Helping smokers to quitBMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2806 (Published 27 June 2018) Cite this as: BMJ 2018;361:k2806
All rapid responses
This eLetter of mine acknowledges the problem- hundereds of thousands falling ill and dying in the big wide world.
It also acknowledges that British business - big and small - has a vested interest in keeping smoking going.
This includes tobacco as well as the new pernicious evapes.
Now, I damn
PUBLIC HEALTH ENGLAND
and the two academic, learned, bodies in England, nay the United Kingdom
Thry moan and they groan about smoking.
Why do ( the British) not call for herbicide spraying of the tobacco crops everywhere in the world.
There are no moral impediments to saving lives?
Now the EVAPING business.
Another way to build up the businessmen‘s bank balances - at the cost of school age children’s health.
I know that we are a nation of shopkeepers. But do we have to stock and sell these obscenities?
Competing interests: No competing interests
Whilst the author rightly makes the point that efforts made in the UK to lower smoking rates have been far superseded by Australia and California, we would like to make the argument that a change from an ‘opt in’ to an ‘opt out’ approach proposed for the NHS is already backed by substantial evidence.
The author uses a randomised trial (Halpern et al) comparing abstinence rates in those offered e-cigarettes, pharmacological therapies or monetary reward within an ‘opt out’ system as evidence that an ‘opt out’ approach may not be efficacious(1). However, we do not believe that this is good evidence that an ‘opt out’ approach would not work. Whilst the study discussed showed less than 1% abstinence rates in groups assigned e-cigarettes or pharmacological therapies, studies have shown that reimbursement for smoking cessation treatment doubles abstinence rates(2). Surveys in the US also show that pharmaceutical aids given out without additional counselling support are not effective in increasing smoking cessation(3) – this is an approach not used in the Halpern et al trial. Therefore, if the study discussed had used more effective or practical means of assessing abstinence rates, it would be a better indicator of how well an ‘opt out’ system may work.
In addition, the argument that smoking is not a disease in itself delegitimises dependence as a health condition. Therefore smoking should be treated as any other disease is, with an ‘opt out’ approach.
A common misconception is that smokers must be ‘ready’ or ‘motivated’ to quit – however, studies have shown that people at all stages of ‘readiness to quit’ quit at the same rate. In Copenhagen a trial showed that when treatment is offered to all smokers, more than double the number that report being ready to quit actually enroll in treatment programs offered (4). Furthermore, spontaneous decisions to quit have been shown to be more effective than pre-planned decisions to quit when smokers feel they are ‘ready’(5). This suggests that an ‘opt out’ approach whereby all smokers are offered support would ultimately treat more people than an ‘opt in’ approach where only those reported as being ready to quit are offered treatment.
Therefore, there is already evidence to suggest an ‘opt out’ approach could be very effective. A randomised control trial comparing groups of smokers in ‘opt in’ or ‘opt out’ groups who are all offered the same treatment options would be a far more effective way of determining the outcome of an ‘opt out’ approach.
Leah Holm-Mercer and Cameron Jenkins
1. Halpern SD, Harhay MO, Saulsgiver K, Brophy C, Troxel AB, Volpp KG. A Pragmatic Trial of E-Cigarettes, Incentives, and Drugs for Smoking Cessation. N Engl J Med [Internet]. 2018 Jun 14 [cited 2018 Jul 3];378(24):2302–10. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29791259
2. Kaper J, Wagena EJ, Willemsen MC, van Schayck CP. Reimbursement for smoking cessation treatment may double the abstinence rate: results of a randomized trial. Addiction [Internet]. Wiley/Blackwell (10.1111); 2005 Jul [cited 2018 Jul 3];100(7):1012–20. Available from: http://doi.wiley.com/10.1111/j.1360-0443.2005.01097.x
3. Leas EC, Pierce JP, Benmarhnia T, White MM, Noble ML, Trinidad DR, et al. Effectiveness of Pharmaceutical Smoking Cessation Aids in a Nationally Representative Cohort of American Smokers. J Natl Cancer Inst [Internet]. Oxford University Press; 2018 Jun 1 [cited 2018 Jul 3];110(6):581–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29281040
4. Pisinger C, Vestbo J, Borch-Johnsen K, Jørgensen T. It is possible to help smokers in early motivational stages to quit: The Inter99 study. Prev Med (Baltim) [Internet]. Academic Press; 2005 Mar 1 [cited 2018 Jul 3];40(3):278–84. Available from: https://www.sciencedirect.com/science/article/pii/S0091743504003172?via%...
5. Larabie LC. To what extent do smokers plan quit attempts? Tob Control [Internet]. BMJ Publishing Group Ltd; 2005 Dec 1 [cited 2018 Jul 3];14(6):425–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16319368
Competing interests: No competing interests