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|From: Joel.||Sent: 2/26/2003 8:32 AM|
| I am not attaching the story below to blame or vindicate the makers of the product in question. I am not looking to discuss or debates the merits of the case. What I think is significant about this article for this board is that it shows the plight and struggles of a man who obviously wanted to quit smoking and reduce his health risks, but who did not realize that quitting was possible without the use of a drug. It also shows the sadness to the family of a man caused by smoking. |
Last month I had a woman in my clinic who was on NRT products for over ten years. She had actually relapsed many years earlier by taking a piece of nicorette gum after being off smoking a pretty significant time period. She said that she was on the gum almost the whole time after that, except for one brief time period when she switched to a patch to quit the gum. She estimated that she spent over $10,000 in NRT products over a 10 year period. I actually got an email from her yesterday and she is doing fine now, writing, "very confident and committed to being a non-nicotine abuser."
The story below is sad, and it is impossible to say what the actual cause of the illness may have been. Smoking in fact does increase the risk of esophogeal cancer. But what we know is that this man was in some form of withdrawal for five years and constantly fighting an active addiction. To keep this quit simple, cheap, withdrawal free, and never having to worry about the potential of future findings of future long-term usage of nicotine just always remember to get and stay smoke is as easy as just knowing to never take another puff!
A Good Fight
By KEN LEWIS
The St. Augustine Record
Pat Greenfield's husband was an intellectual and a sociologist, but he could not think his way out of an addiction to nicotine.
He died of esophageal cancer in April 2000 at the age of 66.
Greenfield blamed her husband's death on the Nicorette gum he chewed compulsively for five years in his attempt to quit smoking. She proceeded in 2002 with the Herculean task of suing the corporation that markets Nicorette, doing it without an attorney.
Her case was promptly dismissed, on a technicality, from federal court in Jacksonville. She had failed to breach the legalese and make a jury listen. She said she could not afford an attorney.
Now she's exhausted, consumed by the case, still brimming with the memory of her beloved husband. She guards her inch-thick pile of legal documents as if it was a living being.
Her story is about failure and hopelessness in the mystifying world of law. It's about her conviction that Nicorette is dangerous, though officials say it is not. It's about her love for Robert Greenfield, her grief, and her wish to fight what she calls "the good fight."
Nicorette is produced by GlaxoSmithKline Consumer Healthcare, L.P., which makes over-the-counter drugs for the huge pharmaceutical corporation, GlaxoSmithKline.
The gum is touted as a "stop smoking aid" to be used for 12 weeks. A user is supposed to quit smoking, then chew the gum to relieve the cravings and discomfort. The instructions say to chew once or twice, then "park" the piece between the gums and the cheek.
Nowhere on the box or in its directions does GlaxoSmithKline say the product could cause cancer or be addictive.
On the upper right hand corner, in blue, is the seal of the American Cancer Society.
GlaxoSmithKline pays the American Cancer Society $1.5 million yearly for use of the seal, said ACS national spokesman Shawn Steward. The money is used for research and lobbying. The relationship benefits both groups, and began in 1996, Steward said. That was the year Nicorette became an over-the-counter drug.
Steward said there is no clinical evidence that nicotine replacement therapy, such as Nicorette, causes cancer.
He said that cigarettes cause cancer because of toxic chemicals in the smoke other than nicotine.
"We're not aware of any connections between nicotine and increased cancer risk," Steward said.
Melissa Dunn, a Glaxo-SmithKline spokeswoman, said "no" when asked if there were carcinogenic effects from Nicorette.
"We certainly encourage people to follow the directions that we've worked so hard with the (Food and Drug Administration). . . to put on those boxes," she said.
In the lawsuit, Greenfield cited an article written in 2000 by Stephen Hecht and colleagues of the Minnesota Cancer Center. Basically, the article stated that tobacco users could be producing a carcinogen in their own bodies after metabolizing nicotine. The carcinogen he discovered is known to lead specifically to lung cancer, Hecht wrote.
He wrote that the carcinogen could be formed inside the body "during nicotine replacement therapy, particularly under conditions of long-term therapy."
But Robert Greenfield died from cancer in his esophagus, not in his lungs.
42 years togetherGreenfield, 71, talks about her husband of 42 years with all the enthusiasm of a new crush.
"What do you say? How do you describe the perfect man?" she asked.
They knew each other for six weeks before getting married. From then on, they were together constantly, first in California, then in Florida, raising two sons and a daughter.
"He was extremely intellectual, a very, very brilliant man," Greenfield said.
He taught sociology at several universities in California, then worked as a criminologist for the state of Florida, she said. They lived in Tallahassee and Jacksonville, moving to St. Augustine Beach for retirement in 1992. Greenfield had been a special education teacher in Duval County.
She said her husband had a knack for understanding "gray areas" and ideas that were not clear. As a criminologist, he could see things that others could not.
He was a passionate man, she said. And he was a smoker. His mother smoked while she was pregnant with him. He started at the age of 13. After more than 50 years of cigarettes, he quit in the mid-1990s, on advice from a doctor. He started chewing Nicorette and could not stop for five years.
In early 2000, a doctor diagnosed esophageal cancer.
Greenfield said her husband asked her to lock up their firearms because the pain was going to be intense. He had 12 weeks to live.
"For months and months and months, I screamed at God, 'Why me?'" she said.
She spent more than a year in profound grief, weeping in church, weeping in Wal-Mart, weeping daily wherever she went.
Then she tried to sue. Greenfield said she talked to at least 30 attorneys, but could not afford their services.
In 2002, she took matters into her own hands, filing a wrongful death suit against GlaxoSmithKline.
She became obsessed with the case and said she devoted at least 1,000 hours of work to it.
U.S. District Judge Henry Lee Adams Jr. dismissed the case in May. He concluded that Greenfield could not bring the wrongful death action because she was not technically her husband's "personal representative."
She wants to appeal, but she doesn't know how. She wants to try again. For now, she'll take a little rest.
While the below article correctly focuses upon brain neurochemistry as dependency's foundation it again misses the mark in a number of important regards:
The day that science can make a pill that allows each of us to painlessly, effortlessly and permanently lose the person we most depend upon is the day it will have found a cure to the most widespread and intensely dependable chemical relationship this planet has ever known. Who on this planet did any of us pucker-up to more than one hundred times each day, and what our lips touched always delivered exactly what we expected, wanted and sought?
- Neurochemical de-sensitization and re-sensitization does not form a "habit" but a true chemical dependency. Since when does a "habit" of using cuss words cause hurt when stopped?
- The vast majority of recovery isn't the relatively short period of time the brain needs to restore acetylcholine receptor and transporter populations to near pre-dependency levels (currently believed to be substantially complete within 10 days to two weeks) but in coming to terms with subconscious conditioning and conscious rationalizations fostered by years of not being willing, or knowing how, to recover from years of brain de-sensitization, conditioning and beliefs.
- We learned from bupropion (Zyban/Wellbutrin) studies that although bupropion added roughly 15 percentage points to placebo group rates at six months that for some still unknown reason its 15 point advantage disappeared between years one and two, as bupropion performance gradually fell back to equal placebo group rates. Why? Did some within the study actually find a way to continue using bupropion longer than the study's treatment period (getting their doctor to prescribe Wellbutrin) and/or does the brain need to undergo additional neuronal re-sensitization once bupropion use ends?
- If this new chemical keeps dopamine flowing at rates much closer to what nicotine did, wouldn't there naturally need to be additional re-sensitization and adjustment to those physical changes once use of the chemical ends?
- There is also a glaring design flaw in the upcoming study and possibly in the one just completed (not enough detail given about the original study to know). Just like here at Freedom we know that education, counseling and support each carry their own effectiveness based upon program content, quality and frequency. If these programs are going to be offered during the course of treatment (while one group keeps abnormally high levels of the dopamine flowing and the other encounters the anxieties and symptoms of of re-sensitization) which group's performance stands to benefit most by the ongoing education and support programs? Keep in mind that in many NRT studies up to 80% of the placebo group relapsed within the first week before the support/ education programs really got going. It wasn't until NRT was tested OTC, and no support/education programs were offered, that we were allowed to see how pharmaceutical grade nicotine peformed as a stand-alone recovery tool (just 7% still quit smoking at six months, up to 7% of gum users and 2% of patch users still dependent upon their OTC product at 6 months, and even lower rates for second time users - almost 0% for second time patch users in two studies).
Millions of words and thousands of quick fix magic cures but still only one rule ... no nicotine today ... Never Take Another Puff! John (Gold x5)
Yale's study may help
smokers kick the habit
By JOHN CHRISTOFFERSEN
Associated Press Writer
November 21, 2004, 4:33 PM EST
NEW HAVEN, Conn. -- Dave Rivers was like a different person when he quit smoking.
"It was bad," the 50-year-old Beacon Falls resident said Friday as he smoked at the meat wholesale company where he is a plant supervisor. "I was nervous all the time. I was very grumpy. You can ask my wife."
The withdrawals got the best of Rivers, who resumed smoking after nine months.
Yale University is hoping to help smokers like Rivers with a new study of a medication that could reduce the withdrawal symptoms that can sabotage those trying to kick the habit.
"Most smokers can quit for a couple of days. But it's the withdrawal and craving that usually get them to go back to smoking," said Dr. Tony George, an associate professor of psychology at Yale who is leading the study.
Withdrawal from nicotine in cigarettes produces less dopamine, a calming brain chemical associated with pleasure. Researchers will test the effectiveness of a medication called Selegiline, which allows smokers who quit to maintain higher levels of dopamine.
The medication, long used to treat Parkinson's disease, showed promise in a study two years ago by Yale involving 40 smokers, George said. Side effects were minimal, the study found.
"Essentially the drug tripled quit rates," George said.
The new study will test a larger group of about 200 smokers in an effort to confirm the results of the first study. Smokers will be asked to participate in the study for about 10 weeks, with periodic follow-ups for the next six months.
Participants will receive weekly counseling on strategies for quitting and coping with withdrawal and cravings. Smokers will also be asked to participate in a related study that will try to find out how expectations affect smoking cessation.
"We will try to find out what they believe about the effect that smoking has on them and how these beliefs change over the course of an attempt to stop smoking," said Andrea Weinberger, project director for study.
The study comes after a variety of nicotine treatment therapies and growing education have helped reduced the smoking rate to about 25 percent of the population, down from nearly 45 percent in the 1960s. But not all smokers respond to those treatments, George and others say.
Rivers is among the smokers who have not benefited from the other treatments. "I would still smoke with the patch on," he said.
The Yale study is the latest effort to address tobacco addiction at the source of addiction in the brain. In 1997, the government approved Zyban, an antidepressant that can curb the cravings and withdrawal symptoms smokers face.
Yale researchers say Selegiline more selectively targets dopamine than Zyban, which works on dopamine and another brain chemical, norepinephrine.
Dr. Michael Fiore, director of the University of Wisconsin Center for Tobacco Research and Intervention, welcomed the focus on dopamine."It's clearly at the heart of nicotine dependence," Fiore said. "At the core is changes in brain chemistry. And if we want to successfully help people quit smoking we need to get a better handle on that."
Yale researchers are hoping the more novel approach will help further reduce the rate of smoking, noting that more than 450,000 Americans die annually from smoking-related illnesses.
"We're not saying we have a cure for tobacco addiction," George said. "But they're adding to our arsenal to help smokers quit."
Kind of makes the reader think that all of the great medications out there have really helped to bring the smoking rate down some 20% over the past 40 or so years. This is a very misleading statement. Here is my recent take on this very issue:"The study comes after a variety of nicotine treatment therapies and growing education have helped reduced the smoking rate to about 25 percent of the population, down from nearly 45 percent in the 1960s. But not all smokers respond to those treatments, George and others say."
One thing I want to comment on is how the article points out that smoking declined from 42% to 23% in the past 40 years, but how the drop-off stalled in 1990. The dates are interesting.
The article is saying is that there are a whole lot more effective ways to quit than by going cold turkey. It is basically talking about NRT products and Zyban. What is interesting is that almost all of these products came into widespread use in the 1990's--the years where the rapid decline in smoking cessation actually stopped.
Nicotine gum was first approved for use in America in 1984, by prescription only. In 1991 and 1992, four patches were approved for prescription use. In 1996 all controls broke loose--the gum and two of the four patches went over the counter and Zyban was just coming into the fray.
So now we have all of these miracle products available, many without prescription. If these products were so good at increasing success, and if they are being used by so many people you would think that smoking rates would be plummeting now when compared to when people just had to rely on their own resolve to quit.
Again, read the following line from the article below:
"The drop-off in smoking stalled in 1990 and has hardly budged since then."
Lets hope not too many miracle products for smoking cessation get introduced in the future as it may result in skyrocketing smoking rates.
The real way to once again increase the long-term success rate of people trying to quit is to help them to understand that they are fighting an addiction to nicotine and that to win that fight and to stay free forever is as simple as making and sticking to a commitment to Never Take Another Puff! Joel
Y O U R T I M E / H E A L T HStub Out That Butt!But don't try to go it alone.
Here are some tricks that make it easier to quitBy CHRISTINE GORMANMore than 42% of adult Americans smoked when the first Surgeon General's Report on Smoking and Health was published. Today, 40 years later, fewer than 23% do. That's good news, but it could be better; a lot better. The drop-off in smoking stalled in 1990 and has hardly budged since then. Surveys show that 70% of tobacco users want to quit, but kicking the nicotine habit isn't easy.
Monday, Jan. 19, 2004
What a lot of smokers don't realize is that the most popular method of quitting; just stopping, a.k.a. going cold turkey; is the least effective. Studies show that getting intensive short-term counseling, taking drugs like Zyban (an antidepressant) or using one of the many nicotine aids (gum, patch, inhaler, nasal spray, lozenge) all double the chance of success. Preliminary results suggest that combining these methods will increase success rates even more.
The trick is to find out what works best for you. For counseling, you don't have to go into full-fledged psychoanalysis; you can pick up practical strategies from various quit-smoking telephone hotlines (for a list of numbers as well as tips, visit smokefree.gov). As for nicotine products, make sure you're using them the right way. You need to chew the gum slowly, for example, not swallowing the saliva until the nicotine can be absorbed through the cheek, says Dr. Elliot Wineburg, who has used everything from drugs to hypnosis at Mount Sinai Medical Center in New York City to help hard-core smokers quit. Many people try to make do with as little nicotine as possible, which is a mistake. "You don't want the brain to go into withdrawal," Wineburg says.
It's never too late to quit. As the years go by, an ex-smoker's risk of heart disease and stroke diminishes until it's essentially the same as that of a person who has never smoked, says Dr. Corinne Husten of the Centers for Disease Control's Office on Smoking and Health. Alas, the risk of lung cancer never quite gets down to what it would have been without smoking. "Even with cancer, people respond better to chemotherapy if they quit," Husten says. Best of all, of course, would be not to take up the habit in the first place.
Copyright © 2004 Time Inc. All rights reserved.
Read the below article carefully when thinking about the "experts" stated opinions as to why the U.S. national cessation rate has stalled. The CDC recently reported that 70% of U.S. smokers want to quit and that 41% made a serious quitting attempt of at least one day during the past year. The two decade cornor stone of U.S. cessation policy has been replacement nicotine. The CDC knows that when the 7 over-the-counter patch and gum studies were combined and averaged that 93% of participants were found to have relapsed to smoking within 6 months. It also knows that the only two studies looking at second time patch use found that nearly 100% relapsed within 6 months (Tonneson 1993, Gourlay 1995). Worst of all, the CDC knows that NRT studies were not blind as claimed. You'd think that our government would want to expose flawed science instead of advocating its adoption. This is disheartening. John
Drop in Smoking Rates StallsBy Rob Stein
CDC Reports Cigarette Use Among Adults Holds Steady
Washington Post Staff Writer
Friday, October 27, 2006; A10
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