Saturday, March 26, 2011

Boston Public Health Commission's Facebook Page

Started a new discussion topic:!/topic.php?uid=47308341278&topic=14716

Achieving Smoking Abstinence

I notice that the Commission is promoting the idea of using the patch to quit smoking. True, using nicotine reduction/weaning therapy does double the 3% success rate achieved by going cold turkey, but why is 6% or 7% considered good enough? Success rates using a harm reduction approach are 10 times higher. How can a harm reduction approach be implemented?

The first step is to recognize that while nicotine is the substance that keeps smokers lighting up, it isn't the substance that causes smoking-related diseases. Smoke contains tar, carbon monoxide, particulates, and thousands of chemicals created by the process of combustion. These, not the nicotine, are what cause the cancer, lung disease, and heart disease triggered by smoking.

The next step is to recognize that all addictions are not created equal. There are no laws against driving while under the influence of nicotine because nicotine is not intoxicating. Nicotine doesn’t impair physical reflexes, nor the ability to concentrate, remember, and make sound judgments. In fact it enhances these abilities. That’s one reason why nicotine is so difficult for the majority of tobacco users to give up. Another reason is because nicotine helps to control symptoms of depression and anxiety, which are problems for about 20% of smokers.

The third step is to learn about smoke-free alternatives. Modern smokeless tobacco products can reduce the risk of smoking-related diseases by up to 99%. Decades of research in Sweden on snus, a type of moist tobacco treated to reduce nitrosamines, show that smoking-related lung disease risks are eliminated, and rates of cancer and heart disease are equal to those of former smokers who don’t use any form of tobacco. Swedish snus users have the same life expectancy as those who have become abstinent from all tobacco products. The FDA is considering whether to approve long-term use of approved nicotine products such as the patch, gum, lozenges, and the prescription inhalers. These may prove acceptable as permanent substitutes for smoking, especially if the FDA takes it a step further and permits higher nicotine content in these products. Finally, electronic cigarettes mimic the experience of smoking but remove the hazards of inhaling smoke. Even the “high” dose of e-cigarette liquid contains the same quantity of nitrosamines in a one-day supply as an FDA-approved nicotine patch (about 8 nanograms), while a pack of cigarettes may contain more than 100,000 nanograms.

The fourth step is to compare the success rates of switching to reduced-harm smoke-free alternatives with success rates for the traditional approach of weaning down and off nicotine. When used as directed, FDA-approved nicotine products have a 7% success rate at 6 months, 5% at one year, and dropping to 2% at 20 months. In Sweden, where the public is given truthful information about the relative harm of smoking versus smokeless products, 66% of snus users are former smokers. Surveys of e-cigarette users show success rates range as high as 82% for consumers who are given advice about equipment and supplies and guidance on how to use the devices properly. Keep in mind that these success rates apply to achieving smoking abstinence. There is no additional health benefit to be gained by insisting on nicotine abstinence.

The fifth and final step is for public health experts to provide truthful information about relative risks of various sources of nicotine to smokers and to the general public. Warning labels that state “This product is not a safe alternative to cigarettes” are misleading half-truths. No product could ever be proven 100% safe. But the labels imply that the health risks of this smokeless product are equal to the health risks of smoking. Nothing could be farther from the truth. Stop talking about “tobacco-related diseases” when 99% of these diseases are caused by inhaling smoke. Stop worrying about curing nicotine addiction, when nicotine without the smoke is about as harmful as caffeine. Stop striving for tobacco abstinence and focus on helping smokers achieve abstinence from smoking.


  1. The NRT in the U.S. must be better than here in the U.K.
    The 'success' rate here for stopping smoking using NRT is 1.6% !!!

  2. A number of recent studies have strongly linked nicotine itself to various cancers. This means that in addition to the cancer risks posed by tar through smoking, nicotine itself increases your chances of developing cancer. It also means that even those on nicotine patches and gums are raising their likelihood of getting cancer. This link is thought to be caused by a property of nicotine which retards your body's ability to slough off damaged cells, giving cancerous cells more time to develop.

  3. How many human subjects were involved in this research? What is the relative risk for lung cancer, oral cancer, and other types of cancers for nicotine patch users? I haven't seen a study involving human subjects that show any increased cancer risk for smoke-free sources of nicotine. The only studies I have seen linking nicotine to cancer have been primary research at the cellular level. What happens at the cellular level may explain a possible biological mechanism, but it tells us nothing about a degree of disease risk applied to humans. Similarly, studies performed on rodents give us information, but not data on disease risk for humans. We do have decades of research on the cancer risks for using Swedish snus, which provides a lot more nicotine than the NRT products or e-cigarettes. In "Summary of the epidemiological evidence relating snus to health," researcher P.N. Lee found that after adjusting for smoking, snus users have no statistically significant increased risks for any type of cancer over non-users. Snus users have significantly lower risks than smokers for all types of cancers.

  4. Correction: One study, performed by Boffetta did show an increased risk of 5 per 100,000 for pancreatic cancer in snus users. This is in comparison to non-users. In comparison to smokers, switching to snus cuts the risk for pancreatic cancer in half. Boffetta's study has been criticized for inclusion of subjects from 40 years ago when snus had higher levels of carcinogens. No pancreatic cancer increase has ever been reported by any other researcher.


  6. There are no smoking bans at the national level. All are state and local level, and each law would need to be changed. Indoor smoking bans contain definitions of smoking and smoke that make it clear they are talking about products that are made of (not derived from) tobacco that are set on fire creating smoke. Vapor is not smoke. However, there are forces at work who do not want to encourage smokers to switch to safer alternatives. They are proposing new laws or amendments to existing laws that would specifically include vapor in smoking bans. There is not a shred of evidence that vapor presents any danger whatsoever to bystanders. The FDA made a big hullabaloo about what their tests found, but left out the fact that the quantities measured were harmless trace amounts. Also these trace chemicals were found only in the liquid, not in the vapor. The vapor has been tested repeatedly by labs around the world and nothing harmful has been detected. See

  7. I am typically to running a blog and I actually appreciate your information. The content has actually peaks my curiosity. I am going to bookmark your website and keep checking for brand new information.

  8. @Anonymous
    "A number of recent studies have strongly linked nicotine itself to various cancers."

    And those (unnamed & unreferenced) studies you mclaiom support a link to cancer completely ignore years of research regarding long-time Swedish snus users, which show no significant increase in ANY cancer types. (Except, of course, Boffetta's questionable study.)

    Snus is known for it's high nicotine content. If it doesn't raise cancer risks IN HUMANS, it's extremely unlikely sources of lower levels of nicotine, such as e-cigarettes, would then inexpicably increase cancer risks.

  9. You'll be capable of certainly see your enthusiasm inside the work you're writing. Our world wants more passionate authors like everyone else who aren?¯t afraid to talk about how they believe. Always pursue your heart.