Smoking cessation
BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7553.1324 (Published 01 June 2006) Cite this as: BMJ 2006;332:1324All rapid responses
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Though entitled “Smoking Cessation”, the theme of this paper is
actually “Nicotine Cessation”.
Despite the authors stating “nicotine itself does not cause major
health problems in most users", and accepting that it is the cigarette
borne delivery system that is dangerous, they trot out the mantra that
“Nicotine Replacement is recommended for up to three months”.
In a similar addiction where the drug is less harmful than the
delivery system we are content to give a replacement product and consider
that a treatment success. Methadone and Buprenorphine are used as
replacement therapies to prevent or reduce the danger of injecting heroin.
Many Methadone users are able to stop injecting but cannot move on to stop
using the opiate they are addicted to and which is provided as a health
intervention indefinitely with an increasing evidence base that this is of
value.
The authors claim that “Smoking Cessation is the most effective means
of secondary prevention for COPD” but a medical profession bent on a
puritanical “war on smoking” (indeed even this journal’s nicotine
addiction offspring carries the banner for “Tobacco Control”) has failed
to apply the lessons it has learnt in opiate addiction to the more
widespread (and arguably more hazardous) condition of nicotine addiction.
In opiate addiction, “Harm Reduction” is seen as a good therapeutic
outcome: why, in nicotine addiction should the only acceptable outcome be
“Total Abstinence”?
A trial of long term Nicotine Replacement Therapy in patients with
COPD who fail to stop smoking with current interventions & measuring
Pulmonary Function over time as an outcome is long overdue; similar trials
in cardiovascular conditions would at least give us an idea of the level
of low dose nicotine that might reduce the harm that smoking (not
nicotine) is doing to our patients.
Competing interests:
None declared
Competing interests: No competing interests
A call for urgent action in the Middle East
I applaud you for emphasising the important role that should be
played by health professionals to counter tobacco use; even brief and
simple advice from health professionals can substantially increase smoking
cessation rates. Health professionals shall lead by example. They should
act as role models for their patients, by ceasing to smoke, and by
ensuring their workplaces and public facilities are smoke and tobacco-
free. Where I come from heavy smoking tends to be the norm rather than the
exception, nor do the regimes set a good example in this regard. Their
tolerance reflects the absence of a sense of responsibility amongst the
cadres in power, who conspicuously fail to draw the attention of the
public to the grave danger that smoking constitutes to health. Ultimately
the responsibility devolves upon the governments of the region to insist
on the requisite health standards of their populations. We cherish the
hope that this will apply to the Middle East with no less force than those
North European and Mediterranean countries which have adopted a more
enlightened policy.
Competing interests:
None declared
Competing interests: No competing interests