A Holistic Approach to Smoking Cessation

“Your tax dollars at work” is a phrase my husband likes to use when he hears another instance of questionable government spending.

At the bottom of an article in the May, 18, 2010 American Journal of Preventive Medicine it stated the smoking cessation project was 97.85% funded ($3.3 M) by the National Cancer Institute (NCI) and that Pfizer Inc. provided study medication and nominal support (2.15%) for recruiting participants ($72K).

The article was “Research Evaluating Effectiveness of Behavioral Counseling and Varenicline (Chantix) for Smoking Cessation.” The research question was which behavioral programs worked best in combination with Varenicline. Using Varenicline was not even in question. If Pfizer wishes to explore its use in different settings - good for them. But, why does the NCI feels it should spend highly sought after public grant funding to support the use of drugs to quit smoking?

We are funding the pharmaceutical approach as if it were the most valid method instead of focusing on what has really worked in the past. Over 90% of those who stopped smoking did so by going “cold turkey” or by reducing and then quitting. They chose not to use evidence-based treatment methods (or drugs) to support their quit attempts.

In 2010, there are more ex-smokers than current smokers. This is quite a large population to evaluate. However, we haven’t investigated ex-smokers in the context of retrospective population-based studies. In the May 2010 publication of the PLoS Medicine, Simon Chapman and Ross MacKenzie at the School of Public Health at the University of Sydney in Australia recently hypothesized that the volume of research and effort devoted to professionally and pharmacologically mediated cessation is inversely proportional to that examining HOW most ex-smokers actually quit.

We continue to focus on the individual. We label smoking a pathology and medicalize cessation. Our system of capitalism converts health needs into commodities. This drives the research funding and distorts the emphasis to the individual and on the pharmacotherapy of cessation.

Healthy People 2010 goals state that efforts to reduce tobacco use in the United States have shifted from focusing primarily on smoking cessation for individuals to more population-based interventions. Such interventions emphasize prevention of initiation, reduction of exposure to environmental tobacco smoke, and policy changes in health care systems to promote smoking cessation. However, our current research funding does not support these goals.

A holistic approach to smoking cessation views the individual in the context of their physiology and internal life as well as the shared cultural and social systems. We must fund research of population-based interventions and take the focus away from drug therapy to “treat” the individual patient.