Nicotine patch has lost luster among smokers Many disappointed with results

sales have plummeted

February 24, 1993|By Los Angeles Times

Like millions of other smokers, Dan Aaronson saw the television commercials touting a new product to help people give up cigarettes.

"Ask your doctor," the advertisement urged. Mr. Aaronson did.

"Try it," said the doctor, scribbling a prescription for a nicotine patch.

That was last April, when sales of the patch were soaring to the highest levels ever seen in a new pharmaceutical product -- $270 million for one quarter alone.

Mr. Aaronson, who had been smoking for 36 years and was up to about three packs a day, had tried to quit before. This time, he slapped on the patch, which releases a small amount of nicotine into the bloodstream to curb the withdrawal symptoms of addiction. He tossed his cigarettes out.

"With the nicotine patch, this was the first time I was able to make inroads into stopping smoking," Mr. Aaronson, 50, says. "I was down to four cigarettes a day. But . . . ."

But he resumed smoking after four months of using the patch.

"I guess," he concedes, "I really wasn't ready to quit."

He wasn't alone. His experience, it turns out, reflects that of smokers across the country.

By the time Mr. Aaronson gave up on the patch last fall, sales of the product were plummeting, success rates were dismal and smoking-cessation experts were coming to some somber conclusions. Such as:

* The nicotine patch is not a panacea to cure tobacco addiction.

One shortcoming of the patch is that it takes four to six hours for the nicotine to get into the bloodstream, says Nina Schneider, an associate research psychologist at University of California, Los Angeles.

* The patch appears to work best when used in conjunction with a stop-smoking program that emphasizes behavior modification.

* Even the patch and a stop-smoking class may not be enough to help the most deeply addicted smokers kick the habit.

"People are disillusioned, but this has been very healthy," says Michael Samuelson, president of the National Center for Health Promotion, which operates the popular Smoke Stoppers cessation program. "People now recognize that indeed this is very complex, pharmacologically, socially and psychologically."

Laboratory testing of the patch before it was released showed that about 20 percent of people remained smoke-free after one year's use. But the actual success rate is thought to be lower, with estimates ranging down to 9 percent.

Stop-smoking experts blame heavy, misleading advertising to consumers and a lack of involvement by the doctors dispensing the patch.

"The response to the product has been unprecedented," says Dr. Calvin Fuhrmann, chief of the respiratory division at Baltimore's Harbor Hospital Center. "It was brilliant consumer advertising -- a breakthrough. And the public responded by demanding this miracle treatment.

"The doctors responded," he adds, "by writing prescriptions but by not instructing patients [in behavior-modification options] and not giving them adequate support. And in my estimation, the patch has been a significant failure because doctors didn't instruct people."

The first of the four nicotine patches marketed in the United States was launched by Marion Merrell Dow -- called Nicoderm -- and was heavily advertised during the Super Bowl last year.

But after a frenzied demand for patches early in 1992, sales plummeted at least 50 percent by year's end. Reports of people who had tried the patch and still couldn't stop smoking were everywhere.

Of the estimated 5 million smokers who tried a patch last year, at least 4 million are thought to have been unable to quit, Dr. Fuhrmann says.

"Many people hoped this was a magic pill, that it would be totally passive," says Mr. Samuelson. "This is ludicrous and dangerous. Patches can only be effective if they are used with a medical component, a strong behavior component and, most important, a sincere desire to stop smoking."

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