Wednesday, 22 June 2011

Follow the money

Cigarettes are going to look pretty gross soon as the tobacco control movement gathers momentum. Packs will now be required to include disgusting pictures of the products’ effects, which probably will contribute more to reducing health costs than a half-dozen Obamacares. One expert on a tobacco control e-mail list that I read opined that the icky pictures, replacing those cool, green Kool packages and flashy Marlboros, would generate distaste and shunning from the store clerks forced to sell these products, further de-normalizing this centuries-old practice of legalized mass drug addiction for private profit.

But another commentator raises a creepy side note: the government’s endorsement of nicotine replacement therapy (NRT) as the best, if not the ONLY, way to go if you want to quit, thus boosting a huge potential market for the pharmaceutical companies who market these products.

The fact of the endorsement is beyond debate: all the packs will be required to list the government’s 1-800-QUIT-NOW line, at which callers will be browbeaten with the official line that NRT will enable them to quit, and only silly, stubborn, foolish people will try to do it on their own. This discourse rather echoes the ubiquitous line from makers of statins that you ‘can't kid yourself’ into thinking that cholesterol can be lowered through diet alone.

The official web site,—which carries the logos of HHS, NIH and the National Cancer Institute at the bottom—says that ‘NRT can double a smoker’s chances of quitting smoking’.

This ‘fact’ has been duly ‘demonstrated’ by the gold standard of ‘science’ today: the randomized, blinded, placebo-controlled trial. All pharmaceutical products have to go through this lengthy testing process to earn the almighty (and lucrative) government seal of approval. In such trials research participants are randomly assigned to study arms and observed over a period of time to see who responds more favorably. NRT does okay in these tests.

But as one indignant cessation campaigner points out, this suggests a serious abuse of scientific method: smokers going into the trial will immediately recognize whether they are getting a dose of their drug or a useless sugar pill. It’s like a study pitting a heroin substitute against nothing and ‘discovering’, lo and behold! that the people getting their artificial dopamine stimulation don’t head out every night to score.

The real test of effectiveness is whether NRT users do better over an extended period than people quitting cold turkey, and there apparently is considerable evidence that they do not. I don’t pretend sufficient familiarity with that scientific literature to judge, but it wouldn’t surprise any person with a working brain that powerful economic interests might be quite happy suppressing such knowledge so that they could better sell their products to millions of smokers anxious to quit.

You’d think that a crucial debate of this sort would have attracted some attention to the policymakers involved and a critical eye from reporters as to whether or not they are appropriately neutral arbiters of the evidence. A 2007 Wall Street Journal article [Kevin Helliker, Feb 8, 2007, ‘Nicotine Fix: Behind Antismoking Policy, Influence of Drug Industry’] headlined the unsurprising fact that the head of the federal panel in charge of setting government policy runs an academic research center funded in part by NRT producer companies.

But four years later, nothing in the news coverage of the recent announcement of the nine new pictorial warnings suggested any controversy at all. John Polito, the cold-turkey advocate, writes on his site:

We cannot blame a profit-driven industry for designing clinical trials so as to vastly inflate the worth of worthless quitting products. What should deeply trouble all of us is that our government, whose own real-world findings are contrary to industry marketing, refuses to expose obvious industry shell games.

Polito then wonders ‘how hard the pharmaceutical industry pushed to get the 1-800-QUIT-NOW message on all cigarette packs and the full extent of its financial influence in designing [the] telephone counseling scripts’.

[NB: The Health Canada Web site referenced in the graphic image at the top does not push NRT as essential for quitting the way the U.S. government version does. Curiouser and curiouser.]

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