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The Great American Smokeout

John R. Polito

Will Megan take advantage of the Great American Smokeout?Here in the U.S., Thursday Nov. 15th's dawn will herald the 43rd Great American Smokeout and yet another opportunity to quit smoking. But there has been a slight change since the American Cancer Society's first Smokeout in 1976. Over the past four decades the pharmaceutical industry, and more recently the neo-nicotine industry, have taken the liberty of redefining the word "quitting."

Instead of the Smokeout being a day to discover that life without nicotine might actually be do-able -- and the days that follow as well -- over the coming days and weeks millions in marketing will be spent encouraging smokers to spend the day toying with vaping e-cigarettes or pharmaceutical grade nicotine, otherwise known as nicotine replacement therapy or NRT - the nicotine patch, gum, lozenge and inhaler.

As for pharma, the sales pitch is usually two-fold. First, it will be suggested that, in the real-world, use of the nicotine patch, gum or lozenge will double a quitter's chances of quitting for good. Next, it will likely be suggested that quitting cold turkey is extremely difficult, that few cold turkey quitters succeed. Both assertions are false.

As for few cold turkey quitters succeeding, nothing could be further from the truth. Although a bit dated, the American Cancer Society's Cancer Facts and Figures 2003 report indicated that over 90% of all long-term successful quitters quit smoking cold turkey. With 46 million ex-smokers, it meant that more than 40 million Americans had successfully quit smoking cold turkey.

Contrary to it being rare for cold turkey quitters to succeed, a far more accurate and honest quiiting methods representation to make during the 43rd Great American Smokeout would be that cold turkey is the cessation method used by more ex-smokers each year than all other stop smoking methods combined.

As for NRT being twice as effective, it occurred only in formal clinical studies in which researchers gave half of the study group a placebo look-a-like nicotine gum, patch or lozenge. Researchers then pretended the fiction that placebo users with lengthy quitting histories wouldn't be able to tell that they'd received an inert or empty NRT product once in the throws of peak withdrawal (24 to 48 hours), and that their study was blind.

Truth is 3 to 4 times as many placebo group quitters were able to correctly declare their randomised assignment as could not. Truth is, that while placebo is the gold standard in most research areas, when dealing with nicotine addiction it has been a license to cheat and steal.

More than 200 placebo-controlled NRT and Chantix clinical trial efficacy findings measured and reflected nicotine expectations and frustrations, not NRT or Chantix's value or worth, if any. It's why, although little or no controls, real-world stop smoking method findings are vastly superior in helping smokers evaluate both a quitting method's ex-smoker productivity and its population level effectiveness.

California, Minnesota, London, Quebec, Maryland, Australia, the United States, never once in any quitter survey have NRT users generated a higher six month or longer quitting rate than those quitting entirely on their own. Never! But how can that be?

The pharmaceutical and e-cig industries are keenly aware that nicotine is a psychoactive chemical which activates dopamine and adrenaline pathways, and that Chantix is a dopamine pathway agonist too. While patch and Chantix relief are slow, continuous and in the background, the nicotine gum, lozenge and e-cigarettes are capable of generating noticeable dopamine pathway "aaahhh" wanting relief sensations.

NRT and Chantix clinical study participants were often enticed to join by being promised a 50/50 chance of receiving weeks or months of free NRT or "medicine." But half were randomly assigned to a placebo group where they were given an inert patch, gum or lozenge which was normally nicotine-free.

When quitting, every two hours the amount of nicotine remaining in the bloodstream is cut by half. Studies have shown that smokers with any significant quitting history know what it feels like to be deprived of nicotine. Is it possible to blind a study involving a psychoactive chemical like nicotine?

A June 2004 study published in Addictive Behaviors examined blinding assessments during clinical NRT studies and found that they were generally not blind as claimed, as "subjects accurately judged treatment assignment at a rate significantly above chance."

Let's put it this way. If you were a smoker hoping to get weeks or months of free nicotine gum or Chantix, would you have stuck around and allowed yourself to be toyed with by researchers if you were confident that you'd been assigned to the placebo group and your expectations of receiving free nicotine or Chantix had been frustrated?

The opposite is also true. If you were confident that your expectations had been fulfilled in that normal full-blown withdrawal was different or diminished, would you have stayed and taken advantage of the study's quitting education programs, counseling sessions, telephone support, or attended group support (each have their own independent quitting effectiveness), and have generally cooperated with those you knew were your ongoing source of free nicotine products?

What does it all mean? It means that America has spent nearly four decades toying with NRT and nicotine designer drugs when we have little or no basis in science, that NRT and Chantix clinical odds ratio victories were unearned. When combined with real-world quitting survey results, it means that the pharmaceutical industry is raking in billions in profits based upon "double your chances" marketing representations that it knows to be false.

July 2018 PLoS One quit smoking method effectiveness chart

Contrary to marketing innuendo, never once in any clinical study did NRT quitters compete with quitters wanting to quit cold turkey - quitters with every expectation of abruptly ending all nicotine use.

Prior to NRT's arrival, each failed cold turkey attempt forced quitters to listen and learn from the school of hard-quitting-knocks. While it took some longer than others, they would self-discover the "law of addiction," that lapse equals relapse, that just one puff and up to 50% of dopamine pathway receptors become occupied by nicotine, that one puff would be too many, while thousands wouldn't be enough. Not so with NRT, Chantix or e-cigarettes.

What lesson is learned by repeated toying with the very chemical the addict is dependent upon? Sadly, the pharmaceutical industry has known since 1993 that NRT success rates actually decline with repeat use.

A 1993 study examined second-time nicotine patch use, what the industry terms "recycling." In that study 0% of second-time patch users had successfully quit at six months. A second nicotine patch study was conducted in 1995 (see Table III) and in it just 1.6% of second-time nicotine patch users were still not smoking at six months. Sadder yet, neither the FDA or the NRT industry have yet warned repeat nicotine patch users of this rather important finding.

Having failed with the very best "science" has to offer, how could failed quitters not, as a group, ooze deep and profound cessation frustrations.

E-cigarette marketing preys upon nearly four decades of NRT failures and frustrations. It pretends the fiction that real quitting is simply too hard, while borrowing from the pharmaceutical industry in suggesting that if replacement nicotine is medicine and its use is therapy, then so is ours.

There is no money to be made in on-your-own quitting. Cold turkey quitting understandably has few champions. But that isn't entirely accurate. It depends upon your definition of champion. America's cold turkey quitters are over 40 million strong and all 100% nicotine-free.

Why not try thinking of this year's smokeout in terms of nicotine: the Great American Nicotine-Out! We invite you to explore WhyQuit, home to cold turkey quitting!

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WhyQuit.com Joel's Library Turkeyville
Written 11/10/05. Updated 08/23/18.
Reformatted 08/23/18 by John R. Polito