Reconsidering what you know about the treatment of tobacco

Placebo is an effective treatment for tobacco

Not a priority. Over the years, I have heard hundreds of reasons to defer, delay. avoid, or discard treatment options and systems change for tobacco treatment. This is a call for reconsideration. Tobacco treatment is effective, more cost-effective than almost all other clinical preventive services, and produces a return on investment. What is holding us back from saving lives, improving quality of life, and reducing health care costs? Do we have the intellectual humility to think again?

All studies for FDA approved medications include placebo, in which includes the full context of treatment including multiple sessions of face-to-face counseling. Counseling, by itself, is an effective treatment. The medication can be a helpful adjunct to counseling but rarely is medication by itself effective. Learn more about the role of counseling here.

Nocebo

effects

Nocebos are the same as placebos but have negative effects…. giving a complex intervention that is inert relative to the disorder in a context that can be harmful or beneficial. What does a patient hear when told that they are addicted to nicotine? Do they learn that the majority of the 56 million people in the USA who used to smoke were able to quit on their own, without medications? Do they become disempowered?

What does the clinician learn when reading a paper that shows a clinical trial has a validated quit rate of 25%. Do they become disempowered?

What does the HMO administrator hear when learning that the ROI from tobacco treatment is modest in the first year but increases in subsequent years. Do they become disempowered?

Can we undo these nocebos with better information? For example: There are 56 million adults in the USA who are former smokers. The majority of these cigarette smokers quit on their own, without medications or counseling.

Data do-over with generic varenicline costs

We need more research

Numerous recent papers exploring the return on investment from tobacco treatment are based on the brand price, which was $316 per month, and now can be obtained for $18 at Cost Plus Drugs. Here is a list of articles for reconsideration.

Although health insurers will cover the cost of medication, most value-based contracts carve out medication costs, so including medication costs so it would be an error for medical groups in value-based contracts to use these data without eliminating prescription drug cost.

Alan Blum writing in the Lancet reiterated that we have all the information we need to end the tobacco pandemic and should apply our resources to media campaigns to better inform the public and professionals.