"What ever you do don't quit cold turkey!"

"What ever you do don't quit cold turkey!"

Joel
Joined: 18 Dec 2008, 23:57

21 Dec 2003, 23:38 #1

Image

"Whatever you do don't quit smoking cold turkey!"

Most medical professionals believe that the way to quit smoking is to use pharmacological aids. They think that pharmacological aids are an effective tool for smoking cessation. Why do they believe this? They believe it because almost all of the smoking professionals of the world tell them that they work. Even the Surgeon General of the United States says that they work. If almost all world experts believe that they work, and the Surgeon General says that they work, well then they must really work. Right?

Well, I look at it like this. Lets say I see a published story come out that says a specific pill prevents colds in 100% of the cases in human trials. Then another study verifies it. In fact, every expert in the world comes out and says colds no longer exist -- the pill has eradicated them.

But most people I knew who took this miracle pill still got colds. Worse than that, I took the pill myself and all of my friends who were on the pill kept giving the cold to me. Pretty soon I would dismiss those studies and no matter how many times I see it I would not believe it. Sooner or later I would have to believe my own eyes and ears, basically my own instincts,  more than expert opinion.

I have seen people use the argument of who should they believe, the Surgeon General of the United States or me. I somehow get the idea that people think that the Surgeon General is a person who has spent years and decades working with nicotine addicts. That somehow being an expert in smoking cessation is a prerequisite for being the Surgeon General.

I have been running stop smoking clinics since 1976. Back in 1976 I told my second group that they were nicotine addicts. If the people in my 1976 clinics were skeptical and wrote the Surgeon General and asked him if it were true that nicotine was a drug addiction he would have answered no it was not.

It was clearly spelled out in the 1964 Surgeon General's Report that cigarette smoking was not an addiction. In the report of the Surgeon General back in 1979 the Surgeon General was starting to say that maybe it was an addiction, but still had put the emphasis on the habit of smoking being the primary problem. In 1988 the Surgeon General finally issued a report stating once and for all that nicotine was an addictive substance.

In all of the programs I did from 1976 through 1987 I was constantly criticized and attacked for saying that cigarette smokers were drug addicts but I had too much first hand contact with smokers trying to quit that was making it abundantly clear that the Surgeon General was wrong. So I accepted the fact that the Surgeon General and most of the experts of the world were not going to agree with me. For eleven years I was wrong that smoking was an addiction because the Surgeon General said I was wrong yet today I am no longer wrong on this fact.

The same thing is happening now when it comes to issues like the effectiveness of all of the quitting aids available today. The Surgeon General and most of the world experts say that these products increase success and that people should not quit cold turkey. Again, I still have too much first hand contact with people who are trying to quit using these products as well as too much contact with people who are actually quitting and succeeding without their use. It is still all too obvious that in real world settings these products do not increase success and that people have a much greater chance of success by disregarding the expert's advice.

So I think I am going to just take a wait and see attitude on what the Surgeon General will say ten years or twenty years from now on what is the most effective way to quit smoking. Maybe he or she will have come around by then, maybe not.  But I know one thing for sure. That all of the people who decided to follow my advice on how to quit, and then stay committed in the interim to the advice that I gave them on how to remain smoke free, that all of these people will still be successful ex-smokers.

My advice to them, that is so controversial today, is simply that to quit smoking and to stay smoke free is no more complicated than just knowing to Never Take Another Puff!

Joel
© Joel Spitzer 2003Related video:
Last edited by Joel on 16 Aug 2013, 12:43, edited 1 time in total.
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DlunyGOLD
Joined: 18 Dec 2008, 23:58

22 Dec 2003, 00:44 #2

What a name for a thread on a "Cold Turkey" Board! Of course, if someone told me this I would probably go cold turkey just for spite and to prove that someone wrong.

I will admit that until I got here I did not think I could do it cold turkey again, after all the previous failed cold turkey quits. After reading your library and the posts here at Freedom I saw that others can do it so why can't I do it! I just got over my fears of going without nicotine by educating myself and seeing that continued use of the substance would not help.

I was very active in Al-Anon for a number of years due to several Alcoholics in my family and among friends. From my experience there I immediately saw what is written here as the truth and the way to treat an addiction. If you were to walk into an Al-Anon meeting and announce that the new method of treating alcoholism was by giving the Alcoholic MORE Alcohol (but in a different way) you would be lucky to get out alive! Just goes to show how much money talks in our society!

Thanks for being here and thanks for letting me ramble and rant.

Happy Holidays! yqb, David One month, two weeks, 2 hours, 43 minutes and 51 seconds. 794 cigarettes not smoked, saving $59.55. Life saved: 2 days, 18 hours, 10 minutes.
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Joel
Joined: 18 Dec 2008, 23:57

22 Dec 2003, 01:15 #3

Hello David:

Yeah, sometimes the titles I use can be quite confusing. Actually, whenever I am using a title that is trying to illustrate a conventional wisdom I will put it in quotes so people don't think I am actually delivering the improbable message. Good examples of this are the strings, "Quitting smoking: A fate worse than death", "Boy, do I miss smoking!", "Everyone is different???" , "I'm mad that I can't smoke anymore!" , "I guess I am doing ok, I just smoked one yesterday" , "I have smoked for so long and so much, what is the use in quitting now?" and numerous others. Actually one I meant to do but forgot was the I'M DYING! thread. I sure hope I didn't scare anyone the day I put that one up.

From the very earliest days of my work in the field of smoking cessation I had a lot of exposure to people coming in from AA, Narcotics Anonymous, Cocaine Anonymous and Alanon backgrounds. I had a lot of people being referred in at meetings from these other groups. These people more than most recognized the validity of the approach I was taking with smoking from the get go. This was in the days before NRT's or any prescription medications, back at a time when every one was told that the way to quit smoking was to cut down because going cold would just be too hard. Anyone who has tried to cut down and control their use of any addictive drug, or witnessed the continuous failures of others attempting a cut down technique knew right away that our program was on to something. More important than the fact that we were the only game in town calling smoking an addiction--we were the only game in town treating smoking as we would treat any drug dependency. Again, people who are familiar with getting control back in their lives with other drug addiction instantly recognized just what they needed to do to get back control of this problem too. It was quickly obvious to people who were successful in recovery that to recover from smoking was as simple as quitting and then sticking to their commitment to never take another puff!

Joel
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Joel
Joined: 18 Dec 2008, 23:57

02 Apr 2004, 08:30 #4

Being that today is April 1, the title of this article could easily have been viewed as an April fools joke. Sadly, it is no joke and it is no laughing matter. Very well meaning people are discouraging smokers from quitting with what is the most tried and true successful method of smoking cessation on the planet. The way to quit smoking and to stay smoke free is simply to not "fool" around with nicotine from any source and as far as for burning tobacco products to know to never take another puff!

Joel
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Joel
Joined: 18 Dec 2008, 23:57

26 Nov 2004, 19:18 #5

Since it is the day after Thanksgiving, I thought it was an appropriate time to bring up "Cold Turkey" posts.
Reply

Joel
Joined: 18 Dec 2008, 23:57

10 Aug 2006, 23:05 #6

I saw where some of our board members were getting some pretty skeptical reactions from family members when the family member was informed that our board member was going to quit cold turkey. Don't be overly critical of the family members having this reaction. If they in fact went out and did any research it would be totally understandable why they would have such reactions because advice given by most professional organizations would be to discourage anyone attempting to quit cold turkey.

Luckily your quit is not contingent on having to convince others that cold turkey is actually an effective way of quitting--all that is important is that you understand the concepts behind this all. Your quit will continue to succeed as long as you continue to stick to your personal commitment to never take another puff.

Joel
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Joel
Joined: 18 Dec 2008, 23:57

10 Oct 2006, 02:47 #7

I just completed a new video that relates to this string.

www.whyquit.com/videos/addiction.wmv
Reply

John (Gold)
Joined: 18 Dec 2008, 23:57

23 Jan 2007, 00:25 #8

Concerns raised over doctors'
ties to drug companies
Problem of pharmaceutical firms paying physicians 'swept under the rug in Canada,' one researcher says

Carly Weeks

CanWest News Service, Monday, January 22, 2007

CREDIT: Bruno Schlumberger, CanWest News Service

Pfizer Canada, the maker of Nicorette, pays physicians to promote the gum as a product that can help smokers quit by reducing nicotine cravings.


OTTAWA -- To celebrate the launch of its new flavoured nicotine gum, Pfizer Canada hired "brand ambassadors" dressed in ski suits to give out free samples in Calgary and Toronto and published promotional material that touted the benefits of the new product.

The company's press release declares: "using Nicorette ice mint coated gum can help smokers quit by reducing nicotine cravings and withdrawal symptoms and significantly improve their chances to quit smoking."

The promotional quote isn't attributed to a Pfizer staff member, but to a Toronto-based general practitioner, who the company says was paid for participating in the promotion.

Canadians expect doctors to provide sound, neutral advice about treatment for health issues. But information is emerging that indicates some are paid to publicize and promote smoking cessation medication, possibly influencing the way smokers approach their battle to quit.

"There's enormous connections between what the drug companies do and what and how doctors practice and what they say and what they write," said Dr. Jerome P. Kassirer, professor at the Tufts University School of Medicine and editor-in-chief emeritus of the New England Journal of Medicine.

Pfizer regularly pays physicians in Canada in exchange for testimonials and research into its smoking-cessation aids without publicly disclosing those ties.

In the last year, there have been growing calls within the medical community for a change in rules to limit relationships with drug companies that could impact a doctor's impartiality.

"These companies, who are very shrewd, are not doing all this out of benevolence. They're doing it because they know that by using these methods, they're increasing the sales of their product -- which is what they want to do," said Dr. David Korn, senior vice-president for biomedical and health sciences research at the Washington-based Association of American Medical Colleges.

Korn is part of an expert task force examining new rules and conflict-of-interest restrictions in the hopes of ending questionable relationships between drug companies and the physicians they fund.

Although the issue doesn't receive the same level of attention in Canada, the problem is alive and well here, according to medical experts.
"I think it's been swept under the rug in Canada," said Kassirer, who recently wrote a book on the subject called On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health. "I think it's a problem in Canada."

The trouble with smoking cessation medication doesn't lie with product safety -- most experts agree they can help some people quit smoking. But there are growing concerns doctors funded by the drug industry may overly promote the benefits to encourage more people to buy the medication.

Doctors are featured repeatedly in Pfizer's promotional material and often speak to the media about the benefits of nicotine replacement therapy products, such as those produced by the company. Johnson & Johnson recently purchased Pfizer Consumer Healthcare, a branch of the parent company that is responsible for nicotine replacement therapy products and other non-prescription medication.

The company uses doctors to speak about its products because hearing from a credible member of the medical community reminds people about the grave problems associated with smoking, said Johnson & Johnson spokeswoman Krista Scaldwell.

"It's the seriousness of tobacco dependence," she said. "It is an addiction, rather than a habit ... Using doctors can make that differentiation."

But others see it as doctors bending the rules of their public contract to be honest, clear and unbiased in order to do the bidding for drug companies.

"I believe that when someone has a financial conflict of interest, that they are influenced, even subconsciously, to think in terms of the gift that they're getting from the company," Kassirer said.

There is evidence to suggest physicians funded by drug companies have a favourable bias toward nicotine replacement therapy products and other smoking cessation aids. A recent Canadian study found researchers who receive money from pharmaceutical companies are more likely to conclude nicotine replacement therapy has a better chance of helping people quit than those without drug company funding.

"It's possible that because of the way science has been conducted that some of the benefits have been overestimated somewhat," said Paul McDonald, a health studies professor at the University of Waterloo, who conducted the study.

The results, which will be made public at a conference in Texas next month, illustrate the need for better disclosure and code of conduct rules so Canadians are aware of any possible influences drug companies may have over research and public statements by doctors, McDonald said.

"I think it's going to be essential for things like smoking cessation treatment ... that the funders and program providers have very explicit policies that enable them to ensure there's no conflict of interest between whatever donations they might receive from any source, whether it be a pharmaceutical source or a government or non-profit organization," he said.

One doctor who has an ongoing relationship with Pfizer agrees Canada's medical community should adopt improved codes of ethics, but said receiving money from a drug company shouldn't suggest a lack of professionalism.

"You've got to make sure as a researcher you don't get co-opted as the spokesperson for that [medication]," said Dr. Peter Selby, clinical director of addiction programs at Toronto's Centre for Addiction and Mental Health. Selby was featured in a press release on a new smoking cessation pill developed by Pfizer titled: "Magic pill to get you to quit smoking!" It was distributed in June 2005 by the Ontario government-funded Media Network for a Smoke-Free Ontario to highlight Selby's research.

"It's as easy as open, pop, swig and swallow. Well, at least it will be," reads the press release.

Selby, who is a vocal supporter of smoking cessation products, said his relationship with Pfizer doesn't influence his research. Rather, he stands behind the products because they provide options for people who want to quit, including those who may not otherwise have access to counsellors or other quitting methods.

"We've got to figure out how do we reach half-a-million smokers who want to quit," he said.

Selby said the system isn't perfect, but that advertising medication that's readily available to the general public is better than not providing options to help people quit.

"There needs to be an ethical way of doing that, there needs to be criteria as to who gets medication and who doesn't," he said.
McDonald said he's not surprised by his study's findings, since similar ones done in other countries have indicated the same, but he's disturbed by the level of research conducted with the help of private-sector funding and the fact Canadians are none the wiser.

"What concerns me is an overwhelming majority of the studies that are being conducted are being conducted in whole or in part with private-sector funding or pharmaceutical funding," he said. "It's just that we need to take that into account in trying to determine how much confidence to have."
Copyright © The Vancouver Sun 2007
Online source: http://www.canada.com/vancouversun/news ... 166896871d
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Joel
Joined: 18 Dec 2008, 23:57

09 Feb 2007, 22:10 #9

From the below article:
"In November 2006, during the week of the Great American Smokeout, doctors around the country participated in a campaign called "Don't Go Cold Turkey." The creator of the campaign was GlaxoSmithKline."
You can see from this string that we saw that one coming at least three years before its introduction.
NICOTINE FIX

Behind Antismoking Policy,
Influence of Drug Industry
Wall Street Journal

Government Guidelines Don't Push Cold Turkey; Advisers' Company Ties

February 8, 2007, Page A1

By KEVIN HELLIKER

Michael Fiore is in charge of revising federal guidelines on how to get smokers to quit. He also runs an academic research center funded in part by drug companies that make quit-smoking aids, and he personally has received tens of thousands of dollars in speaking and consulting fees from those companies.

Conflict of interest? No, says Dr. Fiore, who has consistently declared that doctors ought to use stop-smoking medicine. He says his opinion -- reflected in current federal guidelines -- is based on scientific evidence from hundreds of studies.

Now debate is growing about that evidence, and about who should be entrusted to interpret it. Some public-health officials say industry-funded doctors are ignoring other studies that suggest cold turkey is just as effective or even superior to nicotine patches and other pharmaceuticals over the long run, not to mention cheaper.

At stake is one of the most important issues in the nation's public-health policy. Cigarettes kill an estimated 440,000 Americans a year. Helping America's 45 million smokers kick the addiction could save untold numbers of people.

The Public Health Service, part of the Department of Health and Human Services, issued guidelines in 2000 calling for smokers to use nicotine patches, gums and other pharmaceutical aids to quit, with a few exceptions such as pregnant women. Dr. Fiore, a University of Wisconsin professor of medicine, headed the 18-member panel that created those guidelines. He and at least eight others on it had ties to the makers of stop-smoking products.

Those opposed to urging medication on most quitters note that cold turkey is the method used by the vast majority of former smokers. They fear the federal government's campaign could discourage potential quitters who don't want to spend money on quitting aids or don't like the idea of treating their nicotine addiction with more nicotine.

"To imply that medications are the only way is inappropriate," says Lois Biener, a senior research fellow at the University of Massachusetts at Boston who has surveyed former smokers in her state. "Most people don't want them. Most of the people who do quit successfully do so without them."

Guidelines Revision

The panel is now working on a revision of the guidelines, scheduled for completion early next year. Dr. Fiore, an internist, is again chairman. He says this time only seven of 26 members have industry ties. Karen Migdail, a spokeswoman for the revision effort, says it involves so many voices that "it's hard for one perspective to have an influence on the process." She says Dr. Fiore is "one of the leading experts" in smoking cessation and well-suited to the job.

Dr. Fiore says his panel will give a fair hearing to all points of view on smoking cessation. He says the process is sufficiently collaborative to prevent bias, his or anyone else's, from creeping into the final product. He notes that many of the studies questioning the effectiveness of stop-smoking medication arose after the publication of the 2000 guidelines. The panel will scrutinize them closely before reaching any conclusions, he says.

David Blumenthal, director of the Institute for Health Policy at Massachusetts General Hospital, questions the government's choice of Dr. Fiore. "The chairman of the committee should be unquestionably impartial," says Dr. Blumenthal, who has published extensively on conflicts of interest.

Pharmaceutical companies make several products to help smokers quit. Some give a nicotine fix without a cigarette, such as GlaxoSmithKline PLC's Nicorette gum and nicotine-laced Commit lozenges. Nicotine, the addictive agent in cigarettes, is considered benign relative to the carcinogens in cigarettes. Bupropion, an antidepressant, and Pfizer Inc.'s Chantix -- both pills available only by prescription -- aim to reduce cravings without using nicotine.

Many clinical trials have randomly assigned smokers to take one of these
products or a placebo. Such randomized trials are considered the gold standard in many medical fields, and they have consistently shown that nicotine-replacement therapy or other medicine confers a benefit.

But these trials have limitations. They tend to compare quitters who wanted medication and got it with those who wanted medication and didn't get it -- which is a different group from quitters ready to try going cold turkey. Also, clinical trials tend to attract highly motivated quitters who may not represent the population as a whole. Even the placebo group in these trials often boasts double the success rate of the population of quitters generally.

Studies of quitters outside clinical trials have shown no consistent advantage for medicine over cold turkey, the pharmaceutical industry's primary competitor. An unpublished National Cancer Institute survey of 8,200 people who tried quitting found that at three months, users of the nicotine patch and users of bupropion remained abstinent at higher rates than did users of no medication. But at nine months, the no-medication group held an advantage over every category of stop-smoking medicine. The study was presented at a world tobacco conference last summer.

Real-World Situations

Similar so-called population studies -- which review results of people who already quit or tried to, rather than prospectively randomizing subjects into groups -- have also suggested that cold-turkey quitting can compete with medication in real-world situations. These studies, in California, Massachusetts and Australia, have their own limitations. One is that they depend on people to remember what they did rather than monitoring them in a controlled experiment.

The surgeon general's five-day program for smokers preparing to quit recommends nicotine patches or other medication. Kenneth Strahs, GlaxoSmithKline's vice president of smoking-control research and development, notes that his company's products won approval from regulators at the Food and Drug Administration who demand randomized clinical trials. "The FDA does not conclude either safety or efficacy based on retrospective population studies," says Dr. Strahs. Smoking-control products account for a small fraction of the company's revenue.

The researcher who raised the first serious questions about nicotine-replacement therapy says it may fall into a rarely discussed gap between efficacy in clinical trials and effectiveness in the real world. Greater use of medication is not "associated with any increase in successful quitting in the population," says John Pierce, a University of California, San Diego, professor of medicine who was lead author of a 2002 Journal of the American Medical Association article finding no superior benefit from over-the-counter nicotine substitutes in California.

"If we're going to be intellectually honest, we have to be willing to examine the issue of whether current users [of medication] are obtaining long-term rates of abstinence that are higher than anyone else," says Kenneth Warner, a tobacco researcher and dean of the University of Michigan School of Public Health. "That's going to be very hard for people to do in the smoking-cessation community," because belief in the value of medication runs so deep, he adds.

All sides in the debate agree that intervention by doctors and other health-care providers to confront smokers can be effective in encouraging quitting. Dr. Fiore says the primary goal of the guidelines is to spur such intervention, and he says they have been successful in sharply raising the proportion of doctors who discuss smoking with their patients. Also undisputed is that behavioral support, whether from professional therapists or quit-line counselors, can be valuable.

As the federal government weighs the data in making new recommendations, many of its advisers are receiving money from companies with a stake in the outcome. Dr. Fiore holds a chair at Wisconsin that is funded by GlaxoSmithKline. He directs a tobacco research center that received nearly $1 million in funding from makers of quit-smoking medicine in 2004 and $400,000 in 2005. Between 1999 and 2004, Dr. Fiore personally pocketed $10,000 to $40,000 a year from the quitting-aid industry for honorariums and consulting work. He says he stopped such work in 2005.

In the U.S. government's 2005 civil case against the tobacco industry, it chose Dr. Fiore as an expert witness. He was asked to estimate the damages owed to federal taxpayers as a result of smoking and to devise a plan for
spending those damages. Dr. Fiore came up with an estimate of $130 billion, and a plan to spend about $5.2 billion a year of that mostly on counseling and medication -- a measure that could have doubled the size of the stop-smoking medicine market. (Later, the government reduced its request for damages to $10 billion.)

The American Cancer Society has allowed its logo to be placed on stop-smoking products in exchange for money. A Cancer Society spokesman defends that decision, crediting the pharmaceutical industry for bringing invaluable marketing muscle to the society's Great American Smokeout every November.

Those who advocate medication sometimes fail to disclose that they have financial ties to companies. In an article on Voice of America's Web site last year, Jack Henningfield, identified only as a smoking-cessation expert, urged smokers to "go to the consumer-friendly Web site that I like, which is www.quit.com."

Dr. Henningfield is a principal of Pinney Associates, a consulting firm whose largest client is GlaxoSmithKline, operator of the quit.com site. Other articles citing Dr. Henningfield's views on smoking have identified him as a professor at Johns Hopkins School of Medicine without mentioning the GlaxoSmithKline connection. Dr. Henningfield, who holds a doctorate in psychology, is an adjunct professor at Johns Hopkins. He says only 10% of his income comes from Hopkins.

Dr. Henningfield says he always tells journalists about his financial ties to industry. But in an interview with The Wall Street Journal last summer,Dr. Henningfield promoted the use of stop-smoking medicine without volunteering any information about those ties. He says he thought GlaxoSmithKline's public-relations firm had already provided the information.

In at least two medical-journal articles that Dr. Fiore wrote or co-wrote promoting the use of stop-smoking medicine, no mention was made of his financial ties to the makers of those treatments. Dr. Fiore says the editors of those journals may have ignored his disclosure or he may have failed to provide it. If the latter, "I am sorry about that," he says,adding that those are two of more than 150 medical-journal articles he has published.

Dr. Fiore and other members of the Society for Research on Nicotine and Tobacco refuse to accept any funds from the tobacco industry, even unrestricted research grants. Smoking-control activists say there's a big difference between tobacco companies, which they say engaged in scientific deceit for a half-century, and drug makers that are trying to help smokers quit. Reflecting the view of many in the antitobacco camp, Harry Lando, a University of Minnesota nicotine researcher, says, "I view the pharmaceutical industry as our ally."

After the federal panel with industry-funded scientists came out with its guidelines in 2000, a campaign against cold turkey took root. The Web site of the highest-ranking physician in America -- the surgeon general -- calls it a "myth" that cold turkey is the best way to quit. In November 2006, during the week of the Great American Smokeout, doctors around the country participated in a campaign called "Don't Go Cold Turkey." The creator of the campaign was GlaxoSmithKline.

Advocate Rejected

The how-to-quit Web site of the federal Centers for Disease Control and Prevention rejected a request from John Polito, an ex-smoker in Mount Pleasant, S.C., to include a link to his Web site, WhyQuit.com, which advocates cold-turkey quitting. In a 2002 letter explaining the rejection, the agency told Mr. Polito that drug therapy has been shown to double quit rates.

In an interview, CDC epidemiologist Corinne Husten said the real reason for the rejection is that the CDC doesn't recommend private Web sites. However, the CDC site long included a link to GlaxoSmithKline's quit.com site. Asked about that, Dr. Husten said, "Some things have gotten on the [CDC] Web site that shouldn't be there." (After the interview, the CDC removed the quit.com link.)

Pressure may be growing for doctors to follow the federal guidelines. An article in the December issue of the journal Tobacco Control argued that failure to follow the guidelines could be deemed medical malpractice.

Some health officials don't go along with the federal government's tilt against cold turkey. The state of California's help-line for smokers presents cold turkey as an equally viable option to medication. "The effectiveness of pharmaceutical aids has been proven short-term; long-term, it's still in debate," says Hao Tang, a research scientist with the state department of health services. California has succeeded in reducing its smoking rate to 14%, six percentage points below the national average.

After three decades of smoking, Linda Holstein quit nearly three years ago using a nicotine patch as well as nicotine gum, which on occasion she still pops into her mouth. Elated at being free from cigarettes, Ms. Holstein, a Minneapolis attorney, says, "The gum helped very much."

Others say ingesting medicinal nicotine prolonged withdrawal, leading them ultimately back to cigarettes. During the 20 years that Tanya Blakey, a Georgia teacher, smoked two packs a day, she tried to quit countless times using nicotine-replacement therapy. "Every time I stopped using the NRT, I was smoking again within two or three days," says Ms. Blakey. This week she is celebrating two years without a cigarette, this time having used no medication.

Write to Kevin Helliker at [url=mailto:kevin.helliker@wsj.com]kevin.helliker@wsj.com[/url]
Source link: Behind Antismoking Policy, Influence of Drug Industry
Copyright © 2007 Dow Jones & Company, Inc. All Rights Reserved
Reply

Joel
Joined: 18 Dec 2008, 23:57

01 Apr 2007, 21:34 #10

Being that today is April 1, the title of this article could easily have been viewed as an April fools joke. Sadly, it is no joke and it is no laughing matter. Very well meaning people are discouraging smokers from quitting with what is the most tried and true successful method of smoking cessation on the planet. The way to quit smoking and to stay smoke free is simply to not "fool" around with nicotine from any source and as far as for burning tobacco products to know to never take another puff! Joel
From the below article:
"In November 2006, during the week of the Great American Smokeout, doctors around the country participated in a campaign called "Don't Go Cold Turkey." The creator of the campaign was GlaxoSmithKline."
You can see from this string that we saw that one coming at least three years before its introduction.
NICOTINE FIX

Behind Antismoking Policy,
Influence of Drug Industry
Wall Street Journal

Government Guidelines Don't Push Cold Turkey; Advisers' Company Ties

February 8, 2007, Page A1

By KEVIN HELLIKER

Michael Fiore is in charge of revising federal guidelines on how to get smokers to quit. He also runs an academic research center funded in part by drug companies that make quit-smoking aids, and he personally has received tens of thousands of dollars in speaking and consulting fees from those companies.

Conflict of interest? No, says Dr. Fiore, who has consistently declared that doctors ought to use stop-smoking medicine. He says his opinion -- reflected in current federal guidelines -- is based on scientific evidence from hundreds of studies.

Now debate is growing about that evidence, and about who should be entrusted to interpret it. Some public-health officials say industry-funded doctors are ignoring other studies that suggest cold turkey is just as effective or even superior to nicotine patches and other pharmaceuticals over the long run, not to mention cheaper.

At stake is one of the most important issues in the nation's public-health policy. Cigarettes kill an estimated 440,000 Americans a year. Helping America's 45 million smokers kick the addiction could save untold numbers of people.

The Public Health Service, part of the Department of Health and Human Services, issued guidelines in 2000 calling for smokers to use nicotine patches, gums and other pharmaceutical aids to quit, with a few exceptions such as pregnant women. Dr. Fiore, a University of Wisconsin professor of medicine, headed the 18-member panel that created those guidelines. He and at least eight others on it had ties to the makers of stop-smoking products.

Those opposed to urging medication on most quitters note that cold turkey is the method used by the vast majority of former smokers. They fear the federal government's campaign could discourage potential quitters who don't want to spend money on quitting aids or don't like the idea of treating their nicotine addiction with more nicotine.

"To imply that medications are the only way is inappropriate," says Lois Biener, a senior research fellow at the University of Massachusetts at Boston who has surveyed former smokers in her state. "Most people don't want them. Most of the people who do quit successfully do so without them."

Guidelines Revision

The panel is now working on a revision of the guidelines, scheduled for completion early next year. Dr. Fiore, an internist, is again chairman. He says this time only seven of 26 members have industry ties. Karen Migdail, a spokeswoman for the revision effort, says it involves so many voices that "it's hard for one perspective to have an influence on the process." She says Dr. Fiore is "one of the leading experts" in smoking cessation and well-suited to the job.

Dr. Fiore says his panel will give a fair hearing to all points of view on smoking cessation. He says the process is sufficiently collaborative to prevent bias, his or anyone else's, from creeping into the final product. He notes that many of the studies questioning the effectiveness of stop-smoking medication arose after the publication of the 2000 guidelines. The panel will scrutinize them closely before reaching any conclusions, he says.

David Blumenthal, director of the Institute for Health Policy at Massachusetts General Hospital, questions the government's choice of Dr. Fiore. "The chairman of the committee should be unquestionably impartial," says Dr. Blumenthal, who has published extensively on conflicts of interest.

Pharmaceutical companies make several products to help smokers quit. Some give a nicotine fix without a cigarette, such as GlaxoSmithKline PLC's Nicorette gum and nicotine-laced Commit lozenges. Nicotine, the addictive agent in cigarettes, is considered benign relative to the carcinogens in cigarettes. Bupropion, an antidepressant, and Pfizer Inc.'s Chantix -- both pills available only by prescription -- aim to reduce cravings without using nicotine.

Many clinical trials have randomly assigned smokers to take one of these
products or a placebo. Such randomized trials are considered the gold standard in many medical fields, and they have consistently shown that nicotine-replacement therapy or other medicine confers a benefit.

But these trials have limitations. They tend to compare quitters who wanted medication and got it with those who wanted medication and didn't get it -- which is a different group from quitters ready to try going cold turkey. Also, clinical trials tend to attract highly motivated quitters who may not represent the population as a whole. Even the placebo group in these trials often boasts double the success rate of the population of quitters generally.

Studies of quitters outside clinical trials have shown no consistent advantage for medicine over cold turkey, the pharmaceutical industry's primary competitor. An unpublished National Cancer Institute survey of 8,200 people who tried quitting found that at three months, users of the nicotine patch and users of bupropion remained abstinent at higher rates than did users of no medication. But at nine months, the no-medication group held an advantage over every category of stop-smoking medicine. The study was presented at a world tobacco conference last summer.

Real-World Situations

Similar so-called population studies -- which review results of people who already quit or tried to, rather than prospectively randomizing subjects into groups -- have also suggested that cold-turkey quitting can compete with medication in real-world situations. These studies, in California, Massachusetts and Australia, have their own limitations. One is that they depend on people to remember what they did rather than monitoring them in a controlled experiment.

The surgeon general's five-day program for smokers preparing to quit recommends nicotine patches or other medication. Kenneth Strahs, GlaxoSmithKline's vice president of smoking-control research and development, notes that his company's products won approval from regulators at the Food and Drug Administration who demand randomized clinical trials. "The FDA does not conclude either safety or efficacy based on retrospective population studies," says Dr. Strahs. Smoking-control products account for a small fraction of the company's revenue.

The researcher who raised the first serious questions about nicotine-replacement therapy says it may fall into a rarely discussed gap between efficacy in clinical trials and effectiveness in the real world. Greater use of medication is not "associated with any increase in successful quitting in the population," says John Pierce, a University of California, San Diego, professor of medicine who was lead author of a 2002 Journal of the American Medical Association article finding no superior benefit from over-the-counter nicotine substitutes in California.

"If we're going to be intellectually honest, we have to be willing to examine the issue of whether current users [of medication] are obtaining long-term rates of abstinence that are higher than anyone else," says Kenneth Warner, a tobacco researcher and dean of the University of Michigan School of Public Health. "That's going to be very hard for people to do in the smoking-cessation community," because belief in the value of medication runs so deep, he adds.

All sides in the debate agree that intervention by doctors and other health-care providers to confront smokers can be effective in encouraging quitting. Dr. Fiore says the primary goal of the guidelines is to spur such intervention, and he says they have been successful in sharply raising the proportion of doctors who discuss smoking with their patients. Also undisputed is that behavioral support, whether from professional therapists or quit-line counselors, can be valuable.

As the federal government weighs the data in making new recommendations, many of its advisers are receiving money from companies with a stake in the outcome. Dr. Fiore holds a chair at Wisconsin that is funded by GlaxoSmithKline. He directs a tobacco research center that received nearly $1 million in funding from makers of quit-smoking medicine in 2004 and $400,000 in 2005. Between 1999 and 2004, Dr. Fiore personally pocketed $10,000 to $40,000 a year from the quitting-aid industry for honorariums and consulting work. He says he stopped such work in 2005.

In the U.S. government's 2005 civil case against the tobacco industry, it chose Dr. Fiore as an expert witness. He was asked to estimate the damages owed to federal taxpayers as a result of smoking and to devise a plan for
spending those damages. Dr. Fiore came up with an estimate of $130 billion, and a plan to spend about $5.2 billion a year of that mostly on counseling and medication -- a measure that could have doubled the size of the stop-smoking medicine market. (Later, the government reduced its request for damages to $10 billion.)

The American Cancer Society has allowed its logo to be placed on stop-smoking products in exchange for money. A Cancer Society spokesman defends that decision, crediting the pharmaceutical industry for bringing invaluable marketing muscle to the society's Great American Smokeout every November.

Those who advocate medication sometimes fail to disclose that they have financial ties to companies. In an article on Voice of America's Web site last year, Jack Henningfield, identified only as a smoking-cessation expert, urged smokers to "go to the consumer-friendly Web site that I like, which is www.quit.com."

Dr. Henningfield is a principal of Pinney Associates, a consulting firm whose largest client is GlaxoSmithKline, operator of the quit.com site. Other articles citing Dr. Henningfield's views on smoking have identified him as a professor at Johns Hopkins School of Medicine without mentioning the GlaxoSmithKline connection. Dr. Henningfield, who holds a doctorate in psychology, is an adjunct professor at Johns Hopkins. He says only 10% of his income comes from Hopkins.

Dr. Henningfield says he always tells journalists about his financial ties to industry. But in an interview with The Wall Street Journal last summer,Dr. Henningfield promoted the use of stop-smoking medicine without volunteering any information about those ties. He says he thought GlaxoSmithKline's public-relations firm had already provided the information.

In at least two medical-journal articles that Dr. Fiore wrote or co-wrote promoting the use of stop-smoking medicine, no mention was made of his financial ties to the makers of those treatments. Dr. Fiore says the editors of those journals may have ignored his disclosure or he may have failed to provide it. If the latter, "I am sorry about that," he says,adding that those are two of more than 150 medical-journal articles he has published.

Dr. Fiore and other members of the Society for Research on Nicotine and Tobacco refuse to accept any funds from the tobacco industry, even unrestricted research grants. Smoking-control activists say there's a big difference between tobacco companies, which they say engaged in scientific deceit for a half-century, and drug makers that are trying to help smokers quit. Reflecting the view of many in the antitobacco camp, Harry Lando, a University of Minnesota nicotine researcher, says, "I view the pharmaceutical industry as our ally."

After the federal panel with industry-funded scientists came out with its guidelines in 2000, a campaign against cold turkey took root. The Web site of the highest-ranking physician in America -- the surgeon general -- calls it a "myth" that cold turkey is the best way to quit. In November 2006, during the week of the Great American Smokeout, doctors around the country participated in a campaign called "Don't Go Cold Turkey." The creator of the campaign was GlaxoSmithKline.

Advocate Rejected

The how-to-quit Web site of the federal Centers for Disease Control and Prevention rejected a request from John Polito, an ex-smoker in Mount Pleasant, S.C., to include a link to his Web site, WhyQuit.com, which advocates cold-turkey quitting. In a 2002 letter explaining the rejection, the agency told Mr. Polito that drug therapy has been shown to double quit rates.

In an interview, CDC epidemiologist Corinne Husten said the real reason for the rejection is that the CDC doesn't recommend private Web sites. However, the CDC site long included a link to GlaxoSmithKline's quit.com site. Asked about that, Dr. Husten said, "Some things have gotten on the [CDC] Web site that shouldn't be there." (After the interview, the CDC removed the quit.com link.)

Pressure may be growing for doctors to follow the federal guidelines. An article in the December issue of the journal Tobacco Control argued that failure to follow the guidelines could be deemed medical malpractice.

Some health officials don't go along with the federal government's tilt against cold turkey. The state of California's help-line for smokers presents cold turkey as an equally viable option to medication. "The effectiveness of pharmaceutical aids has been proven short-term; long-term, it's still in debate," says Hao Tang, a research scientist with the state department of health services. California has succeeded in reducing its smoking rate to 14%, six percentage points below the national average.

After three decades of smoking, Linda Holstein quit nearly three years ago using a nicotine patch as well as nicotine gum, which on occasion she still pops into her mouth. Elated at being free from cigarettes, Ms. Holstein, a Minneapolis attorney, says, "The gum helped very much."

Others say ingesting medicinal nicotine prolonged withdrawal, leading them ultimately back to cigarettes. During the 20 years that Tanya Blakey, a Georgia teacher, smoked two packs a day, she tried to quit countless times using nicotine-replacement therapy. "Every time I stopped using the NRT, I was smoking again within two or three days," says Ms. Blakey. This week she is celebrating two years without a cigarette, this time having used no medication.

Write to Kevin Helliker at [url=mailto:kevin.helliker@wsj.com]kevin.helliker@wsj.com[/url]
Source link: Behind Antismoking Policy, Influence of Drug Industry
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