Bill Jamieson: Quit while you’re ahead of the rest of the patch

[Thomas3.20.2010]

RECENTLY published research suggests that nicotine-based drugs may be harming many smokers chances of giving up the weed, writes Bill Jamieson

  

IT IS 23 days and counting, or, by the time I have written this, 23 days, two hours and counting since I fell into the clutches of a most unholy alliance in modern lifestyle politics.

  

I refer to the Faustian alliance between Big Pharma and the anti-smoking lobby. This is no grubby little back-stage deal. It is the Molotov-Ribbentrop pact of health economics. Its exposure is long overdue.

  

Pass me my nicotine patches and the NiQuitin mint drops. I am on Day 23 of what Sheila Duffy, Reichsmarshall of that crack Panzer Division “Action on Smoking and Health” who has forced me to stand outside on countless rain-soaked pavements would doubtless call a Smoking Cessation Programme. I may be quitting fags after 50 years. But I sure ain’t quitting nicotine.

  

Courtesy of the NHS, I have been on Nicotine Replacement Therapy. There are the patches. I’ve got patches in places where you never thought were places. There are the 4mg nicotine lozenges (“for those who smoke within 30 minutes of waking”). And there is the e-cigarette with the glowing green tip.

  

This has not exhausted my repertoire of anti-smoking devices. I have mobilised behavioural therapy and resorted to psychometric tapping: ten taps with the fingers of both hands on the forehead, then on the neck, on the sides of my ribs, on the chest and finally on my knuckles. I deployed this on the second week after dining at an Edinburgh restaurant. The waiter looked on with mounting apprehension. I don’t know if it lowered the nicotine crave but it certainly brought the bill very quickly to the table.

  

But it is down the route of Nicotine Replacement Therapy, that I have been wafted. Why go cold turkey when the pharmaceutical industry, aided and abetted by the better-lifestyle lobby, has laid on such helpful largesse in my drive to stop smoking?

  

Well, there’s only one thing wrong with NRT. It doesn’t work. I am grateful to Patrick Basham and John C Luik for their summary of research into the efficacy of NRT which appears in the current edition of Journal of the Institute of Economic Affairs (neither have ever been employees of the tobacco industries).

  

They set out to examine whether the replacement therapies pursued by anti-tobacco activists really do work for smokers “as opposed to simply enhancing the profitability of those drug firms manufacturing NRT”. Their concern is that the pharma industry “may be willing to stack the deck in its favour in order to win regulatory approval and with it billions of dollars in potential sales for its products”.

     

Over the last 25 years the pharma industry has increasingly entered the nicotine business through the development and marketing of NRTs which include gums, patches, nasal sprays, inhalers, lozenges and varenicline (a prescription medication). Six years ago the business, which the authors say has largely escaped any significant critical evaluation, was estimated to be worth $1.7 billion. It has certainly grown since.

  

Their review of 13 of the most important US studies on the effectiveness of NRT compared to cold turkey cessation is disturbing. Here are some examples. A 2007 study using data from the National Health Interview Survey reported that 75.7 per cent of successful quitters (abstinent for 7-24 months) stopped by using the cold turkey method without pharmaceutical assistance compared with 12.4 per cent who used nicotine patches.

  

A 2009 study found that most of those who quit smoking without planning used neither behavioural nor medicinal support and, most significantly, unplanned attempts to quit were twice as successful as planned attempts using NRT.

  

A 2010 study found that the one year abstinence rate for those using patches was only 0.8 per cent of the sample. This compares with unaided quit attempts which yielded one year abstinence rates of between 3 and 11 per cent.

  

A 2012 study found that “while public health initiatives on smoking cessation have increased substantially… widespread dissemination of these aids has not improved population success rates”. In effect pharmaceutical cessation drugs have not increased the number of smokers who have been able to quit smoking over the longer term.

  

Finally the most recently published study of the effectiveness of NRT followed 787 Massachusetts adult smokers who had quit smoking. It found no difference in relapse rate among those who used NRT for more than six weeks. “Using NRT”, it concluded, “is no more effective in the long term than trying to quit on one’s own”. Unassisted cessation continues to lead NRT by a wide margin.

  

“To put the matter bluntly”, the authors conclude, “the dominance of NRT is not supported by research data: it effectively pushes smokers away from the most successful way to quit and this reduces their chances of successfully quitting. By pushing smokers to NRT, the public health community and the anti-smoking movement paradoxically reduce their chances of stopping smoking and thereby increase their chances of dying from smoking.” In an uncharitable reading, smokers are being “literally sacrificed to the interests of the pharmaceutical industry and its anti-smoking partners”. Meanwhile, the pharma industry gets to enlarge its share of the nicotine market – with official approval.

  

So should I rip off those patches? After reading this research I could have done with a triple strength nicotine lozenge and a pack of Marlborough.

  

The trigger for my own no-smoking moment was a prolonged course of dental surgery where cessation was strongly advised so I do not have much choice in the matter. But it will come down in the end – as it always does – to will power. I must kick the habit, but also its most dubious health industry substitute – entrapment in the Molotov-Ribbentrop Nicotine Pact.