OR
years it was the same routine: wake up,
light a cigarette, inhale deeply and start
the day. "I wouldn't even get out of bed
without a cigarette," said John Palagonia,
53, of Massapequa, N.Y., who was a
two-pack-a-day smoker for more than 20
years.
In 1989, Mr. Palagonia, who
entertains at children's parties dressed as
characters like Barney and Elmo, decided to
quit. He turned to Nicorette gum to curb the
cravings for a cigarette. The smoke savored
between sips of his morning coffee was
replaced with a peppery square. On breaks at
work, driving his car, after dinner - all
the times he had luxuriated in smoke - he
would pop another piece.
"I got to the point that I
was having problems with my teeth, and my
jaw
was killing me," Mr. Palagonia said. He
eventually returned to smoking for a short
time "to get off the gum." What ended up
working for him was counseling, not a hit of
nicotine.
A third of the nation's
nearly 50 million smokers attempt to quit
each year, according to the American Cancer
Society, and that has made smoking-cessation
products an $800 million business in the
United States alone. The products include
gum and patches sold over the counter;
pills, inhalers and nasal sprays sold by
prescription; and even more exotic products
like nicotine-infused lollipops sold on the
Internet.
Still, addiction to nicotine
remains. The medical field has accepted that
fact since the mid-80's, when the Food and
Drug Administration approved, by
prescription, products like gum to give
would-be quitters a substitute comparable to
cigarettes in price and nicotine content,
but without other cigarette toxins.
Now some scientists and
former smokers are voicing misgivings. No
one disputes that cigarettes, which are
laced with toxic additives like ammonia,
pose far graver health risks than nicotine
alone, but nicotine is also classified as a
poison, and in recent studies it has been
shown to break down into a substance that
causes abnormal cell growth. In 2001,
researchers at Stanford University found
that nicotine speeds the growth of malignant
tumors by stimulating the formation of the
blood vessels that feed them, a process
called angiogenesis.
Dr. John Cooke, the lead
author of the Stanford study, said, "As long
as people are using nicotine replacements
properly, it's a win for all of us, if we
can get people to stop smoking. But, I would
urge people not to use it long term."
For people addicted to
nicotine, using the replacement products
properly can be difficult. A study financed
by
GlaxoSmithKline, the pharmaceutical
company that manufactures Nicorette and
other stop-smoking products, found last
November that more than a third of nicotine
gum users continued chewing beyond the 12
weeks recommended under F.D.A. guidelines.
"We estimate 36.6 percent of
current gum users are engaged in persistent
use," said Dr. Saul Shiffman, a company
consultant and the study's primary author.
Though the company says on its Web site that
nicotine "may promote lung cancer," it
insists its products are safe "when used as
directed."
Even the companies that make
nicotine-replacement products acknowledge
problems with treating this particular
addiction. Dr. Kenneth Strahs,
GlaxoSmithKline's vice president for
research and development in smoking control,
said, "I wish we could tell you that if you
took one piece of our gum it would be
enough, but that's not the case. Nicotine
addiction is a chronic relapsing condition."
When the F.D.A. approved
over-the-counter sales of Nicorette gum and
the NicoDerm CQ patch in 1996, sales of the
two products soared. GlaxoSmithKline
reported $578 million in global sales of
over-the-counter nicotine replacements
during 2003, down from $606 million the year
before as other companies jockeyed for
market position.
How effective these products
really are remains a debate. Some ex-smokers
and smoking-cessation experts oppose using
nicotine at all when trying to quit. "It's
like the difference between snorting cocaine
and freebasing it," said Mr. Palagonia. He
has neither smoked nor chewed nicotine gum
for a decade now after years of meetings at
Nicotine Anonymous, a 12-step program.
"The trick with getting off
cigarettes is to stop delivering the drug,"
said Joel Spitzer, a smoking-cessation
counselor and director of education at
WhyQuit.com, an online support and education
site that advocates quitting nicotine cold
turkey.
Mr. Spitzer, who estimates
he has counseled 5,000 individuals in
stop-smoking clinics he has run in Chicago,
says nicotine replacements keep ex-smokers
in a protracted state of withdrawal.
Denise Henrie, a mother of
four from Owasso, Okla., is familiar with
that. Ms. Henrie, 43, tried and failed twice
to quit smoking, using nicotine gum for more
than a year. "You feel a little hopeless,"
said Ms. Henrie, adding, "I just don't want
to be addicted to anything at all." She has
slipped back to her pack-and-a-half-a-day
habit, but she remains optimistic. A package
of Nicorette sits in her kitchen pantry for
a third try.
According to the American
Cancer Society, fewer than 5 percent of
smokers who attempt to quit each year
succeed. Of those who do, the society
reported last year, 91 percent quit cold
turkey.
Some people succeed only
after a long struggle. Jeanne Hutchinson,
59, began chewing nicotine gum in 1984, the
first year it was available by prescription.
"One of the happiest days of my life was
when nicotine gum was allowed to be sold
over the counter," said Ms. Hutchinson, a
social worker in Chicago.
But, years later, she was
still hooked on the gum. "I felt almost like
a drug addict," said Ms. Hutchinson, who
estimates the 12 pieces she chewed each day
cost her more than $15,000 over the years,
without curing her habit. Suffering from a
receding gum line and worn molars, she
joined WhyQuit last January and managed to
stop using nicotine.
STILL, when she reached into
her coat pocket a few months ago and found a
long-forgotten piece of gum, it took all her
willpower not to pop it into her mouth.
That may be why analysts say
that demand for nicotine-replacement
therapies is unlikely to wither anytime
soon. "We see it as a market with tremendous
potential, but efficacy-starved," said
Devesh Gandhi, a research associate at
Sanford C. Bernstein, adding that the market
- for "a product that really works, that
manages both the addiction and the side
effects of the withdrawal" - is there for
the taking.
http://www.nytimes.com/2004/05/02/business/yourmoney/02smok.html?pagewanted=all&position=
Copyrigtht 2004 The New York Times Company