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Sincere thanks, Dr. Borland, for your insightful comments recognizing
the inherent conflicts between harm elimination and reduction, between
policy and profits. As a nicotine cessation educator monitoring the
latest wave of irresponsible harm reduction marketing, I have grave
concerns that we are only one youth fad away from seeing adolescent
nicotine dependency rates skyrocket.
Nicotine addiction is every bit as permanent a disease as alcoholism.
It is a wanting disorder in which brain dopamine pathways assign the same
use priority to nicotine as they do to eating food. But instead of
desiring food 2 to 3 times daily, imagine feeling wanting, urges or craves
15, 20 or even 30 times daily. Imagine that next fix quickly being life's
#1 priority, no longer being able to recall the beauty of going weeks,
months and years without once wanting for nicotine.
Marketing suggesting that replenishment anxiety relief is "pleasure"
is akin to suggesting that it feels good to stop pounding your fingers
with a hammer. We are also seeing laughable harm reduction marketing
centered on the concept of "freedom," or that nicotine is as safe as
U.S. First Amendment commercial free speech concerns will likely
trump marketing control initiatives. In nations where non-profit control
is possible, history suggests that keen awareness as to financial
conflicts among those permitted to define policy is critical if dependency
onset avoidance and effective cessation are goals.
Your government agenda concerns are warranted, Dr. Borland. Nearly
four years since passage of the U.S. Family Smoking Prevention and Tobacco
Control Act and we have yet to see any meaningful change. Imagine 400,000
annual smoking related deaths and no sense of political urgency.
Imagine knowing that NRT shows efficacy against placebo in studies we
know were not blind, while totally ignoring NRT's population level
ineffectiveness evidence-base, and the prospect that three decades of
feeding replacement nicotine to nicotine addicts may have cost millions
I am convinced that replacement nicotine has effectively destroyed
cessation. Having watched decline in adult smoking grind to near
standstill, we now watch as the frustrated harm reductionist throws
cessation under the bus.
I live in a nation where this year cold turkey is again expected to
generate more successful ex-smokers than all other methods combined. Yet,
locating any researcher curious as to the keys to successful abrupt
cessation is mission impossible. If neo-nicotine industry influence is
allowed to define government's harm reduction agenda expect more of the
I submit that advancing delivery technology and declining prices are
already heralding the cigarette's demise. As the cigarette industry moves
toward enhanced smokeless, NRT and electronic nicotine delivery, the
pharmaceutical industry is moving from cessation into maintenance. Market
forces are causing it to occur without intervention.
But if heroin were legal would we allow it to be marketed in front of
children? An immediate priority should be to compel stores to choose
between marketing one of the planet's most captivating chemicals and
having adolescents as customers. How hard would it be to pass local laws
requiring that "all" nicotine products be sold inside clearly marked
nicotine sales locations, where underage youth may not enter? Anyway,
well done, Dr. Borland, in encouraging this much needed discussion.
Director of an abrupt nicotine cessation website and author of "Freedom from Nicotine - The Journey Home"