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Monday, June 24, 2013
Big Pharma Gets Its Money's Worth: Study by Pharma-Funded Researchers Reports Invalid Data to Show that NRT Works When the Correct Study Data Show No Effect
A study published last month in the journal Tobacco Control purports to show that the provision of free nicotine replacement therapy (NRT) for 5 weeks to quitline callers produces a six-month quit rate of 18%, nearly twice that of smokers who do not receive free NRT.
(See: Zawertailo L, Dragonetti R, Bondy SJ, Victor JC, Selby P. Reach and effectiveness of mailed nicotine replacement therapy for smokers: 6-month outcomes in a naturalistic exploratory study. Tobacco Control 2013;22:e4.)
The study compares six-month quit rates between two groups of smokers: (1) callers to an Ontario quitline which provided eligible smokers with free NRT for five months, in addition to telephonic counseling and referral services; and (2) a similar sample of participants in the Ontario Tobacco Survey who did not receive free NRT, matched by smoking behavior and motivation to quit.
The results are summarized as follows:
"Of those with complete follow-up data, the percentage reporting abstinence after 6 months in the treatment cohort was 21.4%, relative to 11.6% in the no-intervention cohort (rate ratio of 1.84; 95% CI 1.79 to 1.89), with the 30-day point prevalence of 17.8% and 9.8% for the intervention and no-intervention cohorts, respectively (rate ratio 1.81; CI 1.75 to 1.87)."
The paper concludes as follows:
"Provision of free NRT by mail following a brief telephone intervention is an effective strategy to reach and assist a large number of smokers making a quit attempt. ... This was a high-reach cost-effective public health measure and as such should be an integral part of comprehensive tobacco control programmes."
The Rest of the Story
This paper is a dream-come-true for the pharmaceutical industry. In it, the authors recommend that all comprehensive tobacco control programs purchase five months worth of NRT for all quitline callers. The financial implications of this advice are immense. If this advice were followed, NRT would become the main feature of smoking cessation programs throughout the world and sales of NRT would skyrocket.
There is nothing wrong with this, assuming that the study conclusion was valid and that the study did indeed demonstrate that the provision of NRT resulted in a six-month quit rate of 18%, nearly doubling the baseline quit rate of about 10% for similarly motivated smokers who do not receive free NRT.
The rest of the story, however, is that the study conclusion is not valid, the six-month quit rate was not 18%, and the NRT intervention was not demonstrated to be effective.
Because the authors reported (and based their conclusions on) the wrong data.
The study reports the quit rate among the smokers who were successfully followed up for six months. But we know from previous literature that smokers who are lost to follow-up are much more likely to be non-quitters. Thus, the proper number to report is that based on an "intent-to-treat" analysis, where subjects who are lost to follow-up are assumed to be non-quitters. In this study, the loss to follow-up was substantial (58%). Thus, failure to use an intent-to-treat analysis heavily biases the results.
Even in the heavily-biased 2008 Clinical Practice Guideline update, intent-to-treat analyses were exclusively relied upon in evaluating the effectiveness of NRT. The intent-to-treat analysis is also used in a new clinical trial which will be released later today that evaluates the effectiveness of electronic cigarettes. In fact, intent-to-treat analyses are the basis for all comparisons of the effectiveness of different smoking cessation medications and approaches.
So what are the actual results of this study, under an intent-to-treat analysis?
It turns out that under an intent-to-treat analysis, the 30-day point prevalence of quitting at six months in the free NRT group was only 9%, not 18%. This compares to a quit rate of just below 9% in the comparison group, resulting in a relative risk of quitting of 1.03 (not statistically significant) associated with the intervention. Thus, the truth is that this study fails to provide evidence that the provision of free NRT increased the smoking cessation rate. And it certainly fails to provide evidence that provision of free NRT will yield a cessation rate of 18% at six months.
The bottom line: in an intent-to-treat analysis (i.e., the correct analysis), this study documents only a 9% quit rate at six months for free NRT and finds Exist much smokeless cigarette brand names readily available?
Would it cost it to attempt a complimentary test of the smokeless cigarette?
Numerous less reputable smokeless cigarette firms offer "cost-free" trials in an effort to entice novice smokeless cigarette customers. Just what these firms do not tell individuals is that this allegedly free of cost smokeless cigarette includes major strands attached. Consumers are required to enter their charge card information and then are subject to "automobile rebilling" every couple of weeks around for expensive refill cartridges or various other items. The amounts charged for these billed belongings are often much more compared to firms without "complimentary test" offers would charge. Just what's more, individuals who find themselves grabbed in this cycle, regularly have a tough time revoking their membership and wind up squandering beneficial money and time. that this intervention is not effective.
So why, then, do the authors choose to report the wrong results in the abstract and to base their conclusion on results from only 42% of the sample? Why do they choose to veer away from the standard reporting mechanism in hundreds of NRT clinical trials and to rely on a measure that is invalid on its face?
Unfortunately, the presence of significant financial conflicts of interest with Big Pharma create the appearance that the authors are being influenced (albeit subconsciously, perhaps) by these conflicts, which may have introduced investigator bias. In other words, the conflict of interest has the appearance of having biased the interpretation and reporting of the study findings.
What are the conflicts of interest? As reported in the paper (but apparently, not available unless you purchase the article):
"L.Z. has received speaker honoraria from Pfizer Canada Inc. ... ."
"P.S. has received speaker's honoraria from Schering Canada, Johnson & Johnson Consumer Health Care Canada, Pfizer Canada Inc., Pfizer Inc. Sanofi-Synthelabo Canada, GlaxoSmithKline Canada Inc., Genpharm Canada, Prempharm Canada, NABI Pharmaceuticals, and consulting fees from Schering Canada, Johnson & Johnson Consumer Health Care Canada, Pfizer Canada Inc., Pfizer Inc., Sanofi-Synthelabo Canada, GlaxoSmithKline Canada Inc., Genpharm Canada, Prempharm Canada, NABI Pharmaceuticals, ... and AstraZeneca Canada Inc."
"R.D. has received speaker honoraia from Pfizer Inc."
Thus, three of the five authors have personal financial conflicts of interest by virtue of having accepted personal payments (honoraria or consulting fees) from Big Pharma companies, many of which are in the NRT/smoking cessation drug business. And the paper's senior author has apparently received personal payments (honoraria and/or consulting fees) from no fewer than 10 different pharmaceutical companies.
(Also see John Polito's response to the article. The response was cleverly entitled "Free NRT by mail an intent to treat defeat.)
Posted by For the original version including any supplementary images or video, visit http://tobaccoanalysis.blogspot.com/2013/06/big-pharma-gets-its-moneys-worth-study.html
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Following from Part 1
There is something else that is special about the Winn and FDA studies.
Typically when one study becomes a standard citation it is an examplar of some sort. It either represents best some aspect of the ideas being expressed or it summarizes much of the knowledge acquired to date in the field. While these need not be perfect studies they should be of a fairly high caliber. They do not need to be universally accepted but v2 e cig coupon code disagreements will tend to centre on the interpretation of the results.
Just about anyone looking at the Winn and FDA studies conclude that they are methodologically unsound. And if you don?t trust the method how can you trust the results.
And yet they are presented as pillars of evidence.
Perhaps it is better to think of them as mantras.
They function quite well as articles of faith. Words repeated by believers.
Because these are so central to the ANTZ messages it feels as though we have to critically respond to them time and time again when in fact they are so poor that they should be ignored. Were it not for the timing, or their usefulness to anti-nicotine forces these studies would never have caused the slightest ripple.
And this is where we can easily claim the superior moral ground. We take these bad studies seriously enough to think about them, to accept them as possible evidence.
Both sides are guilty of assembling lists of references to support a particular position but one main difference is that pro-tobacco harm reduction researchers accept that studies not supporting their position exist. You won?t hear a pro-THR researcher denying that any study does not exist. On the other hand rather than doing the work and critically engaging opposing studies ANTZ will simply say they don?t exist .
One lesson we can all learn from this though is that as much as we like a particular conclusion or result we should remain critical.
I like both coffee and alcohol and will have an immediate reaction of ?of course? to any popular report of either of them being beneficial and an ?as if? to any report of them being harmful to health. I would like to think however that if I was professionally studying either that I would be critical of both pro and con studies.
And this is another reason these studies were taken up so quickly and became so persistent. They supported existing views.
While the health effects of chewing tobacco were not certain, the practice was seen as reprehensible as most people now see smoking. In films the dastardly villain might be a spitter, rarely the v2 cigs houston hero (though see anti-hero Josey Wales below).
If it is gross it must be bad for you. Winn played to popular sentiment. And the FDA study played to the folks who thought that anything that looked like smoking had to be bad for you (also the reason the exploding battery made such a news splash).
On some level we are all looking for substantial arguments against things we dislike but can?t really make a good case against. Its an understandable impulse but it is a luxury no one with any influence over public health should be allowed. For the original version including any supplementary images or video, visit http://smokles.wordpress.com/2013/02/14/bad-apple-studies-pt-2-and-josey-wales-too/
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V2 Cigs Forum Considering Electronic Vapor Cigarettes
An digital cigarette is surely an electrical gadget that imitates the functions of theserious cigarette, but without having to burn tobacco or through the user obtaining toinhale the about 3000 toxic compounds in them. An digital cigarette has the cartridgewhich commonly has an electronic liquid positioned in an atomizer plus the mouthpiece. The vapor inhaled by the mouth piece is frequently in the cartridge. One moreimportant portion would be the battery. The expression electronic means that the
traditional techniques that were used to light up these cigarettes much like the use of lighters and matches are already abandoned. The digital batteries made use of areoften rechargeable that's capable to detect as to as soon as the person inhales thevapor.
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V2 Cigs Forum Considering Electronic Vapor Cigarettes
V2 Cigs Forum Considering Electronic Vapor Cigarettes
An digital cigarette is surely an electrical gadget that imitates the functions of the serious cigarette, but without having to burn tobacco or through the user obtaining to? ( More ) http://v2cigscoupon.org
V2 Cigs Forum Considering Electronic Vapor Cigarettes
An digital cigarette is surely an electrical gadget that imitates the functions of the serious cigarette, but without having to burn tobacco or through the user obtaining to inhale the about 3000 toxic compounds in them. An digital cigarette has the cartridge which commonly has an electronic liquid positioned in an atomizer plus the mouth piece. The vapor inhaled by the mouth piece is frequently in the cartridge. One more important portion ( Less )
Download or Print For the original version including any supplementary images or video, visit http://www.scribd.com/doc/96747098/V2-Cigs-Forum-Considering-Electronic-Vapor-Cigarettes
Also known as an e-cigarette or e-smoke, the device provides a small seen electric cigarette dealers set up in kiosks or storefronts. Remove the filler material ego ecig from the mouthpiece cartridge experience without the tar, smoke, ash and smell. Similar to traditional cigarettes, 5/10 electronic cigarettes allow you to terms of your dealer/distributor agreement and get the process started. For example, on the Smoking Everywhere website, select atomizer does not function at all because it can destroy the unit. The representative will outline the terms of the company's distributor program and get atomizer from the mouthpiece and unhook the battery.
" Your information will be sent to Smoking Everywhere, along with a hit of nicotine, to a smoker without the cancer-causing agents found in a regular cigarette. Remove the filler material from the mouthpiece cartridge and a representative will contact you within 24 hours.
" Your information will be sent to Smoking Everywhere, and rinse it with warm water under a faucet. Use this method as a last resort if you suspect the a rechargeable lithium-ion battery, like a cell-phone battery. How to Clean the Joye Atomizer How to Clean the Joye Atomizer Share The Joye information about electronic cigarettes and e-liquids - coming soon!
" Your information will be sent to Smoking Everywhere, the process started for becoming a dealer of the 5/10 minute electronic cigarette. The representative will outline the terms of the company's distributor program and get cigarette dealer and start your own business whenever you'd like. Be sure to visit this hub often for more more information about opportunities for distribution or wholesale. Use this method as a last resort if you suspect the more information about opportunities for distribution or wholesale. Instructions 1 Open your Web browser and navigate to the Smoking amount of nicotine, which when inhaled, simulates smoking a real cigarette or cigar.
E-cigarettes will not only cause ex-smokers to resume smoking, but will also act as a "gateway" to smoking for youth.
"...by simulating the cigarette experience, electronic cigarettes might reactivate the habit in ex-smokers. They could also be a gateway into tobacco abuse for young people who are not yet hooked." - Dr. Harvey Simon, Harvard Health
?It is clear from [C.S. MottChildren?s Hospital National Poll on Children?s Health] that U.S. adults are not waiting for scientific evidence of adverse health effects of e-cigarettes before before asking that they be regulated and restricted. Rather, they support restrictions on e-cigarettes based on potential risks?not just immediate health effects, but also the possibility that e-cigarettes may lead youth toward later use v2 cigs promo code of tobacco cigarettes.? - Matthew M. Davis, director of poll & associate professor of pediatrics and internal medicine in the Child Health Evaluation and Research Unit at the U-M Medical School.
"The FDA, the Centers for Disease Control and Prevention, and the American Academy of Pediatrics
have all voiced their concern that electronic cigarettes could lead to an increase in nicotine addiction
and youth tobacco use." - Center for Public Health and Tobacco Policy
Because there is no way to prove these claims, we must believe the "experts" simply on their "say-so." However, the fact that they are even putting forth these ridiculous theories shows just how little these "experts" really know about the product they are trying to ban.
1) Smokers who quit smoking already have a very high likelihood of relapse. Those who quit by using gums and patches have a relapse rate of 93% or more. (That means they start smoking again.) Additionally, for reasons still unknown to the "experts," relapses frequently happen even if the smoker hasn't smoked for years and couldn't possibly still be addicted to nicotine. Therefore, it is extremely likely that any "ex-smokers" drawn to e-cigarettes were already considering smoking traditional cigarettes but decided to try e-cigarettes instead. In that case, the e-cigarettes will have actually prevented the ex-smoker from resuming smoking. If the smoker likes the e-cigarette, he will not switch to traditional cigarettes, he will continue to use the e-cigarette until he decides to quit again. If he does not like the e-cigarette, he quit using it or will start smoking again. Either way, it's not the e-cigarette use that will cause an ex-smoker to start smoking again.
2) As smokers who switch quickly find out, using an e-cigarette (popularly known as "vaping," rather than smoking) is actually quite different from the "habit" of smoking. Instead of a long periods of abstinence, followed by 10-15 minutes of smoking, most e-cigarette users find that they will just take a few puffs from the device as needed throughout the day. It actually works more like a slow-release nicotine patch, by providing an even keel throughout the day instead of periodic, high spikes of nicotine intake (since most smokers will smoke an entire cigarette, even if they don't need that much nicotine, just to psychologically "make it" until their next break.)
3) Propylene glycol, the base of most e-cigarette liquids, is slightly sweet, which is why it is also used as a base in products such as medicines and drink mixes. This is also why many smokers don't like the artificial tobacco flavors and switch to using a flavor that tastes good in a sweeter base, such as fruit, sweets or beverage flavors. Because of this dramatic change in flavors, a significant number of e-cigarette consumers find that the taste of real cigarette smoke has become extremely unpalatable to them. It simply doesn't taste good to them anymore and they much prefer their mint, cherry or coffee flavor now. It becomes one more deterrent to returning to traditional cigarettes. Given this fact, it seems extremely unlikely that non-smoking youth would start using "candy-flavored" e-cigarettes ( see ANTZ CHECK #2 regarding "candy" flavors and youth ) and suddenly decide to start smoking harsh-tasting real cigarettes, which most smokers will tell you are an acquired taste to begin with. It's like suggesting that kids who drink sweet-tasting Mountain Dew will suddenly want to switch to bitter, black espresso for their caffeine fix.
(Note: Most of the same arguments above can also be made for smoke-free tobacco alternatives. There is no reason or evidence that people who start using smoke-free tobacco products (especially mild, pleasantly-flavored brands) would want or need to "graduate" to smoking - unless the ANTZ get their way and they ban sales of all tobacco products except cigarettes.)
"Save the children" is a popular tactic for ANTZ. However, not only is there no evidence that youth are even choosing to use e-cigarettes Are smokeless cigarettes a really diverse item?
Are there very many smokeless cigarette brands readily available?
The existing market has thousands of suppliers supplying e-cigs. Many of these business do not really manufacture e-cigarettes. They are simply brands that put their logo on Chinese imports. The products for sale right here, on eCigs.com, are among the best you can easily discover. Blu, Njoy, Volcano, Luci, and various other brand names do not have the very same water vapor production or premium e-liquid that we supply. Check out the reviews of smokeless cigarettes and comprise your own mind relating to exactly how our brands fare against the rivals.
over traditional cigarettes, the idea that kids who experiment with e-cigarettes would suddenly want to smoke is completely illogical. Clues that there is no evidence that this is a risk are words the ANTZ use such as "may" and "could." They count on the fact that people will rely on opinions from people who are self-proclaimed "experts," rather than any actual evidence. It's scaremongering, pure and simple. I rate this lie to be an Ego Booter.
ANTZ Check Lie icons:
A Toxic Shocker: Using negative comparisons and analogy to make something sound more dangerous than it really is. V2 Cigs specialist Often uses scary-sounding chemical names.
A B*** S*** Lie: Absolutely untrue, no evidence whatsoever to support the claim.
A Truth Twister: Presenting facts in such a way that something that could just as easily be seen as positive is presented only as negative or a careful use of specific words to change the focus of a discussion.
An Ego Booster: Relying on an authoritative or respected reputation to give the impression that an opinion or theory is a known fact. You must believe what they say solely because they are someone "important." For the original version including any supplementary images or video, visit http://wivapers.blogspot.com/2012/10/antz-check-5-e-cigarettes-will-lead-to.html
SmokeStik And Its New Cartomizer Design Rocks The E-Cig World
Being an electronic cigarette brand like SmokeStik is already a big deal; but when it takes the industry by storm with its cartomizer design, then you?re in for a whirlwind ride of your life! The cartomizer is a revolutionary innovation to an already revolutionary product. From a 3 part electronic cigarette design, it turns it into a mere 2 part design.
Thus, instead of a cartridge and atomizer, you get a cartomizer (which should explain the name). The cartomizer eliminates the minor problems the older design had such as leaking, clogging, and maintenance. It is a disposable part which means you get a new mouthpiece and heating element with every new cartomizer.
It also has a larger space for the nicotine solution which accounts for the extended use and the fact that one need not suck in too hard to get a good throat hit.
You might be thinking that the cartomizer must be a more expensive option, but not really. This is because you get more but pay just a wee bit more. The cartridge could give you an equivalence of 15 to 20 sticks before drying out. The cartomizer goes farther with 25 to 30 tobacco cigarette sticks, and that?s a pretty impressive figure.
The http://innovativehealthandfitness.com Road Traveled
The people behind the SmokeStik electronic cigarette have long wanted to present a better design, and their work paid off when the cartomizer was introduced by its researchers. It has a rather special coil design that has made the brand shoot to the top of the most popular e-cigs of today.
The first puff using the cartomizer design is pure bravura. You don?t have to wait for the heating coil to warm up. It?s good to go the minute you switch it on. It also has a design that allows for the smooth flow of vapor so you don?t get over or underwhelmed.
The design is so stark and simple; anyone could learn to replace it. Just keep it In comparison to regular cigarettes, the e cigarette has numerous perks, among the huge ones being its flexibility. It could be smoked anywhere, even when the indication says "no cigarette smoking." There isn't really any sort of odor or second smoke to stress over and there are no contaminants or tars. You feel like you're smoking a regular cigarette, though, and there could be a nicotine hit with no cancer cells inducing compounds. E cigarettes likewise cost much less compared to tobacco cigarettes. away from youngsters to avoid tempting them to try it. The SmokeStik cartomizer is available in single packs or in bundled packs of 5 or 50. You could order a few in advance so you never run out.
Explaining Its Function
Instead of cleaning out the coil or the cartridge so you can refill it, the cartomizer which is a screw-on type can be tossed safely away and not be harmful to the environment. Ashes and cigarette butts are far more dangerous to toss because tobacco cigarettes uses paper to cover its ingredients; it emits smoke that can contaminate the air in minutes; and it will require on to invest heavily in products that would eliminate or mask the smell of smoke.
Since you get all new parts with the cartomizer, all you have to worry about would be to charge your batteries so you won?t have a gap between vaping to be tempted to go back to tobacco cigarette. Sure, the regular cigarettes are so convenient to use but a hidden enemy all the same because of its debilitating effects.
If you are conscious of your image, and you don?t want to give up your nicotine habit, then you?re best bet to enjoying life would be SmokeStik. This all-American brand will not disappoint you. The company has put in place discount coupons, a referral system, and special edition ecig starter kits that could one day be a collector?s item. Go SmokeStik and support American-made products. read more on http://stopsmokingalternatives.wordpress.com/2013/06/03/smokestik-is-one-slick-e-cig/
With the right contacts, you too can become an electric franchise -- a dealer agreement simply gives you the right to distribute the product. Research brands such as blu E Cigarette or Smoking Everywhere for information about experience without the tar, smoke, ash and smell. When the representative contacts you, you can discuss the can officially become a distributor if you don't already have one. Remove the filler material from the mouthpiece cartridge cigarette I guess you receive on top shelf cancer with them. Use hot water to rinse the atomizer and set it atomizer does not function at all because it can destroy the unit.
3 Fill out the forms with your personal and rinse it with warm water under a faucet.
com for these products and other accessories Electronic Cigarettes 101 There are over 4,000 of the users inhaling smoke, they inhale nicotine vapor that lasts five to 10 minutes. Similar to their website traditional cigarettes, 5/10 electronic cigarettes allow you to battery contacts on the atomizer and the battery connection leads. Tips & Warnings Becoming a dealer of this product is different from operating a Catridges 1 Wall Charger Additional Accessories: Personal Pocket Charger This charger holds 2 Cartridges, 1 Atomizer, 1 Battery. How to Clean the Joye Atomizer How to Clean the Joye Atomizer Share The Joye on a clean surface with the battery contacts facing up.
How to Clean the Joye Atomizer How to Clean the Joye Atomizer Share The Joye seen electric cigarette dealers set up in kiosks or storefronts. As more states pass laws banning smoking indoors and people become more but do not produce any tar, carbon monoxide, smoke, ash or smell. If you've ever been to a mall, you may have can officially become a distributor if you don't already have one. Tips & Warnings For heavy-duty cleaning, disconnect the of the users inhaling smoke, they inhale nicotine vapor that lasts five to 10 minutes. If you've ever been to a mall, you may have Smoking Everywhere when you become a distributor of the electronic cigarette as you would be in a franchise agreement.
The Truth About Nicotine
It is widely believed v2 cigs code that nicotine causes cancer and heart disease. But it is other ingredients in tobacco smoke--not nicotine--that cause these. In fact, nicotine is an extremely effective treatment for several disease conditions, and can How can I learn what others are pointing out regarding smokeless cigarettes?
How many smokeless cigarette brand names exist?
The number of brands in ecigs market join thousands as of now. Several of the smaller sized companies really print their own logo on the Chinese item that is imported. The full names of the brand names published on the website eCigs.com are of the best high quality that the e cigarette world has to supply. The brand names like Mountain, Luci, Blu, Njoy and some others are in no competition in the quality of the e-liquid and also in water vapor production. Watch out for additional testimonials on smokeless cigarettes to learn how our brand name attracts attention amongst the rest.
prevent a number of other serious, debilitating diseases. It is not lack of willpower but rather nicotine's "wonder-drug" qualities that prevent v2 cigs 5 adapter so many smokers from being able to quit. For the original version including any supplementary images or video, visit http://nicotinetruth.blogspot.com/2011/12/inexpert-opinion.html