Nicotine Replacement Therapy Part 2

The most commonly used method to reduce the craving and the risk of relapse is to use nicotine replacement medication. The reason it is commonly used is that it has been heavily promoted by the manufacturers. It has nothing to do with its effectiveness, because the majority of independent real-world research shows that it is an ineffective method of stopping smoking.

The theory is that Nicotine Replacement Therapy (NRT) provides enough nicotine to the body to lessen the urge to smoke and remove the worst of the nicotine withdrawal effects. Forms of NRT include chewing gum, transdermal patches, nasal spray, inhalers and pills.

Let’s consider the evidence.

The usual source of evidence concerning drugs is clinical trials. As indicated in the previous post, this source is tainted by company influence and the complicity of university professors who are commissioned to carry out the trials. This highly conflicted situation is accepted as ‘normal’ by the medical fraternity which is in bed with Big Pharma.

We referred to the 2004 review by Drs. Silagy, Lancaster, Stead, Mant and Fowler who reviewed the effectiveness of the different forms of NRT in helping people to stop smoking, or in reducing the amount they smoked. The review considered 96 randomized trials in which NRT was compared to placebo (no active treatment), or where different doses of NRT were compared. The measure used was whether the ex-smokers managed to abstain from smoking for at least six months following treatment compared to a control group of people stopping smoking without NRT. The NRT group were reported to be 1.74 times more likely to abstain than those not using NRT.

The reviewers concluded that all of the commercially available forms of NRT (nicotine gum, transdermal patch, the nicotine nasal spray, nicotine inhaler and nicotine sublingual pills/lozenges) are effective as part of a strategy to stop smoking. They stated that NRT increases stop rates by approximately one-and-a-half to two times. If true, that would be positive proof that NRT is an effective medical approach to stopping smoking. Unfortunately, there are issues with the study that make such a conclusion highly debatable.

There are many problems with this study and other studies like it.

First, there is the Sweetener Effect. Sweetened investigators produce sweetened findings.

Another trouble with these kinds of controlled clinical studies is the method. The investigators are proud to claim that the study is “double blind”. In theory, this means that neither the investigators nor the participants know which condition they are in, treatment or control. This prevents biasing the results by expectations and beliefs about the drug effects. The trouble is that the participants may not really be ‘blind’ and they have ways of telling when they are in the placebo group and they respond differently for this reason.

A third problem is that the findings of randomised trials is that the conditions are artificial and the findings from clinical trials rarely hold up in the real world. Evidence from real world studies shows that NRT is ineffective as a method of stopping smoking.

An excellent source of information on the scientific literature on real world studies can be found at http://whyquit.com.

A Gallup Poll national survey in 2013 found that only 1 in 100 successful ex-smokers credited nicotine gum for their success, with only 8 percent quitting with any approved product, and that more quit smoking cold turkey than by all other methods combined. As early as September 2002, the Journal of the American Medical Association reported that: “Since becoming available over the counter, NRT appears no longer effective in increasing long-term successful cessation in California smokers.”

This must be true today not only in California but everywhere in the Western world.

Other available products exceed the effectiveness of NRT including cytisine, an alkaloid extract from the laburnum or golden rain tree (Laburnum anagyroides), which grows all over Europe.  Even Robert West is “enthusiastic about cytisine’s potential saying that “it is the biggest news in smoking cessation treatment ever…Here is a pill that can be produced for next to nothing, that can be bought by even the poorest smoker in India, and that can save literally millions of lives.”

To conclude:

Clinical trials are run by professors with conflicts of interest leading to a Sweetener Effect. The reported results are untrustworthy.

Clinical trials that have supported the use of NRT all suffer from the Sweetener Effect and are all untrustworthy.

Real world studies of NRT consistently show that NRT is no more effective than a placebo.

NRT is not an effective method of stopping smoking and should be avoided.