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Whyquit.com: Factually Inaccurate, But Doing Some Good Nonetheless

July 29th, 2009 by Jonathan Foulds, Ph.D. in Better Health Network, Health Tips
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Last week marked the 10th anniversary of a smoking cessation website called “whyquit.com”. Now those of you who know me, and know that website and its director, Mr John Polito, may wonder why I’m choosing to give it some free publicity. The website is strongly against the use of all pharmacological aids for smoking cessation, and some would argue that it does harm by misinforming smokers about the harms and benefits of these smoking cessation aids. However, although I certainly do agree that the site does misinform about pharmacological aids, it also has a number of positive qualities and presents a different perspective that may appeal to and help some smokers.

The site started 10 years ago primarily to tell the story of a few individuals who were killed very young by smoking caused diseases. The idea was to vividly tell their tragic stories and to inspire others to quit tobacco and so avoid the same. In 2000 Joel Spitzer, an experienced smoking cessation counselor and author joined whyquit and the site took on more of a role of advising smokers how to quit using a very clear philosophy based on the “cold turkey” method.

The site has a large amount of educational material, including free pdf copies of lengthy books by Polito and one by Spitzer. The descriptions of individual cases of tobacco-caused diseases are informative and will inspire some to avoid the same harrowing experience. The site also has a discussion forum called, “Freedom from nicotine.” But once again the fundamentalist opposition to the use of pharmacotherapy aids is evident in the rules for use of “Freedom from nicotine”. The site states that,

“A single-minded program, those applying for posting privileges must have quit all forms of nicotine delivery cold turkey within the past 30 days, without use of any products, pills or procedures, and remained 100% nicotine-free for at least 72 hours. A nicotine-free forum, any nicotine relapse – even one puff, dip or chew – permanently revokes posting privileges.”

This is a rather unusual requirement for people to use a quit smoking discussion site, and it seems rather odd to ban people “permanently” from using the discussion forum, because they had a puff or chewed a piece of nicotine gum.

The site contains a large number of factual inaccuracies, particularly when referring to research on the use of pharmacotherapy for smoking cessation and the evidence on it. There are too many examples to mention, but just to mention a few:

– the site states that nicotine withdrawal lasts 72 hours. Most studies of nicotine withdrawal symptoms find these to be significantly raised after the first week, and typically not returning to normal levels for 3 weeks.
– The site asserts that in “real life” studies nicotine replacement therapy doesn’t work and “cold turkey” always produces a higher quit rate. An example of a study refuting that claim is provided below (West and Zhou, 2007)
– The site asserts that placebo-controlled trials of pharmacological treatments are all severely flawed because participants can sometime guess better than chance (.e.g. because the medicines work so well at treating nicotine withdrawal that participants can tell what the got, so the study is not perfectly “double blind”). On this point the site is somewhat out on a limb as most scientific research bodies regard the randomized placebo-controlled trial as amongst the best ways to find out if a drug treatment works or not.
– The idea that the results are entirely due to participants’ awareness of whether or not they received the drug also doesn’t bare much scrutiny. For example, in dose-response studies or studies where there is also an “active” comparison, participants are less able to identify what treatment they received, but the higher dose typically does better than the lower dose, and both do better than placebo.
– The site is also highly critical of anyone who has been funded in any way by pharmaceutical companies, and implies that such a conflict of interest almost certainly causes those individuals (including myself) to lose all independent judgment. While I agree that researchers should declare their sources of funding and that readers should weigh that information when reading research reports, the idea that the whole field has been bought and sold to the pharmaceutical industry is blatantly false. It is not at all uncommon for researchers receiving pharma funds to publish studies with disappointing results for the pharma company, including reports of potentially serious side effects.
(e.g. Foulds, J., Stapleton, J., Hayward, M., Russell, M.A.H., Feyerabend, C., Fleming, T., and Costello, J. Transdermal nicotine patches with low- intensity support to aid smoking cessation in outpatients in a general hospital: a placebo-controlled trial. Arch Fam Med 1993; 2: 417-423.
Foulds, J. and Toone, B. A case of nicotine psychosis? Addiction 1995; 90: 435-437).

The reality is that for years academic researchers have been encouraged by our employers to build bridges with private industry in order to make scientific advances, and do so with their eyes open. Most acknowledge our funding as openly as possible without becoming very tedious (e.g. my funding sources are mentioned on my home page on healthline and also on my program website, rather than on every single blog post). Most of us draw the line at funding from the tobacco companies because they have such a clear and consistent history of distorting science and using primarily for PR purposes, and largely because their ultimate purpose is to sell a product that is extremely harmful to health, rather than products designed to improve health.

However, the point here is not to quibble with every single point or inaccuracy on the site. Rather readers should be aware that in among the inspirational stories and plenty of good advice on this site, there is an almost fundamentalist agenda that its just wrong to use medicines to help you quit smoking. If you agree with that, or are prepared to take it with a pinch of salt, then you may find other aspects of this “single minded program” to be helpful.

Here’s an example of a recent “real world” study finding that smokers using NRT have a higher quit rate

This post, Whyquit.com: Factually Inaccurate, But Doing Some Good Nonetheless, was originally published on Healthine.com by Jonathan Foulds, Ph.D..

Does The e-Cigarette Deliver Nicotine?

May 7th, 2009 by Jonathan Foulds, Ph.D. in Better Health Network
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I’m currently attending the annual conference of the Society for Research on Nicotine and Tobacco. This is the main organization for nicotine researchers and this conference is often the first place that exciting new research findings are presented, prior to being published in more detail in scientific journals. So this week my posts will be based on some of the most interesting things I have come across at this conference, including new developments in helping smokers quit.

There is currently considerable interest (hype?) in the e-cigarette, and I have written about it before. Last weekend I was walking through our local shopping mall in New Jersey with my 8-year old daughter when she tugged at my arm and said “dad, dad, theres a man smoking over there.” I told her that couldn’t be true because people arnt allowed to smoke inside the mall, but she insisted. On looking over I was surprised to see that sure enough, someone was standing next to a booth and appeared to be puffing away on a cigarette. So we walked over to investigate, and found out that in fact it was an e-cigarette and he was selling the product at the booth. We chatted and he showed me the product which actually looks very impressive. I had already purchased an earlier version a couple of years ago, which was more stogie cigar-sized, but this one looked and puffed very much like a cigarette and was also considerably less expensive than the earlier model.

But whenever discussing this product, to me the first and most critical question (after …”whats in the vapor and might it harm my health?”) is, “does it deliver enough nicotine to satisfy nicotine cravings? “ Until I came to this conference, I hadn’t met anyone who had completed a study that included measurement of blood nicotine levels in people using the e-cigarette. This question is critical because cigarette smokers are used to receiving a boost in blood nicotine levels of at least 10 ng/ml from each cigarette, and for a product to have any chance of effectively reducing craving for or replacing cigarettes it needs to come close to that level of nicotine delivery.

But I was lucky enough to bump into Dr Murray Laugesen, a tobacco control expert from New Zealand who has been one of the foremost proponents of the product. He showed me a preliminary report on the e-cigarette which was being presented at the conference. Full details of the study will be presented in a formal publication sometime in the future, but for right now the main conclusion is that although the e-cigarette CONTAINS a reasonable amount of nicotine it actually DELIVERS very little nicotine to the user, and certainly much much less that can be obtained from smoking. To my mind this relegates the status of this product to that of a very nice and cleverly designed theatre prop, and unfortunately not a product that is likely to be highly effective in helping smokers to quit smoking.

As always, if you are interested in using a product to assist you in quitting smoking, your best bet is to use a product that has been approved by the medicines licensing agency in your country as safe and effective for that purpose (e.g. in the U.S. that would be the FDA).

For more information about Dr Laugesen’s work on the e-cigarette, visit:
http://www.healthnz.co.nz/ecigarette.htm

*This post, Does The e-Cigarette Deliver Nicotine?, was originally published on Healthline.com by Johnatan Foulds, MA, MAppSci, PhD.*