Well my thinking is, also, if it potentially does work, then surely nobody that smokes would get ME, right?
So I guess the question could be to everyone would be, did you smoke when you got ME?
It is extremely clear that smoking cigarettes neither prevents, cures nor treats ME or Long-Covid. No discussion can be had here as the data is that clear. We should not forget that "do you smoke" is the most routinely asked question on any questionnaire.
One could now still ask whether nicotine patches could have a positive effect on these illnesses and that is what this discussion, mainly happening on Twitter and Reddit, is currently about. It's nothing new to the topic of ME/CFS either as nicotine gums appeared in Dr. Goldstein's book back in 90's. For the biggest part nicotine, as treatment for Long-Covid, is something that made it's round at the begining of the Covid pandemic (
), then disappeared and then reappeared motivated by the paper of Marco Leitzke
https://pubmed.ncbi.nlm.nih.gov/36650574/, which started a new wave of patient experiments.
How this paper ever made it through the peer-review phase is something that still shocks me as 3 of the 4 patients treated did not have Long-Covid to begin with, which is extremely shocking given the abundance of Long-Covid patients. If any thing this would rather motivate a question such as "can nicotine prevent the development of Long-Covid if you start consumption after having suffered from acute Covid". According to the author there is a substantial difference between smoking, gum and patches as "patches are fare superior to gums since the theory is made on the basis of constantly low nicotine blood levels until your immune system erased the entire SARS-CoV-2 residuals. Only this protects the acetylcholine receptors from viral re-occupation" as Marco Leitzke states. However, the only studies really looking at this direction seem to show the opposite of this nicotine theory
https://www.pnas.org/doi/10.1073/pnas.2204242119.
Overall, we might still have to wait for more patient data, but if you have a look at the data, for example on Eureka, Twitter or Reddit it certainly does not seem too good of a treatment and is miles behind basic things the majority of patients have tried and usually comes with very bold statements such as "Nicotine gum blocks the receptors, and nattokinase destroys the spike proteins.".
Personally, I'm probably a bit biased as I struggle to take a paper serious where the most significant characterisation of Long-Covid is not satisfied. If I criticize the PACE trial, I have to do so even more here. Something that should be mentioned though is that nicotine patches have a relative small addiction potential and this shouldn't be a worry for those wanting to experiment.
Of course the patches could still be a cure, even with a faulty paper or a different mechanism of action, perhaps they only work for a small subset of mild cases, but that holds for anything. Perhaps in the upcoming weeks more data will appear to support the theory, which of course would be awesome news, but currently I just don't see how this is different to the Ivermectin hype.
