Is `Cold Turkey` The Only Safe Way to Quit Smoking?
Feb. 22 (CBSHealthWatch)--There is little evidence that products like nicotine patches and gums, which help reduce a smoker's reliance on traditional tobacco products like cigarettes, actually reduce the risk of smoking-related disease, according to a new
New York City spends $3M on "Quit Yet?" campaign."We concluded that it is feasible to reduce the risk of tobacco-related disease by reducing exposure to the toxic substances in tobacco. However, it has not yet been proved that any of the novel tobacco products on the market today reduce illness or death compared to that caused by conventional tobacco products," says Stuart Bondurant, MD, professor in the Department of Medicine at the University of North Carolina, Chapel Hill.
Bondurant is chair of the committee of the Institute of Medicine, one of the private, non-profit governmental advisory institutions of the National Academy of Sciences that produced the report.
The committee did not study any products specifically--rather, they looked at the overall category of so-called "tobacco harm reduction" products, which includes tobacco patches, gum, inhalers and nasal sprays as well as drugs to reduce dependence on tobacco, such as Zyban (bupropion).
"We recommend that tried-and-true public health tools--research, surveillance, communication and regulation--be used to ensure that the availability of these products confers less risk to the individual and to the population as a whole compared with conventional tobacco products," Bondurant says. They also propose the creation of a system to assess how these products affect public health and change tobacco use habits.
The cautious tone of the researchers is due in part to the way lower-nicotine and lower-tar (or "light") cigarettes were decades ago first embraced as a way to reduce the levels of nicotine and harmful chemicals that smokers inhaled.
"Long after low-tar and low-nicotine cigarettes were introduced, researchers discovered that people who switched to them ended up inhaling more deeply and smoking more cigarettes to get the same amount of nicotine that their bodies were used to. Which meant that the potential health benefits for using these low-yield products instead of the full-flavor cigarettes were far less than expected, if any," says Bondurant.
As a result, "to demonstrate that these new products reduce exposure to toxic substances, they must be tested in the exact way that people would actually use them," Bondurant says.
"The low-tar nicotine story is scary," says committee member Peter Shields, MD, professor and chief of the cancer genetics and epidemiology program at the Lombardi Cancer Center at Georgetown University Medical Center. "We had basically a public health experiment where everyone from the surgeon general said, 'If you have to smoke, go to the low-tar nicotine' and we made a mistake once. So we're really scared about making the same mistake again."
Other committee members agree. "At this point in time, we're saying it's just premature to make any recommendation because we don't know the effects of the modified tobacco products," adds Dorothy Hatsukami, PhD, professor in the department of psychiatry and psychology at the University of Minnesota.
Still, quitting smoking is far better than smoking. "Using Zyban or nicotine replacement products to actually aid in cessation is safe. There's no question that it's important to use it as a means to become abstinent," says Hatsukami.
So what is the best way to quit? For some people, a combination of different products and approaches is best, says Nate Cobb, lead developer of the QuitNet, a smoking cessation Web site (www.quitnet.org) run by Join Together, a project of the Boston University School of Public Health.
"What we do know is that absolutely, the patch, gum, and Zyban, or bupropion--they work," says Cobb.
People who use one or several of these products correctly have a better chance of being a non-smoker down the road--the problem is that some people don't use the products correctly, Cobb says.
"There is data, that at least the pharmaceutical companies have done, that shows these products aren't used as recommended," Cobb says. For instance, a person may choose to use less nicotine gum than is recommended, only to start craving cigarettes. Or, after a few weeks of successful non-smoking, a person may quit the nicotine patch cold turkey instead of gradually reducing the patch's strength--and find their cravings too intense to fight.
Cobb recommends that people who are trying to quit smoking talk to their doctor about the impact it may have on your body, as well as the different approaches. Support groups or online communities of fellow aspiring non-smokers or former smokers can help, Cobb says, and it's also a good idea to let your family, friends and co-workers know that you are quitting so they can help support you too.