Wednesday, August 15, 2012

How Do Quitlines Reconcile Data Showing that Overwhelming Majority of Quitters Use Cold Turkey Quitting While Taking Loads of Money from Pharmaceutical Companies?

I have been writing recently about the financial connections between groups like the North American Quitline Consortium (NAQC) and Big Pharma. Pharmaceutical funding of smoking cessation strategy and service groups like NAQC might not be so much of a problem if not for data showing that cold turkey quitting is the most commonly used and effective method for smoking cessation, despite the widespread availability and use of smoking cessation drugs.

Today, I want to give readers a sense of what the population-based data reveal about the efficacy of cold turkey quitting compared to the use of drugs.

The Rest of the Story

The most striking data are those reported by the American Cancer Society in 2003 (which are little different from today's numbers). Ex-smokers who had successfully quit smoking were asked to identify the method they had used for smoking cessation. The results were as follows:

"Recommended" therapy (NRT, smoking cessation drugs, counseling): 6.8%
Other: 2.1%
Cold turkey: 91.4%

The critical finding here is that despite evidence that NRT and smoking cessation drugs can double quit rates in clinical trials, actual practice and experience in real life settings suggest that cold turkey quitting continues to represent the most promising method for smoking cessation on a population level. Nine out of every ten successful quitters had used a cold turkey approach, rather than a "recommended" approach.

Interestingly, these findings are repeatedly framed by quitlines, pharmaceutical companies, and other entities with financial interests in the "recommended" approaches as showing that public health practitioners are not doing a good enough job of recommending the "correct" approaches. It appears never to have occurred to these groups that perhaps what the results actually show is that the "recommended" approaches may not be the most effective. Perhaps these groups ought to change the approaches that they "recommend."

This perspective is summarized in a review article by smoking cessation expert Dr. John Pierce published in the 2012 Annual Review of Public Health.

According to the review article: "While quit attempts have increased, widespread dissemination of these aids [pharmaceutical aids and quitlines] has not improved population success rates. Pharmaceutical marketing strategies may have reduced expectations of the difficulty of quitting, reducing success per attempt. Some policies actively discourage unassisted smoking cessation despite the documented high success rates of this approach. There is an urgent need to revisit public policy on smoking cessation."

According to the press release accompanying the article: "'For the past decade, attempts to quit smoking have increased, but the proportion of people who become successful quitters has gone down' said John P. Pierce, PhD, professor of Family and Preventive Medicine and director of Population Sciences at UC San Diego Moores Cancer Center. 'Widespread dissemination of cessation services has not led to an increase in the probability that a quit attempt will be successful.'" ... recent evidence suggests that part of the problem may lie in how cessation aids are marketed by pharmaceutical companies: many such ads suggest that quitting smoking may be as simple as putting on a patch. It appears that younger smokers in particular are now more likely to underestimate the amount of work needed in order to quit smoking successfully."

"Traditionally, the majority of smokers who quit successfully have done so without assistance, and recent data suggests that this has not changed.  However, current national policy discourages unassisted quitting, advising clinicians to make sure smokers who want to quit do so with pharmaceutical assistance.  This policy may undermine smokers’ belief in their ability to quit on their own."

These are critical findings which must be considered by tobacco control practitioners and which should lead to a re-thinking of national smoking cessation strategies and policy. In particular, these are findings that must be considered by organizations like NAQC in determining their policies, programs, and services. Unfortunately, there can be no objective consideration of these scientific and evidentiary issues because NAQC is beholden to pharmaceutical companies by virtue of having taken their money and given them a seat at the advisory table.

(Thanks to Pam Parker for the tip.)

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