Dr.  Hope Landrine,  1954-2019: In Memoriam

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 Dr Hope Landrine, 1954-2019

Hope Landrine’s Life and Work

Dr. Hope Landrine was born in Yonkers, NY, USA on July 4, 1954, to John Albert Landrine and Sarah Alice Palmer. Sadly, after a brief illness, Hope Landrine died in Greenville, NC, USA on Sept 3, 2019.

Hope Landrine was the first director of the East Carolina University Center for Health Disparities Research, and professor of psychology and professor of public health in the Brody School of Medicine. Her bachelor’s degree in psychology was from Westminster College, her masters was from the City University of New York, and her doctorate in clinical psychology from the University of Rhode Island. Landrine was a prolific scientist with more than 125 articles and books dedicated to the health, and socio-political conditions of African-Americans, other ethnic minority populations, women, and those suffering  substance use and addictions. Landrine earned ‘fellow status’ in the American Psychological Association Divisions 9, 45, 38, 35, and 50 for her outstanding contributions to research on social issues, racial-ethnic minorities, health, and women and she was also awarded ‘fellow status’ in the Society of Behavioral Medicine. In 2012, she was honored with the APA Div. 45 Lifetime Achievement Award for Distinguished Lifetime Contributions to research on racial-ethnic minorities. In 2019, she received the James M. Jones Lifetime Achievement Award for her exceptional contributions to the understanding of racial and ethnic psychology.

Landrine’s work in public health was eclectic. Aware of the key role of culture, Landrine believed that plays, videos and songs, could capture people’s attention — and stay lodged in their memories — far longer than statistics in a pamphlet. “[The arts] are probably our best hope for changing hearts and minds and behaviors and attitudes,” she said. “People are more likely to listen to a song about health than take a class on health, let alone read a book on health. But if there’s a song on health and the song is clever enough that people hum it to themselves and learn the lyrics, then I think we can do something.” (Landrine, 2011).Landrine’s outstanding career focussed on racial and ethnic disparities in health and health behaviors, women’s health, discrimination and poverty continues as a beacon of inspiration. Landrine was raised in the inner city where poverty and gross inequities are a perpetual part of everyday existence. Landrine became a member of the ‘Young Socialist Alliance’ and the president of the Black Student Union before going home to read feminists books (Granek, 2007).

In developing her feminist identity, one summer in the early 1970s Landrine saw Betty Friedan’s The Feminine Mystique at her local public library . At the end of that summer, Landrine said she “went back to college as somebody else” (Granek, 2007).  Landrine attributed a change the course of her activism to a classic text on women’s health, Our Bodies Ourselves. When she graduated with a psychology degree, Landrine worked for the Cambridge Women’s Center until enrolling for a master’s at the City University of New York, where she was one the last students to be supervised by Stanley Milgram.

Landrine recalled “not really being interested in psychology as an undergraduate” and she “went there by default, not desire. And even as an undergraduate, I had concerns about it … I thought it was conservative. I perceived it … as a field that seemed to have the potential to defend the status quo – not challenge it – by locating problems within people instead of outside of them…I saw it as conservative and sexist on top of everything else! So, I graduated with no plan for graduate school; no desire to actually pursue psychology at all!” (Granek, 2007).  So true then, as to this very day.

Landrine’s interest in psychology was rekindled by her masters research that was concerned with the feminism and self-esteem. Later, her doctoral study in the University of Rhode Island clinical psychology program Landrine viewed psychiatric disorders as a product of inequality without any necessary involvement of psychological or intra-psychic processes. Her thesis “The Politics of Madness” was even in those days a radical, political approach to psychopathology. The president of  Division 35 of the American Psychological Association, Bernice Lott appointed Landrine to the task force on cultural diversity and, from 1990, Landrine became part of the editorial board of the Division’s journal, Psychology of Women Quarterly and served as the associate editor for several years.  Landrine was invited to write a book review for the first issue of the Journal of Health Psychology and she later contributed multiple articles and served as Associate Editor for two decades.

Hope Landrine’s contribution to health psychology and public health has been enormous and pathfinding.  Landrine’s focus on ethnic minorities, specifically those living in segregated and poor neighbourhoods, has planted seeds, grown trees and has created a forest of ideas and concepts for future workers to explore.

On culture and diversity

From Reviews : Culture and the Lathe of Failure by Hope Landrine, Journal of Health Psychology 1996 1:1, 143-144

“while waving the flag of cultural sensitivity, European– American health promotion programs continue nonetheless to define positive outcomes as the assimilation of European–American health beliefs and health behaviours by native Others. Likewise, while praising the importance of respect for cultural practices such as the oral tradition, European–American disease prevention programs continue nonetheless to rely on posters, flyers, videos and other visual and written media. ‘Sensitivity to diversity’ means that these visual and written materials have been translated into the language of the native Other, and has yet to mean that the Other’s oral tradition (the practice of learning through storytelling, utilizing the culturally significant relationship between story-teller and audience) is the medium for altering health behavior. The tendency to ignore rather than incorporate a cultural community’s indigenous healers, indigenous disease taxonomies, and techniques of traditional medicine are but a few, additional examples of the Western inclination to marginalize and dismiss the very cultural context to which interventions purport to be sensitive.”

“the new, unprecedented focus on cultural diversity is always a focus on an Otherness that is not White—it is Black or Brown or Yellow or Red but never White—such that culture is rendered a mere fetish relevant to minorities and ‘exotic’ peoples alone. Doing so not only derides and dismisses culture while touting it, but also focuses attention on discovering cultural ‘differences’ that reinforce and perpetuate the cultural stereotypes and ethnic stratification purportedly challenged by the focus on diversity.”

From Reviews : Clovis E. Semmes, Racism, Health and Post-Industrialism : A Theory of African-American Health Westport, CT: Praeger, 1996, by Hope Landrine, Journal of Health Psychology 1997 2:3, 428-430

“in the zeitgeist of political correctness and sensitivity to cultural diversity, few in health psychology and related disciplines would dare say what they really think, namely, that while culture plays a role in the health of Hispanics, Asians and a variety of indigenous peoples, it does not play a role in the health of American Blacks because (unfortunately) American Blacks don’t have a culture. Most of the culture they had was lost at sea during the Middle Passage some 400 years ago, and the remainder was beaten out of them, leaving only the scars of the slave masters’ whips behind; those scars, sadly, are their sole cultural legacy. Although never stated explicitly, such beliefs are implicit throughout health psychology. For example, numerous publications on cultural diversity and health describe the health beliefs and practices of a variety of cultural groups in detail—until the authors come to the chapter on Blacks. At that point, the discussion changes to focus on social rather than on cultural variables, i.e. on lack of access to medical care, poverty and low levels of education. These social factors are obviously important insofar as they figure prominently in excess morbidity and mortality among Black Americans—but such social variables play an equally important role in the health of other cultural groups as well, including destitute Mexican-American immigrants, impoverished American Indians, and countless indigenous peoples of Africa, Asia and South and Central America. Specifically, cultural variables nonetheless are viewed as also playing a role in the health of the latter groups, and indeed in the health of every cultural group except African Americans; only for Blacks do discussions of ostensibly cultural factors in health focus on social variables alone.”

On Racial Segregation and Cigarette Smoking Among Blacks

by Hope Landrine and Elizabeth A. Klonoff, Journal of Health Psychology 2000 5:2, 211-219

“THE UNITED STATES continues to be a racially segregated nation and was more segregated in the 1990s than it was in 1860, 1910, and 1940 (Massey & Denton, 1993). This ‘American Apartheid’ (Massey & Denton, 1993, p. 1) is neither the unfortunate remnant of a racist past nor the result of a black preference to live in black neighborhoods; rather, it is the outcome of ongoing racial discrimination in housing and in home loans (Massey & Denton, 1993). High levels of residential segregation characterize the lives of US blacks alone; other US minority groups are not subjected to similar levels of segregation (Massey & Denton, 1993).”

“In summary, this study was an exploratory one designed: (1) to examine for (the first time) the possibility that segregation can be measured at the individual level; and (2) to test (for the first time) the possibility that segregation may be an important social variable to include in research in health psychology. It seems clear that segregation can be measured at the individual level by using some or all of our items, or by developing other items that may be superior to ours. Likewise, these preliminary findings on segregation and smoking suggest that segregation indeed may be an important social variable to include in smoking research and so perhaps in other research in health psychology as well. We encourage development of other measures of segregation for use with individuals, and encourage studies examining this variable. In so doing, it may be beneficial for health psychology to conceptualize segregation theoretically in the manner that public health researchers do, namely: racial segregation is a social-contextual (macro-level) variable that shapes individual exposure and vulnerability to the social and psychological (micro- or individual-level) risk factors that are studied by health psychology and behavioral medicine.”

Perceived Skin Cancer Risk and Sunscreen Use among African American Adults

Latrice C. Pichon, Irma Corral, Hope Landrine, Joni A. Mayer, and Denise Adams-Simms, Journal of Health Psychology 2010 15:8, 1181-1189

We examined perceived skin cancer risk and its relationship to sunscreen use among a large (N = 1932) random sample of African American adults for the first time. Skin cancer risk perceptions were low (Mean = 16.11 on a 1—100 scale). Sun-sensitive skin type and a prior cancer diagnosis were associated with higher perceived skin cancer risk, but demographic factors were not. Unlike findings for Whites, perceived skin cancer risk was not associated with sunscreen use among African Americans.

Residential segregation, health behavior and overweight/obesity among a national sample of African American adults

Irma Corral, Hope Landrine, Yongping Hao, Luhua Zhao, Jenelle L. Mellerson, and Dexter L. Cooper, Journal of Health Psychology 2011 17:3, 371-378

We examined the role of residential segregation in 5+ daily fruit/vegetable consumption, exercise, and overweight/obesity among African Americans by linking data on the 11,142 African American adults in the 2000 Behavioral Risk Factor Surveillance System to 2000 census data on the segregation of metropolitan statistical areas (MSAs). Multi-level modeling revealed that after controlling for individual-level variables, MSA Segregation and Poverty contributed to fruit/vegetable consumption, MSA Poverty alone contributed to exercise, and MSA Segregation alone contributed to overweight/obesity. These findings highlight the need for research on the built-environments of the segregated neighborhoods in which most African Americans reside, and suggest that neighborhood disparities may contribute to health disparities.

Racial discrimination and health-promoting vs damaging behaviors among African-American adults

Irma Corral and Hope Landrine, Journal of Health Psychology 2012 17:8, 1176-1182

Studies have found relationships between racial discrimination and increased health-damaging behaviors among African-Americans, but have not examined possible concomitant decreased health-promoting behaviors. We explored the role of discrimination in two health-promoting behaviors, consuming ≥ 5 fruits/ vegetables daily (FVC) and physical activity (PA), for the first time, and likewise examined discrimination’s contribution to cigarette smoking, among a sample of N = 2118 African-American adults. Results revealed that discrimination contributed positively to smoking and to PA but was unrelated to FVC. These findings suggest that both adaptive and maladaptive health behaviors might be used to cope with the stress of discrimination.

Residential segregation and obesity among a national sample of Hispanic adults

by Irma Corral, Hope Landrine, and Luhua Zhao, Journal of Health Psychology 2013 19:4, 503-508

We explored the role of residential segregation in obesity among a national sample of Hispanics for the first time. Data on the 8785 Hispanic adults in the 2000 Behavioral Risk Factor Surveillance System were linked to 2000 census data on the segregation of 290 metropolitan statistical areas. Multilevel modeling revealed that after controlling for individual-level variables, the odds of being obese for Hispanics residing in high-segregated metropolitan statistical areas were 26.4 percent higher than for those residing in low-segregated metropolitan statistical areas. This segregation effect might be mediated by the obesogenic features (e.g. paucity of recreational facilities and abundance of fast-food outlets) of segregated Hispanic neighborhoods.

Self-rated health, objective health, and racial discrimination among African-Americans: Explaining inconsistent findings and testing health pessimism

Hope Landrine, Irma Corral, Marla B Hall, Jukelia J Bess, and Jimmy Efird, Journal of Health Psychology 2015 21:11, 2514-2524

African-Americans sometimes rate their health as Poor/Fair in the absence of chronic diseases. Theoretically, this lack of correspondence between self-rated health and objective health is due to racial discrimination that results in rating one’s health negatively and in terms of social rather than health variables. We tested this Health Pessimism model with 2118 African-Americans. Results revealed that Poor/Fair self-rated health was predicted mostly by objective health for the Low Discrimination group but mostly by demographic variables for the High Discrimination group, in a manner consistent with Health Pessimism. Inconsistencies among prior studies might reflect differences in the prevalence of high discrimination among their samples.

REFERENCES

Fabrega, H. (1974). Disease and social behavior: An interdisciplinary perspective. Cambridge, MA: MIT Press.

Granek, L. (2007). Interview with Hope Landrine: Health Psychology, August 18, 2007, San Francisco, CA, U.S.A.

Landrine, H. (2011). Erasing inequities. Hope Landrine strives to make health disparities a thing of the past. https://news.ecu.edu/2011/12/01/erasing-inequities/

Personality, Heart Disease and Cancer: A Chequered History

Featured

Type A and B Personality

We discuss here the chequered history of the claims by Psychologists and others about the links between personality and illness, particularly heart disease and cancer. The research has been marred by dirty money and allegations of fraud.

Speculation about ‘Type A’ and ‘Type B’ personalities and coronary heart disease (CHD) has existed for at least 70 years. The distinction between the two personalities was introduced in the mid-1950s by the cardiologists Meyer Friedman and Ray Rosenman (1974) Type A behavior and your heart.  Their ideas can be traced to Franz Alexander one of the ‘fathers’ of psychosomatic medicine.

The Type A personality is described this: highly competitive and achievement oriented, not prepared to suffer fools gladly, always in a hurry and unable to bear delays and queues, hostile and aggressive, inclined to read, eat and drive very fast, and constantly thinking what to do next, even when supposedly listening to someone else. Type A was thought to be at greater risk of CHD,

The Type B personality is: relaxed, laid back, lethargic, even- tempered, amiable and philosophical about life, relatively slow in speech and action, and generally has enough time for everyone and everything.

The Type A personality is similar to Galen’s choleric temperament, and Type B with the phlegmatic.  It is well known that men are at greater risk of CHD than women.

‘Classic’ Studies

The key pioneering study of Type A personality and CHD was the Western Collaborative Group Study (WCGS).  Over 3,000 Californian men, aged from 39 to 59, were followed up initially over a period of eight-and-a-half years, and later extending to 22 years plus. At the eight-and-a-half-year follow-up, Type As were twice as likely compared with Type Bs to suffer from subsequent CHD. 7% developed some signs of CHD and two-thirds of these were Type As. This increased risk was there even when other risk factors, such as blood pressure and cigarette smoking, were statistically controlled.

Similar results were obtained in another large-scale study in Framingham, Massachusetts.  This time the sample contained both men and women.  By the early 1980s, it was confidently asserted that Type A characteristics were as much a risk factor for heart disease as high blood pressure, high cholesterol levels and even smoking.

Failure to Replicate

Later research failed to support these early findings. When Ragland and Brand (1988) conducted a 22-year follow-up of the WCGS, using CHD mortality as the crucially important measure, they failed to find any consistent evidence of an association.

Further research continued up to the late 1980s, yielding few positive findings. Reviewing this evidence, Myrtek (2001) suggests that the modest number of positive findings that did exist were the result of over-reliance on angina as the measure of CHD. Considering studies that adopted hard criteria, including mortality, Myrtek concludes that Type A personality is not a risk factor for CHD.

Enter the Tobacco Industry

With such disappointing results, why did Type A obtain so much publicity over more than 40 years? The reason is in part connected with the involvement of the US tobacco industry.

Mark Petticrew et al. (2012) analysed material lodged at the Legacy Tobacco Documents Library. This is a vast collection of documents that the companies were obliged to make public following litigation in 1998. These documents show that, for over 40 years from the 1950s, the industry heavily funded research into links between personality, CHD and cancer. The industry was hoping to demonstrate that personality variables were associated with cigarette smoking.

Any such links would undermine the alleged causal links between smoking and disease. Thus, for example, if it could be shown that Type A personalities were both more likely to smoke than Type Bs, and more likely to develop CHD, then it could be argued that smoking might be just an innocent background variable.

The Philip Morris company funded Meyer Friedman, the originator of Type A research, for the Meyer Friedman Institute. The research aimed to show that Type A personalities could be changed by interventions, thereby presumably reducing proneness to CHD even if they continued to smoke.

Petticrew et al. show that, while most Type A–CHD studies were not funded by the tobacco industry, most of the positive results were tobacco-funded. As has been pointed out in many areas of science, positive findings invariably get a great deal more publicity than negative findings and rebuttals.

Hans J Eysenck

The late H J Eysenck was one of the most controversial psychologists who ever lived. Generations of UK psychology students had to study his books as gospel.

The German-born, British psychologist worked at the Institute of Psychiatry, University of London.  He did a PhD under Sir Cyril Burt  who was proved to have fabricated researchers and data to support his eugenic theory of intelligence.  (Kamin, 1974, The science and politics of IQ).

Eysenck used the tobacco industry as a source of funding for his research on psychological theories of personality. According to Pringle (1996), Eysenck received nearly £800,000 to support his research on personality and cancer.  Eysenck’s results were a spectacular exception to the general run of negative findings in this field.  Eysenck (1988) claimed that personality variables are much more strongly related to death from cancer than even cigarette smoking.

One of my lecturers while I was an undergraduate had worked for Eysenck as a research assistant for a year. It had seemed clear to him that data massaging was required before placing Eysenck’s studies into publication. Data manipulation or even worse, outright fraud, has surfaced in a major re-analysis of Eysenck’s work on tobacco and personality.

Ronald Grossarth-Maticek

Two of Eysenck’s papers, with Ronald Grossarth-Maticek (pictured above), based  in Crvenka, Serbia, claimed to have identified personality types that increase the risk of cancer by about 120 times and heart disease by about 25 times (Grossarth-Maticek and Eysenck, 1991; Eysenck and Grossarth-Maticek, 1991). They also claimed to have tested a new method of psychological treatment that could reduce the death rate for disease prone personalities over the next 13 years from 80% to 32%. These claims are too good to be true.

These extraordinary claims were not received favourably by others in this field. Fox (1988) dismissed earlier reports by Eysenck and Grossarth-Maticek as ‘simply unbelievable’ and the 1991 papers were subjected to devastating critiques by Pelosi and Appleby (1992, 1993) and Amelang, Schmidt-Rathjens and Matthews (1996).  The ‘cancer prone personality’ was not clearly described and seems to have been an odd amalgam of emotional distance and excessive dependence.

A Case of Fraud?

After pointing out a large number of errors, omissions, obscurities and implausible data, in a manner reminiscent of Leon Kamin’s  analysis of Burt’s twin IQ data, Pelosi and Appleby comment:

It is unfortunate that Eysenck and Grossarth-Maticek omit the most basic information that might explain why their findings are so different from all the others in this field. The methods are either not given or are described so generally that they remain obscure on even the most important points . . . Also essential details are missing from the results, and the analyses used are often inappropriate.

(Pelosi and Appleby, 1992: 1297).

They never used the word “fraud”. They didn’t need to. For an update of this story,  see this post

and this post

Update

I wrote to Ronald Grossarth-Maticek on 3rd December 2018 and again on 5th March 2019 inviting him to respond to the allegations.
Dr. Grossarth-Maticek has responded saying that he will give me an answer within the next month.
He also says that he will send me the results of his actual research.
To be continued…

First Person Accounts of Anti-Smoking Medication

The Internet contains thousands of first-person accounts on the effects of anti-smoking medications. Many of them are positive and fine, while others are plain scary. We can imagine that some of the most scary ones maybe mischievous works of pure fantasy by ‘trollers’ while others could well be genuine accounts designed to warn others. There is no fool-proof way to decide which category any particular report belongs in. Bearing this cautionary note in mind, I reproduce here a few edited accounts that give pause to the use of medications to stop smoking. These 10 cases are not a random or representative sample, but are a minority of scary accounts that have the ring of truth, and should be considered before taking anti-smoking medications.

This set of cases must be considered as a non-randomised, non-controlled, anecdotal account of drug effects. Even if only one or two of them are actually genuine, there would be major cause for concern for any doctor or smoker thinking about their use.

CASE 1:
“This Is My Brain on Chantix…After a few weeks on Chantix, I had managed to stop smoking altogether—but it didn’t feel like a triumphant turn of events. I’d become rather reclusive, avoiding calls from friends, and basically just shuttling back and forth between my office and my apartment. I began to dread six o’clock; it meant I had to walk through the streets again. The subway was now out of the question; it made me too nervous. I stopped going to the gym, too.
I wondered whether Chantix was zapping my brain’s pleasure-delivery system to such a degree that not only did I find no reward in cigarettes, but I also found no reward in socializing, exercising, writing, or any of my usual self-stimulating tricks. I’d pace the floor, sit on the bed, channel surf, pace some more, try to read, but the room had a stale, sinking feeling. Maybe I should go and grab a drink—then at least I might be able to get some rest.
There was no warning against drinking while on Chantix, and even if there had been, I can’t say with any honesty that I’d have adhered to it. (I wasn’t taking any other medication, though.) But while I’ve had my fair share of dark and drunken nights over the years, what I experienced on Chantix was something else altogether. One evening, I steeled myself to go on a date, but after a few drinks with the guy, I abruptly burst into tears mid-sentence. The crying jag lasted about 30 minutes, with the thought I can’t do this anymore looping through my head. This was happening a lot lately, as though someone had spliced other people’s thoughts into the tape whirl of my brain.
Another night, at an East Village bar, an older man in a trench coat caught my attention. I chatted him up for a while, until I realized I was actually trying to go home with the shadow cast by a potted plant. With alcohol in my system, I was somehow able to take this hallucination in stride: “The man who got away … ” But that same evening ended with my taunting a skinhead who was improbably on the corner of Avenue A and 14th Street. “You must be lost,” I snapped. “Are you looking for 1993?” He ended up chasing me into a deli and saying he was going to murder me. (The guy at the register called the cops and the skinhead fled, so I’m fairly confident that he, at least, was real.)”
(http://nymag.com/news/features/43892/index3.html#comments)

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CASE 2:
“Chantix (or champix in Australia ) was the beginning of a total nightmare, I had a full mental and physical checkup and got the all clear. A great sign for a 40 plus man who smoked from 15. However I’m not a total fool and knew smoking would catch up eventually , so I decided to quit smoking and was told about the new wonder drug Champix… I had disassociate feelings that lasted for months after stopping Champix. Panic attacks and anxiety that have not stopped in years.. Even tried smoking again to see if back-tracking to the start would help… And guess what…. nothing helped… not even after being admitted to hospital and trying in vain to make the Doctor believe that Champix was the cause. So please please please don’t take this LIFE DESTROYING DRUG. Quit cold turkey it the best way… I took this in 1997 and its now 2013 and still suffer most days.”
(http://nymag.com/news/features/43892/index3.html#comments)

CASE 3:
“My boyfriend took Chantix for six weeks and quit smoking. It’s been two years since then and he had never been the same since. He’s depressed, angry and mean. He has anxiety. Isolates himself. Has rage. Lost all his friends and our two year relationship that was blissful. I don’t recognize him. He has been on depression medication for a year and is only getting worse. He went from an easy going man who never even said damn in bad traffic to a raging mean isolated sad nervous rageful man. It ruined his life and our future. But he still doesn’t smoke. What a nightmare. He doesn’t enjoy anything he once did-friends, camping, sex etc. He is an empty shell of the man I once knew.”
(http://nymag.com/news/features/43892/index3.html#comments)

CASE 4:
“…I’ve been thinking about going on Chantix for a while. I’ve cut down to about 6 cigarettes a day on my own, but it seems like I need a little boost to make me quit altogether. I asked my doctor if Chantix was safe for people with seizures, he told me to ask my neurologist. I asked the neuro and he told me to ask the pharmacist. I asked the pharmacist and he told me to ask my doctor. The waking dreams seem a little too much like the type of seizures and auras I have, which is a feeling I don’t enjoy.”
(http://nymag.com/news/features/43892/index3.html#comments)

CASE 5:
“In 2008 or 2009 (when I started Chantix), it was a health insurance promotion for Microsoft employees that wanted to quit smoking. So I participated, and was prescribed to me to quit smoking.
How has this affected my life? Well, I lost my wife of (25 years), I lost a wonderful job at Microsoft of 9 years, I had extremely troubling nightmares, that still haunt me today. I was almost hospitalized for severe depression, because my parents were extremely worried about my safety. We got all the way to the point where I had to sign the release form at the mental inpatient hospital, and I got scared and said no, we left.
Ever since then I have been unemployable, I lost my wife, I lost my relationship with my 25 year old son, I am losing my house, I’m 46 and living in parents basement, while I work with physiatrists to stabilize my severe depression. I’m on state DSHS health care.
The hardest thing for me is that I lost the love of my life. And caused her so much pain do to my behavior after/during I was prescribed Chantix, that she is scared of me, and for me. So much so, she asked me to move out then changed the locks on our house. This is the woman I spent 28 of my 46 years with and raised a son. Chantix is one of the most dangerous drugs that can be legally obtainable. It ruins lives! I have no life now. Thanks Chantix.”
(http://nymag.com/news/features/43892/index3.html#comments)

CASE 6:
“I took Wellbutrin several years ago and just started again about a month ago. I too blacked out on this drug after a night of dinner and drinks with a friend. We went our separate ways and then I blacked out… in NYC mind you. Somehow made it home, broke my elevator key in the lock, had no phone and my fiance was out of town. Somehow managed to reach a friend with a key, he rescued me and put me to bed. I have a vague memory of being in the elevator but nothing else. I thought I had been slipped a ruffie at a bar. Have had a few drinks with it this time around and have felt very hungover after 3 glasses of wine, which I can normally handle. Will definitely have to reconsider the alcohol after reading this forum. Thanks for sharing.
(https://www.drugs.com/answers/wellbutrin-drinking-681606.html?page=2)

CASE 7:
“The treatment (150 mg Wellbutrin) was effective in reducing my “appetite” for smoking. It also reduced my appetite for everything, including food. Therefore, at first, I did manage to stop smoking WITHOUT gaining weight or being depressed about giving up the cigarettes. It just didn’t seem important.
After a while, I began to notice that NOTHING seemed important to me. I also seemed to be moving in a world that had slowed down considerably. That may sound good, at first, but the reality was that the only thing that had slowed down was ME–the rest of the world kept going as usual. I began to notice that I couldn’t seem to develop a sense of urgency even when it was IMPORTANT to do so because I had lost my sense of “timing.” I tended to be late everywhere I went, I couldn’t complete assignments on time, and my sleeping time increased dramatically.
I was taking the Bupropion as an aide to break my smoking habit. I was also using prescription nicotine patches in decreasing amounts. The treatment WAS effective in TEMPORARILY breaking the smoking habit and possibly could have had longer lasting effects, however, my skin had a reaction to the patches (I started developing large, red, hot circles everywhere they touched my skin) and I found that I could not effectively lead my day-to-day life while under the influence of the Bupropion. Once I stopped using both products, I slowly returned to smoking.”
(http://www.druglib.com/ratingsreviews/wellbutrin/)

CASE 8:
“My hair started falling out after the first week. During week two, I saw my doctor and told her about this. She said it was not a known side effect. Internet research assured me the hair loss was not coincidental; others had the same reaction. I quit taking it a few days later.”
(http://www.druglib.com/ratingsreviews/wellbutrin/)

CASE 9:
“Day 1 was ok but day 2 started feeling panicked and racing with panic attack and day 3 I put the pieces together with even worse panic attacks …. I gotta quit taking this now today! I have no desire or craving at all for a cigarette but the freakishly scary panic attacks, especially when leaving my home are not worth it…..got to go cold turkey from here on out!”
(https://www.drugs.com/comments/bupropion/for-smoking-cessation.html)

CASE 10:

“I started taking this 9 days ago. The first few days was ok, I was kinda snappy, but ok. After day 7 I stopped smoking, didn’t find it hard to quit, but did have the worst panic attack while driving home, and called my husband and cried for the next 25 minutes. The next day I was ok, but today I was on my way to work. I was 5 mins down the road from my house and turned around. I had to call out of work. I cried and had a huge panic attack. It happened all throughout the day. Called the Dr. She said to stop taking it. It’s OK for quitting smoking for me, but the side affects are not worth it (aside from the sex).”
(https://www.drugs.com/comments/bupropion/for-smoking-cessation.html)

Judging from the cases above, reports of black-outs, depression, suicide, loss of memory, panic attacks, hallucinations, bizarre behaviours, the media reports of lawsuits, and also the findings of the scientific trial by Anthenelli and colleagues, using buproprion or varenicline to stop smoking would have to be your last resort. If absolutely everything else failed, you could consider taking one of them. But, personally, I would never do so, never in a million years.

Conclusions
1) Medication is unsafe. You can ask yourself whether you wish to rely on a drug that has a high chance of giving you nausea, sleepless nights, bad dreams and maybe worse.
2) You will be able to reach your own conclusions. My recommendation is to steer clear of anti-smoking medications.
3) A far better solution is to stop smoking using a Psychological Therapy such as CBT and Mindfulness.
4) CBT and Meditation are more effective and safer than Medication.
5) Your main objective in stopping smoking should be to clear your body-mind of nicotine and any other toxic chemicals, resetting to homeostasis.

SOURCE FOR THE ABOVE CASES: http://nymag.com/news/features/43892/index3.html#comments

E-cigarettes Part 2

When I tell you that the largest corporate investors in e-cigarettes are the tobacco industry, you have every right to be suspicious.

Some patchy evidence suggests that e-cigarette use may facilitate smoking cessation, but definitive data are lacking. No e-cigarette has been approved by the FDA as an aid to stopping smoking. Environmental concerns and issues regarding non-user exposure exist. The health impact of e-cigarettes, for users and the public, cannot be determined with currently available data (Priscilla Callahan-Lyon, Electronic cigarettes: human health effects, Tobacco Control, 2013).

Vaping

Has this situation changed since 2013? Yes, it most certainly has. There have been many new studies of e-cigarette use since 2013 and the new evidence is not looking good for the e-cigarette.

The elimination of cigarettes and other combustable tobacco products can prevent tens of millions of tobacco-related deaths. The introduction of e-cigarettes could be an important step towards the elimination of the scourge of smoking. However, there is one drawback (if you’ll pardon the pun!). Nicotine itself is not harmless. Nicotine exposure can itself do harm, especially during periods of developmental vulnerability such as the fetal through adolescent stages. There can be multiple adverse consequences to early nicotine exposure including impaired fetal brain and lung development, and altered development of cerebral cortex and hippocampus in adolescents.

Back to the Future: Recent Legislation
E-cigarettes are marketed as a smoking cessation aids or as a tobacco replacement. Cancer and respiratory experts see the same ploys being used today with e-cigarettes as occurred in the 1940s with cigarettes, when the Western World started smoking en masse. Vapourizers are often distributed for free and pitched by celebrities and even doctors as cool, liberating and safe. However, they are not approved in Canada and in a few other countries. In March 2009, Health Canada issued an Advisory to Canadians NOT to use e-cigarettes as “these products may pose health risks and have not been fully evaluated for safety, quality and efficacy by Health Canada.” Health Canada issued a notice to stakeholders indicating that all electronic products intended to administer inhaled doses of nicotine are considered new drugs and as such fall under the Food and Drugs Act.

From May 20 2016 new laws came into force in the UK. The changes include rules meaning standardised plain packaging on vaping products and making them weaker. The rules will be enforced under the Tobacco and Regulated Products Regulations 2016 with a one-year transitional period for the sale of old stock. The new rules were as follows:

Smaller Containers
The amount of nicotine vapers inhale in each container will be reduced in two ways. Firstly, the new maximum size of each container will be 10ml. Secondly, the maximum strength of e-cigarette cartridges will drop to 20mg per millilitre (2 per cent) from 24mg
Health warnings
The front and back of e-cigarette packaging will contain health warnings much like regular cigarettes. The warnings will state: ‘This product contains nicotine which is a highly addictive substance’.
E-liquid cartridges must be childproof
New rules state cartridges must be childproof and tamper proof.
Adverts will change
Under the new laws, e-cigarette companies will no longer be able to make claims about vaping being beneficial to people’s health. This includes a ban on comparisons between the merits of vaping compared to smoking cigarettes. Celebrities will also not be allowed to endorse e-cigarettes and free samples cannot be given out in promotional campaigns.
Greater government scrutiny
Manufacturers will submit information to the government on the contents of their products before being allowed to sell them in the UK.
E-cigarettes as a Gateway to Traditional Smoking for Adolescents
One effect of the unregulated distribution of e-cigarettes is that it is ‘renormalizing’ smoking (Fairchild, Bayer & Colgrove, 2014). Increasing adolescent e-cigarette use encourages use of traditional cigarettes and dual use, a transition to cigarette use following use of e-cigarettes. E-cigarettes acting as a gateway to conventional tobacco smoking is something that adolescents and young adults perceive themselves, according to a Swiss study (Akre and Suris, 2015).

Barrington-Trimis et al. (2016) used questionnaires in 2014 from 11th/12th grade students in the Southern California Children’s Health Study. They evaluated the cross-sectional association between e-cigarette use, the social environment (family and friends’ use and approval of e-cigarettes and cigarettes), and susceptibility to future cigarette use among never cigarette smokers in a sample of 1,694 adolescents. Among adolescents who had never used cigarettes, 32% of past e-cigarette users and 35% of current (past 30-day) e-cigarette users indicated susceptibility to cigarette use, compared with 21% of never e-cigarette users. The chances of indicating susceptibility to cigarette use were two times higher for current e-cigarette users compared with never users. A social environment favorable to e-cigarettes in which friends are using them and hold positive attitudes toward e-cigarettes is also associated with greater susceptibility to cigarette use, independent of an individual’s e-cigarette use (Barrington-Trimis et al., 2016).

Dual Use of E-cigarettes and Conventional Cigarettes
Using e-cigarettes can be the first stepping stone to conventional cigarettes. A second stepping stone is dual usage. Dutra and Glantz (2014) examined e-cigarette use and conventional cigarette smoking in a cross-sectional analyses of survey data from a representative sample of US middle and high school students in 2011 (n = 17 353) and 2012 (n = 22 529) obtained in the National Youth Tobacco Survey. They measured experimentation with, ever, and current smoking, and smoking abstinence. The results showed that, among cigarette experimenters (≥1 puff), ever e-cigarette use was associated with higher odds of ever smoking cigarettes (≥100 cigarettes) and current cigarette smoking. Current e-cigarette use was positively associated with ever smoking cigarettes and current cigarette smoking. Dutra and Glantz concluded that the use of e-cigarettes was associated with a higher likelihood of ever or current cigarette smoking, of established smoking, of planning to quit smoking among current smokers, and, among experimenters, a lower likelihood of abstinence from conventional cigarettes. The study suggested that “Use of e-cigarettes does not discourage, and may encourage, conventional cigarette use among US adolescents”.

A study Hitchman et al (2016) examined the association between type of e-cigarette used, frequency of use (daily vs. non-daily vs. no use), and quitting. An online survey included 1643 current smokers, 64% of whom reported no e-cigarette use, 27% used cigalikes, and 9% used tanks. One year later, compared to no e-cigarette use, non-daily cigalike users were less likely to have quit smoking, daily cigalike or non-daily tank users were no more or less likely to have quit, and daily tank users were more likely to have quit (P = .0012). These results suggest that ‘tinkering’ with e-cigarettes gives the smoker a lower chance of stopping smoking.

Dual Use of E-cigarettes with NRT
An EU study by Drs. Farsalinos, Romagna and Voudris examined Factors associated with dual use of tobacco and electronic cigarettes with 7,060 E-cigarette users. They found that risk perception is the most convincing independent indicator of dual use. Occasional use and the use of previous generations of devices have also been associated with dual use. Adequate information about the risks associated with the electronic cigarette is important to avoid double use. 3,530 dual using participants were compared with the same number of vapers. They found that dual users had a longer smoking history, a lower daily consumption of cigarettes and an identical addiction to cigarettes as vapers. Their daily consumption of tobacco cigarettes declined from 20 to 4 cigarettes a day after they started using electronic ones. Most of them were daily vapers but many of them were using their electronic cigarette occasionally compared to full-time vapers.
For the both groups, the most important reasons for using electronic cigarettes were to reduce tobacco consumption and to prevent relatives from being exposed to smoke. The more important reason was to “circumvent the smoking ban in public places” mentioned by more dual users than vapers. The most convincing indicators of dual use are:
a higher risk perception among vapers; the use of first generations of devices; the use of pre-filled cartomizers; the occasional use of electronic cigarettes. The results of this study show that higher risk perception and less frequent use of electronic cigarettes are associated with the dual use of electronic and tobacco cigarettes.


E-cigarettes as Carriers for Drugs more Potent than Nicotine

In selling e-cigarettes, one is opening doors to drug use beyond nicotine. E-cigarettes can be used with all kinds of fluids and mixtures apart from e-liquid. They work well with marijuana. Researchers surveyed 3,847 Connecticut high school students and found nearly one in five e-cigarette users also have used the device to vaporize cannabis or byproducts like hash oil. 18.7 percent of users reported using e-cigarettes to vaporize marijuana. Hash oil can also be substituted for the nicotine solution in many traditional e-cigarettes, and some vendors sell e-cigarettes specifically designed for use with marijuana leaves or wax infused with THC, the active ingredient in marijuana. Vaping concentrated liquid forms marijuana can be much more potent than smoking dried marijuana leaves.

Drug users have also discovered a method of adapting e-cigarettes to vaporize a potent class of hallucinogen known as dimethyltryptamine or DMT. This “hack” is being discussed openly on multiple web forums, with DMT enthusiasts describing how simple it is to consume the drug using an e-cigarette. Certain e-cigarettes generate precisely the correct temperature needed to vaporize the drug. Described as “the spirit molecule” by some users, DMT is one of the strongest known hallucinogens. Depending on the dose and method of ingestion, DMT effects range from short-lived mild hallucinations to much more immersive and hypnotic experiences. Many DMT users report having deeply spiritual experiences, including traveling to other ‘realms.’ Although modifying an e-cigarette in preparation for smoking DMT is relatively simple, errors in this process could prove dangerous. Reports have surfaced online of people claiming to have felt a burning sensation on their lungs while attempting to smoke the drug in this manner.

E-cigarettes as a Tool for Long-term Smoking Cessation
The World Health Organization (WHO) have banned therapeutic claims by manufacturers of ENDS. Sara Kalkhoran and Stanton A Glantz (2016) studied E-cigarettes and smoking cessation in real-world and clinical settings. Because smokers are increasingly using e-cigarettes for many reasons, including attempts to quit combustible cigarettes and to use nicotine where smoking is prohibited, the investigators aimed to assess the association between e-cigarette use and cigarette smoking cessation among adult cigarette smokers, irrespective of their motivation for using e-cigarettes.

They searched PubMed and Web of Science between April 27, 2015, and June 17, 2015. Data extracted included study location, design, population, definition and prevalence of e-cigarette use, comparison group (if applicable), cigarette consumption, level of nicotine dependence, other confounders, definition of quitting smoking, and odds of quitting smoking. The primary endpoint was cigarette smoking cessation. Odds of smoking cessation among smokers using e-cigarettes compared with smokers not using e-cigarettes were assessed.

38 studies were included in the systematic review. Odds of quitting cigarettes were 28% lower in those who used e-cigarettes compared with those who did not use e-cigarettes. The association of e-cigarette use with quitting did not significantly differ among studies of all smokers using e-cigarettes compared with studies of only smokers interested in cigarette cessation. Other study characteristics (design, population, comparison group, control variables, time of exposure assessment, biochemical verification of abstinence, and definition of e-cigarette use) were also not associated with the overall effect size.
Interpretation. Kalkhoran and Glantz (2016) concluded that: “As currently being used, e-cigarettes are associated with significantly less quitting among smokers”.

So much for the hype about e-cigarettes helping smokers to quit. The evidence suggests the opposite to be the case.

E-cigarette Marketing
E-cigarette promotional spending is rapidly increasing. Levels of television advertising are increasing as tobacco companies acquire an increasing share of the market, with Vuse (R.J. Reynolds) and MarkTen (Phillip Morris) launching television campaigns. E-cigarette marketers are applying advertizing ideas from the tobacco industry, allowing products to be marketed to promote traditional smoking.

A key instrument to the success of e-cigarette marketing is the proposition that they are safer than conventional cigarettes. Pokhrel et al. (2015) tested whether exposure and receptivity to e-cigarette marketing are associated with recent e-cigarette use among young adults through increased beliefs that e-cigarettes are less harmful than cigarettes.The findings provided support to the proposition that marketing of e-cigarettes as safer alternatives to cigarettes or cessation aids is associated with increased e-cigarette use among young adults.

Blake et al. (2015) assessed adult smokers’ exposure to information about e-cigarettes, whether their exposure predicted e-cigarette use behavior and perceptions about addiction and reduced harm, and the role played by reduced harm perceptions. Forty percent of 2254 people reported seeing, hearing, or reading about e-cigarettes in the media “a lot of times,” with television and point-of-sale being the most common channels of exposure. Those reporting a lot of exposure were 40% more likely than those reporting low or no exposure to say that using e-cigarettes is “not at all harmful” to a person’s health and 40% more likely to say they use e-cigarettes every day or some days. These results suggest that exposure to information about e-cigarettes is associated with reduced harm perceptions and e-cigarette use.

E-cigarettes are marketed in all media, including television commercials, sports and cultural sponsorship, celebrity endorsement, social networking, online advertising, point-of-sale displays, pricing strategies, and product innovation. E-cigarettes are being sold as a “cool’ product. The same image is being promoted as was the case previously with tobacco advertising. The e-cigarette user is modeled as independent, making a lifestyle choice, identifying with celebrities, at fashionable, trendy places and activities. As the WHO report correctly noted, some e-cigarettes are marketed as socially superior to conventional cigarettes. However, “unsubstantiated or overstated claims of safety and cessation are frequent marketing themes aimed at smokers. Some ENDS marketing also promotes long-term use as a permanent alternative to tobacco, and a temporary one in public places where smoking is banned.”

Glamorizing smoking and attracting children and non- smokers are part of the message. The use of flavours in the marketing such as candy-like flavours are likely to entice children or teenagers to experiment with e-cigarettes.
It is in the interests of the industry that the e-cigarette remains unregulated, that so-called experts state that the safety is unknown, and will not be known for decades. The truth is that we know now that e-cigarettes are unsafe.

Physical, Cognitive and Mood Effects
The most commonly used reasons for vaping on e-cigarettes are that they aid quitting smoking, help avoid relapse, reduce the urge to smoke, and are a lower risk alternative to traditional smoking. How much nicotine does vaping put into the blood? Does it have the expected effects on urges and craving? Dawkins and Corcoran (2014) studied the effect of using an 18 mg/ml nicotine first generation e-cigarette on blood nicotine, tobacco withdrawal symptoms and urge to smoke. The study was supported by SKYCIG Ltd. and the lead author has received sweeteners from the e-cigarette industry. Hence:

Fourteen regular e-cigarette users (3 female) who had been abstinent from smoking and e-cigarette use for 12 hours completed a 3-hour testing session. Blood was sampled and questionnaires were completed concerning their tobacco-related withdrawal symptoms, urge to smoke, positive and negative subjective effects at four stages: baseline, 10 puffs, 60 min of ad lib use and a 60 min rest period. Complete sets of blood were obtained from 7 participants. (That’s a bit odd – what happened to the other seven? ) Plasma nicotine concentration was found to rise significantly from a mean of 0.74 ng/ml at baseline to 6.77 ng/ml 10 min after 10 puffs, reaching a mean maximum of 13.91 ng/ml by the end of the ad lib puffing period. Tobacco-related withdrawal symptoms and the urge-to-smoke were significantly reduced, direct positive effects were strongly endorsed and there were few reports of any adverse effects.
The authors concluded that reliable blood nicotine delivery does indeed occur after acute use of this brand/model of e-cigarette in a sample of regular users. Hardly surprising I guess. It’s a bit like asking whether drinking whisky puts alcohol into your bloodstream and gets you drunk?

Conclusions
1) E-cigarettes are branded as a cheap, cool and less risky alternative to conventional cigarettes. They may well be cheaper and even ‘cooler’ perhaps, but they are certainly not risk free and certainly not safe.
2) Nicotine is a lethal poison. Lack of safety of e-cigarettes and e-liquids is a major issue. Many poisonings are occurring as infants and children are drinking e-liquids directly out of the bottle.
3) The e-cigarette can be a stepping stone to conventional cigarette use, which leads to dual use, then to conventional smoking and possibly to abuse of other drugs.
4) The only way to stop smoking is to eliminate nicotine from the body. Smokers who switch to e-cigarettes remain addicted to nicotine. There is no convincing evidence that E-cigarettes help smokers to quit.
5) E-cigarettes are an obstacle to the process of nicotine elimination and are not helpful. The only safe way to stop smoking is to avoid any form of nicotine from entering the body. Type II homeostasis enables a reset to occur, removing the need to have any nicotine inside the body.

E-cigarettes: Cool, Cheap and Less Risky?

Electronic or E-cigarettes mimic normal cigarettes but they deliver nicotine through a vapour. The vapour is produced by battery-powered heating of a solution of chemicals containing nicotine and propylene-glycol. Inhaling the vapour from an e-cigarette is called vaping. There is no tobacco, no combustion and no smoke. For these reasons, vaping is often viewed as a ‘cool’, cheap and less risky alternative to conventional cigarettes.

E-cigarettes fall into three basic types: (1) “Cigalikes” that resemble tobacco cigarettes, disposable or with pre-filled cartridges; (2) Cylindical “tanks,” designed to be refilled with liquid; (3) Larger, rectangular tanks with a large capacity for fluid. Many of the most widely sold brands of cigalikes are now owned by the tobacco industry. Hardly a coincidence!

The full technical term for devices that deliver nicotine is electronic nicotine delivery systems (ENDS). Here I use the term ‘e-cigarette’ or ‘e-cig’.

Intense competition between hundreds of suppliers has created a diverse range of brands, strengths and flavours. Many of the flavours are designed to have special appeal to children and teenagers. They are also technologically quite ‘whizzy’. There are e-cigarettes with Bluetooth compatible with androids, iOS devices or tablets that allow the user to make calls or listen to music while vaping. E-cigarettes can even give vapers statistics about their consumption via a mobile app.

The accepted wisdom is that vaping should be less harmful than smoking. This is because it delivers nicotine without the thousands of toxicants in tobacco smoke. E-cigarettes do not contain carbon monoxide (CO) or many of the other harmful chemicals found in conventional cigarettes. However, because the e-cigarette mimics the tobacco cigarette in the mechanics of inhaled delivery of nicotine, it can substitute both for the pharmacologic (nicotine ‘rush’) and the behavioural (touch and feel) components of cigarette smoking.

download-1

E-cigarettes create the ‘illusion’ of smoking but without any actual smoke. Is this ingenious or dangerous? We can determine now on the basis of current knowledge that e-cigarettes are unsafe. There is already sufficient evidence that nicotine is a lethal poison and that e-cigarettes are unsafe. Only those with a commercial interest in increasing e-cigarette sales would wish to argue otherwise. As stated by The International Programme on Chemical Safety (IPCS): “Nicotine is one of the most toxic of all poisons and has a rapid onset of action.” There are many different avenues of harm that stem from the e-cigarette.

E-cigarettes: no tar, no carbon monoxide. But are they safe?

E-cigarettes have been on the market world-wide for more than a decade and are increasingly popular including among adolescents and pregnant smokers. Yet e-cigarettes are unregulated in most countries. Electronic cigarettes are currently the most popular stop smoking aids and evidence indicates they can help people to quit. On the other hand, they can can help people to continue smoking also. What is the truth about the e-cigarette?

Currently, there are around 2.5-3.0 million e-cigarette users in Great Britain. About 10 percent of U.S. adults vape, according to the online Reuters/Ipsos poll of 5,679 Americans conducted in 2016. However, this number includes many women who are using e-cigarettes during pregnancy and also adolescents. This places unborn children at significant risk and many teenagers may end up with damaged brains. Use of e-cigarettes among the young is increasing at exponential rates. This growth in usage is perceived as safe with unlimited advertising geared toward vulnerable populations, such as young women who are likely to smoke or vape during pregnancy.

There is real danger in maternal smoking during pregnancy and the consequences this can have on offspring lung function, including the increased risk of childhood wheezing and subsequent asthma, can be lifelong. Recent evidence strongly suggests that much of the effect of smoking during pregnancy on offspring lung function is mediated by nicotine, making it highly likely that e-cigarette use during pregnancy has the same harmful effects on offspring lung function and health as do conventional cigarettes. In fact, the evidence for nicotine being the mediator of harm of conventional cigarettes may be most compelling for its effects on lung development. This raises concerns about both the combined use of e-cigarettes and conventional cigarettes during pregnancy as well as the use of e-cigarettes by e-cig–only users who think them safe or by those sufficiently addicted to nicotine to not be able to quit e-cigarettes during pregnancy.

The unregulated distribution of e-liquid is a cause for concern. Liquids are available in 7.2%, and even up to 10% concentrated solutions. The higher concentrations are available in large quantities on the Internet—with sizes ranging from one litre to a gallon for consumer use and up to a 55-gallon drum for manufacturing purposes. A perfect new murder weapon is in the making. Crime writers take note!

The chemicals used to flavour liquids may themselves be quite toxic. There are already at least 8000 uniquely named flavoured e-liquids, with hundreds of new flavours each month. Makers of e-liquids don’t have to list the ingredients and nicotine amounts. The safety of flavourings in the e-liquids have not been evaluated for their risk levels to the lungs.

Explosions, Poisonings and a Suicide

E-cigarettes are sold with chargers. Every few hours the device requires recharging, like a mobile phone. A problem may arise when the user charges the device using the wrong charger. There is a risk that it may actually EXPLODE! One man lost part of hit tongue and had his teeth blackened. Not surprisingly he gave up vaping immediately. Many such cases have been reported in the media. One unfortunate victim lost an eye during a vaper explosion. This is leading to litigation.

Nicotine is one of the most toxic of all poisons. Accidental ingestion or absorption of nicotine liquid (“e-liquid”) from e-cigarettes is increasingly prevalent. The journal Pediatrics reported that in the period January 2012 to April 2015 the US National Poison Data System received 29,141 calls for nicotine and tobacco exposures in children younger than 6 years (Kamboj et al., 2016). This is an average of 729 child exposures per month. Cigarettes accounted for 60% of exposures, followed by other tobacco products (16%) and e-cigarettes (14%). The monthly number of exposures associated with e-cigarettes increased by 1492.9% during the study period. One death occurred in association with a nicotine liquid exposure.

The safety information on e-liquid containers is generally inadequate and poorly presented. In many cases, the information is printed in such small print that the warnings are invisible to the naked eye. If you can read the small print without a powerful magnifying glass, you’ve got better eyesight than I have.

E-liquid bottle small
This image of an e-liquid container is approximately twice the actual size

Candy-flavoured e-liquids are bound to have an instant appeal to children. Flavours such as: Bubble Gum, Blueberry Candy, Apple Candle, Licorice, Butter Toffee, Blueberyy Cotton (candy floss). Small wonder hundreds of children are smelling and swallowing these enticing fluids.

The Pediatrics journal authors’ report concluded that: “Swift government action is needed to regulate these products to help prevent child poisoning. Prevention strategies include public education; appropriate product storage and use away from children; warning labels; and modifications of e-cigarette devices, e-liquid, and e-liquid containers and packaging to make them less appealing and less accessible to children.”

There is also at least one e-liquid suicide. According to the Daily Mail (28 November 2015) a BBC TV contractor was found dead in his living room after drinking a mix of alcohol and the liquid used in e-cigarettes. Jonathan Keen, 46, described as a functioning alcoholic, was found by his girlfriend at his flat in Chesham, Buckinghamshire, next to remnants of fluid used in e-cigarettes and empty cans of cider. The Buckinghamshire Coroner Richard Hulett heard that Mr Keen would regularly mix his own concentrations of nicotine to use in the cigarette substitute. Recording a verdict of suicide, Mr Hulett said it was the first time he had heard of someone ‘dying directly from this’ in the county.

A hidden danger of e-cigarettes is mislabelling of the nicotine contents of the e-liquid. People may innocently vape on what appears to be a low dosage of nicotine when, in reality, the level can be much higher. The person would quickly becomes addicted and switch to conventional cigarette smoking. Writing in the Journal of Pediatric Nursing, Buettner-Schmidt et al. (2016) reported that only 35% of e-liquid containers were child-resistant. Moreover, more than half of the e-liquid containers were mislabeled by at least 10%. Again, these findings make a strong case for legislation on child-safe packaging and clear nicotine labeling.

Nicotine Replacement Therapy Part 2

The most commonly used method to reduce the craving and the risk of relapse is to use nicotine replacement medication. The reason it is commonly used is that it has been heavily promoted by the manufacturers. It has nothing to do with its effectiveness, because the majority of independent real-world research shows that it is an ineffective method of stopping smoking.

The theory is that Nicotine Replacement Therapy (NRT) provides enough nicotine to the body to lessen the urge to smoke and remove the worst of the nicotine withdrawal effects. Forms of NRT include chewing gum, transdermal patches, nasal spray, inhalers and pills.

images-1.jpg

Let’s consider the evidence.

The usual source of evidence concerning drugs is clinical trials. As indicated in the previous post, this source is tainted by company influence and the complicity of university professors who are commissioned to carry out the trials. This highly conflicted situation is accepted as ‘normal’ by the medical fraternity which is in bed with Big Pharma.

We referred to the 2004 review by Drs. Silagy, Lancaster, Stead, Mant and Fowler who reviewed the effectiveness of the different forms of NRT in helping people to stop smoking, or in reducing the amount they smoked. The review considered 96 randomized trials in which NRT was compared to placebo (no active treatment), or where different doses of NRT were compared. The measure used was whether the ex-smokers managed to abstain from smoking for at least six months following treatment compared to a control group of people stopping smoking without NRT. The NRT group were reported to be 1.74 times more likely to abstain than those not using NRT.

The reviewers concluded that all of the commercially available forms of NRT (nicotine gum, transdermal patch, the nicotine nasal spray, nicotine inhaler and nicotine sublingual pills/lozenges) are effective as part of a strategy to stop smoking. They stated that NRT increases stop rates by approximately one-and-a-half to two times. If true, that would be positive proof that NRT is an effective medical approach to stopping smoking. Unfortunately, there are issues with the study that make such a conclusion highly debatable.

There are many problems with this study and other studies like it.

First, there is the Sweetener Effect. Sweetened investigators produce sweetened findings.

Another trouble with these kinds of controlled clinical studies is the method. The investigators are proud to claim that the study is “double blind”. In theory, this means that neither the investigators nor the participants know which condition they are in, treatment or control. This prevents biasing the results by expectations and beliefs about the drug effects. The trouble is that the participants may not really be ‘blind’ and they have ways of telling when they are in the placebo group and they respond differently for this reason.

A third problem is that the findings of randomised trials is that the conditions are artificial and the findings from clinical trials rarely hold up in the real world. Evidence from real world studies shows that NRT is ineffective as a method of stopping smoking.

An excellent source of information on the scientific literature on real world studies can be found at http://whyquit.com.

A Gallup Poll national survey in 2013 found that only 1 in 100 successful ex-smokers credited nicotine gum for their success, with only 8 percent quitting with any approved product, and that more quit smoking cold turkey than by all other methods combined. As early as September 2002, the Journal of the American Medical Association reported that: “Since becoming available over the counter, NRT appears no longer effective in increasing long-term successful cessation in California smokers.”

This must be true today not only in California but everywhere in the Western world.

Other available products exceed the effectiveness of NRT including cytisine, an alkaloid extract from the laburnum or golden rain tree (Laburnum anagyroides), which grows all over Europe.  Even Robert West is “enthusiastic about cytisine’s potential saying that “it is the biggest news in smoking cessation treatment ever…Here is a pill that can be produced for next to nothing, that can be bought by even the poorest smoker in India, and that can save literally millions of lives.”

To conclude:

Clinical trials are run by professors with conflicts of interest leading to a Sweetener Effect. The reported results are untrustworthy.

Clinical trials that have supported the use of NRT all suffer from the Sweetener Effect and are all untrustworthy.

Real world studies of NRT consistently show that NRT is no more effective than a placebo.

NRT is not an effective method of stopping smoking and should be avoided.images.jpg

Why Smokers Should Avoid Nicotine Replacement Therapy

We all know that tobacco is the world’s number one killer. The tobacco plant itself is not unattractive. It’s the nasty nicotine inside and all the other s**t that ends up in the smokers’ lungs that is the problem.

Tobacco plant small
A harmless looking tobacco plant

Big Pharma wishes the world to believe that their drug-based therapies are effective methods to stop smoking. Smokers are offered nicotine in a less risky manner than inhaling smoke from burning tobacco. Or they are offered a medicine as a method of ‘weaning’ off smoking, using one drug to help stop using another.

The effectiveness of drugs is tested in clinical trials. Clinical trials are studies in which people volunteer to test new drugs or devices. All new treatments (drugs and medical devices) must go through clinical trials before being approved by the Food and Drugs Administration (FDA) in the US, the European Medicines Agency (EMA), and the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK.

One would like to imagine that the conclusions reached by these agencies are based on the best information science has to offer. Unfortunately clinical trials and reports can be cleverly manipulated so that drugs appear in a positive light. The area of clinical trials is a minefield of dubious practices, commercial skullduggery and misleading information.

Unfortunately clinical trials are often twisted abominations of science designed to trick people into thinking drugs are safe and efficacious when oftentimes they are the exact opposite.

What can appear on the surface to be well-controlled scientific clinical trials may have a dubious pedigree. There are many reasons for this. Like many other businesses, universities depend upon funds from other industries to increase cashflow. There is pressure on university professors in medicine and psychology to accept research funds from diverse sources including drug companies who need universities to run clinical trials.

For a variety of different reasons the evidence collected from some elements of this research can be tainted and untrustworthy. In order to cross the hurdle of FDA/EMA/MHRA approval, drug companies require positive results from clinical trials that follow rigorous scientific methods. The influence of commercial interests and the need for industrial income flows can lead to outcomes that are not always ideal.

The influence of Big Pharma on governments, regulatory bodies and the professions cannot be underestimated. Its influence on the medical profession begins from the moment a student starts at medical school. Offers of textbooks, study grants, and other incentives start in Year One. The ‘grooming’ process continues throughout a doctor’s career, with many attractive incentives and offers designed to recruit doctors and their patients into clinical trials.

One doctor I know was offered a free flight on Concord and three days of paid holiday in return for recruiting five patients into a trial. University professors who direct the trials are equally well rewarded, as are those who put their names on the papers that report positive clinical findings.

We end up in a situation where the health service and the general public are fooled into accepting expensive drugs that are ineffective or less effective than drug companies claim. Quite often drugs prescribed by doctors on the advice of the ‘authorities’ are nothing more than active placebos with unpleasant side effects.

Unfortunately, this situation exists with the principle method used by smokers to kick the habit, Nicotine Replacement Therapy (NRT). NRT is heavily promoted by companies, endorsed by expert committees, and university professors, yet the evidence on its real world effectiveness is totally lacking. This evidence suggests that it is no better than a placebo or a simple sugar pill.

SMOKING TREATMENT WOMAN
Model.
Nicotine substitutes in the form of chewing gums.


The Sweetener Effect

At first sight, the pharmacy approach to smoking seems a bit nuts. Why would you want to replace one form of an addictive drug by another? You wouldn’t help an alcoholic by drip-feeding them alcohol. That would be absolutely crazy. Ditto, heroin cocaine or ecstacy. So why should experts have us all believe that the best way to cure nicotine addiction is by giving people nicotine?

The answer is simple: it’s the Sweetener Effect. These experts have been bought. That’s right, the leading advocates of NRT have all received payments from the companies selling the product. Big Pharma has big pockets and plays willing academics like puppets on a string. It’s a very old saying that “he who pays the piper calls the tune.” In the field of medicines, there are plenty of willing pipers playing the company’s tune.

I discuss briefly below a few examples of research on NRT and other treatments can never be accepted as trustworthy. The scientists robustly deny that they have been influenced. They are disingenuous or naïve or wrong. Bear in mind that ‘conflicts of interest’ don’t need to be conscious. Financial connections can influence investigators at an unconscious level which can leave them in a state of complete denial. Let’s consider a few examples.

Case 1: Michael C Fiore, a University of Wisconsin Professor of Medicine, in charge of revising US federal guidelines on how to get smokers to quit.
Dr Fiore runs an academic research centre funded in part by drug companies that make quit-smoking aids. Dr. Fiore personally has received tens of thousands of dollars in speaking and consulting fees from those companies.

John R. Polito, founder of WhyQuit published a Press Release on November 12, 2009, containing the following interesting facts:

“After spending millions on the University of Wisconsin’s (UW) studies since 1992, the smoking cessation arm of the pharmaceutical industry expects its money’s worth. Welcome to pay day!
A University of Wisconsin quit smoking study press release told smokers that they needed to purchase and suck on a nicotine lozenge while at the same time wearing a nicotine patch. The spin by Professor GlaxoSmithKline (Dr. Michael C. Fiore) and his staff at UW’s Center for Tobacco Research and Intervention (UW-CTRI) was masterful.
The University’s press release claims to announce key findings from a UW-CTRI study published in the November 2009 issue of Archives of General Psychiatry entitled, “A Randomized Placebo-Controlled Clinical Trial of 5 Smoking Cessation Pharmacotherapies.”
Used in three of five active group study arms, the nicotine lozenge was clearly the study’s focus. GlaxoSmithKline’s Commit nicotine lozenge was the only lozenge sold when the study was commenced in September 2004.
Arguably, no man on earth has done more to promote use of replacement nicotine products (NRT) than Dr. Michael C. Fiore. In 1992 he was lead author of a nicotine patch review published in the Journal of the American Medical Association (JAMA). He subtitled his paper “Clinical Guidelines for Effective Use.” It foretold his future in serving as lead author and panel chairman in coining official U.S. quit smoking policy in 1996, 2000 and 2008. It’s called the PHS “Clinical Practice Guideline,” and each time was written and updated by expert panels drowning in pharmaceutical industry financial influence.
Dr. Michael C. Fiore founded and has served as director of UW-CTRI since its creation in 1992. He co-authored this new study along with six UW-CTRI staff members.
In 1998, GlaxoSmithKline (then Glaxo Wellcome) spent $1 million to establish a University of Wisconsin Foundation “named chair” for Dr. Fiore to occupy. According to Dr. Fiore’s sworn testimony, the endowed chair made available to him unrestricted grants of up to $50,000 per year.” (Slightly edited by the author).

Case 2: A review of the effectiveness of Nicotine Replacement Therapy published by Drs. Silagy, Lancaster, Stead, Mant and Fowler in 2004 by the Cochrane Library.
The Cochrane Library is held up to be the repository of ‘Gold Standard’ scientific reviews of therapies and medicines. The information in the Cochrane Library influences decision-making by authorities who approve new medicines and technologies such as the ‘NICE’. The authors concluded: “All forms of nicotine replacement therapy (NRT) can help people quit smoking, almost doubling long term success rates.”

Yet there was a massive conflict of interest among the authors. A footnote to the publication states: “C. Silagy received funds for consultancy work undertaken (at various times) on behalf of Pharmacia and Upjohn, Marion Merrell Dow, Glaxo Wellcome and SmithKline Beecham. G. Fowler and D. Mant were involved in a trial of transdermal nicotine (ICRF 1994).” One of the reviewers of the paper was Professor Robert J West of University College London (see Case 3 next). It really is like putting the foxes in charge of the henhouse.

Case 3: Professor Robert West, Editor of the journal Addiction. He is also the world’s most vocal advocate of NRT.
Professor Robert ‘NRT’ West has published dozens of papers suggesting positive results from NRT but not a single paper showing zero results. The journal Addiction and Professor West openly admit to conflicts of interest. The journal Addiction has an “Ethical Policy” which states: “ADDICTION has asked its senior editors to provide brief statements on any interests which might be seen as having a potential bearing on the independence of their editorial judgements”. Editor West states: “Robert West has received travel funds and hospitality from, and undertaken research and consultancy for pharmaceutical companies that manufacture or research products aimed at helping smokers to stop. These products include nicotine replacement therapies, Champix (varenicline) and Zyban (bupropion). This has led to payments to him personally and to his institution….”

The trouble is that we simply don’t know how much of an influence there has been. There can be no doubt that travel funds, hospitality, research grants and consultancy payments over a long period of time must have an influence. If a journal editor is a paid consultancy fees by Big Pharma, it is sensible to question the reliability of reports published in his/her name, especially those that advance products made by the sponsoring companies. I have some experiences of my own to draw upon.

In the 1990s I did a piece of research on stress experienced by carers of people with dementia. I do not understand how but Big Pharma has very long tentacles and somehow or another a major drug company got wind of of our results. I certainly did not approach them. However, the company began a charm offensive that was, to put it bluntly, quite inappropriate. My team were invited to give a talk in a symposium at an international conference at a well-known resort in Switzerland. The whole process was quite incredible. From the moment I said I would consider it, the phone hardly stopped ringing.

All kinds of sweet little deals were on offer: business class air tickets, a five-star hotel, a chauffeur-driven limo to the airport, and goodness knows what else. I could hardly believe it when the company offered to prepare our PowerPoint slides for us! This was the moment that I ‘smelt a rat’. We attended the symposium, but my co-presenter and I paid our own fares, booked our own hotel, and prepared our own slides. The symposium team were all “old-hands” who had stayed at a luxury hotel for several days as guests of the company. All had slides showing the company logo.

I wonder what happens to the values of academics as supporters of independent thinking and freedom of speech when the almighty dollar appears on the conference table. I had known the chair of the symposium many years before as a PhD student. I found his role as Big Pharma’s spokesperson a little disconcerting. He told me his hobby consisted of flying his own aeroplane.

There is no limit to Big Pharma’s antics in influencing opinion. One of the key tricks from its tool-bag is to employ ghost-writers to produce the reports of their clinical trials. From the company’s viewpoint, it’s a ‘win-win’, intellectually-lazy-but-enriched academics get their names on papers that they don’t need to write, and, it’s another positive finding, and another cheque in the bank account. Another dollar, another day, and nobody needs to know.

The collaboration between universities and industries has led to an erosion of standards and a distrust of science. Worse, millions of patients are being offered ineffective treatments. The only way to gather trustworthy evidence is to ensure that the clinical trials are independent, unbiased, and free of strings and sweeteners. Sadly, in today’s world, where everything is about profit, that rarely happens.

Reports on clinical trials conducted by the pawns of the pharmaceutical industry too often a sham – exercises in propoganda nothing to do with natural science. And guess who pays? You, me, patients and consumers!

To be continued…

Reasons To Avoid Nicotine Replacement Therapy

We all know that tobacco is the world’s number one killer. The tobacco plant itself is not unattractive. It’s the nasty nicotine inside and all the other s**t that ends up in the smokers’ lungs that is the problem.

Big Pharma wishes the world to believe that their drug-based therapies are effective methods to stop smoking. Smokers are offered nicotine in a less risky manner than inhaling smoke from burning tobacco. Or they are offered a medicine as a method of ‘weaning’ off smoking, using one drug to help stop using another.

The effectiveness of drugs is tested in clinical trials. Clinical trials are studies in which people volunteer to test new drugs or devices. All new treatments (drugs and medical devices) must go through clinical trials before being approved by the Food and Drugs Administration (FDA) in the US, the European Medicines Agency (EMA), and the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK.

One would like to imagine that the conclusions reached by these agencies are based on the best information science has to offer. Unfortunately clinical trials and reports can be cleverly manipulated so that drugs appear in a positive light. The area of clinical trials is a minefield of dubious practices, commercial skullduggery and misleading information.

Unfortunately clinical trials are often twisted abominations of science designed to trick people into thinking drugs are safe and efficacious when oftentimes they are the exact opposite.

What can appear on the surface to be well-controlled scientific clinical trials may have a dubious pedigree. There are many reasons for this. Like many other businesses, universities depend upon funds from other industries to increase cashflow. There is pressure on university professors in medicine and psychology to accept research funds from diverse sources including drug companies who need universities to run clinical trials.

For a variety of different reasons the evidence collected from some elements of this research can be tainted and untrustworthy. In order to cross the hurdle of FDA/EMA/MHRA approval, drug companies require positive results from clinical trials that follow rigorous scientific methods. The influence of commercial interests and the need for industrial income flows can lead to outcomes that are not always ideal.

The influence of Big Pharma on governments, regulatory bodies and the professions cannot be underestimated. Its influence on the medical profession begins from the moment a student starts at medical school. Offers of textbooks, study grants, and other incentives start in Year One. The ‘grooming’ process continues throughout a doctor’s career, with many attractive incentives and offers designed to recruit doctors and their patients into clinical trials.

One doctor I know was offered a free flight on Concord and three days of paid holiday in return for recruiting five patients into a trial. University professors who direct the trials are equally well rewarded, as are those who put their names on the papers that report positive clinical findings.

We end up in a situation where the health service and the general public are fooled into accepting expensive drugs that are ineffective or less effective than drug companies claim. Quite often drugs prescribed by doctors on the advice of the ‘authorities’ are nothing more than active placebos with unpleasant side effects.

Unfortunately, this situation exists with the principle method used by smokers to kick the habit, Nicotine Replacement Therapy (NRT). NRT is heavily promoted by companies, endorsed by expert committees, and university professors, yet the evidence on its real world effectiveness is totally lacking. This evidence suggests that it is no better than a placebo or a simple sugar pill.

SMOKING TREATMENT WOMAN
Model.
Nicotine substitutes in the form of chewing gums.


The Sweetener Effect

At first sight, the pharmacy approach to smoking seems a bit nuts. Why would you want to replace one form of an addictive drug by another? You wouldn’t help an alcoholic by drip-feeding them alcohol. That would be absolutely crazy. Ditto, heroin cocaine or ecstacy. So why should experts have us all believe that the best way to cure nicotine addiction is by giving people nicotine?

The answer is simple: it’s the Sweetener Effect. These experts have been bought. That’s right, the leading advocates of NRT have all received payments from the companies selling the product. Big Pharma has big pockets and plays willing academics like puppets on a string. It’s a very old saying that “he who pays the piper calls the tune.” In the field of medicines, there are plenty of willing pipers playing the company’s tune.

I discuss briefly below a few examples of research on NRT and other treatments can never be accepted as trustworthy. The scientists robustly deny that they have been influenced. They are disingenuous or naïve or wrong. Bear in mind that ‘conflicts of interest’ don’t need to be conscious. Financial connections can influence investigators at an unconscious level which can leave them in a state of complete denial. Let’s consider a few examples.

Case 1: Michael C Fiore, a University of Wisconsin Professor of Medicine, in charge of revising US federal guidelines on how to get smokers to quit.
Dr Fiore runs an academic research centre funded in part by drug companies that make quit-smoking aids. Dr. Fiore personally has received tens of thousands of dollars in speaking and consulting fees from those companies.

John R. Polito, founder of WhyQuit published a Press Release on November 12, 2009, containing the following interesting facts:

“After spending millions on the University of Wisconsin’s (UW) studies since 1992, the smoking cessation arm of the pharmaceutical industry expects its money’s worth. Welcome to pay day!
A University of Wisconsin quit smoking study press release told smokers that they needed to purchase and suck on a nicotine lozenge while at the same time wearing a nicotine patch. The spin by Professor GlaxoSmithKline (Dr. Michael C. Fiore) and his staff at UW’s Center for Tobacco Research and Intervention (UW-CTRI) was masterful.
The University’s press release claims to announce key findings from a UW-CTRI study published in the November 2009 issue of Archives of General Psychiatry entitled, “A Randomized Placebo-Controlled Clinical Trial of 5 Smoking Cessation Pharmacotherapies.”
Used in three of five active group study arms, the nicotine lozenge was clearly the study’s focus. GlaxoSmithKline’s Commit nicotine lozenge was the only lozenge sold when the study was commenced in September 2004.
Arguably, no man on earth has done more to promote use of replacement nicotine products (NRT) than Dr. Michael C. Fiore. In 1992 he was lead author of a nicotine patch review published in the Journal of the American Medical Association (JAMA). He subtitled his paper “Clinical Guidelines for Effective Use.” It foretold his future in serving as lead author and panel chairman in coining official U.S. quit smoking policy in 1996, 2000 and 2008. It’s called the PHS “Clinical Practice Guideline,” and each time was written and updated by expert panels drowning in pharmaceutical industry financial influence.
Dr. Michael C. Fiore founded and has served as director of UW-CTRI since its creation in 1992. He co-authored this new study along with six UW-CTRI staff members.
In 1998, GlaxoSmithKline (then Glaxo Wellcome) spent $1 million to establish a University of Wisconsin Foundation “named chair” for Dr. Fiore to occupy. According to Dr. Fiore’s sworn testimony, the endowed chair made available to him unrestricted grants of up to $50,000 per year.” (Slightly edited by the author).

Case 2: A review of the effectiveness of Nicotine Replacement Therapy published by Drs. Silagy, Lancaster, Stead, Mant and Fowler in 2004 by the Cochrane Library.
The Cochrane Library is held up to be the repository of ‘Gold Standard’ scientific reviews of therapies and medicines. The information in the Cochrane Library influences decision-making by authorities who approve new medicines and technologies such as the ‘NICE’. The authors concluded: “All forms of nicotine replacement therapy (NRT) can help people quit smoking, almost doubling long term success rates.”

Yet there was a massive conflict of interest among the authors. A footnote to the publication states: “C. Silagy received funds for consultancy work undertaken (at various times) on behalf of Pharmacia and Upjohn, Marion Merrell Dow, Glaxo Wellcome and SmithKline Beecham. G. Fowler and D. Mant were involved in a trial of transdermal nicotine (ICRF 1994).” One of the reviewers of the paper was Professor Robert J West of University College London (see Case 3 next). It really is like putting the foxes in charge of the henhouse.

Case 3: Professor Robert West, Editor of the journal Addiction. He is also the world’s most vocal advocate of NRT.
Professor Robert ‘NRT’ West has published dozens of papers suggesting positive results from NRT but not a single paper showing zero results. The journal Addiction and Professor West openly admit to conflicts of interest. The journal Addiction has an “Ethical Policy” which states: “ADDICTION has asked its senior editors to provide brief statements on any interests which might be seen as having a potential bearing on the independence of their editorial judgements”. Editor West states: “Robert West has received travel funds and hospitality from, and undertaken research and consultancy for pharmaceutical companies that manufacture or research products aimed at helping smokers to stop. These products include nicotine replacement therapies, Champix (varenicline) and Zyban (bupropion). This has led to payments to him personally and to his institution….”

The trouble is that we simply don’t know how much of an influence there has been. There can be no doubt that travel funds, hospitality, research grants and consultancy payments over a long period of time must have an influence. If a journal editor is a paid consultancy fees by Big Pharma, it is sensible to question the reliability of reports published in his/her name, especially those that advance products made by the sponsoring companies. I have some experiences of my own to draw upon.

In the 1990s I did a piece of research on stress experienced by carers of people with dementia. I do not understand how but Big Pharma has very long tentacles and somehow or another a major drug company got wind of of our results. I certainly did not approach them. However, the company began a charm offensive that was, to put it bluntly, quite inappropriate. My team were invited to give a talk in a symposium at an international conference at a well-known resort in Switzerland. The whole process was quite incredible. From the moment I said I would consider it, the phone hardly stopped ringing.

All kinds of sweet little deals were on offer: business class air tickets, a five-star hotel, a chauffeur-driven limo to the airport, and goodness knows what else. I could hardly believe it when the company offered to prepare our PowerPoint slides for us! This was the moment that I ‘smelt a rat’. We attended the symposium, but my co-presenter and I paid our own fares, booked our own hotel, and prepared our own slides. The symposium team were all “old-hands” who had stayed at a luxury hotel for several days as guests of the company. All had slides showing the company logo.

I wonder what happens to the values of academics as supporters of independent thinking and freedom of speech when the almighty dollar appears on the conference table. I had known the chair of the symposium many years before as a PhD student. I found his role as Big Pharma’s spokesperson a little disconcerting. He told me his hobby consisted of flying his own aeroplane.

There is no limit to Big Pharma’s antics in influencing opinion. One of the key tricks from its tool-bag is to employ ghost-writers to produce the reports of their clinical trials. From the company’s viewpoint, it’s a ‘win-win’, intellectually-lazy-but-enriched academics get their names on papers that they don’t need to write, and, it’s another positive finding, and another cheque in the bank account. Another dollar, another day, and nobody needs to know.

The collaboration between universities and industries has led to an erosion of standards and a distrust of science. Worse, millions of patients are being offered ineffective treatments. The only way to gather trustworthy evidence is to ensure that the clinical trials are independent, unbiased, and free of strings and sweeteners. Sadly, in today’s world, where everything is about profit, that rarely happens.

Reports on clinical trials conducted by the pawns of the pharmaceutical industry too often a sham – exercises in propoganda nothing to do with natural science. And guess who pays? You, me, patients and consumers!

To be continued...

Anti-Smoking Medication: Why It Should Be Avoided.

Bupropion

Buproprion, also known as Zyban and Wellbutrin, is a nicotine-free treatment licensed for smoking cessation. It is claimed that Bupropion helps to reduce nicotine withdrawal and the urge to smoke. Bupropion can be used safely with NRT, the company literature states.

An issue to be aware of, if you are contemplating using Zyban, is the possibility of side effects. The most common side effects are a dry mouth, insomnia, a change in appetite, agitation and headaches. The most common side effects which cause people to discontinue use of bupropion are shakiness and skin rash. Also, bupropion can cause seizures. If you have epilepsy or an existing seizure disorder, you definitely should NOT take this drug. It is also important to carefully follow your doctor’s recommendations about dosage, due to the risk of seizures.

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Guidance to Doctors on Zyban
Soon after the introduction of Zyban as a prescription drug, newspapers began reporting deaths in patients prescribed with Zyban. The Guardian reported on 26 April 2001 that the anti-smoking drug was suspected of causing adverse reactions in 35 people who had died in the UK since it was introduced in June 2000. This acknowledgement came at the inquest of Kerry Weston, 21, a British Airways air hostess who was found dead in a hotel room in Nairobi, Kenya, two weeks after she began taking the drug to help her quit her 15-a-day habit.

Following these reports, on 31 May 2001 the Committee on Safety of Medicines (CSM) announced a change to the prescribing regime, and strengthened warnings for doctors prescribing Zyban. The CSM reviewed current evidence and advised a delay in increasing the dosage during the period of treatment, and a strengthening of the warnings given to prescribers that Zyban should only be used for patients at risk for seizures if there were compelling clinical reasons.

Professor Breckenridge, Chair of the CSM said:
”The Committee on Safety of Medicines and the Medicines Control Agency in conjunction with other European Regulatory Authorities … will be keeping the safety of Zyban under close, constant scrutiny.”

Suicide Risk
Two investigators in Finland, Drs. Pirkko Kriikku and Ilkka Ojanperä investigated the relationship between bupropion and suicide in post-mortem investigations (Forensic Science International, 23 June 2016). They reviewed 33,727 post-mortem investigations in Finland over five years (2009-2013) and identified cases in which bupropion was detected. Cases positive for other antidepressant drugs were reviewed for comparison.

The post-mortem examinations included, in all cases, the routine screening and quantification of hundreds of drugs and poisons. Bupropion was detected in 65 cases. While this is only .2% of all deaths, a large proportion of the bupropion-positive deaths resulted from suicide (55%). In fatal poisoning cases found positive for bupropion, the proportion of suicide was even higher (77%).

The research ‘highlights’ were:
• Suicide was the most common manner of death among users of bupropion.
• Suicide was significantly more common among users of bupropion than among users of other antidepressant drugs.
• Individuals positive for bupropion died younger than users of other antidepressants.

There are no known suicides following the use of CBT to stop smoking, definitely a safer option than bupropion.

Varenicline
Also known under the trade names of Chantix or Champix, varenicline is a medicine licensed in the US and UK in 2006. It is claimed that varenicline mimics the effect of nicotine on the body. Varenicline is a nicotinic receptor partial agonist—it stimulates nicotine receptors more weakly than nicotine. Therefore, it can reduce the urge to smoke and relieve withdrawal symptoms. The normal dosage is 1 mg twice daily for 12 weeks. Varenicline has not been tested in those under 18 year’s old or pregnant women and therefore is not recommended for use by these groups.

In 2009 the FDA announced a Black Boxed Warning on the prescribing information for Chantix (varenicline) and Zyban (bupropion). The warning highlighted the risk of serious mental health events including changes in behaviour, depressed mood, hostility, and suicidal thoughts when taking these drugs.
“The risk of serious adverse events while taking these products must be weighed against the significant health benefits of quitting smoking,” said Janet Woodcock, M.D., director, the FDA’s Center for Drug Evaluation and Research. “Smoking is the leading cause of preventable disease, disability, and death in the United States and we know these products are effective aids in helping people quit.”

The FDA also issued a warning that Chantix “may be associated with a small, increased risk of certain cardiovascular adverse events in patients who have cardiovascular disease”.

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Side effects of the drug include nausea in approximately 30% of people taking varenicline, headaches, insomnia, and nightmares. More rarely occurring side effects include change in taste, vomiting, abdominal pain, flatulence, and constipation.

Aljazeera America reported that over five years, 544 suicides and 1,869 attempted suicides had been reported to the FDA as “adverse events” in connection with Chantix, according to documents obtained under the Freedom of Information Act. The FDA asked Pfizer to investigate reports of violence by Chantix users and report back by 2017.

You need to ask yourself whether the chance to stop smoking using a medicine like Chantix or Champix is worth the risk. A vitally interesting scientific report was published in 2016. This was the largest clinical trial on anti-smoking medication ever conducted.

FDA/Big Pharma Clinical Trial

Many deaths have been reported in the media and elsewhere following smokers’ usage of bupropion and varenicline. However, it is difficult to absolutely prove these deaths were caused by the drugs. It is true that the suicide data from Finland are quite convincing. Sixty-five buproprion-linked suicides in Finland and 2,700 lawsuits in America are difficult to ignore. However, plainly there could be additional factors other than the drug itself that led to the deaths, e.g. drug abuse, alcohol abuse, depression, family issues, unemployment and stress.

To establish cause-and-effect it is necessary to carry out a controlled trial. On the theory that there’s no smoke without fire, the FDA requested a trial to investigate the association between the anti-smoking medications and psychiatric disorders. The study was reported in The Lancet in 2016 by Robert Anthenelli and colleagues. The investigators included several known advocates of anti-smoking medications working in collaboration with company scientists from Pfizer and GlaxoSmithKline, the funders of the study.

Incredible though it might seem, the investigators administered the drugs to 8,144 people, half of whom had a history of psychiatric problems. The study sample included 3549 (44%) men, had an average age of 46·5 years, and 6584 (82%) participants were of white race/ethnicity. The aim was to measure the incidence of moderate and severe adverse events. It is important to note that:

“Participants had to be considered clinically stable for inclusion (i.e., no exacerbations of their condition in the preceding 6 months; on stable treatment for at least 3 months, with no treatment change anticipated during the study), and considered by the investigator not to be at high risk of self-injury or suicidal behaviour.” The 8000+ participants were given either varenicline (1 mg twice daily) or bupropion (150 mg twice daily) or a nicotine patch (21 mg per day) or a placebo for 12 weeks with a 12-week non-treatment follow-up. What did they find?

First the good news: nobody died! Daily visits and close supervision from the researchers made that an impossibility. All three of the anti-smoking medications produced reductions in smoking. Varenicline produced the strongest effect, doubling the abstinence rates for buproprion and NRT patch.

Now the bad news. Considering only the non-psychiatric sample, all three of the medications led to significant increases in psychiatric symptoms. Approximately one in three of the buproprion group showed signs of psychiatric disorder – a statistically higher number than in the placebo group. This result was only possible by chance with a probability of one in ten thousand. The varenicline group and the nicotine patch group also showed significantly higher rates of psychiatric disorders. Of particular significance was the increased incidence of abnormal dreams and insomnia. In addition, a quarter of the varenicline group experienced nausea.

It is impossible to know what aspects of the results of this highly controlled trial would be repeated in the real world. We do know that real world studies never produce the same high abstinence rates obtained in clinical trials. We also do not know the full impact of buproprion and varenicline when combined with recreational use of alcohol and illicit drugs, something that can easily happen is the everyday, real world. However, there are plenty of scary reports in the media. The FDA issued a Drug Safety Communication in 2011 to include potential alcohol interaction, risk of seizures, and studies of side effects on mood, behaviour or thinking.

This was a very good idea, as the results of the large trial had found evidence that the drugs were pushing their own drug trial subjects closer to a psychiatric illness.

In 2015 the FDA announced that a Moderate-level Drug Interaction exists between varenicline and alcohol in which some patients treated with varenicline have experienced decreased tolerance to alcohol, including increased drunkenness, unusual or aggressive behaviour, or they had no memory of things that happened. Varenicline users have been advised to limit their consumption of alcohol until they know whether varenicline affects their tolerance for alcohol. Also they are advised to use caution driving or operating machinery until they know how quitting smoking and/or varenicline may affect them.

If a varenicline user develops nervousness, agitation, hostility, aggressive behaviour, depression, thoughts of suicide, or have other changes in behaviour or thinking that are not typical, the FDA warns that they must immediately stop taking varenicline and contact their doctor.

The only safe way to stop smoking is to eliminate nicotine from your body. Smokers who switch to e-cigarettes must remain addicted to nicotine. There is no convincing evidence that E-cigarettes do actually help smokers to quit. The evidence suggests that medication is unsafe. You can ask yourself whether you wish to rely on a drug that has a high chance of giving you nausea, sleepless nights, bad dreams and maybe worse. My recommendation is to steer clear of anti-smoking medications. A far better solution is to stop smoking with CBT and Mindfulness. CBT and meditation are both more effective and safer than medication.

The only effective way of returning the body-mind to a natural state of homeostasis is to eliminate all forms of nicotine and other foreign agents from the bloodstream.

Stop Smoking Now

If you’re a smoker and want to give up the habit, then Stop Smoking Now is designed for you. The approach involves restoration of homeostasis without nicotine in the body or nicotine replacement, e-cigarettes or any other kind of crutch in the form of medication.

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The truth is Stop Smoking Now could not only save your life, it offers you a healthier and longer life as well. It also could save you a shed-load of money. A new car every year, fabulous holidays, and a much higher quality of life are all yours if you really want them. But it isn’t really about the money. It’s about your health and well-being.

To gain these benefits, all you need to do for the next 7-10 days is to follow the process. Yes, that’s right, it really is that simple. Hard to believe, right?

Well consider this. I have spent the last forty years fine-tuning the best possible ways for smokers to overcome the habit. My role as a Health Psychologist has brought me into contact with people from all backgrounds and cultures who have been at all the different stages of stopping smoking. In many cases, the smokers started out as desperate and hopeless cases, feeling that nothing could work for them. They had tried almost everything to stop smoking, but nothing had succeeded. Instead of blaming the faulty and futile systems they had been using to stop smoking, including most of all, their own willpower, they typically blamed themselves. They blamed themselves for being “weak”. Sounds familiar?

All a person needs to stop smoking is a system that actually works. A week or two weeks of serious application and, bingo, you will hit the jackpot, stop smoking, and remain a smoker for the rest of your life. Like many ex-smokers, you will experience feelings of joy and empowerment, hugely increased self-control and life satisfaction by achieving what previously seemed impossible – to stop smoking. Nothing can offer you a greater boost to your self-esteem than to stop smoking, absolutely nothing. It’s better than winning the lottery. Because it’s not just about the money you’ll save, it’s about a Whole New You.

Stop Smoking Now gives you the most effective method of stopping smoking. The processes described here will enable you to bring about the change.

I know – I have been there!

In my twenties virtually everybody was smoking. Smoking was the natural and normal thing to do. You could smoke almost anywhere. In shops, cafes, pubs, clubs, cinemas, theatres, absolutely everywhere. It seems crazy now, but that’s how it was. I was a pack-a-day smoker and guess what, I actually thought I was enjoying it. Sound familiar?

Cigarette advertising was everywhere. In newspapers, magazines, on TV, at the movies and on huge billboards all over the place. People would literally drive along motorways and freeways smoking cigarettes and crash their cars gawping at the billboards. It seems a different reality now, but that’s exactly how it was. All kinds of subtle and clever messages designed to get everybody to smoke a particular brand. Brands for ladies, brands for teens, brands for minorities, brands for everyone.

My brand was XXXXX. I don’t really know why. I can’t explain it. As far as I was aware, it had nothing to do with the evocative brand imagery. But at a pre-conscious level, it almost certainly had a lot to do with it. Of course, I tried other brands too, but I usually drifted back to XXXXX. I had probably been smoking for about 10-11 years when something happened that stopped me in my tracks and got me thinking. I switched to the low tar version of XXXXX, called XXXXX Ultra Lites.

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I was living in the US when I switched to this ‘sleek’ low-tar brand, a supposedly ‘safer’ method of smoking – ‘safer’ according to the the big tobacco companies, that is. My grey-and-white pack of XXXXX looked smooth and on-trend, the perfect thing for a ‘Man-about-Town’. Like millions of others all over the world, I was one ‘cool dude’ making the switch to ‘low tar’. Until I discovered the truth, that is…

Little did I realize at first what a complete sham these ‘lights’ really were. The tobacco companies had discovered the sneaky idea of making tiny holes in the sides of the filters so when you inhaled you got extra air mixed in with the smoke. This fooled the machines used for measuring cigarette tar levels into assigning lower tar levels inside the cigarettes. Millions of ‘cool dudes’ all over the world were being taken for a ride because the cigarettes contained the exact same chemical concoction of tobacco as the regular, high tar brands. And you paid extra for the privilege! When the government scientists finally figured out what was going on, the terms “light,” “low,” and “mild” in product labeling and advertisements were banned in the USA.

A week or two after I had made the switch I woke up one morning with an unexplained headache and began to notice I was having to inhale ever more deeply to get any real ‘satisfaction’ from my Ultra Lites. This was in 1976 when I was working at the University of Oregon with Professor Ray Hyman. Ray Hyman remains one of the tiny number of people to have one of Psychology’s few real ‘laws’ named after him: the ‘Hick-Hyman Law’.

One evening over dinner Ray gave me a penetrating stare and said: Given all you know about the ill-effects of smoking, why the heck are you still smoking? He stopped me dead, so to speak. I really couldn’t give a rational answer. It was at that very moment that I decided to give up smoking. Within a few days of preparation, I did it. I destroyed my remaining cigarettes and never smoked again.

As I sit at my laptop, forty years later, I can honestly say that I gave up smoking thanks to the headaches from my XXXXX Ultra Lites and the pep talk from my friend. My thanks go out to them both. This was the best health-related decision that I took in the whole of my life. Thanks Ray! Thanks XXXXX Ultra Lites! It’s now forty short years since I quit smoking.

Once I took the decision to quit smoking, however, it was far from plain sailing. I discovered how very difficult it can be. I was crotchety with the whole world. I couldn’t sleep properly. I was sharing my woes with the inside of a beer bottle. There was an inexplicable gap in my life. A vacuum of nothingness that was difficult to fill.

This was how it all started, the main reason I decided to write books and run programmes and campaigns to help other people to stop smoking. After I returned from my visit to the US, a very smart PhD student called Paul Sulzberger came to me with the idea. He and I started running Stop Smoking courses. We put together a course of five sessions that groups of people attended over a period of eight days. The sessions started on a Tuesday and finished the following Wednesday. It was highly successful. Eighty-five percent of smokers had given up by the end of the eight days. The remaining 15 percent had all reduced their consumption significantly.

News of our Stop Smoking programme spread like wildfire and we took the programme all over New Zealand and into Australia. We must have helped 20,000-plus smokers give up the habit. Our research and an independent research organisation told us that we were producing some very exciting results, the highest cessation rates ever recorded. We did ads on TV and in the major papers and franchised the system internationally and it is still running under various umbrellas to this day.

In the mid-80s I returned to London as Head and the first Professor of Psychology at the School of Psychology at Middlesex Polytechnic. The busy London lifestyle felt a bit different to more laid-back New Zealand. In my efforts to continue the march against smoking, I needed a more efficient approach so I converted the method into a self-help pack I called the QUIT FOR LIFE Programme, which was published by the British Psychological Society.

The BPS QFL Book Cover

In 2005, the first edition of the version you are now reading was published. In its current edition, Stop Smoking Now has proved to be the most successful stop smoking method ever invented. Yes, that’s right, ever invented.

I have the results of scientific trials prove this. One of my most memorable moments was when I returned on a visit to the beautiful South Island of New Zealand on holiday with my son, Michael. While in Dunedin we visited a friend who lived in the suburb of St Clair. It was a warm and sunny afternoon. A person who, at first I did not remember, had taken my smoking cessation programme many years before came over, looked me straight in the eye, and said: “You saved my life. You helped me stop smoking 25 years ago. Now I’m 75 and fit as a fiddle, thanks to you, I wouldn’t still be here if you hadn’t helped me stop smoking.” This is not the only time I have received the heart-warming announcement: “You saved my life”. Many others have said exactly the same thing.

I too probably wouldn’t still be alive today if I hadn’t stopped smoking. I know from bitter experience. I watched my one-and-only brother Jon die from throat cancer caused by smoking. Jon had only just reached his sixtieth birthday.

But that’s all history now. Let’s return to the present…You are on a different path, a path that can lead to health, increased quality of life, and happiness.

What You Need To Stop Smoking Now
You have taken the first precious step on the path to changing your smoking habit. You have within your hands a powerful and unique system designed to enable you to reach this important goal to stop smoking. You have the desire. You have the motivation. You have the ability. In this book, you have the strategies, the know-how you need to do it, to Stop Smoking Now. Follow the guidance in this book, and you will stop smoking in just a few days, and, think about it, you will never need to smoke again!

This will be the most important step to improve your health that you can take in the whole of your life. Experiencing the process from beginning to end is something you will never forget. You will be a changed person, a New You.

You already realize that smoking is the most stupid, addictive and harmful habit known to humankind. It is predicted that one billion people will die in the 21st Century as a consequence of smoking. One way of solving the world’s population explosion, I suppose… But a smoking-related death it’s not normally a quick death. Smoking-related illnesses are nasty, protracted and painful and require thousands of health care dollars. Having watched my brother slowly die in great pain, it’s something I wouldn’t wish on anybody.

Stop Smoking Now offers you the best chance to overcome your smoking habit without any help from Big Pharma. It offers you a way to extinguish the habit, once and for all. And that’s without taking a shed load of gut-busting drugs. The methods in this book have been evaluated with hundreds of smokers in randomized controlled trials. Tens of thousands of people like you have successfully overcome their smoking habit using these methods.

If you use all of the procedures with commitment and perseverance, you will overcome your smoking habit for ever. You twill be a Calm and Confident Non-Smoker.

Stop Smoking Now is in three stages.

Part One is all about Theory. I discuss the psychology of smoking and quitting. I introduce Cognitive Behaviour Therapy (CBT) and its cousin, ‘Mindfulness’, explain how they work, and how they can help you to give up smoking once and for all. It will help you to think about and become acutely aware of what you do when you smoke, why you do it, and what smoking really means to you.

If you’re not much interested in Theory and want to cut straight to the nitty-gritty, you can skip Part One and move directly to Part Two. Part Two is the Practical stuff, the guts of the whole system. It guides you, step by step, from the addicted smoker you are now to a new healthful life as a non-smoker. The process takes 7 to 10 days. This will be your new beginning, a brand new life, the most dramatic way to improve your quality of life, extend your lifespan and make you better off financially in one smart move.

Part Three is also Practical. It’s about Regaining your Life as a Non-smoker. It guides you over the pitfalls of being a recent quitter and helps you to prevent relapse and maintain your non-smoking permanently.

Why You Should Stop Smoking Now
Stopping smoking is, without any doubt, the most important thing you can do to improve your health. If you stop smoking:

• You will live longer and live a healthier life.
• You will significantly reduce your chance of having a heart attack, stroke, or cancer.
• Your skin, hair, body and clothes will no longer reek of tobacco.
• Your fingers will stop turning yellow.
• Your sex life will show a significant improvement.
• If you are pregnant, you will improve your chances of having a healthy baby.
• The people you live with, your loved ones and your children, will have a healthier, less polluted environment.
• You will save a lot of extra money to spend on luxuries and holidays.

How This Method Can Help You
There are thirty different procedures that have helped thousands of smokers give up the habit. Nobody can predict which particular procedures will work best for you – everybody is different. However, by trying this wide range of different procedures, you are giving yourself your best chance of success. Please try them all.

Believe it or not, you can possibly enjoy certain aspects of the process of stopping smoking. It is part of the design to make this method as an enjoyable and fun experience as possible. You will learn a lot about yourself and the potential you have to change yourself for the better. Yes, to actually make yourself a better and more aware and fully functioning person. But I would not be telling you the whole truth, if I didn’t tell you that it can be very, very difficult. You already know that.

An addicted smoker is always, to a degree, dysfunctional. The changes that make you will make will help you to be a fully functional human being again. Like you used to be before you took up the habit, or rather, before the habit took over you.

Drinking, eating, Internet surfing, shopping, chilling, watching TV, gaming, gambling – anything to excess can quickly turn into an addiction. Smoking is a habit which seems extremely difficult to change. As an ex-smoker I know. But smoking can be brought under control easily and permanently by applying this systematic programme.

The book can be used as a stand-alone, self-help, how-to method of quitting or it can be combined with the treatment offered by your local health service providers. Two or more smokers can also Stop Smoking Now together to generate an element of cooperation, or even competition. Who gets there first, is always an interesting challenge, as is Who stays there the longest?

I wish you absolute and complete success in becoming a happy and successful non-smoker.