Cold turkey twice as effective as NRT or Zyban

John (Gold)
John (Gold)

May 20th, 2006, 5:37 am #1

Cold Turkey Twice as
Effective as NRT or Zyban
WhyQuit - Friday, May 19, 2006[/size]
All real-world performance studies to date suggest that expensive nicotine replacement therapy products (NRT) like the patch, gum and lozenge are a total waste of money. In none have NRT quitters performed better than those who quit smoking without them. Now, a May 2006 study survey has found cold turkey success rates twice as high as among those using the nicotine patch, gum, inhaler or bupropion (Zyban and Wellbutrin).

Published in the May 2006 edition of Addictive Behaviors, the survey analyzed 2002 and 2003 patient quitting method data collected by 1,000 Australian family practice physicians. Patients were asked their smoking status, how long since they had last smoked and which of twelve quitting methods they used during their last attempt.

The study established success rates for each of twelve methods by "dividing the total number of successful patients (former smokers) by total number of patients attempting to quit (former plus current) using that method." In analyzing former smokers, it looked at the quitting method used by each former smoker during their last attempt, regardless of the year in which they quit. In assessing current smokers it looked at their last unsuccessful attempt, so long as it occurred within the prior five years. As shown below, the analysis produced rather high success rates.

Success rates among 2,207 former smokers and 928 current smokers were: cold turkey 77.2% (1,942 former, 575 current); nicotine patch 35.9% (145 former, 259 current); nicotine gum 35.9% (52 former, 93 current); nicotine inhaler 35.3% (12 former, 22 current); and bupropion (Zyban or Wellbutrin) 22.8% (36 former, 122 current).
Not only was cold turkey quitting the most effective method -- doubling the rate of pharmacology quitters -- it was by far the most productive method. Successful cold turkey quitters accounted for 1,942 of 2,207 former smokers, a whopping 88% of all success stories.

In theory, all quitting methods should do at least as well as cold turkey. If not, the method has somehow managed to undermine the quitter's own natural ability to break free from nicotine's grip. The Australian study shows that NRT and bupropion clearly undercut a quitters odds. Other methods surveyed came closer to keeping pace with cold turkey.

Reported rates include: family physician assistance, other than counseling 60.2% (71 former, 47 current); herbal preparations 63.2% (31 former, 27 current); hypnotherapy 53.5% (31 former, 27 current); support/counseling e.g. "SmokeStop," "Quitline" 44.2% (19 former, 24 current); self-help materials e.g. quit smoking manual 58.5% (48 former, 34 current); other methods not listed 69.8% (81 former, 35 current).

What's amazing is that Australian support and counseling programs actually preformed eight percentage points better than the nicotine patch or gum when those products form the cornerstone of Australian quitting efforts. It demonstrates the effectiveness of quality support. When contrasted to cold turkey, it shows that quitters are not succeeding because of NRT but in spite of it.

A Closer Look at Recent Data

The study notes that bupropion (Zyban/Wellbutrin) was not as readily available as other quitting methods in Australia until February 2001 when it joined NRT in its use being subsidized by the government. This fact caused researchers to take a second look at the data, limiting current and former smokers to those making quit attempts between February 2001 and March 2003.

Once again cold turkey quitters clobbered those toying with pharmacology by a two to one margin: cold turkey 40.2% (269 former, 400 current); nicotine patches 21.5% (52 former, 190 current); nicotine gum 11.4% (8 former, 62 current); nicotine inhaler 22.2% ( 4 former, 14 current); and, the reason for the second look, bupropion 20.8% (30 former, 114 current).

Australian Study Will Be Hidden from Smokers

If the true import of this study were ever shared by a major media source it could cost the pharmaceutical industry billions in profits. That's why it will not happen. Like all prior quitting method surveys it must remain hidden from smokers. It will be buried beside a recent survey of UK smoking cessation services, a support based program specifically tailored to assist NRT and bupropion quitters, but in which a few cold turkey quitters managed to squeeze in.

Published in the April 2005 edition of Addiction, the survey of one-year UK program success rates found that 25.5% of cold turkey quitters were still not smoking compared to only 15.2% of NRT quitters, 14.4% of bupropion users, and 7.4% of those using both NRT and bupropion at the same time.

It will be buried beside a California study in the September 2002 edition of the Journal of the American Medical Association (JAMA) which concludes "NRT appears no longer effective in increasing long-term successful cessation in California smokers." It will join ignored surveys from Minnesota, Quebec, Western Maryland and London, each evidencing zero NRT advantage over those quitting without it.

Evidence Clinical Studies Fatality Flawed

As the volume of real-world survey evidence demonstrating NRT's total ineffectiveness explodes, our understanding of what went wrong in randomized clinical trials of NRT is becoming clearer. Clinical studies assigned participants to one of two groups - those who were to receive the active NRT device being tested (the nicotine patch, gum, inhaler, spray or lozenge) or to a placebo group which was given an identical looking delivery device that was nicotine free.

Generally clinical trials produced results that were exactly the opposite of those found in the Australian survey. Those assigned to the NRT group normally had six month quitting rates that were roughly double those achieved by the placebo group. But how?

Most quitters joined clinical studies in hopes of getting weeks or months of free NRT products. Although NRT studies were supposed to be blind, in that participants would not be able to identify their group assignment, researchers failed to account for the fact that nicotine is a psychoactive chemical producing a dopamine/adrenaline high. Quitters with any prior quitting history knew what it felt like to be deprived of nicotine.

A June 2004 study reviewed blindness in NRT studies and discovered that only 17 of 73 NRT studies took the time to assess blinding, and that 12 of the 17 (71%) failed their own assessment as "subjects accurately judged treatment assignment at a rate significantly above chance."

An April 2005 study published in the Journal of Consulting and Clinical Psychology examined NRT blinding. It randomly assigned smokers who had no intention of quitting during the next six months to use either NRT or placebo. The assigned objective was to try and reduce daily cigarette consumption by half. After six months participants were asked to guess whether or not they had received nicotine or a placebo. Three times as many placebo group quitters correctly guessed placebo as guessed nicotine.

Fraud or Slick Nicotine Marketing?

The pharmaceutical industry intentionally keeps smokers in the dark when it comes to both success rates for second time NRT users and the percentage of quitters getting hooked on the cure. Since April 1993 it has known that almost 100% of second time nicotine patch users relapse to smoking within six months. By November 2003 it knew that 36.6% of nicotine gum users were engaged in chronic long term use. Delivering 25% more nicotine, it has every reason to believe that nicotine lozenge dependency rates will go even higher.

There is a grand widening canyon between NRT truth and reality, between clinical efficacy findings and real-world effectiveness. The burning question has quickly become, is it consumer fraud for the pharmaceutical industry and its consultants to continue to tell those addicted to smoking nicotine that replacement nicotine doubles their chances of success, when they know full well that it doesn't?


May 20th, 2006, 5:52 am #2

The new Australian study started an interesting diaglogue at a group called Globalink, comprised mostly of people who work in the tobacco control field. Here is a commentary that I added to that forum a couple of weeks ago:
Re: Unassisted Cessation

I am going to attach a commentary that I wrote a few years back and have posted at At the end of the commentary is a link to the original article, so that you can see the actual American Cancer Society chart being talked about and a link back to the original American Cancer Society publication.

I have truly been amazed on how real world experiences seem to be totally ignored by the smoking cessation research community. Actually, I don't believe that the researchers who participate here at Globalink are going to find anything credible in this commentary. It is really overly simple. It was not written to influence or change the mind of people in the research community. It was written for the general public.

I do however think that health care practitioners who read here, and maybe public health officials--people who really are out there on the front lines dealing with! individuals or the public in real world settings and who may be frustrated with how their interventions seem to go with their patients or their community--that these people may benefit from reading this commentary as well as really paying attention to the discussion that Simon Chapman's observation is spawning here.

There are a few other commentaries that I have put up at over the years that touch on some of these issues. I am going to attach links to these articles too.

Joel Spitzer

So how did most successful ex-smokers actually quit?

If you look around the Internet or even request information from professional health organizations on how to quit smoking you are likely to find that the standard advice given is to use a pharmacological approach, i.e., nicotine replacement products and or Zyban. Each time you see this advice you will also be told that these approaches double your chances of quitting. Some sites and gr! oups come out and almost say, point-blank, do not go cold turkey--basi cally leaving the reader with the impression that nobody could possibly quit this way.

The American Cancer Society's Cancer Facts & Figures 2003 report contains a chart which shows the percentage of current smokers who have tried different routes at quitting smoking and also indicates the percentage of current ex-smokers who quit by different techniques.

The numbers that are highly telling are the percentages that indicate how former smokers had actually quit. Keep in mind that this chart is limited. It does not tell us how long they had quit or other key pieces of information, such as, did the people who used quitting aids such as NRT ever actually get off the NRT. But I am not concerned about that at this moment.

According to the American Cancer Society report, how did former smokers actually quit? Those using drug therapies and counseling had a 6.8% quitting rate while those using other methods 2.1%. The remainder quit cold-turkey or cut down! . In that it is generally accepted that cutting down techniques do not work, we can safely assume that they had an extremely limited impact upon the overall number. So, approximately 90% of the people who are successfully classified as former smokers quit cold turkey. On the same page as Table 3 is located you will find the following recommendation:

"All patients attempting to quit should be encouraged to use effective pharmacotherapies except in the presence of specific contraindications."

You have to ask yourself how many of the successful ex-smokers in the world today would have actually succeeded if they sought out and listened to "professional" advice such as this.

If you are trying to determine what is the best way to quit, you have a choice. You can go with the "experts" or you can go with what 90% of successful quitters have done.

Take Your Own Survey

So how do most people really quit smoking? Don't take our wor! d for it, or the American Cancer Society's, but instead talk to every long-term ex-smoker you personally know. See how many of them fall into one of the following three categories:

1. People who woke up one day and were suddenly sick and tired of smoking. They tossed them that day and never looked back;

2. People who get sick. Not smoking sick, meaning some kind of catastrophic smoking induced illness. Just people who get a cold or a flu and feel miserable. The feel too sick to smoke, they may feel too sick to eat. They are down with the infection for two or three days, start to get better and then realize that they have a few days down without smoking and decide to try to keep it going. Again, they never look back and stuck with their new commitment; or

3. People who leave a doctors office given an ultimatum. Quit smoking or drop dead--it's your choice. These are people who some sort of problem has been identified by their doctors who lays out in no uncertain terms that the person's life is at risk no! w if they do not quit smoking.

All of these stories share one thing in common--the technique that people use to quit. They simply quit smoking one day. The reasons they quit varied but the technique used was basically the same. For the most part they are clear examples of spur of the moment decisions elicited by some external, and sometimes unknown circumstance.

I really do encourage all people to take their own survey, talking to long-term ex-smokers in their real world: people who you knew when they were smokers, who you knew when they were quitting and who you still know as being successful long-term ex-smokers. The more people you talk to the more obvious it will become how people quit smoking and how people stay off of smoking. Again, people quit smoking by simply quitting smoking and people stay off of smoking by simply knowing that to stay smoke free that they must Never Take Another Puff!


Original reply:

Other related readings:

The Setting Quit Date article linked above is another example of how researchers try to ignore the obvious conclusions of a study and slant research to fit the agenda of selling medications to help people quit.

Here is a commentary that I wrote in reply to an comment written at the British Medical Journal response board in the article "Catastrophic" pathways to smoking cessation: findings from national survey"

(see full story at

A response was written there saying:

"...because something commonly happens in a particular way 'in the real world' then this should be considered the best way."

Smoking cessation experts often seem to have to be telling people to dismiss real world experiences. Usually I see a little different variation of the comment above. Common statements I have seen are something to the effects that while it is likely that a person may at times encounter real world quitters who succeeded by using non-recommended techniques, usually meaning no pharmaceutical intervention or in what this study is showing, people who used no set quitting date, that these people are just the exceptional cases. What the experts are trying to do in effect is discredit observations made by people, making them think that the occurrence of such experiences are really rare.

The author above was at least accurate enough to say, "While it i! s true that most smokers who quit do so without any specific behaviora l support or pharmacological treatment..." The rest of the comment was going on to try to give the impression that there would have been even more successful quitters if people would just do what smoking cessation experts say should work as opposed to doing what actual quitters continually say has worked for them.

The tactic being employed here is to leave the impression that we could just have a whole lot more successful quitters if people would just utilize the miraculous effective products out there that actually help people to quit. There is also the perception being portrayed that there really are very few ex-smokers out there because most who have tried to quit have done so unaided and everyone just knows how improbable it is for people to be able to quit in an unaided attempt.

Medical professionals and the general public are being misled to believe that quitting smoking is just too plain difficult for people to do on their own and that the odds of ! a person actually quitting on their own is really pretty dismal.

This would all make perfect sense if not for the fact that we have so many successful ex-smokers in the real world. In America, we have more former smokers than current smokers. Over half of the people who used to smoke have now quit smoking. From the comment made above it should be clear to all that most of the people who have quit either did not know of professional recommendations for quitting or chose to ignore professional intervention techniques. Yet these people successfully quit anyway. I think that this is an important point to hit home with all medical professionals. The medical profession has got to start to help people to realize the real potential of success that individuals do have to quit smoking instead of perpetuating the idea that quitting is just too hard for an individual smoker to expect to actually succeed without help.

While this article should have been about plannin! g techniques, the original author and a few experts weighing in on the discussion have tried to turn it into a referendum on selling pharmaceutical interventions. Nicotine replacement products have been around for over two decades now-- and a significant percentage of smokers have used them to try to quit smoking. If a product has been around for decades, used by millions of people worldwide, AND, has been truly effective, it should be easy for most health care practitioners to come up with lots and lots of successful patients, colleagues, family members and friends who have quit with these products.

As I said in my original commentary above:

" I don't believe that there is a single professional smoking cessation "plan your quit" advocate who will suggest other medical professionals should take a similar survey. For if they did their study results would almost certainly be called into question when the health care professional starts seeing the results of his or her real life survey. The experts will end up having to spend ! quite a bit of time trying to explain away the discrepancy, using rationalizations like the people who planned their quit "didn't do it right" or didn't "plan" long enough or were "just more addicted smokers."

In all honesty, I don't expect my encouraging of real world observations by health care professionals to have much impact with smoking cessation experts. They are going to profess to believe whatever other experts keep telling them to believe or, what the funders of their studies believe.

I do however believe that health care workers who are on the front line and actually deal with patients who smoke are going to be a bit more critical and analytical about this. If they spend any time talking with patients they are going to see through the rhetoric and the rationalizations of the experts.

I have always tried to disseminate the message that just because something works in the lab or in study conditions doesn't necessarily translate to the ! fact that the process will work in the real world. The smoking cessati on experts seem to have to work on the basis that just because something works in the real world doesn't mean that it is a good approach if it doesn't seem to work in a lab.

I have high hopes that medical professionals really wanting to help their patients are going to be more influenced by what they see is successful than by being told by the experts what should be successful, but somehow not replicable in their own practices.

One more example of how researchers or policy makers make what I believe are unwarranted or unsupported conclusions or recommendations to specific data interpretations. It happened back in 2003 in the Malta Medical Journal.

Here is a link to the study:
Excerpts from that PDF file

Quantitative Results
There were 246 applicants who applied for the 13 smoking cessation clinics organised by the ! Health Promotion Department in Malta during the year starting in October 1999. Out of these, only 134 presented themselves for the introductory session, with this number falling to 101 for Session No. 2 - the quit session (see Table 2). While the immediate success rate at the final session was 27% (n=27) as a percentage of the participants attending the quit session, the six-month success rate dropped to 10% (n=10), with dropouts being counted as smokers.

Of these ten quitters who were still not smoking at six months after the end of the clinic:

• seven were males, while three were females;

three were aged 30-39 years (30%), two were between 40 and 49 years old (20%), four were in their 50's (40%), and one was 64 years old;

• nine were continuously abstinent for the whole duration of the six months (one male had re-started smoking, only to quit again 3 months before the six-month follow-up);

• and only two (20%) had used nicotine! replacement therapy as an aid to stopping.

Implications for improving the outcome

The 10% prevalent abstinence rate (9% continuous abstinence rate) at six months after the end of the Malta clinics is low compared to international standards (20-30% in the UK16 and 15-30% in the USA1), particularly as these are measured at one year, and assuming no differences in the methods used and their application. One significant factor that may account for this difference is the freedom of choice for use of pharmacotherapy (in this case, nicotine replacement therapy). While UK and US recommendations1,6,7,14,17 put pharmacotherapy (NRT and bupropion) as the cornerstone of therapy, Maltese smoking cessation clinics still leave the choice for use or non-use of NRT to the participants. In fact, of the 10 quitters who were not smoking at six months after the end of their respective clinics, only two (20%) had used nicotine replacement therapy.

Then from table six of that study:
Table 6: Recommendations of study

The! use of pharmacotherapy (NRT and/or bupropion) as a cornerstone of smoking cessation clinics.

Again, they disregarded the fact that the majority of success was seen with the people who did not use pharmacotherapy and instead said that one of the problems is that participants had too many choices, and the "logical" conclusion was somehow to make pharmacotherapy the cornerstone of treatment.

Member of GLOBALink - The International Tobacco-Control Community
Last edited by Joel on August 26th, 2013, 1:25 pm, edited 1 time in total.


May 20th, 2006, 6:42 am #3

Fascinating reading, thank you very much.

One thing that really strikes me when reading both of the above posts is that my family doctor, who has tried to convince me to quit smoking for the past 15 years that I have been his patient, has prescribed patches and Wellbutrin for me over the years, but has never actually talked to me about, or recommended, quitting cold turkey!

When I look at my quit meter, "young" as it is, I know for a fact that I have not been nicotine free for this long in more than 30 years, including the times I have used NRT and Wellbutrin. You can rest assured that on my next visit to my doctor, I will be sure to let him know exactly how I quit (cold turkey) and where I got the courage and knowledge to do so successfully (right here at Freedom)! I am going to give him the website and ask him to spend some time reading the information available here. I will then ask him to consider at least including a recommendation to this site as an option when talking to other patients about smoking cessation.

I think that the main reason NRT or Wellbutrin assisted quits did not work for me is that I thought they were an easier way out. I believed that I would not have to deal with the effects of withdrawal at all; I believed that I would simply wake up one day and the compulsion to smoke would be gone. Never did it occur to me that I still had to call upon my own strength and conviction for it to work!


Happily nicotine free for Two weeks, five days, 4 hours, 12 minutes and 7 seconds. A grand total of 441 nicotine sticks not ingested, saving $149.95 of my hard-earned money. Life saved: 1 day, 12 hours, 45 minutes.


May 20th, 2006, 7:11 am #4

I think it is important to note that most physicians and indeed, many if not most experts in the field are making their recommendations believing that the advice they are giving to use these products is the best advice available. They have always been told and are still being told by most experts that quitting without pharmacotherapies is just too difficult for most smokers.

I believe that most of the experts in the middle ages who believed the earth was flat or that the earth was the center of the universe were true believers of those premises too--again, because all of the experts of the day said that those "facts" were true. Over time though, sometimes many years and decades the true facts did manage to come out.

All of our members and lurkers have an opportunity to help their doctors to be better able to help their patients. It is not even by referring them to Freedom, or or to any online support. It is by helping them see that for you what made quitting possible was simply getting nicotine out of your system and the one thing that is making this quit stick is the fact that you recognize that you cannot put nicotine back into your system ever again.

If physicians, dentists and other health care professionals see and hear this enough they will start to recognize what message they can give to really help their other patients break free from nicotine. The message is oh so simple, to get and then stay nicotine free just never deliver nicotine again from any replacement source and as far as the smoked form goes, to stay nicotine free is as simple as just knowing to never take another puff!


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Patient Nicotine Dependency Recovery
Resources for Medical Professionals
Health care professionals know that quitting is one of the best things their patients can do to improve their overall health and quality of life. But when alerting patients to existing tobacco related health problems, or the long-term consequences of smoking, far too often the provider's warnings go unheeded. When coupled with extremely high relapse rates among patients who do attempt, the endless cycle of frustration can condition health care professionals to simply stop trying to motivate cessation. The fact is, adequately armed, as a medical professional you are perfectly positioned to make a major difference.

Studies have shown that patients do hear their provider's health risk messages and that your intervention can make a tremendous difference in them attempting cessation and recovery.
1 While health care professionals know the benefits of smoking cessation, they are not always informed or trained on successful intervention measures. Many providers have been sold on believing that alternate nicotine delivery vehicles such as the over-the-counter nicotine gum, patch, lozenge are state-of-the-art treatment strategies. While they are considered to be "state of the art," in real world settings they are actually quite ineffective treatment strategies. A March 2003 meta-analysis shows that 93% of patients using these approaches relapse within six-months. 2, 3, 4

No matter how much or how long a patient has smoked nicotine, they need to understand that the possibility of quitting exists for them. The self-help resources and materials below can aid you in helping patients quit smoking or end dependence upon other forms of nicotine delivery. Whether used to develop a deeper personal understanding to share with patients, as printed and shared patient handouts, or their existence and availability is simply brought to the patient's attention, given an opportunity, these free motivation, education and support resources have the potential to make a significant difference over what you've previously experienced.

Motivation Nicotine dependent patients who try quitting and fail generally attribute relapse to a lack of strength or willpower. In reality the inability for people to quit is much more likely to be from a lack of understanding of how to quit that from a lack of strength or willpower. can give your patients the information and understanding they need to successfully quit smoking once and for all.

Founded in July 1999 by John R. Polito, a once hopelessly addicted sixty cigarette-a-day smoker, the original WhyQuit was originally a motivational site whose goal was to provide a
potent sampling of the hazards of smoking. evolved over time to a site that now that can provide additional motivation, education and support for any patient who you may have began to move toward making the decision to quit. Your guidance can prime your patients to want to quit; our additional information can support them through the quitting process.

Education The American Cancer Society's Cancer Facts & Figures 2003 report indicates that 91.4% of all successful long-term quitters quit entirely on their own without NRT products such as nicotine gum, the patch, lozenge, spray, inhaler, bupropion (Zyban/Wellbutrin) and without hypnosis or acupuncture. These people basically quit by going cold turkey. We've designed our site to help smokers understand that they too can quit if they implement this successful approach.

Joel's Library is WhyQuit's education cornerstone. Joel Spitzer has been developing and conducting smoking prevention and cessation programs for the past 32 years. His programs are designed to help his clients understand why people smoke, why they should stop, how to quit, and most importantly how to stay quit. His library's roughly one hundred short articles present smoking and nicotine as a true chemical dependency. Indexed under seven topics - dependency, health risks, quitting, relapse prevention, weight control, youth prevention, and history - each article in the collection is united by the underlying theme that to get off and stay off of cigarettes the smoker must learn to "Never Take Another Puff."

A quick sampling of the library shows how Joel addresses the
cessation blood-sugar swing issue, the emotional loss associated with quitting, sleep adjustments, fixating, anger, quitting crutches, "cheating," and the important issue of cessation weight gain.

Joel's "
My Cigarette My Friend" has become a staple in cessation programs around the globe and is an excellent ice-breaking article to keep available in your patient waiting area.

We have compiled an online Ebook that you may wish to download and print for patients who do not have Internet access. Entitled "
Never Take Another Puff" Joel's Library is available in .PDF book format (1.75 MB - 141 pages) and can be printed and presented as gifts to patients. Our only request is that our materials be made as freely available to patients as we have made them to you, without any cost or charge.

This link is to Joel's
upcoming clinics and seminars in and around the Chicago area. Health care providers and staff are invited to attend, take notes, and incorporate Joel's cessation teachings, content and concepts into your practice or wellness program.

Serious Group Support Founded on September 8, 1999 by John R. Polito and Joanne Diehl, Freedom from Tobacco is a free 3,000+ member MSN hosted message board support forum . With the help of scores of dedicated volunteers, and the guidance of Joel Spitzer, Freedom evolved into a world-class education oriented abrupt cessation forum where every member remains highly focused on a single topic - no nicotine today, Never Take Another Puff!

A 100% nicotine-free environment in every respect, Freedom's rules may sound harsh but they not only provide important rehabilitation sanctuary from those still under the influence of nicotine, they hammer home the essential understanding of relapse prevention that will be necessary if your patient is going to sustain a permanent quit.

New arrivals are given a road-map of reading assignments designed to help navigate
the first 72 hours of detoxing nicotine. They are also encouraged to explore Freedom's more than 170,000 indexed and archived messages. New quitters are granted group posting privileges once they provide written certification of having remained completely nicotine free for 72 hours.

Today hundreds of Freedom graduates form a knowledgeable, skilled and supportive army of dedicated volunteers who are waiting to reach out to a new generation of arrivals that can include your smoking patients. Freedom's last two efficacy reviews both generated
39% midyear continuous nicotine cessation for new members demonstrating participation in the group by posting at least once.

Please rest assured that Freedom has
strictly enforced policies against any member rendering medical advice regarding any symptom described on the message board. Freedom's Courtesies and Rules expressly forbid members from rendering advice or making any recommendations regarding specific health concerns, answering member medication or herb concerns, or from making dieting recommendations. Instead members are strongly encouraged to see the assistance of qualified professionals.

We're here to help and there's only one rule ....

No nicotine today, Never Take Another Puff!

John (Gold)
John (Gold)

May 20th, 2006, 7:14 am #5

It would be wonderful if your physician were to actually listen and investigate, Bonnie. I think it's a pretty fair statement that most physicians know very little about chemical dependency recovery. My oldest daughter is now completing her third year of medical school and has yet to receive any instruction on how to help smoking patients avoid this nation's leading cause of preventable death. It is my understanding that very few medical schools offer such training and the focus at most that do is pharmacology.

I have encountered scores of NRT consultants around the globe calling themselves "experts" in smoking cessation. Many of their live seminar presentations are now finding their way online for all to see, especially in the UK. If any member here were to listen to a few of them I think they'd be shocked at what's being taught and how little these so called "experts" really know about nicotine dependency recovery. This group truly is producing some of the most educated ex-smokers on earth. I only hope you each understand just how valuable your insights are.

I know I've said it often but not learning or being taught the law of addiction is a horrible reason to die. Be proud of you, Bonnie! You've come far these past 19 days. Still just one overriding concept keeping each of us on the free side of the bars and our now arrested dependency on the other ... no nicotine just one day at a time, Never Take Another Puff, Dip or Chew!

John (Gold x7)

John (Gold)
John (Gold)

May 20th, 2006, 10:36 pm #6

The above link is to a graph of quitting method success rates
that I created from study. It's a bit wide for posting in the thread.

John (Gold)
John (Gold)

July 11th, 2006, 7:23 am #7

13th World Conference on Tobacco
or Health Drenched in Nicotine
WhyQuit - Monday, July 10, 2006[/size]
Keenly aware of smoking's massive annual slaughter and in search of help, government health officials from around the globe will descend upon Washington DC from July 12-15 for the 13th World Conference on Tobacco or Health. What they'll find instead is that the conference's two corporate sponsors -- GlaxoSmithKline and Pfizer - have produced a well orchestrated commercial designed to convince them that government subsidized nicotine is the answer, replacement nicotine or NRT. What they won't hear is the truth, that replacement nicotine has never proven effective in any real-world setting and likely never will.

The California tobacco survey, the Minnesota insurance survey, Quebec Quit and Win, the Tobacco in London survey, Western Maryland, UK NHS Smoking Cessation Services, Australia family practice survey, two decades after its 1984 introduction NRT does not have a single real-world performance victory, none. But that isn't stopping the pharmaceutical industry from encouraging health officials to waste precious resources purchasing a worthless remedy.

NRT Clinical Studies Were Not Blind and Are Not Trustworthy

The reason NRT will never be effective in head-to-head real-world competition is that the expectations of cold turkey quitters to abruptly end all nicotine use are beyond the ability of the pharmaceutical industry to exclude, redefine, tease, torment, play upon, frustrate, defeat or destroy.

The clinical lesson kept quiet by the pharmaceutical industry and its army of loyal research consultants is that clinical efficacy studies were an expectations nightmare. Study participants joined in hopes of receiving weeks or months of free replacement nicotine. Instead of NRT clinical odds ratio victories evidencing NRT efficacy they reflect the defeat and fulfillment of the nicotine addict's nicotine expectations.

Nicotine is a psychoactive chemical and a substantial percentage of participants knew what it felt like when their dopamine/adrenaline high was or was not replaced. This isn't news to a replacement nicotine industry that appears to be operating from the tobacco industry's nicotine play-book. Researchers found themselves resorting to the extreme of toying with small amounts of nicotine as a placebo device masking agent as early as a 1982 nicotine gum study. The practice is also noted in a number of nicotine patch studies.

Clinical efficacy and community effectiveness are two entirely different standards. According to an August 2004 article by Dr. Lois Biener, PhD, Senior Research Fellow, University of Massachusetts, "the effectiveness of NRT in the general population has not been established. In spite of the fact that NRT and other drugs are included in the Public Health Service guidelines, their efficacy has only been demonstrated in carefully controlled clinical trials. Evidence of their effectiveness in general population has been difficult to find."

Dr. Biener is one of two Conference presenters who have demonstrated the courage to speak truth to pharmaceutical industry muscle, money and influence. The other is Dr. John Pierce, PhD, Professor of Family and Preventive Medicine, University of California, San Diego.

Dr. Pierce analyzed seven years of data from the California Smoker's Survey, one of the world's largest. His study, published in the September 11, 2002 issue of the Journal of the American Medical Association, concluded that "NRT appears no longer effective in increasing long-term successful cessation in California smokers."

There is growing awareness that highly manipulated clinical studies cannot and should not be taken at face value. Equally important are performance evaluations, a step that both GlaxoSmithKline and Pfizer know they must avoid and belittle as unscientific if their golden nicotine goose is to continue laying golden eggs.

More than two years have passed since Mooney reviewed the blinding procedures associated with 73 "allegedly" double-blind NRT studies. Published in the June 2004 issue of Addictive Behaviors, he found that clinical NRT studies were not generally blind as claimed in that "subjects accurately judged treatment assignment at a rate significantly above chance."

Most placebo group members dropped out in the first few weeks of clinical studies. The NRT pharmaceutical industry has had two full years to conduct rather simple NRT blinding evaluations to prove that clinical NRT study results do not reflect the worst junk science and greatest smoker hoax the world has ever seen. The industry has had nearly four years since Dr. Pierce's ineffectiveness survey finding to produce its own survey showing effectiveness but it hasn't and won't. Why? Because it can't.

Instead, the 13th World Conference on Tobacco or Health will be used to introduce new excuses for NRT's dismal performance and to make implied promises of future performance that cannot and will not be kept. What health policymakers should be asking is how many priceless periods of cessation confidence have already been squandered? How many lives have needlessly been lost?

False Advertising

GlaxoSmithKline's site asserts, "In general, NRTs have been shown to double a smoker's chances of quitting versus 'cold turkey.'" Pfizer's Nicotrol website asserts, "Studies have shown that nicotine replacement therapy can double a smoker's chances of quitting versus cold turkey."

GlaxoSmithKline and Pfizer should be compelled to identify any study which invited cold turkey quitters to compete against those wanting and seeking replacement nicotine, in which the NRT rates doubled the rates of cold turkey quitters. Given that NRT has never once prevailed over "cold turkey" quitters in any head-to-head real-world survey and that those wanting to quit "cold turkey" were never invited to challenge NRT in any clinical trial, aren't both GlaxoSmithKline and Pfizer, the pharmaceutical industry sponsors of the World Conference, engaged in intentional smoker deception?

Nicotine Being Painted as Helpful, Enjoyable and Safe

Look what curious youth and smokers are reading about smoking nicotine at GlaxoSmithKline's Nicorette website. "Smoking stimulates chemicals in your brain that appear to enhance awareness and concentration. It increases dopamine levels, which improves your mood. It even increases the levels of some hormones, including adrenaline. This is why cold-turkey attempts seldom work. But Nicorette helps you control cravings, while gradually weaning your body from nicotine."

Momentarily overlook the fact that today almost all successful quitters around the globe are quitting cold turkey (80 to 90%). Instead, focus on the nicotine benefits suggested. What visitors are not told is that GlaxoSmithKline has determined that at least 36.6% of all current nicotine gum users are chronic long-term users of greater than 6 months ( Tobacco Control, Nov. 2003).

What is not shared are recent studies evidencing that nicotine is a major player in the harms caused by smoking. It has now been linked to chronic depression, hardening of the arteries, accelerated tumor grow rates, to rendering chemotherapy substantially less effective, memory impairment and early dementia.

United Kingdom NRT industry consultants are expected to boast to the World Conference that their nation has approved NRT for both child smokers above age 12 and pregnant smokers. According to Professor Theodore Slotkin with the Department of Pharmacology and Cancer Biology at Duke University Medical Center it's a recipe for disaster.

"There is abundant evidence that the major problem for fetal development is exposure to nicotine rather than other components of cigarette smoke." "NRT, especially by transdermal patch, delivers more nicotine to the fetus than smoking does."

A March 2003 study published in Reproductive Toxicology found that the nicotine concentration in the brains of fetal mice were 2.5 times greater than the nicotine concentration found in the mother's bloodstream when nicotine was continuously administrated, as would be the case with the nicotine patch. A pregnant smoker need only imagine what it would be like if her mind were trapped and forced to constantly endure 2.5% more nicotine than normal.

"The patch is the 'easiest' NRT approach, and it turns out that this is the absolute worst form of nicotine administration for the fetus. Essentially, achieving a continuous steady-state plasma level of nicotine in the mother removes the protective effect of the placenta (delay of entry to fetus, partial catabolism of nicotine) because all water spaces become saturated with nicotine," explains Slotkin.

Tobacco Industry/Pharmaceutical Industry Agreements

Imagine spending billions on advertising which boasts that your product can double a smoker's chances of quitting yet never once mentioning the horrors that await smokers if they fail to purchase it. Is it coincidence that those selling replacement nicotine continue to fail to mention smoking related diseases or is there an oral or written non-compete agreement between the tobacco and pharmaceutical industries?

Is it coincidence that Philip Morris' website has touted replacement nicotine as a key to successful quitting? Is it coincidence that the per use cost of over-the-counter replacement nicotine remains at or near the cost of cigarettes when NRT products are not subject to tobacco excise taxes? What are NRT production costs?

Failure to Disclose NRT's Actual Quitting Rates

Youth and young adults listening to NRT marketing are being led to believe that quitting with NRT is relatively easy and the NRT products are generating high success rates. This marketing message plays directly into the tobacco industry's hand in actually inviting experimentation, knowing that quitting is easy. Worse yet the message is false.

Professors Saul Shiffman and John Hughes are both admitted GlaxoSmithKline consultants. In March 2003 they combined and averaged seven over-the-counter (OTC) nicotine patch and gum studies - that manner in which almost all U.S. NRT is sold and used today - and found that 93% of study participants had relapsed to smoking within six months. Those attending should ask the Conference's sponsors why they have kept OTC NRT's dismal 7% six-month quitting rate a secret these past three years.

Imagine GlaxoSmithKline's consultants establishing that only 7% of OTC patch and gum quitters were still not smoking at six months, while a page at its Nicorette website carries a title which reads, "According to one study, 90 percent of 'cold turkey' quitters start smoking again within six months." Is that not admitting defeat?

Failure to Disclose Second-Time NRT Use Rates

Unlike abrupt nicotine cessation, where the odds of success actually increase with each subsequent attempt (as quitters eventually discover the amazing power of one puff of nicotine to shatter and destroy a quitting attempt) NRT's already dismal odds of success dramatically decline with repeat NRT use.

All Internet websites advocating the use of NRT keep quiet about the only two nicotine patch studies that have ever examined success rates for second-time patch users. Not knowing the results carry potential of being a life or death issue for true believers of NRT marketing hype as one study found a 100% six-month failure rate (Tonnesen 1993) and in the other 98.4% relapsed (Gourlay 1995).

A February 2004 study by Shiffman in Addiction boldly concludes "Smokers with a history of past failure of pharmacological treatment have lower success rates without pharmacological treatment, but equally good outcomes with active lozenge treatment."

What the 2004 study abstract fails to reveal is that unlike the 1993 and 1995 studies examining second-time nicotine patch use, Shiffman declared repeat NRT use "effective" after only 6 weeks instead of 6 months. Even worse, nicotine lozenge users in Shiffman's study were given up to 20 free lozenges per day for a period of six full months. Imagine giving alcoholics alcohol via IV bags for 6 months while declaring those still wearing the bags successful quitters at 6 weeks.

But that has not stopped GlaxoSmithKline from using what is primarily abrupt nicotine cessation historical quitting data in an attempt to sell replacement nicotine to those who have already repeatedly tried it and failed. For example, GlaxoSmithKline's website asserts, "It is quite common for smokers to make anywhere from three to six quit attempts before achieving success."

With each passing year of NRT use, NRT use recycling becomes more critical as in some nations almost 50% of all smokers have already tried quitting with NRT at least once and failed. Instead of doubling national cessation rates as promised, here in the U.S. cessation has almost ground to a halt.

Not only are health policymakers allowing a completely ineffective line of quitting products to remain on center-stage, they have remained silent for more than two decades as the NRT industry has bashed, trashed and attempted to claim a larger share of the market by all but destroying confidence in the planet's most productive quitting method - abrupt nicotine cessation.

A May 2006 study in Addictive Behaviors analyzed 2002 and 2003 patient quitting method data collected by 1,000 Australian family practice physicians. Our most recent quitting method performance evidence, it found that cold turkey success rates were twice as high as among those relying upon the nicotine patch, gum, inhaler or bupropion (Zyban and Wellbutrin). Not only was cold turkey quitting the most effective method, it was by far the most productive method accounting for 1,942 of 2,207 former smokers, a whopping 88% of all success stories.

Time to Abandon NRT Group Think

If GlaxoSmithKline's 10% at six-month cold turkey figure is correct, even the most ridiculous quitting product imaginable should generate testimonials from 10% of users at six months, so long as it does not somehow undermine the quitter's own natural recovery odds - as does NRT at 7%. It's why no area is more ripe for consumer fraud than smoking cessation.

If current NRT clinical efficacy and real-world effectiveness standards are the benchmark for evaluating a new wave of now arriving pharmaceutical cessation products then the best hope for earth's one billion nicotine dependent humans may well be prayer, and lots of it. We should not trust forward movement while traveling a road built on known and intentionally ignored blinding failures.

Actual drug performance must be elevated above clinical findings, especially when the clinical studies themselves attract a self-seeking population in search of weeks or months of free replacement nicotine, not a population wanting to abruptly end all nicotine use.

Clinical studies have no trouble randomizing quitters with similar expectations. What they cannot do is hide the presence or absence of the dopamine/adrenaline high produced by a powerful psychoactive chemical such as nicotine. What they cannot do is hide the fact that those wanting to abruptly end all nicotine use did not participate in any NRT studies. What they cannot hide is that it is impossible to randomize opposing expectations regarding receipt of a psychoactive substance.
No Copyright - This Article is Public Domain
Last updated July 10, 2006