Dear Mr. President:
Forgive me, but after hearing you confirm on September 23, 2013 that "I chew Nicorette gum," after hearing NRT use reports year after year after year, I've bitten my lip long enough.
As commander in chief in the war to help save the nearly 2 million American smokers gassed to death by their dependency since you took office, I'm certain you'd agree, at a minimum we owe smokers the truth.
As a recovered nicotine addict and pro bono director of WhyQuit since 1999, a free nicotine dependency recovery site that annually receives 2.5 times as many unique visitors as the total number of calls to the nation's 1-800-QUIT-NOW quitline (2.2 million versus 880,887), I write hoping to awaken you to the reality that toying with Nicorette and NRT is costing lives, that your administration's cessation policy is, respectfully, a deadly mess.
Mr. President, as all real-world studies confirm, for a host of reasons (including study blinding integrity concerns so horrific that the industry resorted to use of active placebo patches and gums containing small amounts of nicotine for at least 14 years - see footnote 2), replacement nicotine's clinical efficacy failed to transfer into population level effectiveness.
Instead of simply admitting NRT's failure and changing course, the U.S. Department of Health and Human Services (HHS) instead chose to hire NRT industry consultants and advocates as tobacco control directors at both the FDA and CDC, where they spin and reinforce failed policy.
Having law degrees, I suspect we'll both be able to recite all nine elements of fraud until our dying breath. But will we know it when we see it? And will we appreciate the falsehood's consequences? More to the point, is it reasonable to expect a person consumed by and living the following HHS falsehoods to simultaneously protect our nation's 34.1 million daily smokers from them?
"Nicotine gum can double your chances of quitting successfully." "The nicotine patch can double your chances of quitting successfully." "Most people who quit don't quit cold turkey on their own." Cold turkey "works for some smokers ... but not many. Fewer than 5 percent of smokers can quit this way."
After 39 years of Nicorette being a cornerstone of U.S. cessation policy, after billions spent marketing it, what percentage of successful ex-smokers owe their success to Nicorette? According to a July 31 Gallup Poll, just 1 percent. In fact, all approved quitting aids combined account for a tiny fraction of successful quitters, only 8%.
President Obama, the tail is wagging the dog. Contrary to decades of HHS cold turkey bashing, more Americans are quitting cold turkey than by all other means combined. When comparing cold turkey to gradual weaning schemes, weaning is substantially less effective.
But it worked for you, right? Wrong. As you know, getting hooked on the cure was not an approved use, at least not until April 1, 2013, roughly a month after a senior vice president of the firm having exclusive Nicorette consultancy responsibility was appointed director of the FDA's new tobacco office.
Mr. President, I beg you to dig deep and despite your dependence, to try to be objective. Why would HHS hide the results of the only population level cessation method data review it has ever conducted, the 2006 NCI Hartman study? Why no follow-up study? Because the findings on pages 35 and 36 are in total conflict with the lie that NRT doubles "your" chances. Because combining those findings with the findings on page 34 conflicts with the HHS falsehood that cold turkey works for "some smokers ... but not many."
Clearly, the word "your" suggests real-world effectiveness, not clinical efficacy over placebo.
Whether a heavy or a light smoker, population level effectiveness reviews such as the Pierce 2012 ARPH study scream that the feeding of replacement nicotine to nicotine addicts is totally ineffective and costing lives.
Mr. President, although mine is currently under arrest, you and I have brain wanting disorders. Dopamine pathways permanently compromised by nicotine have assigned nicotine use the same priority as they assign to eating food. It's the same dopamine pathway wanting, urges and craves felt by the alcoholic, and the heroin, cocaine and meth addict.
We can be embarrassed about our illness, and devote the rest of our lives to trying to hide, minimize or lie about it, or we can become its master and teach others to do the same.
As leader of the free world, aren't you entitled to a pass? No. Not when every year nicotine addiction is the proximate cause of smoke's "but for" cause in fact killing of more than 400,000 Americans. Not after taking two oaths to protect and defend them. Not while your subordinates behave as though your Nicorette captivity is a desired solution, as though employees for GlaxoSmithKline and Pifzer.
Mr. President, at this moment, at most, you stand 72 hours away from inhabiting a nicotine-free body and mind, and moving beyond peak withdrawal. Aren't you the slightest bit curious as to what it feels like to go the distance and again experience days, weeks and then months without once wanting to use?
But we cannot quit for others, including the First Lady. As you know, attempting to do so creates a natural sense of self deprivation that leads to nicotine relapse.
As a nicotine dependent President, you were handed a golden opportunity to study, learn, discover, master, teach and share, to improve the health and lives of millions. My two daughters think no less of dad because of his honesty in admitting his drug addiction. If anything, it's been protective.
And while entirely normal to think that nicotine is the President's stress-buster, that it helps him cope, nothing could be further from the truth. Just one lesson among hundreds, stress and alcohol increase urine acidification. The more acidic the user's urine, the quicker their kidneys eliminate the alkaloid nicotine from their bloodstream.
Mr. President, think back to when you used to change your own flat tires. While the never-smoker reached for a jack, we first reached for nicotine. Remember? Stress acidified our urine adding the onset of early withdrawal to the mix. Once we finished nicotine replenishment, the exact same stressful situation that confronted the never-smoker remained. There was still a tire to change.
You may have seen news accounts of a recent study suggesting that one million American ex-smokers relapsed during 9/11. Each quit while remaining deeply yet falsely convinced that smoking nicotine was a stress-buster. This and many other critical recovery lessons do not appear on any HHS website. Why? Because the primary focus of your subordinates remains nicotine replacement.
It's my hope that you'll demand answers to two questions: (1) how do most American's quit and (2) does the population level effectiveness evidence-base suggest that toying with replacement nicotine is costing lives?
A panel of experts with disturbing financial ties to the quitting products industry was the architect of current national cessation policy. One policy provision consumes all others. It reads: "Numerous effective medications are available for tobacco dependence, and clinicians should encourage their use by all patients attempting to quit smoking."
Mr. President, that policy effectively outlaws cold turkey quitting. It's why there is not one word of encouragement to America's cold turkey quitters on any HHS website, nor one link to any smart turkey quitting site. Instead, at every turn, HHS continues to falsely suggest that their natural instincts in ending nicotine use are wrong, that it's twice as likely they'll fail, that few cold turkey quitters succeed.
I leave you with a link to Neal's online quitting journal. I beg you to read a few entries and then multiply what happened to Neal by the millions of others over the past 4 decades who trusted, believed and toyed with replacement nicotine until too late.
More than 400,000 annual deaths, we owe it not only to NRT's victims but to Neal's 11 year-old surviving daughter and millions of other families, for their government to start telling the truth. There was always only one rule to success, Mr. President. It's that you and I are REAL drug addicts, that for us, when quitting, there's no such thing as just one, or just once, that one puff, dip, vape or chew will always be too many, while thousands never enough.
John R. Polito
Nicotine Cessation Educator