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

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..


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2 Responses to “Whyquit.com: Factually Inaccurate, But Doing Some Good Nonetheless”

  1. joejiamachello says:

    Could the author of the above article please explain how treating nicotine withdrawal symptoms with pharmacological nicotine is any different than using inhaled nicotine to allay these chronic symptoms?
    If you believe treating nicotine addiction with different delivery mediums of nicotine is a viable treatment regimen then you must also believe that treating alcohol addiction would be best treated with further doses of alcohol. Or perhaps you also espouse that the best way to treat opiate addiction is to further administer doses of the opiate substance through an alternate delivery vehicle.
    Typical of those who recommend pharmacological solution to many problems it seems you aim is to only treat the symptom instead of treating the cause. The root cause of nicotine addiction dependency is nicotine. The easiest way to get free of dependency is to stay free of the substance.
    One other point of inaccuracy in your article. The materials at Why Quit and Freedom From Nicotine state that a persons blood serum is 99.9% free of nicotine in 72 hours but that it takes on average two weeks to fully withdraw from the effects of the chemical.

    I can add that from my personal experience, several unstances of treatment with Nicotine Replacement Therapy did not lead to successful long-term (permanent) tobacco cessation for me. I never was able to get free of nicotine ntil I got clean of nicotine by abrupt removal of the causal substance. That was over 4 and a half years ago. Couldn't be happier, and that's the TRUTH!

  2. joejiamachello says:

    Could the author of the above article please explain how treating nicotine withdrawal symptoms with pharmacological nicotine are any different than using inhaled nicotine to allay these chronic symptoms?
    If you believe treating nicotine addiction with different delivery mediums of nicotine is a viable treatment regimen then you must also believe that treating alcohol addiction would be best treated with further doses of alcohol. Or perhaps you also espouse that the best way to treat opiate addiction is to further administer doses of the opiate substance through an alternate delivery vehicle.
    Typical of those who recommend pharmacological solution to many problems it seems you aim is to only treat the symptom instead of treating the cause. The root cause of nicotine addiction dependency is nicotine. The easiest way to get free of dependency is to stay free of the substance.
    One other point of inaccuracy in your article. The materials at Why Quit and Freedom From Nicotine state that a person’s blood serum is 99.9% free of nicotine in 72 hours but that it takes on average two weeks to fully withdraw from the effects of the chemical.

    From personal experience I can tell you that several rounds of prescribed treatment with various forms of Nicotine Replacement Therapy did not result in the desired result – long term cessation of tobacco smoking. The only method that has worked for me – permanently – is Nicotine REMOVAL Therapy. I got clean of nicotine over four and half years ago by abrupt cessation. Isn't that the point of quit smoking therapy, to get and stay free? Here's a shocking recommendation for all you purveyors of pharma therapy. In order to quit smoking you have to quit smoking. That really means you have to quit ingesting nicotine. In my humble opinion you are not helping people get where they want to go. You are only recommending a way to perpetuate addiction dependency.

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