Pharmacological Crutches

10 Nov 2000, 20:01#1

Joel's Reinforcement Library


Pharmacological Crutches


Due to the recent release of Nicorette®, a chewing gum containing nicotine, I feel it is necessary to issue a special warning to all clinic participants who may be considering experimenting with this product. The gum is intended to be used by smokers to ease the severity of symptoms encountered during initial smoking cessation.

But the ex-smoker occasionally desires a cigarette months and even years after quitting. He may feel that the urge is due to a physiological residual effect of withdrawal. This thought may lead to the idea that trying the gum may help get rid of the desire. But, the actual cause of the thought for a cigarette is due to a psychologically triggered response. Some situation, person or event is causing the thought for a cigarette. While these occasional triggers may be annoying, they pass in seconds and may not occur again for hours, days or even weeks.

If the ex-smoker tries the gum, the end result will be tragic. For once he takes the first piece, his addiction to nicotine will be established. Once again he will be in nicotine withdrawal. Then he will have to make a choice--either relapsing into full fledged smoking or once again encountering the two week nicotine withdrawal. All this because he wanted to ease a thought for a cigarette which would have only lasted seconds.

Even the intended use of nicotine gum presents certain problems. Many hope the gum will be a panacea for the truly addicted smoker. But caution must be given to the non discriminate use by any smoker who feels that this new aide will help him break free from cigarettes. For while the gum may reduce the severity of initial withdrawal, it does so at a cost.

Normally, when a smoker quits, physical discomfort will peak within 72 hours and totally subside within two weeks. While the first three days may be traumatic, with proper support any smoker can successfully get through this period.

Use of the gum may reduce the initial severity of withdrawal when quitting. The ex-smoker may continue chewing the gum for months, never reaching peak withdrawal. But because blood nicotine never reaches the levels maintained by cigarettes, nor totally leaves the body, he feels minor withdrawal symptoms on a chronic basis. When he finally quits using the gum, he will probably experience the same withdrawal he would have originally encountered when quitting cigarettes.

The gum may help an addicted smoker break some of the psychological dependence and conditioned responses before experiencing potential difficult withdrawal. But the cost for this easing of initial symptoms is a prolonged chronic withdrawal followed by peak symptoms when giving up the gum. This is a lot of long term discomfort which could be avoided by simply ridding the body of all nicotine by quitting cold turkey.

When you quit smoking, you broke free from the addiction to nicotine. As long as you keep all nicotine out of your body you will never again have to worry about the health consequences of smoking or deal with the withdrawal of quitting. If you wish to stay free, don't try the gum, and as for cigarettes, cigars or pipes - NEVER TAKE ANOTHER PUFF!

NOTE: I originally wrote this in 1984. Since then, a number or similar products, (e.g., patches, gums, other devices are currently under development), have been introduced as over the counter cessation aids. The same principal applies to them all - they are transferring the delivery system of the drug nicotine. If the smoker simply stops, withdrawal will peak and start to subside within 72 hours. Use of the agents will unnecessarily prolong the cessation process as well as add to the expense.
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12 Nov 2000, 22:19#3

HI Joel

It's funny, I know that all the time I was talking about buying some nicotine chewing gum, patches ("will have to cover my whole body with them! ha ha!") etc I wasn't serious about giving up smoking. My excuse for not buying them was that it worked out pretty expensive if they didn't work, but deep down I knew they were not going to work, because I wasn't serious or even that inteested in quitting. It is only when I first found this site that I began to think well maybe it can be done? I'm glad now I didn't waste my time and money pretending to be serious about quitting, and my first serious quit/and my only quit was here at Freedom.
Thanks
Linda x
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12 Nov 2000, 22:31#4

Hello Linda:

I just want to point out one real important fact. You can quit your first time. You will hear lots of material to the contrary, that you have to quit over and over until it finally takes. This is absolutely wrong. The only reason it takes most people multiple attempts to quit is that they don't understand the addiction to nicotine. How could they, no one really teaches it. People had to learn by screwing up one attempt after another until it finally dawns on them how each time they lost it, it happened by taking a puff. If you understand this concept from the get go, you don't have to go through chronic quitting and smoking. So learn from other people's mistakes, not your own. Going through a quit once is bad enough, going through it over and over again is horrible and should be avoided at all costs. The way to avoid it is to always remember to never take another puff!.

Joel
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25 Sep 2001, 19:05#8

I know most of our member don't need to read this one, they are here because they have already realized the pitfalls of NRT usage. But at times you can find yourself tempted by the well meaning friend or acquaintance who, when you are under times of stress and feeling "stress," will try to convince you that while they understand why you don't want to take a cigarette and relapse back to smoking, why not just take a piece of gum or a patch to "get the edge off."

You must understand that these people don't understand drug addiction. They see cigarettes as the dangerous addiction and not the true culprit--nicotine. It would be like telling an alcoholic who has only drank whisky or scotch that he should take a beer or a glass of wine to calm his nerves. The person giving this advice does not understand nicotine addiction.

Don't be tempted by other people's lack of real understanding. Nicotine in any form cannot take the edge off anything for an ex-smoker. For a smoker it can end withdrawal, for a few minutes. For an ex-smoker it can cause chronic withdrawal that can last a lifetime. For the newly relapsed smoker may never be able to muster the strength or even the desire to quit again before it is too late. The addiction may cost the smoker his or her life.

The only way to avoid relapse is to never administer nicotine in any form. To stay free of your addiction make sure that it is clear to yourself that your task is to stay nicotine free--not just cigarette free. This means that you need to realize that the way to stay in control is to follow the next sentence and interpreting each statement with equal significance. The way to stay nicotine free is to never take a chew of nicotine laced gum, never take another dose from a nicotine laced patch, never take another whiff of a nicotine laced inhaler, never take another drink of a nicotine laced fluid, never take an injection from a nicotine laced needle, and, never take another puff!

Joel
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25 Sep 2001, 22:33#9

Thanks Joel! This thread reminds me of a long conversation I had last night with a friend from Chicago : )))))

I do want to encourage all of our newbies to be very careful when surfing tobacco/smoking sites on the internet. There are new tobacco sites springing up across the internet that peddle nicotine to every smoker who arrives seeking help and guidance. Also be aware that their list of quitting tips offer some of the worst quitting advice that you'll ever see, and it's truly nothing more than a recipe for perpetual relapse. I sometimes wonder if the people putting these sites together are really sincere about wanting smokers to quit. I pray they are!

I reviewed a brand new site yesterday and this is what they were telling smokers -

1. Wait to quit during a period of low stress in your life.

2. When you are ready, buy and use nicotine products like the patch, gum, spray or inhaler. If you don't buy them you're twice as likely to fail !

3. If you do fail and smoke a few, don't be hard on yourself. It's normal to slip and cheat.

These three statements are contrary to Freedom's basic core teachings. If we're going to tell smokers to wait at all (which is totally unnecessary), we should tell them to wait until they're experiencing the most stress that they've ever felt because they CAN break free during such times and in doing so they increase the likelihood that stress will never again be used as their mind's junkie excuse for relapse.

As for not being hard on cheating and slipping, these statements either show that person making them has absolutely zero understanding of the law of addiction or that they don't understand how the nicotine addict's junkie mind operates. During withdrawal we're searching for legitimate excuses to immediately bring our early quit anxieties to an end.

Imagine coming across a list of online quitting tips on day three that reassure a quitter in the heat of battle not to worry about a little cheating here or there! WRONG! Just one puff and it's back to square one with your determination and energy spent, while far weaker emotionally than you were the day you started. Yes, one puff of new nicotine and this quit is over! We hope that you've got another quit left in you but there is never any guarantee!!

The key to learning to live life with normal dopamine levels is not by taking drugs that will elevate them for an extra 2,160 hours (the recommended 90 days for NRT programs) when you can begin to do so within just 72 hours. As Table 40 of the USDHHS Guidelines so clearly tells us, the over-the-counter nicotine patch produces an 88.2% failure rate within six months (just three months after the user stopped using NRT ).

The "doubles your odds of quitting" assertions being made in association with the sale and promotion of NRT is based upon how the placebo (or no nicotine in my patch quitters) did at 6 months. Yes, the nicotine fed quitters who got to use nicotine three months longer than the placebo group did better than the placeo group, but not by much!

True, only 6.7% of the placebo group remained quit at 6 months, as compared to 11.8% who wore the O.T.C. patch, but Freedom educated, counseled and supported quitters are not placebos - we're the real deal! One more way to look at these results is to subtract from the 11.8% those who would have quit anyway (6.7%). When you do, you're left with just 5.1% of all quitters receiving any benefit whatsoever from the nicotine patch. Imagine a T.V. commercial for nicotine products that is honest enough to tell smokers that 95% of all our customers fail at quitting within six months. It's crazy!

What's most important in my mind is that the simple fact that we here at Freedom are not the ignorant placebo in some medical study. The Guidelines themselves repeatedly declare and recommend that quitters quit by the following method but sadly you will NEVER read any of the below at any online site engaged in selling nicotine products to nicotine addicts:
USDHHS Guidelines Recommendation Number 5:

"There is a strong dose-response relation between the intensity of tobacco dependence counseling and its effectiveness. Treatments involving person-to-person contact (via individual, group, or proactive telephone counseling) are consistently effective, and their effectiveness increases with treatment intensity (e.g., minutes of contact).

With only a couple of two week clinics under my belt I'm still pretty green at delivering live educational clinic programs but even so, 50% of those attending my first clinic are still nicotine clean six months later. Joel is far more skilled at this and over 50% of his clinic students remain free at one year! Although it sounds a bit drastic, I understand that the Mayo Clinic has an eight day inpatient program where over 60% of their abrupt nicotine cessation participants have remained nicotine clean for one year while their NRT quitters only did about half as well.

The key is in getting quitters through the first 72 hours so that they can begin to feel true healing begin. Once you begin to actually feel the withdrawal anxieties begin to subside, your confidence begins to build! The key to victory during those first 72 hours is to only fight and focus on that battle that is occurring RIGHT NOW, this very moment!

Prepare to give your all, should the need arise (which it may not), but stay focused on only today! If you were going to walk across your entire country (from end to end, or coast to coast) would you be more likely to succeed if you continued to picture and think about how far you actually have to walk, or would your chances of success be greater if you only focused on continuing to put one foot in front of the other? Think about it! Don't breed defeat in your mind, simply take it one step at a time, and glory will be yours! You can do this!

Breathe deep, hug hard, live long! John
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02 Apr 2002, 08:28#10

The Times of India Online

Nicotine patches can do more harm than good

ANI [ MONDAY, APRIL 01, 2002 5:03:08 PM ] ASHINGTON: Nicotine patches and gum may be hazardous to health. Nornicotine, a component of nicotine, can interfere with chemical reactions in the body, triggering adverse health effects, according to a report published in the Science Daily.

The Daily quoted a study published in the Journal of the American Chemical Society. The study was conducted at the Scripps Research Institute, California.

The study suggests that smokers who are under medication or use nicotine patches are at a greater risk. Nornicotine could modify these drugs, possibly reducing drug potency and cause side effects, according to the report. While patches and gum can vary in nicotine content, those who continue to smoke while using these products expose themselves to higher health risks by getting extra nicotine, they said.

The study also says that nornicotine adds to the health dangers of smoking itself. Although nicotine has been shown to be a dangerous chemical in addition to its known addictive properties, this is the first demonstration of the chemical potential of a nicotine metabolite, they said. "This represents another potentially adverse chemical found in tobacco that's coming from nicotine itself," said the study's lead author, Kim D Janda. "We've got to be more aware of this."

The addictive effects of nicotine have been known for some time. Nornicotine, also a natural constituent of tobacco, was thought to be a minor player in addiction. While investigating ways to treat nicotine addiction, Janda and graduate student Tobin Dickerson conducted a detailed chemical analysis of nicotine.

They found that nornicotine is not just an innocent bystander. It catalyses certain reactions that play major roles in processing chemicals that circulate in the body, whereas nicotine itself has no effect on these chemical reactions.

The finding was surprising because it was believed that, under conditions found in the body, only certain enzymes were able to catalyse these reactions, and nornicotine is not an enzyme. The compound, which differs from nicotine by a single carbon atom, is the first example of a metabolite that acts as a catalyst for chemical reactions, the researchers said.

The researchers demonstrated that nornicotine could interact with many important chemical reactions, including the conversion of glucose into energy.

They also identified certain medicines, including steroids and antibiotics, which are likely to interact with nornicotine. This drug interaction could trigger potentially adverse health effects. Tests are currently underway to determine specific drugs that may put smokers and other users of nicotine products at increased health risks.

Those who want to quit smoking may wish to consider treatments that don't involve nicotine, he added. "Unfortunately, although some nicotine-free treatments are currently undergoing testing, to our knowledge there are no nicotine-free treatments for smoking cessation therapies currently available over-the-counter," Janda said.
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27 Aug 2002, 08:57#12

I see we have a few people who found us after starting out with NRT quits. I will bring up a few articles addressing NRT usage--we just want to make it clear that this quit is different because by going cold turkey the person quitting is actually getting nicotine out of his or her system system and will soon be totally out of withdrawal. Then to avoid ever facing withdrawal again is as simple as always remembering to never take another puff!

Joel
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03 Sep 2002, 01:36#13

Any heatlth facts on long-term gum use? Tess met a guy that's been smoke-free for a year.... having switched his nicotine delivery mechanism completely to Nicorette. I can remember you mentioning that you've known other people who have been gum-users for years.

Other than telling this guy that he's still an actively using drug addict, is there any bite I can offer.... you're risking x, y, z by continuing to use the gum? I believe for most people, gum is only a temporary delivery device, until people go back to smoking. That's a big risk. It's also more expensive than cigarettes, and, when taken in recommended dosage, (would an addict ever really follow a recommended dosage forever?), it keeps the person in perpetual withdrawal. Perhaps these are factors that could motivate the person to consider quitting. Any others?

Curiously,

Bob
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03 Sep 2002, 01:37#14

I just read post 11 above, so that's something to work with...
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03 Sep 2002, 01:50#15

Good find Bob....

"to our knowledge there are no nicotine-free treatments for smoking cessation therapies currently available over-the-counter"

Here's one (and it's free): http://groups.msn.com/FreedomFromTobacc ... epage.msnw
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26 Feb 2003, 22:32#17

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!

Joel

A Good Fight
By KEN LEWIS
Staff Writer
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

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.
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24 Mar 2003, 21:27#18

For Vickie's old smoking buddies. Actually it is more for Vickie so she can just learn to ignore her old smoking buddies.
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03 Aug 2003, 20:31#19

With the pending release of nicotine water I thought it would be beneficial to relate it to the release of the nicotine gum back in 1984. This product and others like it have been around for over 19 years now. Count the number of people you know today who used these products as directed and successfully quit smoking and stopped using the drug and are off all nicotine for over a year now. Yet creative marketing has gotten many people to believe these products are a great value to mankind. Never allow yourself to be manipulated by marketing--to stay free from an active addiction requires that you stay free from all nicotine replacement products and to avoid the fastest, most powerful and most deadly way of delivering nicotine again you must always remember to stick to your commitment to never take another puff! Joel
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19 Aug 2003, 06:47#20

For Mike: The same concepts here applies to your chewing tobacco delivery system of nicotine.
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!





Joel





A Good Fight


By KEN LEWIS
Staff Writer


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

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
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08 Jul 2004, 21:51#21

I am troubled when I hear people who say that they can't quit because they can't tolerate the side effects of NRT or because they can't afford or don't want to pay the high price of the products. They are feeling handicapped before they start to quit and they are giving these products credit that they simply does not deserve. No matter how many times you hear from official agencies and from the pharmaceutical manufactureres that these products double your chance of success, the truth is in real world settings these products rarely ever work. Your quit will succeed if you just stop smoking and delivering nicotine from all sources and will last as long as you want as long as you simply stick to your commitment to never take another puff!

Related readings:

So how did most successful ex-smokers actually quit?
"What ever you do don't quit cold turkey!"
Who Should You Believe?
Is cold turkey the only way to quit?
Quit Cold Turkey
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30 Aug 2004, 06:17#22

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!

Joel

A Good Fight
By KEN LEWIS
Staff Writer

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

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.



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22 Nov 2004, 18:17#23

While the below article correctly focuses upon brain neurochemistry as dependency's foundation it again misses the mark in a number of important regards:
  1. 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?
  2. 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.
  3. 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?
  4. 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?
  5. 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).
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?

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."
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22 Nov 2004, 20:28#24

Note the paragrph in the article John posted above:
"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."
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:
40 Years of Progress?
I am attaching an article below from the January 19, 2004 issue of TIME magazine. It talks about the decline in smoking rates in America since the original release of the U.S. Surgeon General's report in January of 1964. The author was apparently led to believe that a whole lot more quitters would be successful if they would just stop trying to go cold turkey and use the many quitting aids available that can "double a person's chance of success."
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 H
Stub Out That Butt!
But don't try to go it alone.
Here are some tricks that make it easier to quit
By CHRISTINE GORMAN
Monday, Jan. 19, 2004
More 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.

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.
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22 Nov 2004, 21:10#25

This type of reporting must be very frustrating to you Joel. For myself and anyone else here at Freedom, we know cold turkey is the only way to go. Thanks for your efforts.

By the way, while I was driving my daughter to school the other day, we were discussing the 6th month anniversary of my quit (she's one of my biggest supporters). She asked me how I quit and I told her (I thought she already knew)that I had quit cold turkey. She said something like "That's good because nicotine gum and stuff just prolongs your addiction." I was silent for awhile and asked her where she had heard that. She told me she learned it in her "DARE" (drug abuse resistance education) program at school. So at least somebody out there knows what's what even if they are teaching it to 12 year olds who hopefully aren't smoking anyway. Steve 6 months
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