Who Should You Believe?

Joel
Joel

October 5th, 2003, 8:10 pm #1

Who should you believe on what is the most successful technique for quitting smoking-the government and most smoking cessation experts in the world and the professional health organizations of the world and the pharmacological industry and almost any one whose career seems to be based in smoking cessation or me? I guess using this standard it would be best not to believe me. But before jumping ship there is one other important group of people that you may find that will back me up and who are already quite credible to you. It's the people in your family and your friends in your real world who have successfully quit smoking and are off all nicotine products for at least one year or longer.

Find out how the people you know who are long-term ex-smokers actually stopped smoking. By long-term I mean people who are currently off all nicotine for at least a year or longer. You will see most of them never heard of me. You will see that many of them had previous quits that did not take, using all sorts of professional help and advice in those quits. You will find that the vast majority of these people (and I do mean the vast majority) did not follow what is considered the standard recommended advice or the how to quit guidelines by the world professionals on the quit that actually took and is still on going. They in fact most likely quit by stopping smoking one day for one reason or another and then have been able to stay off by still knowing at least to this point in time to never take a puff.

Talk to every long-term ex-smoker you know. Do your own surveys. While you are at it, talk to the current smokers you know too. See how many of them have used the products and followed the advice of the professionals. Try to find one of them who once had quit but are now smokers again who didn't take a puff. Finding one person like this is going to take you the rest of your life. Find out how many of the current smokers you know once had quit and actually had months, years or decades of not smoking behind them, only to lose those quits by following the advice of professionals who said things like, "Don't let a slip make you go back to smoking."

Pretty soon you will see it is not a matter of pitting me against the rest of the world professionals. It becomes a matter of pitting every long-term smoker you know who has successfully quit against the world professionals. Do the surveys and then I will just become another voice in the crowd of real people who have proven to you how to quit smoking and how to stay smoke free.

Below is a paragraph of a letter I sent to John in June of 2000:

"It's like seeing a published story come out that 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 my friends 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 you have to believe your eyes, ears, basically, your own instincts more than expert opinion."

I guess I should point out one other fact that I could use in the defense of my views. I have seen people use the argument of who should they believe, me of the Surgeon General of the United States. I somehow get the idea that people think that the Surgeon General is a person who has gone through years and decades of working with nicotine addicts. That somehow being an expert in smoking cessation is a prerequisite of 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 clinics were skeptical and wrote the Surgeon General at the time if it were true that nicotine is a drug addiction he would have said 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 put out 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. I was wrong all that time because the Surgeon General said I was wrong. But today I am no longer wrong on this fact.

So I think I am going to just take a wait and see attitude on what the Surgeon General ten years from now or twenty years from now will say is the most effective way to quit smoking. Maybe he or she will have come around to my way of thinking by then, maybe not. But I know one thing for sure. That all of the people who decided to go along with my way of thinking, and follow my advice on how to quit, and then stay committed in the interim to the advice that I have given them to remain smoke free, that they will all still be ex-smokers. Considering my advice that still seems to be controversial today is simply that to quit smoking and stay smoke free is no more complicated than just knowing to never take another puff!

 Joel
Quote
Share

Joel
Joel

October 5th, 2003, 8:23 pm #2

The three most common stories you will hear of how long-term quitters actually quit smoking:
  1. The woke up one day and realized they were sick and tired of smoking and never touched one since.
  2. They got sick. Not smoking sick, just sick--often just a cold or a flu. They felt miserable, didn't feel like eating or smoking. In a few days the infection subsided and they stated to get better. They realized that they had a few days under their belts without smoking and decided to keep the quit going and never went back.
  3. They left their doctor's office with an ultimatum--quit smoking or your going to drop dead--your choice!
You will be amazed at just how many people who are long-term ex-smokers fit into one of these three categories. The technique to quit for all three of these groups are the same, it is just that their initial motivations for quitting varied. It is the same technique being used by every member here, which is simply to have quit smoking and then sticking to the commitment they have made when joining up to never take another puff!

Joel

Last edited by Joel on September 11th, 2012, 1:05 pm, edited 1 time in total.
Quote
Share

Michelle72482
Michelle72482

November 21st, 2003, 2:27 pm #3

Joel, I think what you do is an awesome and caring thing. To never have smoked yourself, but yet help those who do, quit is a remarkable and selfless thing.....Thank you.
Quote
Share

ChristinenSam
ChristinenSam

November 21st, 2003, 3:04 pm #4

Joel, thanks for bringing up this post. And I agree with Michelle - you are wonderful for all the work you do for nicotine cessation.

The thing that really made me know that what you say is right, is that you totally and completely seem to be able to elaborate on how I felt, what I thought, etc even though you don't smoke and were not ever addicted to nicotine. How could you know? You are right .

Christine
Quote
Share

John (Gold)
John (Gold)

November 26th, 2003, 9:54 pm #5

Do your own survey.
Trust your ears and eyes.

Psychological conditioning isn't just a by-product of an addictive chemical's half-life, it's also used in marketing to get us to believe and buy.

The tobacco industry wants you to believe that smoking nicotine is an adult choice issue while ignoring the fact that true chemical addiction means that the only choice the addict has is chemical withdrawal or that next mandatory smoke.

The pharmaceutical industry is spending a massive amount of money to condition smokers to believe that buying more nicotine is the answer to all our problems.

Athough I've tried hard to get nicotine addicts to actually read the latest NRT studies and reflect upon the disasterous relapse rates for themselves (numeric relapse rates in excess of 93% at six months that those pushing nicotine will continue to refuse to discuss), as Joel points out there is a much easier way to discover the truth.

The world's most brilliant marketing minds may be able to package relapse as victory but the proofs in the pudding. Trust in those you know or love to be a bit more honest with you than those trying to profit off of your addiciton.

Although the NRT industry has done an amazing job of successfully erasing almost all cold turkey quitting recommendations in cessation literature around the globe, they cannot erase the fact that all but a tiny sliver of those becoming free from all forms of nicotine are doing so by deciding to not put any more nicotine into their bodies.
Freedom should cost you nothing!
Breathe deep, hug hard, live long! John
Quote
Share

Rickgoldx5
Rickgoldx5

November 26th, 2003, 11:59 pm #6

Joel,
Funny I was thinking about this yesterday. After I joined Freedom maybe about a week , my M.D said I might want to try a quit smoking class they had at thier clinic.
I went the next day thinking it might help. Wrong! I was the only one out of 20 people quitting cold turkey. All they did was sit around this table and whine about everything in general. I never went back. But I got to thinking of all my friends that quit. Only one out of 5 used N.R.T. and she started smoking again a month later. I can't imagine how miserable thats got to be. To be in constant withdrawls for months!
Thank for showing me my way to Freedom!
Rick
One year, six months, three weeks, one day, 2 hours, 43 minutes and 38 seconds. 45689 cigarettes not smoked, saving $11,400.25. Life saved: 22 weeks, 4 days, 15 hours, 25 minutes.
Quote
Share

TOM DPLN1 GOLD
TOM DPLN1 GOLD

April 10th, 2004, 3:44 am #7

ONE OF THE FIRST POSTS I READ AS A NEWBIE. IT PUSHED ME
OVER THE EDGE TO QUIT COLD TURKEY. I QUIT THE DAY I READ
THIS. HOPE EVERONE ELSE FIND THIS AS THOUGHT PROVOKING
AS I DID.
Quote
Share

carvoiero gold
carvoiero gold

April 10th, 2004, 6:38 am #8

This is a good post
- I came to this site because I just stopped smoking and was looking for a support site and someone at another site suggested whyquit.com because I had expressed my views on NRT and cold turkey (these have always been completely in line with Joel's). It was the best thing I could have done - the idea of NTAP, no 'slips' allowed etc was just what I needed to keep the quit strong this time - for the last time. If I NTAP then I can never become a smoker again! Simple. I probably should have known that already, but my junkie mind wouldn't let me register it before!
Thank you Joel for doing all you can to help nicotine addicts like myself.
Marion
Quote
Share

Fong KK
Fong KK

April 10th, 2004, 12:50 pm #9

When I started my quit, I was lurking at AS3 newsgroup looking for an effective quit method and also hoping to find any kind of support I can get. I wasn't sure Cold Turkey is the way to go but I already started it. The discussions at AS3 were mixture of quit methods and that doesn't give me much confidence in my quitting cold turkey. I was at the same time looking for a quit meter to help keep track of my quit. Then I came across a post by a Robin that suggests whyquit.com for a link to get a quit meter. It was from then on that I stayed on with Freedom.

I am confident now that cold turkey is the way to go and the education I get from Freedom is fantastic !. This is the excellent post that reinforced my quit . Thanks Joel.

Fong

4 Weeks, 22 hours, 55 minutes and 26 seconds. 868 Cigarettes not smoked, saving $173.72. Life saved : 3 Days and 20 minutes
Quote
Share

screechwinter
screechwinter

May 30th, 2004, 11:47 pm #10

yeah. this just about says it all.

ahnaka
One month, two weeks, five days, 12 hours, 16 minutes and 45 seconds. 742 cigarettes not smoked, saving $194.95. Life saved: 2 days, 13 hours, 50 minutes.
Quote
Share

John (Gold)
John (Gold)

May 31st, 2004, 1:19 am #11

Should you believe ...
the pharmaceutical industry?

Talking about believing! Here are ten things that pharmaceutical industry does not want smokers to know about nicotine replacement therapy (NRT):
  1. Cold turkey quitters were NOT invited to compete NRT quitters in NRT studies as insinuated in NRT commercials
  2. NRT studies were not double-blind as claimed. Instead they suffered from massive wide-spread blinding failures
  3. Your natural six-month odds of quitting without any education programs, counseling or formal support is about 10%
  4. Only 7% of those using over-the-counter (OTC) NRT as a stand-alone quitting aid are still not smoking at six months
  5. 7% of OTC nicotine gum quitters are still chewing nicotine gum at six months
  6. 36.6% of all current nicotine gum users are chronic long-term users of greater than six months
  7. Almost 100% of second-time nicotine patch users relapse with six months
  8. 91.2% of successful long-term ex-smokers quit entirely on their own without any product, procedure or program
  9. Education, understanding, new skills and serious support can more than triple your natural 10 odds
  10. Just one day at a time not putting any nicotine into your body 100% guarantees success to every quitter!

Quote
Share

Joel
Joel

August 5th, 2004, 7:15 pm #12

The three most common stories you will hear of how long-term quitters actually quit smoking:
  1. The woke up one day and realized they were sick and tired of smoking and never touched one since.
  2. They got sick. Not smoking sick, just sick--often just a cold or a flu. They felt miserable, didn't feel like eating or smoking. In a few days the infection subsided and they stated to get better. They realized that they had a few days under their belts without smoking and decided to keep the quit going and never went back.
  3. They left their doctor's office with an ultimatum--quit smoking or your going to drop dead--your choice!
You will be amazed at just how many people who are long-term ex-smokers fit into one of these three categories. The technique to quit for all three of these groups are the same, it is just that their initial motivations for quitting varied. It is the same technique being used by every member here, which is simply to have quit smoking and then sticking to the commitment they have made when joining up to never take another puff!

Joel
Quote
Share

Joel
Joel

October 4th, 2004, 7:25 pm #13

As this article discusses, I am a big advocate of people doing their own personal surveys to get an idea of how most people they personally know succeed at quitting.
Quote
Share

Ouija7
Ouija7

October 6th, 2004, 12:49 pm #14

Quit cold turkey !!!

100% of the long term smokers I know quit cold turkey. 11 out of 11 people! I do find it amazing that it took Joel to point this out to me. I am forever greatful! Including my own quit makes 12 out of 12.

Ouija7- 4 days from Gold!
Quote
Share

John (Gold)
John (Gold)

April 20th, 2006, 10:31 am #15

Quote
Share

suannu153
suannu153

April 27th, 2006, 4:14 am #16

All those I have known who have quit successfully for much more than any 6 months have been those who have quit cold turkey. From throwing up after the first cigarette in the morning and the packet then hit the bin to ripping the NRT patch off in hospital and going cold turkey in hospital; all are successful long term quitters.
I know but 1 case of someone using NRT to quit but she had counselling to go alongside her quit, the rest manage a week and are often smoking with the patches on!!

Susan


---
3weeks 15:43 smoke-free, 437 cigs not smoked,
Quote
Share

Joel
Joel

July 12th, 2006, 7:41 pm #17

I thought it would probably be a good idea to pop this one up this week. I suspect with the 13th World Conference on Smoking going on this week there will likely be lots of press releases coming out on how all of the world experts are touting the great success that could be achieved if people would just buy quit smoking medications. There will probably be no mention the the fact that most people who have quit have done so by simply quitting and that all people can successfully stay off if they simply make and stick to a personal commitment to never take another puff.

Joel
Quote
Share

Joel
Joel

August 10th, 2006, 11:09 pm #18

The three most common stories you will hear of how long-term quitters actually quit smoking:

1. The woke up one day and realized they were sick and tired of smoking and never touched one since.

2. They got sick. Not smoking sick, just sick--often just a cold or a flu. They felt miserable, didn't feel like eating or smoking. In a few days the infection subsided and they stated to get better. They realized that they had a few days under their belts without smoking and decided to keep the quit going and never went back.

3. They left their doctor's office with an ultimatum--quit smoking or your going to drop dead--your choice!

You will be amazed at just how many people who are long-term ex-smokers fit into one of these three categories. The technique to quit for all three of these groups are the same, it is just that their initial motivations for quitting varied.

It is the same technique being used by every member here, which is simply to have quit smoking and then sticking to the commitment they have made when joining up to never take another puff!

Joel
Quote
Share

Joel
Joel

January 12th, 2007, 7:35 pm #19

I saw where a member noted that today was the anniversary of the 1964 Surgeon General's report on Smoking and Health. Actually, January 11, 1964 was another landmark day for Luther Terry who was the Surgeon General who released the report. It was the day he himself actually quit smoking. Here are two videos that discuss Luther Terry's role in that report:
Video Title
Dial-Up
HS/BB
Length
Added
Addiction - the Surgeon General says ... 4.42mb 13.2mb 12:00 10/09/06
Criteria of Addiction 4.09mb 12.2mb 11:06 10/09/06
Quote
Share

Joel
Joel

January 12th, 2007, 7:55 pm #20

According to an article in the NIH Record, the biweekly newsletter for
employees of the National Institutes of Health, Dr. Luther Terry was a
smoker and he quit smoking in 1964.

Excerpt:

"Back in 1964, Dr. Luther Terry, then U.S. surgeon general, was
understandably a bit nervous. He was about to release the first-ever
Surgeon General's Report, which confirmed several long-suspected
theories regarding the detrimental effect of smoking on health. As he
was riding to the news conference, thinking about what he would say,
he lit up a cigarette. Noting the cigarette, an adviser, who knew
Terry was a chronic smoker, suggested that the surgeon general be
prepared for the first question reporters were certain to ask: Do you
smoke, Dr. Terry? Terry could not believe reporters would be
interested in his personal habits. Sure enough, though, following
Terry's announcement of the landmark SG report and his comments about
the health dangers of smoking, a savvy reporter asked Terry if he
smoked. "No," Terry replied. The reporter - convinced he had done his
homework - double-checked his notes. Knowing Terry's history, the
writer pressed further, "Dr. Terry, when did you quit?" A smiling
Terry responded, "About 30 minutes ago." He never smoked again."

Source:
National Institutes of Health (NIH)
NIH Record from April 17, 2001
http://www.nih.gov/news/NIH-Record/04_17_2001/main.htm
http://www.nih.gov/news/NIH-Record/04_1 ... tory02.htm
Quote
Share

John (Gold)
John (Gold)

January 23rd, 2007, 12:27 am #21

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
Quote
Share

John (Gold)
John (Gold)

February 9th, 2007, 9:09 pm #22

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
Quote
Share

Just Hannes
Just Hannes

February 9th, 2007, 9:27 pm #23

This one is very familiar in the story above:

"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"

Here we call this the social chewer or closet chewer.

The relapse of a "social smoker" 

Frits (63 days free)
Last edited by Just Hannes on May 17th, 2013, 4:22 am, edited 1 time in total.
Quote
Share

John (Gold)
John (Gold)

February 10th, 2007, 12:18 am #24

I was wondering if anyone here would notice that, Frits.
It's my hope that the Agency for Healthcare Research and Quality (AHRQ), which is responsible for formulating U.S. cessation policy via expert panels, will awaken to the realization that allowing stakeholders to author policy is totally unacceptable. The article notes that in 2004 the current chairman and his programs received about $1 million from cessation pharmaceutical interests. How much in cessation pharmacology funding and research would he and his programs receive next year if he were to openly declare this year that there is little or no evidence that pharmacology is effective for smoking cessation in real-world use, as suggested by the current survey data evidence-base? Going from a million to zero based upon a single assertion reflects a massive massive conflict of interest.
Quote
Share

Joel
Joel

September 3rd, 2007, 6:12 am #25

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
Quote
Share