Do Proactive Measures by Doctors Aid in Smoking Cessation?
Despite the rapid decline in prevalence of smoking in the general population, it remains the most important cause of preventable death in the western world. But is smoking itself preventable by therapeutic intervention? Indeed, is smoking a disease that doctors could or should prevent and treat? If you accept the National Institute of Health’s definition of addiction as a chronic, relapsing brain disease, the answer is yes. But the NIH’s philosophy is dubious, to say the last.
All round the world, telephone help-lines have been established to assist smokers to abandon the habit. But do they do any good, other than provide a certain amount of employment to those who man them (not to be underestimated in these hard economic times)?
A paper in the British Medical Journal for April 28 suggests an answer, and there are no prizes for guessing what it is. The answer, in a word, is no.
The authors of the paper wanted to see whether more intensive and “proactive” advice (we’ll call you regularly, to chivvy you along), with or without the offer of free nicotine patches, would improve the rate of smoking cessation as compared with “standard support and advice.”
Interestingly, of the first 75,272 callers to the help line after the researchers started to recruit their subjects, only 5355 (7 percent) were even willing to state a date by which they intended to quit or try to quit. And of those, only 2,591 were eligible and willing to take part in the trial. Bear in mind that those who called the help line in the first place were not necessarily representative of smokers as a whole.
The trial subjects were divided into four groups, those who had standard support and advice, those who had standard support and advice plus the offer of free nicotine patches, those who were given enhanced telephone support, and those who were given enhanced telephone support plus the offer of free nicotine patches. Seventy percent of those who offered free nicotine patches took the offer up.
The results were not encouraging.
Unless you live in a cave somewhere in the wilds of Tibet, you have been thoroughly educated concerning the health risks of tobacco usage. That being said, if you are an adult and choose to smoke, you accept that risk. The risks associated with steamhouse sex, and recreational drug use have also been widely publicized. Again, if you participate in such behaviour and accept the risks, that is well and good. But please, if your chosen lifestyle results in some unpleasant problems down the road, don’t whine. And don’t ask me to pay for your self-inflicted pathology. Besides, we have our hands full combatting sugar, salt, transfats, obesity, lethargy, illiteracy, institutional ineptitiude, cat litter, non recyclical plastics, diminishing ozone, and a rapidly enlarging carbon footprint.
“And don’t ask me to pay for your self-inflicted pathology”
But under the present system, taxpayers indeed pay for the pathology of smokers who have exhausted their resources.
Actually, smoking is one of the few nasty, stupid, unhealthy habits that does NOT shift costs to others.
Non-smokers (such as myself) are not immortal! They also get serious and terminal diseases. Even if you argue that the diseases that non-smokers get are less costly to treat than those of a typical smoker — a tricky argument in and of itself — the difference in cost is almost certainly offset by tobacco taxes.
Furthermore, smokers on average die sooner than non-smokers —5 to 7 years by some estimates. This saves us a tidy bundle in Social Security payments.
Actually, taking a bath in cologne is a much more nasty, stupid and unhealthy habit that no one can evade.
I can be around a smoker with mild discomfort. If I happen to walk in the PATH of someone who had taken a bath in cologne, it could even be 15 minutes later, it completely locks my lungs up. I’m not alone in this either.
While I’ve been given the ability to avoid smokers if I wish, I don’t have this choice with the “bathers”. I am forced to be around them like it or not.
Cologne causes lung cancer, emphysema, COPD among other ailments thought once to be only from smoking.
If given the choice, I will take the smoker any time. At least they are polite and I can breathe.
I’m wondering when alcohol will be outlawed.
Of course under the soon to be implemented Obamacare mandate things will change. The LED protocol, Let Em Die, should allow a thinning of the flock. I wonder if special dispensations will be provided for the select few?
We might want to consider all the social costs of human activities… Back 50 years ago most adults smoked. Fat people were few. No one did regular exercise except for those who did various sports. Smoking does shorten one’s life span. However smokers generally do not experience increased medical costs until about the end of their life spans. The non-smoking obese however have increased medical costs for decades before the end comes for them.
Then we should consider those who do everything “right”. They live longer, collect Social Security for perhaps a decade longer. Visit doctors more often adding to Medicare costs. More often end their long life spans in nursing homes on Medicaid. A study conducted in the Netherlands found that the “healthy” actually ended up costing society more than did smokers. The obese are also “expensive”, especially if they become diabetic. Being diabetic is “expensive”. It also increases your chances of ending up on dialysis, which is even more “expensive”.
So perhaps we made a mistake encouraging people to stop smoking…
I suspect that few understand, acknowledge, and accept the risk.
I think most simply deny it.
Stupid is as stupid does.
The cost to society is greater with the obese than it is with smokers. My father smoked all his life, died at 82 with a sudden heart attack. My obese wife has been on insulin since 1999. The two insulins she uses cost $700 every three months. (mostly paid by Medicare) Then there are meters, test strips, needles. (mostly paid by Medicare). Doctor visits and lab tests four times a year. (mostly paid by Medicare). Diabetes causes heart problems, circulation problems. It is an “expensive” disease to have, although today diabetics do have near normal life spans. The only medical problem my father had before his death was with his lungs. Diabetics “bottom out” from time to time. If driving, they are likely to crash. Which she did on December 31, 1999. Fortunately she simple ran off the road into a snowbank. But other diabetics have either killed themselves or others when these things happen. In my considered opinion, smoking is a safer activity than becoming a diabetic and it is a mistake to encourage people to quit smoking if they are going to replace their nicotine addition with an addiction to food instead… Just this Libertarian’s opinion.
Francis ‘Frantic’ C. McCann began her lifelong tobacco addiction at the age of nine. On average, she smoked eleven large cigars every day of her life. Sometimes more. Nevertheless, Francis lived and thrived, until her untimely death at the age of fourteen. She left a very small carbon footprint. Her brother, John John, ws as thin as a rail, never smoked, was abstinent, and was a committed vegan. He died at the age of 31, struck by a pickup truck being driven by an itinerant faith healer near Tuscaloosa Ala. while jogging. Talk about social justice.
You’re wrong. I smoke. I know, understand and accept the risks. In some ways I prefer the relatively quick death to the long slow drawn out deaths you healthy people choose.
lolly, please investigate the difference between the words, “few”, “most”, and “all”.
You may find that an understanding of the subtle differences between these words will be useful to you.
You see, Good Doctor, there you go again with looking at the results and coming to conclusions. That’s just not how it’s done anymore.
Your polite, glancing mention of the economic incentives to lie for funding can hardly be less minimal, but humans being the scum they generally are, I think those incentives are what now drives society, Big Medicine most especially included. Working to build up, to discover, to produce measurable good is so passe. Working to shovel money to your buds is far more efficient, especially when governments have such piles of it lying around, just waiting to be spent.
In other words, conclusions first, study later, after we’ve used most of the study funding for ourselves. Everything from academia is now suspect, pending minute examination and confirmation of the entire study.
Because let’s face it: there really are far too many studiers studying useless things, because there aren’t really that many important things in all the world TO study!
And those might be hard.
“more”, not “less”
Oops.
Yes, financial incentives are more likely to compel smokers to quit than ‘support’. When cigarettes are $25 a pack under Obamacare (penalties, of course) cigarettes will be bought and sold on the black market via of the drug cartels.
I was at a small retail commercial farm a few days ago buying produce. Among the row crops there were a couple of rows of tobacco. The tobacco was not on open offer for sale. Perhaps it was for the owner’s habit, but I imagine the price of tobacco has something to do with it being grown.
It’s also likely that this farmer realizes there are significant additives in commercial cigarettes and rolls his own ‘organics’.
I think a more useful study would be “Will it matter if you smoke once ObamaCare is enacted?”. That study will determine the increase in life expectancy associated with advances from capitalistic medicine over the past 50 years and will then project future life expectancies for smokers and non-smokers based on the likelihood of future advances and the continuation of current practices.
Of course it would be simpler to just grab the actuarial tables from 1955 and check the numbers because there will be no future medical advances once the profit motive is removed and casual observation strongly suggests that current practices will be abandoned as “too costly”. If you’re dying of other previously curable causes before smoking kills you then it won’t matter if you smoke. Willow Bark! Get your Willow Bark!!
The failure of smoking-cessation programs to stop smoking isn’t because smoking is a voluntary behavior.
It’s because nicotine is a highly addicting drug. Some medical studies have found its addictive potential to be comparable to heroin.
The best solution may be for smokers to stay on those nicotine patches permanently–just like heroin addicts stay on methadone. They’re getting a regular nicotine fix, but without the carcinogens found in cigarettes.
And no one’s ever successfully quit smoking, so you must be correct….
And if people stop smoking and switch addictions to food? The obese are addicted to food just as badly as a smoker is addicted to nicotine. The question here is “social cost”. Obesity leads to diabetics and other medical complications. Diabetes is an “expensive” disease and most diabetics today will live longer than smokers do. They will also cost society more in medical costs. They also “bottom out” while driving and get into crashes. The lifetime health care costs of the obese are greater than the life time costs for smokers. The total social costs of the obese are greater than they are for smokers. An objective study using the costs of Social Security, Medicare, Medicaid would show that the obese definitely cost more than smokers. As a matter of fact, the life shortening aspects of smoking indicate that smokers actually cost society “less” over their lifetimes than the obese do.
You might be interesting in knowing that Dalrymple, who was a practicing doctor before he retired, supervised many people’s withdrawal from heroin and has considerable experience with it. Unlike the portrayals of heroin withdrawal we see in movies, REAL heroin withdrawal is surprisingly easy. Dalrymple has reported in other articles that the symptoms of heroin withdrawal are very close to what someone with a mild flu would experience. (Dalrymple reports that withdrawal from alchohol, on the other hand, is much more difficult and calls for close medical supervision.)
Indeed, withdrawal from alcohol is sometimes fatal.
Heroin withdrawal is very unpleasant for a few days but prompt cessation is not dangerous. Abruptly stopping drinking can be very dangerous, as can withdrawal from benzodiazepines; properly-managed detoxification regimes will handle the nastier sequelae – in the case of alcohol, usually by substituting a tapered dose of a benzo drug such as diazepam (Valium) or lorazepam (Ativan) and sometimes barbiturates or even clonidine. Heroin withdrawal is palliated with drugs like Suboxone. Similar treatments for nicotine addiction are practically non-existent. But the main problem is that pharmaceutical treatments for addiction are usually useless in the long run. No-one quit heroin by taking Suboxone. They quit by wanting to quit, and by undertaking the necessary lifestyle changes to accommodate this (rehab, addiction counselling, Narcotics Anonymous etc.). Relief from the gross physiological dependency on substances is typically a relatively minor part of long-term recovery.
I quit smoking without the help of a third party several years ago. It was one of the most difficult things I have ever endured. It is a pursuit that must be taken on from within. I am all the stronger for having won the battle. I have absolutely no desire to smoke ever again. I give anyone credit for trying, but this is one thing that takes absolute personal responsibility. It is painful and trying, you have to fight through it. Nobody else can give to you the fight, the will that is required to conquer the addiction, that can only come from you.
Kudos to you, Liv, and may you enjoy many years of good health.
I’m glad I never started. Don’t know if I have what it would take to stop.
I have a hard enough time with peanuts….
Oh, and it helps to curse at the tobacco companies and think of quitting as a punch in their face (*metaphor disclaimer).
Those who smoke or chew tobacco do so because that is what they wish to do. Fat people are fat because they choose to overeat and avoid physical exercise. The great majority of AIDs sufferers contracted the disease because of risky sexual activity or IV drug use, of their own free will. The individual is ultimately responsible for his/her choices in life. Everything else is childish excuses.
As someone who has both quit smoking AND lost a significant amount of weight within the past five years, I feel qualified to say that no amount of advertising, media pressure, doctor’s advice, free help lines, employer pressure, or anything else will cause anyone to quit smoking (or lose weight). A person has to WANT to do it. It takes tremendous will power, and that cannot be imposed from without.
I have been tobacco free for over six months. I quit by using the patch for six weeks. I still have the occasional yearning for a cigarette, but it hasn’t been difficult to resist.
I lost nearly 100 lbs the old fashioned way – limiting my food intake to sensible levels and exercising. Gimmick diets and/or pills don’t work. I have kept the weight off for five years by maintaining the new routine & turning into a lifestyle.
I say this not to put myself on a pedestal – anyone can do it. But it takes hard work and honest desire. A helpline might provide encouragement to somone who needs it, but it can’t implant determination. Only one person can do that, and it’s the person in the mirror. You have to want it – not in an idle “wouldn’t it be nice” way – but in a “I’m going to DO this no matter what” way.
That said, you CAN do it.
^^ This ^^
There is valid scientific evidence of the genetic origin of addicitive proclivities. As an ex-smoker (quit 11 years ago) who thoroughly enjoyed every cigarette and cigar I ever smoked over 25 years I can tell you beyond the shadow of a doubt that nicotine is highly addictive. If addiction to nicotine is not a disease, then addiction to alcohol, heroin, or any other substance does not qualify as a disease.
Like any other addiction the first step to a cure is when the addicted person WANTS to quit.
most ex-smokers finally seem to quit without professional or pharmaceutical assistance.
…to the chagrin of finger-waggers everywhere, above all those at the government trough.
Personal experience, common sense and widespread anecdotal evidence reinforce the idea that if you really want to quit, you will, if not this time, then next. And if you really don’t want to quit, you won’t. But there’s little money in common sense, especially in the nanny state.
All kinds of things are treated as dis-ease in today’s incredibly dumb new world order.
Pregnancy is a dis-ease. Obesity is one, too.
Using words to attempt to quantify everything under the sun, researchers clearly don’t have enough to do.
scientism not science
Renaming everything behavioural (choice) as a disease is liberal newspeak to absolve people of guilt.
I don’t know what all the fuss is about.
Quitting smoking is easy, I’ve done it a million times.
Here is what I’ve concluded about smoking, based on my own lifelong, unscientific experience.
Nicotine is addictive and certain human brains are, receptor wise, more prone to smoking than others. Growing up around smoking parents will make you more prone to smoke.
I had my first drag on the beach at age 13, and it made me very dizzy. As time wore on, the dizziness went away. I was an occasional or intermittent smoker for many years, but went cold turkey about 8 years ago. Oddly (to me) a full ashtray or someone puffing on a weed started to look truly disgusting, tho’, full disclosure, I could and probably would light up around someone smoking, but have only one cigarette.
Some famous people died of lung cancer, and it impacted me greatly, John Wayne (tho’ I later read it was something else), Steve McQueen, Telly Savalas. My dad.
Now, I’m at an age where EVERYBODY I know who has smoked lifelong has some serious, ugly ailments, most commonly lung cancer & emphysema.
IF you are a dedicated smoker, odds are very high that that will be your future.
The Doctor is Out (aren’t you relieved ?
)
Addiction is personal; if you quit, you do it when you do it, agencies be damned.
Even the word “cessation” is a cop-out marketing term for quitting the habit; it attempts to soften the determination and persistence it takes to go cold turkey, which is the best way to achieve a non-smoking status according to addictionologists. Gum, patches, acupuncture, etc. are profit-centered crutches that ensure the client remains a cripple, still dependent, not quitting, but always trying. As Yoda said: “Do or do not. There is no try.”.
I was an activist in searching for the health consequences of smoking as I was a smoker. When I went to work at Social Security HQ in reviewing Social Security disability claims, it was plain the consequences were much more extensive and not available to the public. My wife was of the same mind. We both quit cold turkey.
Neither of us quit smoking per se. We just quit buying cigarettes. As neither of us was a moocher, that cut off our supply. We smoked them until they were gone and that was that.
Too bad the cigarette packages do not have information on identifying Leukoplakia.
Wasn’t leukoplakia the lead role in Star Wars???
I thought smokers were born that way. I wasn’t so was able to get off the drug after only 35 years of puffing.
Tis true. 67% of infants born of mothers who smoked during pregnancy were born with a little butt at the end of their spine.
Every dollar spent on education as a preventative for smoking is absolutely wasted money.
One of my kids did a research project which compared the rates of smoking between two age/race/sex/income and education matched groups. One was radiologic technologists and the other, respiratory therapists. The respiratory therapists work with smokers every day, and see the results of the smoking habit first-hand. Guess who had the higher rate of smoking? You got it, the respiratory therapists. Not by a little, by a factor of 7.
Smoker For Life
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Smoking is like masturbation. One will kill you the other will stunt your growth. Nevertheless, they have been going on since before we broke off from the primate family tree and they will continue to flourish forever come what may.
Why would anyone WANT to quit smoking? What a ludicrous proposition. Saying it will “kill” you is like saying you shouldn’t drive a car or even ride in one anymore due to dreadful kill-rate statistics.
If Obamacare forces me to stop smoking due to punitive taxes, fine. I’ll graduate to smoking “weed” which I assume will be cheaper.
People smoke precisely because it calms you down. If I were prevented from smoking, I’d probably get so jazzed up I’d end up running 5 miles a day in the morning and in the evening, something I’ve never done and have no intention of starting anytime soon.
Ultimately, people like myself smoke because we are professional lazy bums. Smoking is a wonderful excuse for not doing so many things these days. Is it really worth holding on to a job where you have to work in a “non-smoking” environment all day? I don’t think so. I’d rather work part-time somewhere where I can sneak off every 10 minutes or so to get a puff.
It’s just not what it used to be. Even in graduate school I remember having a class of 6 or 7 in the professors office all puffing away like chimmenys. Needless to say, those days are long gone. I doubt very much that I’d attend graduate school these days…….it sounds like a “drag”.
Running…I love how self-righteous fitness freaks get all huffy about “paying for fat people’s bad choices” then turn around and demand knee replacements, physical therapy, ambulance rides from the 5K where they’ve dropped from a heart attack–all results of their own bad choice to take up running. Log, eye, speck.
After forty-odd years of two packs a day of Winstons/Salems/Marlboros, Winstons only for the last ten or fifteen years, I had my next to last cigarette on July 8, 2008. (The last was a couple of years later when a little hottie that had piqued my curiosity went outside the bar for a smoke, I went with her, and she offered me one, which I took. Ultimately, I didn’t smoke the whole cigarette, haven’t had another, and didn’t have her either, but it was a nice fantasy for awhile.)
I’ve heard and kinda believe the “easiest thing I’ve ever done, done it thousands of times” thing, but the truth to me is that the addiction part is pretty easy. If you’ve been a heavy smoker you’re going to be very uncomfortable and maybe even sick for three days or so, maybe as much as a week. After that, the real problem if you’ve been a longtime smoker is you don’t have a clue what nonsmokers do. Just like “safe” districts make politicians crazier, smoking areas make smokers more dedicated smokers and I say that as someone who spent a lot of years going outside to smoke in Alaska; Alaska smokers are tough. You don’t have a hair on your butt if you put your coat on to go out for a smoke in Fairbanks at thirty or forty below. (Actually there’s a trick to pulling that macho act off but I’m not going to share it.)
For awhile I had dreams about smoking, found myself digging in my shirt pocket, absent-mindedly reaching for a smoke, but once I decided to quit, that was it; the cravings came, but they were motivated by situations I found myself in, not physical craving after the first week or so. That said, the only way I was able to quit was the fact that Juneau and Anchorage had both outlawed smoking in bars. How many times I’d been “quit” for weeks or even months and bummed a smoke in a bar, bought a pack in a bar and left what I didn’t smoke behind even, and found myself buying a pack the next day and going right back to two packs a day. The reality is that you can’t quit smoking. You can NOT SMOKE, but you’ll spend the rest of your life two puffs away from two packs a day.
And for any of you who think quitting smoking is tough, we can talk about quitting drinking if you ever let yourself get to the point of physically needing alchohol; that one you can’t do by yourself and you can die from trying. I’m an alcoholic and I still drink, but I don’t drink distilled spirits – one Helluva sacrifice for a one-time half a fifth a day Chivas drinker – and I NEVER let myself drink to the point where I need to drink. If you drink and wake up needing a drink, having the shakes regularly, or ever start having dry heaves, you need to get yourself checked in NOW! I’m not going to tell you to quit, but I’ll sure as Hell tell you to quit drinking like that or it WILL kill you. ‘Course, the two do go together; most of the alcoholics I know are smokers and most of the smokers I know are alcoholics. Some of us manage to control our bad habits but we’ll go to our grave with them.
To: #20 Art Chance
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Anyone reading Art Chance’s “Mea Culpa” cannot but feel sorry for him and the agony and lack of ecstasy he’s going through.
Even though he no longer smokes or drinks, you can tell that’s all he thinks about, day and night, month after month, year after year until, as he himself says, he will take his cravings to his grave.
Ugh. What a way to go through life and what a way to go. It’s precisely his morbid situation that I’ve avoided and will continue to avoid. I smoke and the last thing on my mind is giving it up. I simply will not do it and end up a half-crazed, whimpering ex-addict the rest of my life.
Some places are more civilized than others, mind you, about this. At Amsterdam’s airport they provide this glassed in “cage” where smokers can partake of their habit to their heart’s content right in the middle of the terminal.
(It’s there, by the way, because a couple of years ago, I bitterly complained about the smoking ban throughout the airport. I told them the only reason I flew KLM was because at one time you could smoke EVEN IN THE CAFETERIA while having your coffee while waiting for your 8 hour (non-smoking) flight to the US. I said if they didn’t do something about it, I’d take Lufthansa in the future.) I guess they listened to me.
So Mr. Chance, I suggest you go back to your old “macho” habits and smoke away. If not, your last thought as they cover your grave will be about a cigarette whereas when they cover mine, it’ll be with me with a lit cig in my mouth….(and a carton buried with me, just in case)
No, feel a Helluva lot better not starting my day with a coughing fit or a hangover. I know I’m an addict and I’ve managed to manage it; don’t smoke at all and keep the booze under control.
When I’m watching the light growing dim, it won’t be a cigarette or a drink I’m thinking of; it’ll be something about 19 with high, firm breasts and a belly I can bounce a quarter on, now that’s an addiction worth having!
If I make 75, my 75th birthday present to myself is a pack of Winstons, a bottle of Chivas, and the youngest, prettiest whore I can find; at that point, it just doesn’t matter.
I tell my patients they can smoke if they want. They will be the one who suffer heart and lung disease. It is up to them, they can smoke and suffer the consequences.
This has worked better than preaching.
The truth will out.
“The Truth Will Out”
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1. Most people who smoke, in fact, do not get heart or lung diseases. Ever.
2. Many people who DO get heart or lung diseases have never smoked. Ever.
Most people who smoke, positively STINK. But that’s another issue. In fact, the vast majority of non-smokers complain about “smoking”, not because it can cause diseases, but because of the stench a smoker is prone to. But like I said, that’s another issue.
There are also “categories” of smokers. A few, like me, are “clean” smokers. Few people ever actually see me smoke. I don’t smoke indoors anywhere because I admit the stench gets into the walls, curtains and so on and can linger there for months if not indefinitely.
Secrets to hide the smell:
1. Always have a stalk of FRESH CELERY in the fridge. Nothing kills the stench in your mouth faster than that. I always chew on a celery stalk before an “important” meeting or visiting the dentist and it’s never failed me. It’s like magic.
2. Listerine works wonders too. But the secret is (besides gargling) to splash some on your clothes…..that eucalyptus smell lingers forever and hides any tobacco residue. Also around your neck.
3. However, Listerine can often (depending on your skin makeup) smell like “medicine”. To avoid that, use BAY RUM……a kind of man’s cologne. It too works wonders…splash it on your clothes…just a few drops will do. You’ll smell like you just got off a yacht.
I’ve seen people selling METAL CAR PARTS, for Pete’s sake, on ebay and advertizing that the parts come from a “non-smoking home”…….Ahahahahahaha.