Volume 203 - Issue 2
Eight challenges faced by general practitioners caring for patients after an acute coronary syndrome
Authors: Peter L Thompson and Alistair W Vickery
Med J Aust 2015; 203 (2): 80-81. || doi: 10.5694/mja15.00386
Published online: 20 July 2015
Published online: 20 July 2015
Many smokers quit on their own, and unassisted quitting should be considered before other methods
In reply: We thank Mendelsohn and Camp for their comments on our article. Their opinion on the best way to quit smoking may be relevant to some smokers, but it is not shared by all ex-smokers, nor by all other quit-smoking authorities.
In contemporary practice, 54% to 69% of Australian ex-smokers had quit unassisted.1 Reservations about the adequacy of unassisted quitting are at odds with a 2013 Gallup poll in the United States, which showed that only 8% of ex-smokers attributed their success to pharmacotherapy, whereas 48% credited quitting “cold turkey”.2 Other internationally recognised Australian quit-smoking authorities have expressed the opinion that the impact of unassisted cessation on reducing smoking prevalence is underappreciated, and unassisted quitting should be considered before pharmacotherapy and other methods.3
The effect of social media campaigns on smoking cessation, an area in which Australia has considerable international leadership, may also be a major contributor.4 We note that Mendelsohn and Camp promote pharmacotherapy not only in their letter, but also on Mendelsohn's “Smokers' Clinic” website,5 without acknowledging that many patients successfully quit on their own. This is particularly so when patients have had a health shock such as an acute coronary episode, which was the context of our article. It has been shown that 57% of people who were smokers before an acute coronary syndrome were not smoking 8 months after their coronary event.6
We appreciate the correction to our statement on the efficacy of nicotine replacement therapy (NRT). Mendelsohn and Camp are quite right. The correct interpretation of the 2012 Cochrane review7 is that NRT increases the rate of quitting by 50%–70%, and we acknowledge that long-term cessation success rates remain low.
Competing interests
No relevant disclosures.
References
- Smith AL, Chapman S, Dunlop SM. What do we know about unassisted smoking cessation in Australia? A systematic review, 2005-2012. Tob Control 2015; 24: 18-27. 1
- Newport F. Most US smokers want to quit, have tried multiple times. Princeton, NJ: Gallup, 31 Jul 2013. http://www.gallup.com/poll/163763/smokers-quit-tried-multiple-times.aspx (accessed Mar 2015).
- Smith AL, Chapman S. Quitting smoking unassisted: the 50-year research neglect of a major public health phenomenon. JAMA 2014; 311: 137-138. 3
- Wakefield MA, Coomber K, Durkin SJ, et al. Time series analysis of the impact of tobacco control policies on smoking prevalence among Australian adults, 2001-2011. Bull World Health Organ 2014; 92: 413-422. 4
- Dr Colin Mendelsohn Smokers' Clinic. Top 10 myths about smoking. http://colinmendelsohn.com.au/top-10-myths-about-smoking (accessed Mar 2015).
- Holtrop JS, Stommel M, Corser W, Holmes-Rovner M. Predictors of smoking cessation and relapse after hospitalization for acute coronary syndrome. J Hosp Med 2009; 4 (3): E3-E9. 6
- Stead LF, Perera R, Bullen C, et al. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2012; (11): CD000146. lefthere