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2018 findings: cold turkey trounces
Nicoderm CQ, Chantix, Nicorette and e-cigs

December 27, 2018   John R. Polito

How are most smokers quitting and which stop smoking method is most effective? Although fundamental questions, the initial problem is, who to believe.

Should smokers blindly trust winner proclaiming headlines atop articles such as this, or engage in a bit of digging, reading, fact checking and reflection?

For example, the next Nicoderm CQ nicotine patch commercial you see is likely to shout "DOUBLES YOUR CHANCES OF QUITTING" across the screen at the 23 second mark. But is it true?

What GlaxoSmithKline's Nicoderm commercials don't share is an astrick following their "double your chances" claim. But, guess what? Under the FAQ heading "Why not quit cold turkey?" the Nicoderm CQ and Nicorette websites both do.

There, it states "*Doubles your chances of quitting vs. placebo."

Which is more honest and reflective of quitting, defining "your chances" as a product's clinical efficacy versus users of a placebo look-a-like, or how it performs under real-world conditions against all other quitting methods, by all types of smokers? In other words, the method's population-level effectiveness.

Current Chantix commercials go beyond "your chances" word games. During 2018, Pfizer hired Goodfella's star Ray Liotta, one of America's toughest tough-guys, to openly admit that, prior to Chantix he wasn't tough enough to quit on his own.

The ad campaign's message is simple. If tough guy Ray couldn't quit without Chantix, then how in the world can you?

But did Ray really quit smoking by using Chantix?

Ray Liotta's 2016 Facebook and Instagram posts claim that he quit smoking when his daughter was four, which occurred in 2002. The problem is, how could Ray have taken Chantix in 2002 when it wasn't approved by the U.S. Food and Drug Administration for sale until 4 years later in 2006?

2018 Quitting Champion - cold turkey prevails over Chantix, Nicoderm CQ, Nicorette and e-cigs

2018's Overall Winner: Cold Turkey

Clearly, 2018’s most intensely researched quit smoking issue was whether e-cigarettes are more effective than NRT (the nicotine patch, gum, lozenge) or prescription pills (Chantix or Zyban).

Surprise! The 2018 quitting method study winner was once again cold turkey, the undisputed real-world quitting champ since invention of the cigarette-making machine in 1847.

In fact, cold turkey prevailed in the only two 2018 quitting studies in which it was allowed to participate: Weaver et al and Benmarhnia et al.

Weaning only half as effective as abrupt cessation

Among unassisted quitters, the 2018 Weaver study found abrupt smoking cessation was twice as effective as gradual weaning or cut-down approaches. While the Benmarhnia study waters down cold turkey's success rate by combining it with less effective gradual weaning under the heading "No Aid Used," it still prevails over all other quitting methods.

Abrupt cessation's superiority over weaning is a critically important recurring fact. Why? Because, crave reduction aside, stepped-down nicotine weaning is presented as the scientific basis as to how replacement nicotine (NRT) works. But, again, don't take my word for it.

Visit GlaxoSmithKline's Nicorette.com website. Click on "How does Nicorette work?" There, it states, "As your body gradually adjusts to getting less nicotine, you’ll step down the amount you take until the day when you don’t need any at all."

Although less delivery control than when using nicotine gum, the lozenge, or e-cigs, the nicotine patch is a weaning scheme too.

At NicodermCQ.com, click on Nicorette CQ FAQ (upper right) and then question #2. There, we read: "If you smoke more than 10 cigarettes a day, follow the 10-week plan. Use NicoDerm CQ Step 1 (21 mg) for 6 weeks, NicoDerm CQ Step 2 (14 mg) for 2 weeks and NicoDerm CQ Step 3 (7 mg) for 2 weeks. If you smoke 10 or fewer cigarettes a day, follow the 8-week plan. Use Step 2 (14 mg) for 6 weeks and Step 3 (7 mg) for 2 weeks.

2018's Effectiveness Champion: Cold Turkey

Cold turkey not only clobbered cigarette weaning in Weaver, it doubled Chantix and e-cigarette rates, while tripling nicotine patch, gum,and lozenge performance.

And in Benmarhnia, not using any quit smoking aid was twice as effective as e-cigarettes or NRT in helping quitters end all tobacco use.

2018's Productivity Champion: Cold Turkey

Effectiveness aside, what about productivity? Which method generated the most successful quitters? The winner again, cold turkey.

In Weaver, cold turkey generated 10 times as many ex-smokers as NRT, twice as many as e-cigarettes or gradual weaning, and 10 times as many as prescription medications (Chantix and Zyban combined).

Cold turkey productivity was even higher in the Benmarhnia study where Table 5 indicates that roughly 80 percent of 283 smokers who successfully ended all tobacco use, did so without resort to e-cigs or any approved stop smoking aid.

Making Sense of Contrary Clinical Trial Findings

So, why does cold turkey demolish the competition in real-world quitting yet fail to prevail inside randomized clinical trials?

A large and extremely loyal group of pharma-funded university PhD cessation researchers have devoted decades to helping GlaxoSmithKline and Pfizer make billions off of placebo-controlled smoking cessation trials.

Never biting the hand that feeds them, having tied their research reputations to pharma, what they've kept silent about for decades is the fact that their placebo-controlled studies were not blind as claimed, that their studies did not recruit or include smokers wishing to quit cold turkey, and that their findings are in serious conflict with how approved products are used and performing under real-world conditions.

And then, along came an unlikely benefactor, the e-cigarette. Fueled primarily by the lure of billions in profits, the e-cigarette’s exploding popularity demanded and forced head-to-head quitting method comparisons. The problem? While pharma and its PhD army had successfully attacked or helped suppress scores of cold turkey victories over the years, what possible explanation could they invent for continuing to ignore the entire real-world quitting picture?

Let's start with the basics. Ask yourself, if you wanted to quit smoking cold turkey, would you join a formal clinical study dangling free NRT, Chantix or Zyban as study recruiting bait? Neither did they.

If you were an experienced quitter who’d become expert at recognizing full-blown withdrawal within 24 to 48 hours of quitting, if you had joined an NRT study, would you have been able to quickly tell whether or not the nicotine gum you’d been given was instead a nicotine-free placebo? So could they.

And how would you have felt as you came to realize that the timing and content of counseling and support within the clinical trial was tailored to help NRT or Chantix users succeed, not to benefit the dopamine deprived placebo group?

Sadly, thirty-three years of randomized clinical trials had absolutely nothing to do with "your chances" and everything to do with an addict's expectations.

Surveys Need Correcting

Smokers deserve richer population level quitting data. What’s needed is for unbiased and independent researchers to go back and repair all quitting method surveys in which it’s becoming glaringly obvious that pharma-influence had a hand.

Knowing that most smokers quit cold turkey, if you were writing a quitting method survey, would one of your many quitting method questions ask participants if their last quitting attempt was cold turkey, defined as the abrupt and complete end of use of all nicotine or tobacco products, without use of any quitting medication?

Look closely at the U.S. Department of Health’s 944 page 2018 PDF version of the U.S. Population Assessment of Tobacco and Health (PATH) survey. Also examine the 2015 Word version of England's Smoking Toolkit survey.

Written by university researchers beholden to pharma-funded research, search either document for any reference to cold turkey, abrupt cessation or unaided or unassisted quitting. Now search for questions about the nicotine patch, gum, lozenge, Chantix, Zyban or e-cigarettes.

Why zero mention of cold turkey while filled with questions about other quitting methods? Because a complete and accurate quitting picture would devastate pharma’s cessation financial interests, demolish the Food and Drug Administration's quitting product approval reputation, suggest that the CDC has spent three decades promoting failure, relapse and disease, and possibly cause Parliament to consider defunding NHS Stop Smoking Services, where participants are all but force fed quitting products.

Ask yourself, like gradual weaning schemes generally, if the only thing over-the-counter replacement nicotine products double is relapse, during the 33 years since the FDA first approved Nicorette gum, how many millions of smokers lost their lives by repeatedly buying into the NRT lies that nicotine is "medicine" and its use "therapy"?

It's why, sadly, the PATH and Toolkit surveys must continue to ignore the giant turkey in the room. It's why Philip Morris has long proclaimed that NRT is the key to quitting. And it's why, with Big Tobacco buying up the e-cig industry, studies like Weaver and Benmarhnia will become rarer and rarer.

I, John R. Polito, am fully and solely responsible for the content of this article. Any factual error will be promptly corrected upon notice emailed to john@whyquit.com

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Written 12/27/18 and last revised on 12/27/2018 by John R. Polito