NEJM drops the ball on smoking cessation

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A lengthy article in this week s New England Journal of Medicine catalogues a variety of approaches to helping smokers quit within the healthcare setting, including counseling, smoking cessation medications such as bupropion and varenicline, as well as conventional nicotine replacement modalities like gum, inhalers, and patches. Unfortunately, the majority of these approaches have a success rate no higher than 9 percent a far cry from the 70 percent quit rates seen among smokeless tobacco users. Yet the 10-page article makes no mention of this alternative.

While the journal article notes that smokers too often do not use evidence-based treatments, it does not seem to acknowledge that the treatments it reviews have a failure rate of about 90 percent. The available smoking cessations aids are an abysmal failure, ACSH s Dr. Elizabeth Whelan observes. She was baffled that the article did not acknowledge the dramatically higher success rates experienced by smokers who make use of smokeless tobacco products. These rates have ranged from 30 to 70 percent in clinical trials, as ACSH advisor and professor of medicine at the University of Louisville Brad Rodu has documented in his recent paper published in Harm Reduction Journal. The authors omission of this much more successful method seems to be a misguided moral attitude, says Dr. Whelan.

Aside from providing further documentation of the virtual failure of conventional smoking cessation aids, the article does underscore the important role that counseling can play in a smoker s attempt to quit. The authors analysis of 35 different clinical trials found that participants six-month abstinence rates increased as their minutes of counseling increased: there was a 27 percent abstinence rate for those who received up to 90 minutes of intensive counseling, as opposed to those who did not. This finding points to the importance of outside emotional support and practical guidance for individuals trying to shake any addictive habit.

ACSH s Dr. Josh Bloom takes exception to the NEJM article itself. This very long paper dwells on methods that don t work, he says. They discuss five clean nicotine delivery methods, none of which are effective, while failing to even mention the one device that does seem to work: the electronic cigarette. Why they are taking this stance is unknown, but for them not to even mention the existence of e-cigarettes borders on malpractice, in my opinion.