More hard evidence that NRT doesn’t work

Black and white photo of an old man smoking a cigarette with a message asking Is NRT costing lives?

The data of a eruption Real-world smoking cessation studies suggest that nicotine replacement therapy (NRT) compromises successful quitting. Surprisingly, the latest study begins with the assumption that NRT is 25% less effective than quitting without help.

Entitled “Effectiveness of smoking cessation aids: A population-based survey in England with 12-month follow-up, 2015-2020(Jackson 2022), the study is available as a Open access PDF proposed by the journal Addictive Behaviors.

The Jackson 2022 authors begin by noting that while NRT has been shown to be effective in randomized clinical trials, “what is observed under trial conditions does not necessarily generalize” to real-world conditions, that data from observation are needed to establish efficacy.

“This is essential to inform treatment providers and enable smokers to make informed decisions,” they wrote.

In the background, three of the same researchers have already analyzed the United Kingdom twice earlier”Tobacco Toolkit Study“Survey Data (STS) Assessing the Effectiveness of Over-the-Counter NRTs (WayBack Link 2015).

A Mayo Clinic Proceedings Study 2014 (Kotz 2014) was a cross-sectional study examining 6-month follow-up STS surveys combined with data from 2006 to 2012. The authors found that “compared to smokers not using any of the cessation aids”, “the use of NERs purchased without a prescription were associated with a lower likelihood of abstinence (odds ratio, 0.68; 95% CI, 0.49-0.94).

A 2019 Addiction The study (Jackson 2019) looked at STS data from 2006 to 2018 and found that by comparing 8,348 people who quit unaided to 5,206 people who quit over-the-counter, the smoking abstinence rate unadjusted was 16.8% for people quitting without help and 11.6% for over-the-counter (free full text) NRT users.

Now, back for a third look, a more prospective 12-month follow-up involving STS data from 2015 to 2020, Jackson 2022 found that the unadjusted odds of quitting OTC NRT were 43% lower than quitting unaided (odds ratio, 0.57, 95% CI, 0.39-0.84) and 40% less for prescription NRTs (odds ratio, 0.60; 95% CI, 0.37 -0.98).

Jackson 2022 then heavily adjusts the raw results for potential confounders before submitting the adjusted results to Bayes factor analysis. It does this based on the assumption that NRT would be 75% as effective as quitting unaided (OR = 0.75), “a point between the effect sizes observed in studies indicating rates of lower quitting rates associated with these aids in smokers motivated to quit.”

Running Jackson 2022 Fully Adjusted and Highest NRT Odds Ratio Discovery (Model 3) via a Bayes Factor Calculator using 2.0 instead of 0.75 as the “tested hypothesis”, the result is a Bayes factor of 0.012, suggesting that those who tell smokers that NRT doubles their chances are almost certainly saying a “killing fields“phew.

By the way, doing the same calculation using “double your odds” and the unadjusted results from Jackson 2022 (Model 1) produces a Bayes factor of 0.07.

Twenty years ago, a JAMA 2002 study concluded that “Since becoming available over-the-counter, NRT no longer appears effective in increasing long-term smoking cessation success among California smokers.” How many more years before the NHS, FDA, CDC, NCI, SmokeFree.gov, WHO, ACS, Permanent Kaiser and GlaxoSmithKline stop shouting the lie that NRT “doubles your chances”?

Jackson 2022 subjects the raw results to “rigorous adjustment” for “potential confounders” including age, gender, occupation, employment status, education, subjective strength of cravings or desires. they drink alcohol.

While this is certainly a laudable goal – increasing the likelihood that TRN is actually the cause of decreased quitting success – when has TRN ever been advertised or sold on the basis of an adjustment factor included?

In fact, a July 2022 study analyzed 33,077 dropouts and found “no evidence of significant interactions between treatment outcomes and participant characteristics, type of NRT, or dose of NRT”.

I’m sure the authors would agree that the external validity and generalizability of observational stopping method efficacy survey results generally reflect “your odds” much more than clinical trial efficacy results. highly contrived placebo controlled for weeks or months of free nicotine replacement like study recruitment bait.

The unadjusted results from Model 1 of the study reflect “the full impact of real-world variability.”

This third study in the Tobacco Toolkit fits perfectly into Quitting Smoking, Weapons of Mass Distraction, a study just released. free open access book by the teacher Simon Chapman (CV)the former editor of BMJ Tobacco Control magazine.

There, with one hand tied behind his back (efficiency), Chapman bludgeons the smoking cessation industry with a single quit method factor (productivity). Jackson 2022 highlights both.

Aside from winning the effectiveness of unaided quitting, in the country with likely the highest rate of use of approved quit smoking products, among the limited group of STS dropouts analyzed by Jackson 2022, Among the 257 dropouts most likely to have stopped their chemical addiction to nicotine (disqualifies 93/100 e-cigarette users still addicted) 158 or 61% did so without help.

Chapman also notes how quitting method survey questions about the most productive method in the world (cold turkey) mysteriously disappeared.

Since cigarettes are not an addictive drug, do the last STS 2022 Survey Questions to understand “Cold Turkey” Where “abrupt and complete cessation of nicotineof the 22 quitting methods listed to the question: “If any, which of the following methods did you try to help you quit smoking during the last serious quit attempt?”

The short answer? No. Divide and conquer, the STS survey seems never done. He totally ignores the giant turkey in the room.

Originally funded by GlaxoSmithKline and Pfizer and created by Robert West (resume), a paid consultant for GlaxoSmithKline, Pfizer and Johnson & Johnsonpeople who quit via England’s most productive quitting method are forced to read beyond NRT, Zyban, Champix, Zyn, On!, Nordic Spirit, Velo, Lyft, Skruf, hypnotherapy, acupuncture, e-cigarette , burn-free heating cigarette like iQOS , and Juul before scratching my head deciding to choose between none of these, other or I don’t know.

As if written for the benefit of the Neo-Nicotine industry, the survey is useful in providing answers about transfer, replacement and switching between various nicotine delivery devices, but not the quitting, recovering from nicotine addiction or actually quitting.

He echoes the abstract of the Jackson 2022 study presenting the results of varenicline while relying on his hypothesis of defeating the Bayes factor NRT by declaring his NRT results “inconclusive”.

It does so despite the study documenting 5 times more NRT users than varenicline users (270 versus 54) and while noting that in 2021 Pfizer recalled varenicline globally due to contamination. carcinogen and that “it is not yet clear whether varenicline will re-enter the UK market.”

Quoting the first paragraph of Jackson 2022, “Cigarettes are especially deadly, ultimately killing up to two-thirds of people who smoke them nonstop.” “People live much longer when they quit, regardless of their age when they quit – but the earlier they quit, the more years of life expectancy they gain.” “Maximizing the success of each quit attempt is therefore of crucial importance.”

Three NRT STS strikes and you’re out? I myself have failed the NRT four times and have been feverishly following this topic since the last introduction of nicotine into my bloodstream on May 15, 1999 at 10pm EST, I have not been holding my breath.

As a retired lawyer, I can’t help but wonder how much longer until the legal profession wakes up to the possibility that over the past 4 decades, millions of nicotine addicts could have unnecessarily lost his life because pharma, its army of mercenary PhD students and gullible health care bureaucrats have conditioned them to believe that nicotine is medicine, its therapeutic use and that it doubled their odds.


Thumbnail photo of John R. PolitoJohn R. Polito earned his Juris Doctor degree from the University of South Carolina Law School in 1985, where he graduated Wig & Robe. He’s a 3 pack a day ex 30 smoking and the founder in 1999 of whystop. A nicotine cessation educator since 2000, John has been mentored by Joel Spitzer for two decades, featuring over 100 live nicotine addiction recovery programs inspired by Joel’s programs. He is the author of “Breaking Free From Nicotine – The Journey Home,” “smart turkey” and 6 peer-reviewed journal articles. John is the founder and director of Turkeyville, a 15,000-member Facebook support group exclusively for people giving up cold turkey. Email: [email protected]



Knowledge is a method of surrender

Maria D. Ervin