Placebo was never a real-world quitting method

John R. Polito, Nicotine Cessation Educator,
January 12, 2012

Many of Alpert, Connolly and Biener's population level NRT post- cessation findings are disturbing and worthy of further and deeper review. What's most baffling is that any government would invest so much confidence and so many lives in a product without demanding a shred of population level evidence as to its worth.

According to this paper, the odds of relapse for a heavily dependent NRT quitter who had quit less than six months were 3.53 times that of a heavily dependent quitter who quit without NRT or professional help. If true, that puts a rather hefty dent in NRT's most favored failure explanation, its selection bias theory.

This finding makes troubling the fact that varenicline (Chantix/Champix) failed to prevail in long-term point prevalence quitting over nicotine patch in the only head-to-head clinical trials to date (Aubin 2008 and Tsukahara 2010).

Alpert and colleagues do not attempt to explain the conflict between clinical trial and population level NRT findings. But I submit that this outcome was suggested by the first NRT clinical trial ever, the 1971 nicotine gum study by Ohlin and Westling.

Ohlin and Westling found that counseling and support ("ten visits and more persuasion") was superior to nicotine gum alone, but that nicotine gum could defeat placebo gum users. Even then, Ohlin and Westling documented obvious nicotine gum blinding concerns.

Try to name any other placebo-controlled study area where the condition sought to be treated (withdrawal) does not exist until researchers command its onset. Name any other study area where the placebo group is actually punished within 24 hours by a rising tide of anxieties.

Have three decades of referring to nicotine as "medicine" and its use "therapy" undermined natural learning and the quitter's ability to self- discover the most critical recovery lesson of all, that lapse almost always equals relapse, that one puff is too many and thousands never enough?

Nearly all population level quitting method surveys to date have found NRT less effective long-term than quitting without it. If true, are taxpayers today paying to reduce the quitter's odds of success? Are we responsible for undercutting their chances and costing many their lives?

John R. Polito Nicotine Cessation Educator

Conflict of Interest:

Pro bono director of a cold turkey stop smoking website.

Conflict of Interest

None declared