But since they’ve been created, there’s been a debate over the value of nicotine alternatives.
In 2002, researchers at the University of California, San Diego, conducted a large survey that showed the products seemed to offer no benefit. But the study did not follow people over time.
“Some studies have questioned these treatments, but the bulk of clinical trials have unequivocally endorsed them,” Dr. Michael Fiore, director of the University of Wisconsin’s Center for Tobacco Research and Intervention and one of the most recognized American experts on tobacco control, tells the New York Times.
Dr. Fiore was the chairman of the panel that wrote the U.S. Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependence in 2008.
“There are millions of smokers out there desperate to quit, and it would be a tragedy if they felt—because of one study—that this option is ineffective,” he tells the NY Times, which reports, however that he has admitted receiving payments from drug makers.
In fact, the panel he led that recommended including nicotine replacement as part of federal guidelines for tobacco treatment had come under fire in the past, because panel members had received payments from the product manufacturers.
But some doctors don’t blame the replacement products, but the smokers who use these NRTs in a haphazard way. “Patient compliance is a very big issue,” says Dr. Richard Hurt, director of the Mayo Clinic’s Nicotine Dependence Center, who was not involved in the study.
According to him, products like nicotine gum and patches “are absolutely essential, but we use them in combinations and doses that match treatment to what the individual patient needs,” unlike smokers who are self-treating.
Mainly a large survey
In the new study, Harvard researchers followed a representative sample of 1,916 adults, including 787 people who, at the start of the study, had recently quit smoking. Participants were interviewed three times, about once every two years in the 2000s.
During interviews, researchers asked the smokers and quitters about their use of gum, patches and other such products, their periods of not smoking and their relapses. The study was conducted in Massachusetts.
The researchers found that about one-third of the people trying to quit had relapsed at each stage. They also found the use of replacement products made no difference, whether they were taken with the guidance of a cessation counselor or for the recommended two-month period (they usually weren’t).
Using NRTs also backfired in one subgroup of heavy smokers. Defined as smokers who smoked their first cigarettes within 30 minutes after waking, these heavy smokers used replacement products without counseling. At the end of the study, they were found to be twice as likely to relapse as heavy smokers who did not use NRTs.
“Our study essentially shows that what happens in the real world is very different” from what happens in clinical trials, study co-author Hillel R. Alpert of Harvard University tells the New York Times. Other co-authors of the study are Dr. Connolly and Lois Biener of the University of Massachusetts, Boston.
The researchers argue that while nicotine replacement appears to help people quit, it is not enough to prevent relapse in the longer run.
“Motivation matters a lot; so does a person’s social environment, the amount of support from friends and family, and the rules enforced at the workplace. Media campaigns, increased tobacco taxes and tightening of smoking laws have all had an effect as well,” the NY Times report concluded.
Indeed, in many developing countries where resources aren’t enough to fund NRT products, smoking rates have been slashed mainly by adopting national policies that changed the environment of smokers. These policies include raising cigarettes prices by increasing their taxes and preventing the smuggling of cheaper goods, creating smoke-free workplaces, banning smoking in public spaces and enforcing graphic warnings on cigarette packs. Ukraine is one country that has successfully slashed its smoking rates without much use of nicotine replacement products.
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