized something. Maybe they designed the nasal spray that way on purpose, hoping to guard against "abuse." I wouldn't put it past them.

absolutely. i would have to really dig to find the reference. but yes, the spray was deliberately designed to be dysfunctional and frustrating in order to encourage cessation. there was a wonderful 'Tropical Bob' video on that a while back also.

now it will be very interesting to see what happens with the uk intellicig. how will they guard against abuse this time? hidden nicotine levels? self destructing cartos?

 

[DC2]

Although I have to say that the ideas expressed in the last paragraph show promise (unless this is just another example of "New-Speak.")

I believe the dam has sprung it's first leak.

 

[Bill Godshall]

I was ready to post this same ACS response, but Elaine beat me to it.
It's also posted on the drug industry funded website/organization Treat Tobacco (but only with drug industry products)
Home Page

While its nice the ACS now says
The tobacco control field needs to stop acting as if it is involved in a zero-sum game and, instead, advocate for comprehensive tobacco control approaches that include BOTH individual and population based approaches - the data are very clear that this is what works and that it is cost-effective. Our advocacy activities should reflect that and not pit one approach against another.
the ACS continues to demonize and grossly misrepresent the health risks of ALL other smokefree tobacco/nicotine alternatives (except NRT), and lobby for prohibitions on their sale and usage.
And of course, the ACS failed to acknowledge that they've received tens of millions of dollars from GSK and other NRT manufacturers to promote thier use as the most effective way to quit smoking.

Other drug industry funded groups/researchers/advocates have posted criticisms of the Albert et al study include.

Jonathan Foulds
"Does Nicotine Replacement Therapy Help Smokers To Quit?": Smoking Cessation Community - Support Group

ATTUD
http://www.treatobacco.net/en/uploa...ments/ATTUD response to Alpert et al 2012.pdf

Richard Hurt
Nicotine Replacement Therapy Study: A Closer Look - Global Bridges

 

[rothenbj]

As I said a couple days ago in another thread, the ANTZ are only averse to nicotine if it is supplied by anyone other than BP. If it comes in one of their packages it's "Use'em if you got'em". It's the new American way.

 

[rolygate]

Is it possible to work out the exact percentage who succeeded or failed to quit, or is the paper not public?

Also, can anyone explain Fould's argument/s to me, please?

I got lost in his argument about the comparative motives of subjects, which didn't seem to address the actual results.

If a reasonably large-scale trial of NRT-assisted quitting shows that the majority return to smoking, why is this result questioned, as no one seems to be attacking the methodology or calculations?

Is a low response rate indicative of (a) overall apathy, and an equal number of successful and unsuccessful quitters; or (b) more likely to show successful quitting; or (c) more likely to show unsuccessful quitting?

 

[DC2]

Is a low response rate indicative of (a) overall apathy, and an equal number of successful and unsuccessful quitters; or (b) more likely to show successful quitting; or (c) more likely to show unsuccessful quitting?

I haven't read the study, or the criticisms, so if I'm way off base feel free to correct me please.
And I didn't sleep at a Holiday Inn or anything either, but I do have some slight background in designing studies.

Generally speaking a low response rate indicates that people dropped out of the study.
Which generally means they stopped caring about the study.

And that very well could mean they failed even worse than those who didn't drop out.

 

[Vocalek]

John Polito has had a letter to the editor published about this study.

http://whyquit.com/pr/021112.html

 

[TennDave]

Elaine- very interesting read:
"Two studies analyzed success rates among second-time nicotine patch users and the results were devastating. A 1993 study found a 100 percent six-month smoking relapse rate,17 while a 1995 study found that 98.4% of second time patch users failed."

"Sadly, since 1996 U.S. smoking cessation health officials have been sleeping with the pharmaceutical industry, in actually allowing industry consultants to author U.S. quitting policy. In June 2000 they were married. It was then that a stroke of corporate genius resulted in one Guideline cessation policy recommendation consuming all others; that unless medically contraindicated, that all quitters should henceforth purchase and use approved quitting products."

"And whose stroke of corporate genius was that? I submit that the idea was Glaxo-Wellcome's, as suggested by the purpose clauses of a million dollar University of Wisconsin endowment agreement dated October 15, 1997,20 an agreement whose stated purpose was to "assist the Director of the Center for Tobacco Research and Intervention as indicated." And what possible motivation could Glaxo-Wellcome have had for wanting to "update" the Guidelines so as to create a "new national standard of care" that would require "every patient visiting a healthcare setting" to be "urged to quit and provided with" (among other things) "pharmacotherapy"? On July 1, 1997, with Dr. Fiore's help, Glaxo-Wellcome started marketing Zyban."

"It's beyond time for a divorce. The June 2000 medicinization of smoking cessation brought decline in the U.S. adult smoking rate to a standstill."

"Smoking is America's leading cause of preventable death. Current U.S. cessation policy is contributing to those deaths. It's time for HHS Secretary Kathleen Sebelius to demonstrate understanding and leadership. It is within Secretary Sebelius' power to immediately suspend current U.S. cessation policy and order HHS to begin servicing the motivation, education, counseling and support needs of America's largest segment of quitters, those trusting their natural instincts."

I especially like the comment about "trusting their natural instincts."
I wonder what direction will be taken now....will e-cigs be lumped into other methods and against "cold-turkey" quitting or will there eventually be a movement to allow us to "trust our natural instincts?"

 

[Spazmelda]

Eeek! I actually haven't finished reading that letter from Polito, but it kind of suggests to me that he (or others) would use the same sort of arguments about electronic cigarettes, which makes me think that this research that NRTs don't work is going to lead to the assumption that e-cigs don't work for the same reasons.

This section did bring some thoughts to mind:

The average smoker only has so many priceless periods of cessation confidence before paying smoking's ultimate price. If Doran 2006 is correct and cold turkey is substantially more effective than NRT, quitting attempts squandered on replacement nicotine have likely contributed to hundreds of thousands of premature smoker deaths.

I can get what he's saying here (and in the following paragraphs where he explains further). I had tried to quit so many times with gum and patches that I had given up hope. I also tried cold turkey and didn't get very far either. As I continued to fail, with every attempt my resolve that I'd ever be free got more smashed and dejected.

Now, I'd really hate to see this same sort of logic get applied to e-cigs. For me they were totally different. As soon as I got my first one I had a hope that I hadn't had since probably my first quit attempt. I felt a confidence that I'd completely lost. I've been able to reduce my nicotine slowly and at a rate I've been comfortable with. The physical act of vaping satisfies something that the mere presence of nicotine in my body was never able to do. With the e-cigs I've been able to reduce my nicotine from 24 mg/ml, slowly down to 12 mg/ml over 6 months, with very little problems.

There is something fundamentally different about the e-cig, and I would hate to see it get lumped in as ineffective with the NRTs. Back to the simple 'quit or die' message.

(I know he didn't talk about e-cigs in the letter, it's just a worry I was having as I was reading through it. Now, off to finish...)

 

[rolygate]

JRP makes three powerful arguments:

1. Pharma-assisted quitting doesn't work as the fail rate is very high.

2. The more pharma-assisted quit attempts are made by an individual, the more likely they are to fail. For patches, the fail rate was shown to be between 98.4% and 100% on the second quit attempt.

3. All medical trials in which the success rate of pharmacotherapies was measured against placebo are worthless because subjects are well aware they are being given a placebo. Thus, statements such as, "NRT doubles your chances of quitting" are wrong because they refer to trials where the NRT quitters performed better than the placebo quitters - who relapsed because they knew they were not receiving treatment. It is impossible to convince a nicotine-dependent person that they are receiving nicotine or treatment when they know they are not.

The commonly-heard phrase "NRT doubles your chances of quitting" is exposed as an outright lie, and the reasoning is clearly shown.

He also infers that the reduction in smoking prevalence stopped when pharma gained control of the quitting industry.

 

[TennDave]

Well, not in the letter but from the two testimonials of those who died trying NRT's the e-cigs are mentioned. I would have to think that they got bad products (not enough nic for them- something I did too when I first started) and they didn't have the support for the e-cigs like we do here on the ECF- I know that if if wasn't for the ECF, I would have probably chalked up my tiny 510 e-cig I got as a failed attempt as well.

 

[Spazmelda]

Well, not in the letter but from the two testimonials of those who died trying NRT's the e-cigs are mentioned. I would have to think that they got bad products (not enough nic for them- something I did too when I first started) and they didn't have the support for the e-cigs like we do here on the ECF- I know that if if wasn't for the ECF, I would have probably chalked up my tiny 510 e-cig I got as a failed attempt as well.

Yes, I had just gotten up to that point before I wrote my post. LOL! Then I saw that e-cigs were mentioned in the case of the patients.

His argument of why nicotine replacement doesn't work, starting here:

I submit that industry and government cold turkey bashing, and government neglect of cold turkey quitter counseling and support needs, helps fuel and motivate countless thousands of annual cold turkey relapses, resulting in the indirect killing of smokers.

But there's another and possibly larger indirect NRT killing field. It's replacement nicotine's interruption of natural learning of the most important stop smoking lesson of all, that lapse nearly always equals relapse, that one equals all, that one puff is too many, while thousands never enough.

Natural relapse learning eventually teaches us nicotine addicts the same relapse prevention lesson eventually gleaned by the alcoholic, that there's no such thing as just one sip or puff.

would also seem to be easily used against e-cigs. But for some reason I and many others *have* been able to at least reduce nicotine with the e-cig. I haven't gotten to 0 yet, but I have confidence that I will. Will have to see. That is already more success that I ever had with the patches or gum. I don't believe I ever got past the lowering stages of the patches without 'cheating' and I know I never got down to the 2mg gum.

OTOH, e-cigs aren't supposed to be used for the purpose of quitting, so this is all just idle ramblings on my part. Reduced harm is a different story from cessation. I do understand that.

 

[TennDave]

Right- I keep getting asked by "friends," when are you going to quit "smoking" completely. I know better than to become engaged in that argument with those who are so brain washed. I don't know if I will ever live without nicotine and that doesn't bother me one bit. I too have lowered my nic levels when my "body told me" to. I am at 18mg now- that seems to be where my body is comfortable.

 

[fumarole]

Polito's opinion seems to be that, by inference, Glaxo-Welcome are the largest-scale corporate murderers in the US. The shareholders are probably happy though.


Philosophy class debate:
State your reasons why, either for or against, the proposition that a Glaxo-Welcome shareholder who is also a smoker, who fails in attempts to quit using GW products and then begins to die from a smoking disease, has no justifiable complaint because he has profited from his own death.

 

[inter_ceptor00]

I think the real problem is that E-cigs are nicotine replacements but not therapies designed to lead to complete smoking cessation. E-cigs and PV's are just a better way to get nicotine than from cigarettes or chewing tobacco. NRT's are supposed to lead to quitting...but how do you quit something when you just continue to take it in another form(patches, gum, lozenges) or replace it with medication that mimics the effects of nicotine on your brain(chantix and similar medications)? You can't. So you would either have to keep taking them or eventually quit cold turkey anyways by stopping use of the NRTs. PV's and E-cigs are not for quitting, they are for continuing our use of nicotine but in a better, healthier(for everyone), more enjoyable way. This needs to be our selling point. We are all adults who do not want to quit using nicotine but want a better way to go about getting it. I know some people will disagree and say vaping has allowed them to quit using nicotine, this is true and likely because PV's only supply nicotine while cigarettes/chewing tobacco have other chemicals that add another layer of dependence to their use. Quitting just nicotine has to be easier than quitting nicotine+a bunch of other addictive crap at the same time.