Earlier this week NPR ran an item about how anti-smoking efforts have evolved over the decades. Since 1984 when the first nicotine gum became available over the counter, nicotine replacement therapy drugs have been promoted by the pharmaceutical industry to help people quit. But what is the most effective way to stop smoking? According to a paper by Simon Chapman and Ross MacKenzie published last week in PLoS Medicine, between two thirds and three quarters of smokers quit by “cold turkey” or by reducing and then quitting without these drugs.
The paper attracted a lot of media attention and debate. On NPR, Simon Chapman spoke about the “megaphone” of the industry promoting nicotine replacement therapy that drowns out the message that people can quit smoking unaided. But other points of view were put across. John Hughes of University of Vermont, spoke on NPR about his concern for the hardcore smokers – those who cannot be motivated to quit who may be helped by these medicines. The Daily Mail quoted a spokesperson from the UK Department of Health who claimed the evidence suggests that smokers quitting without assistance are less likely to be successful. But in their article Chapman and MacKenzie say that there might be industry bias in the literature finding that anti-smoking medicines are effective. They cite a study that found whilst 51% of industry-funded trials reported that nicotine replacement therapy was effective, only 22% of non-industry funded trials reported that this therapy worked.
So how noisy is the nicotine replacement therapy megaphone? On ABC Australia Simon Chapman said that the market for these drugs was estimated at US $1.7 billion in 2006 and that smokers in the US subjected to more than 10 smoking cessation advertisements a month. More than 133 people commented in response to this article taking different points of view. Comments also came into the LA Times Health blog about the “medicalisation of smoking cessation”. Chapman and MacKenzie say that this industry has led to a kind of “professional amnesia” about the millions who quit in the decades before nicotine replacement therapy drugs. This was a point picked up in a Daily Mirror article, which quoted Chapman as saying that decline in smoking in the US began with the Surgeon General’s Report into Smoking and Health in 1964.
GlaxoSmithKline – one of the leading manufacturers of nicotine patches – put across their point of view in the Australian, unsurprisingly saying that nicotine replacement therapy had a role to play. But Chapman and MacKenzie say that getting medical help to quit smoking is the only message getting across. The Sydney Morning Herald used the New South Wales Quitline as an example of how nicotine replacement therapy is being endorsed – it urges smokers to speak to their doctor about the medications that are available. In contrast, Chapman calls for public sector communications to redress the balance by reminding smokers that many people quit unaided and to reassure smokers that unsuccessful attempts to quit are not “failures” but steps towards future success.
Read and comment on the article to tell us what you think. Responses so far include a comment from Stanton Glantz who says changing the environment by providing quit lines and smoke free areas is the best way to enable smokers to quit.