Saturday, April 4, 2009

Quitting smoking with NRT, 1.6% success rate

The tobacco industry has been roundly condemned for alleged unethical research conduct for decades. As the association between smoking and lung cancer began making news back in the fifties, some tobacco companies conducted their own research which showed contradictory results. Shame on those nasty tobacco companies, the money grubbing bastards.

They sponsored scientific conferences and published their studies in medical journals. And, it was not uncommon for members of the medical profession to lend their support to one particular brand of cigarettes or another. Shame on those nasty doctors, the money grubbing bastards.

That’s all changed now. Nowadays, it’s more likely to be the pharmaceutical industry that’s fudging the facts on the “scientific” evidence. And, the drug companies can put more spin on a study than a Nolan Ryan fastball. Shame on those nasty drug companies, the money grubbing bastards.

And, shame on the anti-smoker cult for promoting useless interventions on behalf of their puppet masters in the pharmaceutical industry.

Every anti-smoker group in the country is pushing smoking cessation drugs and nicotine replacement therapy; Physicians for a Smokefree Canada, the Canadian Lung Association, the Non-Smokers Rights Association, etc. Doctors push the product on patients and even government health agencies like the Ontario Ministry of Health Propagan . . . er, Promotion endorse the use of the stuff.

And, it’s not just in Canada. It’s a worldwide phenomena, with drug company shills in the anti-smoker brigade pushing pharmaceutical nicotine from Montreal to Madagascar; Toronto to Timbuktu.

Wouldn’t it be funny if the stuff turned out to be as useless as teats on a bull? Do you think anybody would be embarrassed? No? OK, so you’re right. They know no shame.

Now, the anti-smoker cult is quick to tell us that the vast majority of smokers really want to quit. Unfortunately, they are often less than honest in the information they provide to the public. And, I’ve read some of their studies and their math often leaves something to be desired . . . like a sixth grade education.

But, I have no doubt that there are, indeed, many smokers who would like to quit. Some might want to quit for health reasons; others may be growing weary of the de-normalization campaign of the anti-smoker cult and the social exclusion it represents. Smoking is banned in most social settings, and in most workplaces. Even smoking outdoors is becoming a hassle.

In fact, smoking bans are interfering with more and more aspects of a smoker’s life. So, it’s not surprising that some would rather switch than fight and start waving the white flag.

However, human nature dictates that we look for the easiest, least painful means of accomplishing any goal, including any decision to quit smoking. So, those smokers become easy targets for the marketing strategies of the pharmaceutical industry and their sales representative in the anti-smoker brigade.

But, just how effective is nicotine replacement therapy in accomplishing the objective?

Well, according to one study, it isn’t. Effective that is. Well, OK, it’s more effective than sugar pills or gummy bears, but . . . OK, OK. So, it wasn’t tested against gummy bears, but you get the point, right?

The study was called: “Effectiveness and safety of nicotine replacement therapy assisted reduction to stop smoking: systematic review and meta-analysis”. Hasn’t that got a nice ring to it? Very . . .er, scientific.

The study reviewed several trials which enrolled a total of 2,767 smokers given either nicotine replacement therapy for 6 to18 months or a placebo.

The percentage of smokers who managed to stay off cigarettes for six months with nicotine replacement therapy (NRT) was 6.75%, compared to 3.28% for those given a placebo. Uh-huh. 3.28% managed to quit using a sugar pill. (I wonder how many heroin addicts could give up their habit using a placebo.)

The percentage still not smoking at final follow-up after one year was 1.6% for the NRT group, compared to 0.4% for the placebo group.

From this, the authors of the study conclude: “Available trials indicate that nicotine replacement therapy is an effective intervention in achieving sustained smoking abstinence for smokers who have no intention or are unable to attempt an abrupt quit. Most of the evidence, however, comes from trials with regular behavioural support and monitoring and it is unclear whether using nicotine replacement therapy without regular contact would be as effective.”

Hmmm. Does that mean nicotine replacement therapy would be even less effective without “behavioural support and monitoring”? Might the placebo have actually out-performed NRT?

Just how hard were the authors of this study laughing when they wrote the part that says “nicotine replacement therapy is an effective intervention?” Was it a little chuckle, a rumbling guffaw or were they actually rolling on the floor laughing their asses off? Shame on the money grubbing bastards..

Oh, yeah, one of the study authors, Paul Aveyard, admits to receiving compensation from the Swedish drug company (McNeil) which sponsored the initial trials used in their report. But, conflicts of interest, whether real or perceived, are par for the course these days. Although the claim that NRT is an effective intervention does suggest some bias might be present.

I wonder if Health Canada will make the makers put a disclaimer on their packaging. You know, something simple, like: “Warning: This product is totally useless 98% of the time.”

Yeah, you’re right. It’ll never happen. You pay your money and you take your chances, folks.

PS You can read more about the study on Dr. Michael Siegel’s blog, Tobacco Analysis.

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