Pharmaceutical giant Pfizer is in the middle of a major campaign to convince Australian smokers that they should not try to quit without taking anti-smoking medication.
The company sells over-the-counter nicotine replacement therapy (NRT) and prescription drug varenicline (brand name Champix). A Pfizer brochure “what makes you think you can quit this time?” and website stress that “only 3-5% of people who try to outsmart cigarettes without treatment succeed”, that “a serious quit attempt needs a plan” and that most smokers “require help from a health-care professional”.
Each of these claims is highly contestable. Pfizer and other pharmaceutical companies see cold turkey as the enemy of their efforts to medicate as many smokers as possible. Smoking cessation has become increasingly pathologised to the point that public awareness of its natural history has become heavily distorted.
For years, cold turkey has been denigrated as a hopeless strategy and ignored in public campaigns. But ask 1000 ex-smokers how they stopped and you get a very different answer. As occurs with personal efforts to stop problem drinking, gambling and narcotics use, population studies consistently have shown that a large majority of smokers who permanently succeed in quitting do not use any form of assistance.
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In 2003, 20 years after the introduction and widespread promotion of cessation pharmacotherapies, those trying to stop in the past year unaided (64.2%) were still twice as many as those using pharmacological aids (32.2%) and only 8.8% of US smokers attempting to quit used a behavioural treatment. Moreover, despite the best efforts of the well-resourced pharmaceutical industry to promote pharmacologically mediated cessation, a large body of clinical trials demonstrating that various forms of pharmacotherapy and other forms of help can significantly improve cessation, the most common method used by those who successfully stop remains unassisted cessation (cold turkey or reducing before quitting).
In 1986, the American Cancer Society reported that “Over 90% of the estimated 37 million people who have stopped smoking in this country since the Surgeon General’s first report linking smoking to cancer have done so unaided”.
Today, multiplying the number of people using a method by the number successfully quitting using it, there is daylight between the number of ex-smokers who have stopped unassisted and the next most common successfully attributed method (nicotine replacement therapy). A 2007 paper in the American Journal of Public Health [97(8):1503-9] showed that of smokers who had quit successfully for 7-24 months, 75.7% had gone cold turkey; 8.6% had cut down then quit and 12.4% had used NRT.
Pfizer’s claim that “most require help” is not only nonsense, but contrasts with a reference it cites in its own brochure, which states “about one-third of smokers now use a medication when they try to stop”, meaning that two-thirds don’t. Its claim that smokers need a plan is also highly debatable. A recent study (Nicotine Tob Res 2009;11(7):827-32) of unplanned cessation found that unplanned cessation attempts were twice as successful as planned attempts and significantly, that most unplanned quit attempters do not use any assistance.
The emphasis about the futility of people trying to stop smoking unaided acts to exclude popular understanding of what is the most common story of cessation: doing it without professional or therapeutic help. When citizens have common, ordinary and self-limiting ailments, traits and behaviours constantly redefined as needing treatment, avoidable iatrogenic consequences and burgeoning health-care expenditure can follow. But the steady erosion of human agency and self-belief as people lose confidence in their ability to recover or change unhealthy practices is perhaps of greater concern.