February 7th, 2010 by Jonathan Foulds, Ph.D. in Better Health Network, Research
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The journal Tobacco Control has on its website a list of the top 10 most read articles each month. One paper that has been near the top ever since it was published in 2005, was written by Dr Kjell Bjartveit and his colleague Dr Tverdal, on “Health consequences of smoking 1-4 cigrettes per day.”
The study included 23,521 men and 19,201 women, aged 35–49 years when they were initially screened for cardiovascular disease risk factors in the mid 1970s and followed them up to 2002. The researchers calculated the total risks of death and relative risks adjusted for confounding variables, of dying from ischaemic heart disease, all cancer, lung cancer, and from all causes, and examined the effects of regular smoking of only a few cigarettes per day. Read more »
This post, Classic Study: There’s No Safe Threshold For Cigarette Smoking, was originally published on
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December 23rd, 2009 by Jonathan Foulds, Ph.D. in Better Health Network, Health Tips
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As we approach the beginning of the new year, many of us are considering our New Year resolutions for 2010. For many smokers, quitting will be near the top of the list. Particularly in these tough financial times, many smokers are deciding it doesn’t make financial sense to keep smoking. When it comes to new year resolutions, it’s not essential that the change start immediately from midnight on December 31st, but if there isn’t a plan to get started pretty soon afterwards there’s a real risk that the planned change never happens. Read more »
This post, New Years Resolutions And Tips To Help You Quit Smoking, was originally published on
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November 6th, 2009 by Jonathan Foulds, Ph.D. in Better Health Network, Health Tips
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Every now and again I like to pick one of the classic research studies on smoking cessation in order to highlight some of the key findings. Today I’m going to focus on the part of the Lung Health Study.
The Lung Health Study is certainly one of the best smoking cessation studies ever carried out, partly because of the comprehensive nature of the assessment and follow-up of its 5,887 participants and partly because it was way ahead of its time in delivering a truly “state-of-the-art” intensive smoking cessation intervention which was compared in a randomized manner to the effects of “usual care”. The Lung Health Study (LHS) was a randomized clinical trial of smoking cessation and inhaled bronchodilator therapy in smokers 35 to 60 years of age who did not consider themselves ill but had evidence of mild to moderate airway obstruction. Read more »
This post, Classic Smoking Cessation Study Suggests You Can Save A Life For $2000, was originally published on
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August 14th, 2009 by Jonathan Foulds, Ph.D. in Better Health Network, Health Tips
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Many smokers I’ve seen for help in quitting have made a comment like, “if only I could be isolated on a desert island for a couple of weeks without cigarettes, then I could quit.” Earlier this week a news item from my home country (Scotland) told of a 56 year-old successful businessman named Geoff Spice who had smoked for 43 years and then decided to live on a remote island by himself for a month to quit smoking. And this island is really remote…with no electricity and only sheep for companionship (?!). So do you think this is a god way to quit smoking?
Perhaps the closest thing to this here in the United States is the option of going to a specialist clinic for residential tobacco dependence treatment. A handful of these residential clinics exist, with the most famous being ones at Mayo Clinic and Hazelden Foundation (both in Minnesota) and the St Helena Center in California. These residential clinics typical have a 4 to 8 day program including classes, pharmacotherapy and multidisciplinary therapy. They are also typically quite expensive ($3000 to $6,000) for the patient (though not in comparison to the cost for inpatient treatment for lung cancer!).
These clinics typically boast high long term (6 month to a year) quit rates (25 to 65%). The Mayo Clinic published a comparison between one year quit rates in their inpatient and outpatient program, finding a higher quit rate after residential treatment (45% v 23%). Of course it is possible that those attending expensive inpatient treatment were more highly motivated (and more affluent) than the average smoker seeking treatment. However, it is plausible that the methods taught in the classes are helpful, and that there is an advantage of getting off to a good start by virtually guaranteeing abstinence for the first few days.
The main challenge for those who start their quit attempt at a residential clinic, or on an island, is staying quit once they return to their normal environment with all the same triggers and cues.
I’d be interested to hear of the experiences of anyone who has tried these or other “extreme” tobacco dependence treatments.
Links to further information:
http://www.mayoclinic.org/ndc-rst/residential.html
http://www.smokefreelife.com/overview.php
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=12709094
http://news.bbc.co.uk/2/hi/uk_news/scotland/highlands_and_islands/8179781.stm
This post, Quitting Smoking Has Higher Success Rate In Inpatient Programs, was originally published on
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July 29th, 2009 by Jonathan Foulds, Ph.D. in Better Health Network, Health Tips
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Last week marked the 10th anniversary of a smoking cessation website called “whyquit.com”. Now those of you who know me, and know that website and its director, Mr John Polito, may wonder why I’m choosing to give it some free publicity. The website is strongly against the use of all pharmacological aids for smoking cessation, and some would argue that it does harm by misinforming smokers about the harms and benefits of these smoking cessation aids. However, although I certainly do agree that the site does misinform about pharmacological aids, it also has a number of positive qualities and presents a different perspective that may appeal to and help some smokers.
The site started 10 years ago primarily to tell the story of a few individuals who were killed very young by smoking caused diseases. The idea was to vividly tell their tragic stories and to inspire others to quit tobacco and so avoid the same. In 2000 Joel Spitzer, an experienced smoking cessation counselor and author joined whyquit and the site took on more of a role of advising smokers how to quit using a very clear philosophy based on the “cold turkey” method.
The site has a large amount of educational material, including free pdf copies of lengthy books by Polito and one by Spitzer. The descriptions of individual cases of tobacco-caused diseases are informative and will inspire some to avoid the same harrowing experience. The site also has a discussion forum called, “Freedom from nicotine.” But once again the fundamentalist opposition to the use of pharmacotherapy aids is evident in the rules for use of “Freedom from nicotine”. The site states that,
“A single-minded program, those applying for posting privileges must have quit all forms of nicotine delivery cold turkey within the past 30 days, without use of any products, pills or procedures, and remained 100% nicotine-free for at least 72 hours. A nicotine-free forum, any nicotine relapse – even one puff, dip or chew – permanently revokes posting privileges.”
This is a rather unusual requirement for people to use a quit smoking discussion site, and it seems rather odd to ban people “permanently” from using the discussion forum, because they had a puff or chewed a piece of nicotine gum.
The site contains a large number of factual inaccuracies, particularly when referring to research on the use of pharmacotherapy for smoking cessation and the evidence on it. There are too many examples to mention, but just to mention a few:
– the site states that nicotine withdrawal lasts 72 hours. Most studies of nicotine withdrawal symptoms find these to be significantly raised after the first week, and typically not returning to normal levels for 3 weeks.
– The site asserts that in “real life” studies nicotine replacement therapy doesn’t work and “cold turkey” always produces a higher quit rate. An example of a study refuting that claim is provided below (West and Zhou, 2007)
– The site asserts that placebo-controlled trials of pharmacological treatments are all severely flawed because participants can sometime guess better than chance (.e.g. because the medicines work so well at treating nicotine withdrawal that participants can tell what the got, so the study is not perfectly “double blind”). On this point the site is somewhat out on a limb as most scientific research bodies regard the randomized placebo-controlled trial as amongst the best ways to find out if a drug treatment works or not.
– The idea that the results are entirely due to participants’ awareness of whether or not they received the drug also doesn’t bare much scrutiny. For example, in dose-response studies or studies where there is also an “active” comparison, participants are less able to identify what treatment they received, but the higher dose typically does better than the lower dose, and both do better than placebo.
– The site is also highly critical of anyone who has been funded in any way by pharmaceutical companies, and implies that such a conflict of interest almost certainly causes those individuals (including myself) to lose all independent judgment. While I agree that researchers should declare their sources of funding and that readers should weigh that information when reading research reports, the idea that the whole field has been bought and sold to the pharmaceutical industry is blatantly false. It is not at all uncommon for researchers receiving pharma funds to publish studies with disappointing results for the pharma company, including reports of potentially serious side effects.
(e.g. Foulds, J., Stapleton, J., Hayward, M., Russell, M.A.H., Feyerabend, C., Fleming, T., and Costello, J. Transdermal nicotine patches with low- intensity support to aid smoking cessation in outpatients in a general hospital: a placebo-controlled trial. Arch Fam Med 1993; 2: 417-423.
Foulds, J. and Toone, B. A case of nicotine psychosis? Addiction 1995; 90: 435-437).
The reality is that for years academic researchers have been encouraged by our employers to build bridges with private industry in order to make scientific advances, and do so with their eyes open. Most acknowledge our funding as openly as possible without becoming very tedious (e.g. my funding sources are mentioned on my home page on healthline and also on my program website, rather than on every single blog post). Most of us draw the line at funding from the tobacco companies because they have such a clear and consistent history of distorting science and using primarily for PR purposes, and largely because their ultimate purpose is to sell a product that is extremely harmful to health, rather than products designed to improve health.
However, the point here is not to quibble with every single point or inaccuracy on the site. Rather readers should be aware that in among the inspirational stories and plenty of good advice on this site, there is an almost fundamentalist agenda that its just wrong to use medicines to help you quit smoking. If you agree with that, or are prepared to take it with a pinch of salt, then you may find other aspects of this “single minded program” to be helpful.
Here’s an example of a recent “real world” study finding that smokers using NRT have a higher quit rate
This post, Whyquit.com: Factually Inaccurate, But Doing Some Good Nonetheless, was originally published on
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