The future of tobacco

Unchallenged, we’ve watched the harm reductionist experiment with,
declare themselves experts in, and destroy smoking cessation. Now they
want an even bigger playing field. Today they seek to destroy tobacco
control as we know it. Many have already joined forces with tobacco and
pharmaceutical interests in promoting the world’s most addictive
teratogen, while labeling those dedicated to helping nicotine addicts
break free as "quit or die" fanatics.

Reigning in the harm reductionist isn't a matter of “quit or die”
attitudes but recognition of the tremendous drain of devoting an entire
life to chasing and keeping-up with nicotine’s two-hour blood-serum half-
life. It's a willingness to weigh the price paid by a billion
malfunctioning minds that have been chemically compelled to greet news of
mother’s death with a nicotine induced dopamine "aaahhh" reward sensation.
How do we compare the price of present chemical servitude to risks of
future harm when making policy decisions?

Imagine mandatory nicotine induced adrenaline releases never again
allowing you to know or experience extended periods of prolonged mental
quiet or calm. Imagine the irony of a mandatory adrenaline rush before
bed. Imagine every stressful acid producing event neutralizing reserves
of the alkaloid nicotine, and inducing early withdrawal. Imagine a flat
tire compelling you to reach for nicotine instead of the jack.

Demanding rock solid evidence isn’t about quit or die attitudes but
about serious concerns over students already using NRT to get through the
school day, only to reach for smoked nicotine’s massive bolus and
unmatched speed when the bell rings. Imagine the impact upon youth
dependency rates once billions in potent "clean-nicotine" harm reduction
marketing begins touting the newest candy flavoring, boasting the latest
speed breakthrough in "stirring the senses," in proclaiming weight loss
benefits, or better grades through enhanced alertness.

Before the world again puts all its eggs in one basket -- as done
with NRT – those advocating change must be compelled to established youth
and adult nicotine use baselines in as small a geographic area as they
like, and then put their harm reduction theories to the test by producing
any real-world benefit. It is a feat that NRT has yet to accomplish in
any six-month or greater quitting survey.

It’s one thing to notice so many Swedish men using snus, another to
notice that Swedish women don’t, and pure theory to believe that a
transfer campaign would produce substantially greater good than harm.

The author fails to mention that the tobacco industry is already
resigned to moving toward delivery of pharmaceutical grade nicotine.
Won’t harm reduction then also be compelled to advocate their interests?
We’ve already seen PM USA documents on how it plans to evolve into a
pharmaceutical company. It’s off to a good start. PM USA has actually
grown US market share after pulling all magazine cigarette ads and
replacing them with its TV and magazine “trust us” campaign.

It isn’t a matter of a "quit or die" mentality but of having already
watched harm reductionists combine forces with pharmaceutical interests to
push clinical replacement nicotine down the cessation world’s throat.
Well intentioned or not, they actually helped destroy thousands of vastly
superior quitting programs around the globe. They named it right from the
beginning - replacement nicotine - and instead of doubling cessation as
promised it has brought US national cessation rates to almost a
standstill.

Prior to NRT, both the UK and US had abrupt cessation programs
producing one year rates in excess of 25%. In fact, Table 6 of Janet
Ferguson’s “The English smoking treatment services: one-year outcomes,”
Addiction. 2005 April;100 Suppl 2:59-69, notes that while 15.2% of NRT
quitters were still not smoking at 1 year, 25.5% of those quitting cold
turkey succeeded in doing so. A rather important yet ignored fact.

Imagine having a clinic program producing a fairly steady 30% one
year rate, where every quitter ended all nicotine use together and was on
the exact same recovery page. Imagine the beauty of watching the group
feed off of each shared symptoms and motivations as they navigated the up
to 72 hours of nicotine detox. Imagine seeing their faces as peak
withdrawal passed, the anxieties started to diminish, and the number of
crave trigger encounters declined. Imagine the awe of watching them for
the first time begin to sense and believe that life without nicotine might
actually be doable.

Enter the sincere harm reductionist and profit driven pharmaceutical
company with a half-baked NRT quitting theory and a long-term vision of
clean "replacement" nicotine for all. But unlike clean(er)-delivery harm
reduction implementation, they first had to prove that NRT would actually
aid smoking cessation. But how?

In clinical studies they quickly discovered that nicotine was a
psychoactive chemical producing alert dopamine/adrenaline intoxication.
It made it all but impossible to use placebos to produce blind "science-
based" studies. Instead, they resorted to either the extreme of actually
employing nicotine as a placebo device masking agent, with zero
preliminary testing of how doing so would compare to normal rates of
abrupt cessation, or dispensing with blinding assessments altogether.

But by the time the nicotine spray and inhaler came along someone
realized that if you wait and do your blinding assessment at the 1 year
mark, instead of early in the study when most of the placebo group was
dropping and memories were still fresh, that just maybe, the figures would
look a bit better. The bottom line is that in the end it didn't matter
whether or not the studies were blind. Marketing simply declared to the
world that they were while science turned its head.

It's been a year since Mooney’s blinding assessment survey revealed
that NRT studies were not blind. Since then we’ve seen zero concern by
health policymakers or regulators that NRT’s odds ratio victories were
likely unearned, which would validate a host of real-world surveys where
NRT showed zero advantage. We’ve also seen zero remorse for the
intentional destruction of the world's cessation programs by declaring
them non-science-based, getting funding sources pulled, or destroying
their effectiveness by having them invaded by addicts under the influence
of nicotine.

We now know that unassisted OTC NRT use generates just 7% at six
months. We know that almost all NRT is today used unassisted. We know
that quitting rates for second-time patch users drop to near 0%
(Tonnensen, Addiction, Apr 93 and Gourlay, BMJ 1995). With millions of
smokers now having attempted patch cessation more than once it’s shocking
that those who have created this mess remain silent. How many thousands
have needlessly died? We could reverse the tables and declare their
agenda to be "clean-nicotine or death" but we won't.

We cannot continue to allow science to be perverted or again throw
out the baby with the bath water in order to test yet another half-baked
theory. This time science should demand "real" science first.

John R. Polito

Competing interests:
None declared