Newsmaker: Nicotine patches

The symptoms were unpleasant, but Murray Jarvik was thrilled to have proved a point.

''Our heart rates increased,'' Jarvik later recalled of his 1984 experiment, which showed for the first time that nicotine could be absorbed through the skin. ''Adrenalin began pumping, all the things that happen to smokers.''

Jarvik, a University of California psychologist who applied the substance on his own arm and those of his assistants after he was refused permission to try it on patients, published his discovery under the cautious title ''Transdermal administration of nicotine''.

Three decades ago nicotine was not even recognised as the key addictive ingredient in tobacco, and Jarvik appeared to be off on a frolic as he suggested it might divert people from smoking. There was nothing in the obscure academic paper to hint at the unstoppable industry it would spawn.

Nicotine replacement therapies (NRT) - patches, sprays, gum and lozenges - have soared to more than $1 billion in annual sales in the US since their release in 1992, and changed the way governments and doctors approach smoking, which remains the biggest contributor to preventable disease.

But the supremacy of the patch was challenged this week by a group of Boston doctors.

Their research tears down the orthodoxy that NRT doubles the chance an attempt to quit smoking will be successful, by showing for the first time that hundreds of ordinary people who used the products in the real world - away from the artificial bubble of a clinical trial - were no more likely to stay off tobacco long-term than those who went cold turkey.

For the most hardened smokers, using a nicotine substitute even appeared to undermine their resolve - perhaps because they wrongly expected an easy ride.

Public funding of NRT in the United States has gone from strength to strength - 39 states now pay for low-income residents to have it, up from 17 in 1996.

In Australia, too, it is deeply entrenched; the federal government has spent $9 million mainly on Nicorette and Nicabate patches since a subsidy was approved last year. The National Tobacco Campaign, which operates the Quitline, promotes NRT ahead of giving up spontaneously.

Meanwhile a growing body of research - often funded by manufacturers - is recommending NRT use start weeks before a quit attempt and continue long-term or even indefinitely.

Hillel Alpert, the Harvard scientist behind the new study published in the journal Tobacco Control, said NRT infatuation was diverting funds from proven programs such as ''mass-media counter-marketing campaigns, adoption of smoke-free laws, raising the retail price of tobacco products through excise tax increases and restricting advertising and promotion.''

Alpert is likely to find NRT difficult to dislodge. Manufacturers may carefully select trial participants, biasing the results by concentrating on those most likely to be helped. But in the eyes of regulators and funders, these are still authoritative studies.

And the NRT story has another advantage, at least in the country that has incubated the industry. It coincides with the American narrative of individual striving, while tax controls and advertising carry a whiff of the ''socialised medicine'' bogyman.

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