Tobacco Treatment Specialist
If a doctor were to call himself a tobacco treatment specialist what would you think he does? It’s ambiguous. Is he treating a disease called tobacco, similarly to the way in which a cancer treatment specialist is obviously someone who treats cancer? Or, if you talk of an acupuncture treatment specialist, it’s clearly a practitioner of acupuncture who is using it to treat suitable conditions.
It would not be surprising if among the thousands of chemicals in tobacco leaves there were not a few with therapeutic potential. Nicotine, for example, has anti-inflammatory properties and could in theory be used to treat a disease of the large bowel called ulcerative colitis; it’s interesting that people who smoke are less likely to suffer from this disorder than non-smokers.
But I don’t think this is what our tobacco treatment specialist means. Or does he? He’s certainly very keen on using nicotine patches to treat the so-called disease of smoking, and one way he recommends you do it, if you’re a smoker, is as follows. Two weeks before you make the attempt to quit you start using nicotine patches in addition to smoking your usual daily number of cigarettes. This he calls ‘prequit’ use of nicotine patches.
Another encouraging piece of information on this tobacco treatment specialist’s website is this:
Quitting smoking is like going into battle…you need to plan your campaign carefully and prepare for the assault!
It sounds all rather complicated, really.
This doctor, whose name is Colin Mendelsohn, is obviously a high-flying academic. He gives a list of fifty-two publications and is not only a member of the Australian Association of Smoking Cessation Professionals, but also a member of the Society for Research on Nicotine and Tobacco and of the Association for Treating Tobacco Use and Dependence. This last mentioned produces a bi-annual journal called, appropriately enough, the Journal of Smoking Cessation.
A cornerstone of this approach to the smoking problem is the claim that it’s based on scientific evidence, the vaunted evidence-based approach. This is important in researching the effectiveness (or otherwise) of treatments in physical diseases that can be assessed objectively. But as I have pointed out in my books, smoking is manifestly not a disease in the usual sense of the word, like diabetes or arthritis: it’s a voluntary activity. Furthermore, if a smoker quits by using a particular treatment for an arbitrary length of time, and then decides to start smoking again, does this mean the treatment being assessed has failed or is less effective than one where smokers refrain for a longer period?
It’s problematical to apply the criteria of evidence-based treatments to methods of smoking cessation. Also, trials may not have been done, or they may give equivocal results, or even if they appear to give scientifically cast-iron results, this doesn’t necessarily mean they will be helpful to smokers. For example, there’s evidence to show that using nicotine products can result in a nearly four-fold increase in quitting rates, from 4 per cent to 15 per cent, but this means the vast majority of people (85 per cent) are not helped by the intervention. If this is the best that evidence-based treatments can produce it seems to me these researchers need to go back to the drawing board.
Let’s return to Dr Mendelsohn, the advocate of giving more nicotine to nicotine addicts (synonym: smokers) because, he says, the evidence supports this approach to quitting and that it should even be the default option. In addition, on his website he quotes the shibboleth that nicotine releases dopamine in the brain. (Which is why, it is claimed, smoking is pleasurable for smokers.) I asked him by email if he would please tell me the evidence for this statement.
He replied promptly and courteously, but instead of answering my query directly, referred me to two academic papers. I looked these up. As far as I could see neither contains or points to any direct evidence in living humans that nicotine causes dopamine release. It may, of course, be true, but at present it’s only a theory.
One of the papers (Dani JL et al. doi:10.4172/2155-6105.S1-001) deals with hypotheses and animal experiments which surely cannot be taken as proof that the same situation obtains in humans. The other paper (Benowitz N. doi: 10.1146/annurev.pharmtox.48.113006.094742) is similar and merely states ‘Nicotine causes the release of dopamine’ but gives no references for this and again mentions rat experiments.
So I wrote again to Dr Mendelsohn asking for his further comments; reply came there none.
It seems to me the current orthodox fixation on an evidence-based approaches to smoking cessation makes the whole problem far too complicated. It needs to be understood that smoking is a psychological problem and treatment should move away from the use of nicotine products and drugs to being nicotine- and drug-free.
Text © Gabriel Symonds