Cold Turkey Twice as Effective as NRT or Zyban
All real-world performance studies to date suggest that expensive nicotine replacement therapy (NRT) products like the nicotine patch, gum and lozenge are a total waste of money. In none have NRT quitters performed better than those who quit smoking without them. Now, a May 2006 study survey has found cold turkey success rates twice as high as among those relying upon the nicotine patch, gum, inhaler or bupropion (Zyban and Wellbutrin).
Published in the May 2006 edition of Addictive Behaviors, the survey analyzed 2002 and 2003 patient quitting method data collected by 1,000 Australian family practice physicians. Patients were asked their smoking status, how long since they had last smoked and which of twelve quitting methods they used during their last attempt.
The study established success rates for each of twelve methods by "dividing the total number of successful patients (former smokers) by total number of patients attempting to quit (former plus current) using that method." In analyzing former smokers, it looked at the quitting method used by each former smoker during their last attempt, regardless of the year in which they quit. In assessing current smokers it looked at their last unsuccessful attempt, so long as it occurred within the prior five years. As shown below, the analysis produced rather high success rates.
Success rates among 2,207 former smokers and 928 current smokers were: cold turkey 77.2% (1,942 former, 575 current); nicotine patch 35.9% (145 former, 259 current); nicotine gum 35.9% (52 former, 93 current); nicotine inhaler 35.3% (12 former, 22 current); and bupropion (Zyban or Wellbutrin) 22.8% (36 former, 122 current).
Not only was cold turkey quitting the most effective method -- doubling the rate of pharmacology quitters -- it was by far the most productive method. Successful cold turkey quitters accounted for 1,942 of 2,207 former smokers, a whopping 88% of all success stories.
In theory, all quitting methods should do at least as well as cold turkey. If not, the method has somehow managed to undermine the quitter's own natural ability to break free from nicotine's grip. The Australian study shows that NRT and bupropion clearly undercut a quitter's odds. Other methods surveyed came closer to keeping pace with cold turkey.
Reported rates include: family physician assistance, other than counseling 60.2% (71 former, 47 current); herbal preparations 63.2% (31 former, 27 current); hypnotherapy 53.5% (31 former, 27 current); support/counseling e.g. "SmokeStop," "Quitline" 44.2% (19 former, 24 current); self-help materials e.g. quit smoking manual 58.5% (48 former, 34 current); other methods not listed 69.8% (81 former, 35 current).
What's amazing is that Australian support and counseling programs actually preformed eight percentage points better than the nicotine patch or gum when those products form the cornerstone of Australian quitting efforts. It demonstrates the effectiveness of quality support. When contrasted to cold turkey, it shows that quitters are not succeeding because of NRT but in spite of it.
A Closer Look at Recent Data
The study notes that bupropion (Zyban/Wellbutrin) was not as readily available as other quitting methods in Australia until February 2001 when it joined NRT in its use being subsidized by the government. This fact caused researchers to take a second look at the data, limiting current and former smokers to those making quit attempts between February 2001 and March 2003.
Once again cold turkey quitters clobbered those toying with pharmacology by a two to one margin: cold turkey 40.2% (269 former, 400 current); nicotine patches 21.5% (52 former, 190 current); nicotine gum 11.4% (8 former, 62 current); nicotine inhaler 22.2% ( 4 former, 14 current); and, the reason for the second look, bupropion 20.8% (30 former, 114 current).
Australian Study Will Be Hidden from Smokers
If the true import of this study were ever shared by a major media source it could cost the pharmaceutical industry billions in profits. That's why it will not happen. Like all prior quitting method surveys it must remain hidden from smokers. It will be buried beside a recent survey of UK smoking cessation services, a support based program specifically tailored to assist NRT and bupropion quitters, but in which a few cold turkey quitters managed to squeeze in.
Published in the April 2005 edition of Addiction, the survey of one-year UK program success rates found that 25.5% of cold turkey quitters were still not smoking, compared to only 15.2% of NRT quitters, 14.4% of bupropion users, and 7.4% of those using both NRT and bupropion at the same time.
It will be buried beside a California study in the September 2002 edition of the Journal of the American Medical Association (JAMA) which concludes "NRT appears no longer effective in increasing long-term successful cessation in California smokers." It will join ignored surveys from Minnesota, Quebec, Western Maryland and London, each evidencing zero NRT advantage over those quitting without it.
Evidence Clinical Studies Fatality Flawed
As the volume of real-world survey evidence demonstrating NRT's total ineffectiveness explodes, our understanding of what went wrong in randomized clinical trials of NRT is becoming clearer. Clinical studies assigned participants to one of two groups - those who were to receive the active NRT device being tested (the nicotine patch, gum, inhaler, spray or lozenge) or to a placebo group which was given an identical looking delivery device that was nicotine free.
Generally clinical trials produced results that were exactly the opposite of those found in the Australian survey. Those assigned to the NRT group normally had six month quitting rates that were roughly double those achieved by the placebo group. But how?
Most quitters joined clinical studies in hopes of getting weeks or months of free NRT products. Although NRT studies were supposed to be blind, in that participants would not be able to identify their group assignment, researchers failed to account for the fact that nicotine is a psychoactive chemical producing a dopamine/adrenaline high. Quitters with any prior quitting history knew what it felt like to be deprived of nicotine.
A June 2004 study reviewed blindness in NRT studies and discovered that only 17 of 73 NRT studies took the time to assess blinding, and that 12 of the 17 (71%) failed their own assessment as "subjects accurately judged treatment assignment at a rate significantly above chance."
An April 2005 study published in the Journal of Consulting and Clinical Psychology examined NRT blinding. It randomly assigned smokers who had no intention of quitting during the next six months to use either NRT or placebo. The assigned objective was to try and reduce daily cigarette consumption by half. After six months participants were asked to guess whether or not they had received nicotine or a placebo. Three times as many assigned to the placebo group correctly guessed placebo as guessed nicotine.
Fraud or Slick Nicotine Marketing?
The pharmaceutical industry intentionally keeps smokers in the dark when it comes to both success rates for second time NRT users and the percentage of quitters getting hooked on the cure. Since April 1993 it has known that almost 100% of second time nicotine patch users relapse to smoking within six months. By November 2003 it knew that 36.6% of nicotine gum users were engaged in chronic long term use. Delivering 25% more nicotine, it has every reason to believe that nicotine lozenge dependency rates will go even higher.
There is a grand widening canyon between NRT truth and reality, between clinical efficacy findings and real-world effectiveness. The burning question has quickly become, is it consumer fraud for the pharmaceutical industry and its consultants to continue to tell those addicted to smoking nicotine that replacement nicotine doubles their chances of success, when they know full well that it doesn't?
Related Links and Articles
- Cold turkey clobbers e-cigs, NRT and Chantix, Polito, JR, 07/18/18
- JNCI study finds pharmaceutical stop smoking aids ineffective, Polito, JR, 12/22/17
- Nicotine cessation: lost in the deserts of Abu Dhabi, Polito, JR, 03/16/15
- 10 studies screaming "leave replacement nicotine alone!" Polito, JR, 01/01/15
- Australia's half-baked quit smoking campaign, Polito, JR, Nov. 30, 2013
- The Great American quit smoking sham, Polito, JR, Nov. 18, 2013
- BMJ's non-publication policy should extend to pharma's nicotine, Polito JR, Oct. 19, 2013
- A letter to Obama: one nicotine addict to another, Polito JR, Sept. 26, 2013
- Gallup Poll: cold turkey 48 times smarter than Nicorette, Polito JR, Aug. 26, 2013
- Cold turkey quitting still king, Polito JR, July 15, 2013
- Pharma bias destroys ITC quit smoking medication study, Polito JR, Aug. 20, 2012
- Potent warnings, horrible quitting advice: what's the CDC smoking?, Polito JR, March 17, 2012
- Replacement Nicotine's Killing Fields, Polito JR, Feb. 11, 2012
- Dying truths about quitting smoking methods, Polito JR, Nov. 14, 2011
- Bias against cold turkey quitting apparent in literature, Siegel, M, Nov. 3, 2011
- Suicidal behavior and depression in smoking cessation treatments, Moore TJ et al, Nov. 3, 2011
- Study finds cold turkey quitting more effective but concludes opposite, Siegel, M, Nov. 1, 2011
- Tar wars over smoking cessation, BMJ Link, Chapman, S, Aug. 8, 2011
- Is a 14% Chantix success rate worth risking death?, Polito JR, June 14, 2011
- Chantix fails to defeat nicotine patch, Polito JR, March 30, 2011
- Chantix serious injuries exceed 8,500, Polito JR, Jan. 29, 2011
- Chantix - Champix worth questioned, Polito JR, Jan. 6, 2011
- How to quit smoking, Polito JR, Dec. 18, 2010
- GlaxoSmithKline continues defrauding smokers, Polito JR, Nov. 2, 2010
- Little communication in failed war against smoking, Polito JR, August 8, 2010
- Addiction to Smoking Nicotine a Mental Illness and Disease, Polito JR, April 12, 2010
- Smokefree.gov really Buymeds.now, Polito JR, March 24, 2010
- American Association of Public Health Physicians Calls for End to Cold Turkey Discrimination, Nitzkin, JL, March 21, 2010
- CDC Ignores Cold Turkey Quitters, Polito JR, March 11, 2010
- New Study Shows That Even Extended Nicotine Replacement Therapy is Extremely Ineffective; Unaided Quitting Rates are Far Better , Siegel M, March 4, 2010
- Four Members of FDA Tobacco Products Scientific Advisory Committee Have Received Pharmaceutical Money; Influence of Industry on FDA Grows, Siegel M, March 2, 2010
- GlaxoSmithKline Given a Seat on FDA Tobacco Products Scientific Advisory Committee, Siegel M, March 1, 2010
- The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences, Chapman S and MacKenzie R. PLOS Medicine, February 2010
- Smoking Racket, ABC.net, Chapman S, February 10, 2010
- Five facts Chantix ads keep hidden, Polito JR, December 29, 2009
- UW-CTRI's Holiday Health Media Manipulation, Polito JR, December 16, 2009
- Petition for Honest Quit Smoking Studies, Polito JR, December 2, 2009
- University of Wisconsin: World's Pharm Nicotine Sales Center, Polito JRWhyQuit, November 12, 2009
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- Tobacco control integrity champ demands review of U.S. cessation policyPolito JR, July 18, 2009
- IN MY VIEW: Effectiveness of Nicotine Replacement Therapy Needs to Be Re-Examined, Siegel M, July 17, 2009
- Nicotine patch inventor fudges patch study findings, Polito JR, July 12, 2009
- Cold turkey trounces pharmacology in GlaxoSmithKline quitting study, Polito JR, July 9, 2009
- Pharmaceutical Money-Related Bias in Smoking Cessation Research is Now Readily Apparent; New Article Demonstrates How This Bias Pushes Medication, Siegel M, July 8, 2009
- Initial National Expert Panel on Smoking Cessation Also Had Severe Conflicts of Interest with Big Pharma; Repeating the Mistake: Inexcusable , Siegel M, April 7, 2009
- New Study Shows that Nicotine Replacement Therapy is Ineffective for Gradual Smoking Cessation, But Concludes the Opposite, Siegel M, January 13, 2009
- Have smokers been hoodwinked and bamboozled by placebos?, Polito JR, Nov. 14, 2008
- Smoking cessation trials, Canadian Medical Association Journal, Polito JR, February 29, 2008
- Pfizer's Chantix Continues Killing Quitters, Polito JR, October 22, 2008
- Chantix and Champix mental health safety assurances contrary to evidence, Polito JR, May 21, 2008
- U.S. quit smoking policy integrity drowns in pharmaceutical influence, Polito JR, May 13, 2008
- Press Release on Smoking Cessation Guidelines Fails to Disclose Financial Conflict of Interest of Expert Panelists , Siegel M, May 12, 2008
- NIH Expert Panel Recommends Smoking Cessation Pharmaceuticals for Every Smoking Patient; Panel Chair and 8 Members Have Financial Ties to Big Pharma , Siegel M, May 8, 2008
- Does updated tobacco treatment "Guideline" reflect sham science?, Polito JR, May 5, 2008
- FDA Chantix Handling Betrayed Public Health, Polito JR, February 29, 2008
- Is Receiving a Placebo the Same Thing as Trying to Quit Cold Turkey? The Limitations of NRT Clinical Trials, Siegel M, March 16, 2007
- Flawed research equates placebo to cold turkey - John R. Polito, 03/07
- Nicotine Fix - Behind Antismoking Policy, Influence of Drug Industry - Kevin Helliker, 02/07
- WSJ Highlights Financial Conflicts of Chair of Federal Guidelines Panel - Michael Siegel, MD 02/07
- Nixing the Patch: Smokers quit cold turkey - Ken Millstone, 02/07
- New Study Challenges Thinking on Use of NRT During Pregnancy - Michael Siegel, MD, 02/07
- Nicotine for the Fetus, the Infant and Adolescent - H.K. Ginzel, MD, 02/07
- The secret to quitting smoking - John R. Polito, 01/07
- Financial Ties Between Guideline Panels and Big Pharma Run Deep - Michael Siegel, MD, 01/07
- Chantix - an 8 in 10 failure rate or worse? - John R. Polito, 12/06
- Do physician's have a legal duty to ignore Guideline Recommendation 7? - John R. Polito, 12/06
- Is the U.S. government's quitting policy killing smokers? - John R. Polito, 10/06
- Will Chantix really help me quit smoking? - John R. Polito, 08/06
- It's unlikely this NRT study was blind - John R. Polito, 08/06
- Conference Sponsorship by Pharma Precludes Objective Symposium - Michael Siegel, MD 07/06
- 13th World Conference on Tobacco or Health Drenched in Nicotine - John R. Polito, 07/06
- Cold Turkey Twice as Effective as NRT or Zyban - John R. Polito, 05/06
- Nicotine Not Medicine, Its Use Not Therapy - John R. Polito, 04/06
- How to use behavorial findings to sell NRT - John R. Polito, 01/06
- GlaxoSmithKline Attacks Cold Turkey Quitting - John R. Polito, 12/05
- UK Guidance for NRT use in pregnancy and by children - ASH London, 12/05
- June 2000 Guideline Chairman Michael Fiore's Testimony - see PDF pages 14 & 15, 05/05
- The Nicotine Patch, Gum and Lozenge - Mounting Evidence of a Sham - John R. Polito, 04/05
- 40 Years of Progress? - Joel Spitzer, 10/04
- Widespread Blinding Failures Put NRT Studies in Serious Question - John R. Polito, 06/04
- Nicotine Gum Maker's Concern Raises Concerns - John R. Polito, 05/04
- A Quitter's Dilemma: Hooked on the Cure - New York Times, 05/04
- Quebec CT Quitters Disprove "Double Your Chances" NRT Assertion - John R. Polito, 04/04
- Are nicotine weaning products a bad joke? - John R. Polito, 10/03
- Is CT Quitting More Productive & Effective than NRT? - John R. Polito, 07/03
- Are Teens Getting Hooked on NRT? - John R. Polito, 06/03
- March 2003 OTC NRT Meta-Analysis Finds 93% Midyear Relapse Rate - John R. Polito, 03/03
- Quitting Methods - Who to Believe? - Joel Spitzer, 2003
- JAMA Study Concludes NRT is Ineffective - John R. Polito, 09/02
- Real-World Nicotine Patch and Gum Rates - John R. Polito, 06/02
- Does the OTC Nicotine Patch Really Double Your Chances of Quitting? - John R. Polito, 04/02
- Is Nicotine Replacement Therapy The Smoker's Last Best Hope? - John R. Polito, 11/00
- Financial Disclosures for June 2000 Guideline Panel - U.S. Public Health Service, 06/00
- June 2000 Guideline Recommendation 7 - pharmacotherapy use by all quitters - 06/00
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