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In the early 1990s, I was the guest of the local health service in Broken Hill, New South Wales, during a national week promoting quitting smoking. I went on the local radio and the host invited ex-smokers to call in and talk about how they had quit.
Consistent with everything we know about the method most ex-smokers used at their final successful attempt to quit, many callers talked about quitting cold turkey (unassisted).
A series of papers about the unassisted quitting process by Andrea Smith and colleagues at the University of Sydney gives more details.
I recall the last caller wanting to tell the world that all the ways people had been discussing were all very well. But no one had mentioned the very best method of all. Could I guess it? There was an auspicious silence and our caller then extolled the importance of letting Jesus Christ into his life. Jesus could stop you smoking. Everyone should know this, he said.
Why miracles are a smoke screen
Across a 40 year career, I’ve seen countless testimonies supporting miracle smoking cures. These range from fairground hypnotists, acupuncture, herbal remedies, dipping your cigarettes in magic potions before you smoke them, paying someone to point a “laser” at special parts of your body while they extract $450 from your wallet, Alcoholics Anonymous-style smoking temptation story sharing, thinly disguised religious pitches from church-based health groups talking about “higher powers”, mantras to recite when tempted, and various offerings from the pharmaceutical industry.
The Cochrane Collaboration has systematically reviewed the evidence for 78 different interventions for quitting smoking.
The popularity of many quit methods is closely related to the marketing and promotional budgets of those standing to profit from their widespread use.
Quit smoking aids, including for the prescription drug Champix, have been heavily promoted.
Champix (varenicline) (a prescription drug) and nicotine replacement therapy (NRT) have had the longest, most lavishly supported innings, with NRT being advertised in prime-time media for many years.
But after some 30 plus years of NRT being promoted, its record is frankly underwhelming.
Buying NRT over the counter and trying to quit without additional professional support has a statistically significantly lower rate of successthan trying to quit unassisted. Over-the-counter use of NRT promises about a 7% long-term success rate (in other words, a 93% failure rate).
With professional support, NRT fares better but very few smokers access such support, so the population impact is limited. For example, less than 4% of smokers ever call the Quitline.
How about e-cigarettes?
On July 6, submissions closed on a House of Representatives committee looking at the regulation of e-cigarettes, The 332 submissions were swamped by many individuals’ personal anecdotes explaining e-cigarettes have been a miracle.
People write passionately about having tried many other ways of stopping unsuccessfully. Some make compelling statements about their health rapidly improving. They want to spread their good news and encourage others to try to do what they have done. Their stories are very real: we’ve all met someone who knows someone who quit by vaping.
However, those who have tried and failed to quit using e-cigarettes are far less likely to be as enthusiastic and evangelical. Just as someone who tried to lose weight and failed is highly unlikely to want to take the time to write a political submission about their failure, so too is it unlikely a smoker who tried vaping, kept smoking and then discarded e-cigarette use, would bother to write.
And significantly, over one in four of Australians who smoke daily have either used or experimented with e-cigarettes and then abandoned them (see table 9).
Beware self-selection bias
Such positive personal testimonies represent self-selection bias about success and cannot be given credibility when it comes to making generalisations about the success or otherwise of any cessation method.
We would not count as strong evidence the heartfelt testimonies of those swearing by any given method.