smoking cessation methods not based on scientific evidence

SMOKING CESSATION METHODS NOT BASED ON

SCIENTIFIC EVIDENCE

Cengiz ÖZGE, Associate Professor.Mersin University Faculty of

Medicine Department of Chest Disease

Contents

• Introduction

• Electronic Cigarette

• Acupuncture and associated

methods

• Hypnosis

Among Cigarette Smokers

• 70% wants to quit smoking.

• 35% seriosly attempted to quit in

the last year.

• 80% previosly attempted to quit.

• 3% manages to quit in a year.

• Quit in a single setting

• Success more than 90%

• Refund of money is guarantee

What is the scientific evidence ?

WHY ME ?

MetaMetaanalysisanalysis

Randomised Randomised controlled trialscontrolled trials

Cohort studiesCohort studies

Case-control studiesCase-control studies

Case-reportCase-report

““Editorial”, clinical opinion...etc.Editorial”, clinical opinion...etc.

animal studies, in vitro studies...etc.animal studies, in vitro studies...etc.

Evidence Pyramide

Evidence Category

Source of Evidence

A Randomized controlled trialsRich body of data

B Randomized controlled trialsLimited body of data

C Non-randomized trialsObservational studies

D Panel Consensus Judgment

SCIENTIFIC EVIDENCE

Electronic cigarette

Electronic cigarette

• A Commercial product of

tobacco.

• Certified by the Ministry

of Agriculture.

• Not designed for

smoking cessation

therapy.

• No presented scientific

study.

Acupuncture

• Have a history of 3000 years.

• Have been in Europe since

1600ths.

• Chen-Chin : Needle-Heat

• Acus: Needle

• Punctura: Prick

Acupuncture

• There are almost 1000

stimulation points in the

human body.

• 650-700 of these points

are being used.

• It is beleived that there is

an acapunture point for

every organ in the ear.

Mechanisms of the effects of Acapuncture

• The body has two opposite energy called

Yin and Yang working in synergy.

• This energy travels in the canals called

meridians.

• If the balance fall off, an abnormaly

ensues.

• Acapuncture helps to maintain this

balance.

Theory of five elements

• Wood,fire, earth, metal and water.

• All the phenomenon in the universe

structurally meets these five elements.

• They are in a continuous movement and

alteration.

• If this balance is falls off diseases ensue.

• Acapuncture maintains this balance

Mechanisms of the effects of Acapuncture

• Endorphine

• Met-encephalin

• Serotonine

• Dopamine

Fields of administration of acupuncture

• Cure of pain• Apettite control and

slimming

• Reduction of Stress

• Acceleration of metabolism.

• Treatment of allergy.

• Migrene and headache.

• Treatment of Insomnia.

• Cessation of smoking.

Acupuncture • Auricular acupuncture

• Moxibustion

• Acupressure

• Electro Acupuncture

• LASER Akapunktur

• Luxopuncture

• Bioresonance

• Moratherapy

Moxibustion• Application of heat

to the acupuncture

points instead of

needles.

Electro Acupuncture

LASER Acupuncture

• Electric current• LASER irradiation

Acupressure

•Pressure application onto the acupuncture points.

Luxopuncture

• Developed in France

• Condensed infra red

light application to the

acupuncture points.

Bioresonance Moratherapy

• Plain electrode contact on

the human skin at certain

sites

• Electromagnetic vibration.

• Depends on the claim that

faint low frequency

vibrations carry knowledge.

R.I.S.E

• Reflection Instrument Scanning

Electro-pulse

• I quit smoking (IQS)

• Beta-endorphine

A meta-analysis of studies into the effect of acupuncture on addiction

G TER RIET, J KLEIJNEN, P KNIPSCHILD British Journal of General Practice, 1990, 40, 379-382.

• Between 1963-1989

• Total of 27 studies

• 15 of them for

smoking cessation.

A meta-analysis of studies into the effect of acupuncture on addiction

G TER RIET, J KLEIJNEN, P KNIPSCHILD British Journal of General Practice, 1990, 40, 379-382.

A meta-analysis of studies into the effect of acupuncture on addiction

G TER RIET, J KLEIJNEN, P KNIPSCHILD British Journal of General Practice, 1990, 40, 379-382.

A meta-analysis of the effectiveness of acupuncture in smoking cessation

ASHENDEN R, SILAGY CA, LODGE M, FOWLER G. Drug and Alcohol Review (1997) 16, 33-40

• Have at least two therapy groups,

• Randomized

• No old (previous) control group is

used.

• 9 studies are taken into

consideration

• A total of 2707 patients.

A meta-analysis of the effectiveness of acupuncture in smoking cessation

ASHENDEN R, SILAGY CA, LODGE M, FOWLER G. Drug and Alcohol Review (1997) 16, 33-40

Total (95% CI) OR: 1.48 (CI:1.13-1.48)

A meta-analysis of the effectiveness of acupuncture in smoking cessation

ASHENDEN R, SILAGY CA, LODGE M, FOWLER G. Drug and Alcohol Review (1997) 16, 33-40

• Acupuncture seems to be better

according to the control group;

• *HOWEVER!!

• NOT better than the Sham acupuncture.

( OR:1.16 % 95 CI: 0.90-1.49)

A meta-analysis of the effectiveness of acupuncture in smoking cessation

ASHENDEN R, SILAGY CA, LODGE M, FOWLER G. Drug and Alcohol Review (1997) 16, 33-40

A meta-analysis of the effectiveness of acupuncture in smoking cessation

ASHENDEN R, SILAGY CA, LODGE M, FOWLER G. Drug and Alcohol Review (1997) 16, 33-40

• All are self-reports, no CO

measurements

• Only 4 studies have 12 months of

follow up.

• 4 studies single-blind, 5 studies open.

• Studies are small.

• Methodological scores are low.

• Randomized controlled studies• Acupuncture• Acupressure• LASER acupuncture• Electrostimulation• Sham acupuncture• 24 studies were evaluated

White AR, Rampes H, Campbell J. Acupuncture and related interventions for smoking

cessation.Cochrane Database of Systematic Reviews 2006, Issue

1. Art. No.: CD000009

White AR, Rampes H, Campbell J. Acupuncture and related interventions for smoking

cessation.Cochrane Database of Systematic Reviews 2006, Issue

1. Art. No.: CD000009

White AR, Rampes H, Campbell J. Acupuncture and related interventions for smoking

cessation.Cochrane Database of Systematic Reviews 2006, Issue

1. Art. No.: CD000009

• No high quality studies about acupunture

and associated applications are present

• No prominent dominancy in a year’s follow

up.

• The effectivness that was seen in the early

period was abated by the removal of a

study which was conflicting with the

homogenicity of the study.

Alternative therapies for tobacco dependenceL.M. Villano, A.R. White / Med Clin N Am 88 (2004) 1607–1621

A Randomized Controlled Clinical Trial of Auricular Acupuncture in Smoking Cessation

Ta-Peng Wu, Fang-Pey Chen, Jui-Yao Liu, Ming-Hsien Lin, Shinn-Jang Hwang

J Chin Med Assoc • August 2007 • Vol 70 • No 8

ACUPUNCTURERESULT

• There are no scientific evidence for the effectivess of

• Acupuncture,• Acupressure,• LASER acupuncture and• Electrostimulation to be used for the cessation of

smoking.

HYPNOSIS• HYPNOSE: The name of the God of

Sleeping in Greek Mythology.

• This is a state of bringing

someone into a deeply

sleeping like situation

where his/her behaviour

can be kept under control

by another person.

HİPNOZ

• A state of sleeping achieved by

words, looks and suggestions.

A person in this state (subject)

is open to the suggestions and

influences of the applying

person but closed to the other

stimulations from the

surrounding.

HypnosisHypnosisHistoryHistory

• Before the holy books,

sorcery and medicine were

used together in religious

ceremonied.

• In 1778 Dr.Franz Mesmer

• In 1847 for quitting tobacco

• In 1958 American Medical

Association approved Medical

hypnosis.

HYPNOSISFields of Application-1

• Depression• Social phobia (zoophobia, acrophobia,

hydrophobia)• Tic disorders • Stammer • Enuresis nocturna, • Psycological pain disorders. • Obesity • Anorexia, Blumia • Alcohol and tobacco addiction • Panic attack.

HYPNOSISFields of Application-2

• Conversion Disorders • Posttraumatic Stress Disorders• Psycologic Memory losses • Sleep Disorders• Bruxism• Sexual Functional Disorders (Impotence, premature, ejaculation, vaginusmus)• Onichophagia • Obsession• Personality Disorders

HYPNOSISFields of Application-3

• Psycological tremors• Dyslexia• Cure of chronic physical pain.• Painless child delivery• Trigeminal Neuralgia.• Nervous Hypertension• Asthma• Allergic Skin Disorders.• Psoriasis• Treatment of the wharts.• Migraine, • Attenuation of pain due to

cancer • Treatment for the teeth

without application of anesthesia.

Hypnosis and Cessation of Smoking

• Its means of effect is not clear.

• Relaxation,

• Extreme suggestibility

• Hightened imagination proposed to

act on the underlying impulses.

• Inhibition of the left cerebral hemisphere

Hypnosis and Smoking Cessation

• 1st Session: Interview, understanding hypnosis, being

hypnotized.

• 2nd and 3rd Session: Administering regression hypnotherapy

to eliminite obstacles to quitting smoking; uncovering

unconscious reason cousing smoking.

4th. Session: Direct suggestion session

(Changing unconscious patterns causing smoking. Replasing

with new habits.)

• 5th Session: Ego strengthening hypnosis session

(Strengthening positive emotions such as focusing on future,

self-confidence self-esteem in the person who quitted

smoking.)

• 6th Session: Learnig self-hypnosis and EFT techniques

(Teaching daily techniques that will be used to preserve

wellness consistently)

Cochrane Database of Systematic Reviews Hypnotherapy for smoking cessation (Review)

Abbot NC, Stead LF, White AR, Barnes J 1998, Issue 2 Last assessed as up-to-date: 15 February 2005.

• Between 1966-2005.

• 28 studies are found.

• appraisable 9 studies.

• 19 studies were excluded.

• Randomized.

• Follow up at least for 6 months.

Cochrane Database of Systematic Reviews Hypnotherapy for smoking cessation (Review)

Abbot NC, Stead LF, White AR, Barnes J 1998, Issue 2 Last assessed as up-to-date: 15 February 2005.

Exclusion

Criteria

.

.Cochrane Database of Systematic Reviews Hypnotherapy for smoking cessation (Review) Abbot NC, Stead LF, White AR, Barnes J 1998, Issue 2 Last assessed as up-to-date: 15 February 2005.

Cochrane Database of Systematic Reviews Hypnotherapy for smoking cessation (Review)

Abbot NC, Stead LF, White AR, Barnes J 1998, Issue 2 Last assessed as up-to-date: 15 February 2005.

Cochrane Database of Systematic Reviews Hypnotherapy for smoking cessation (Review)

Abbot NC, Stead LF, White AR, Barnes J 1998, Issue 2 Last assessed as up-to-date: 15 February 2005.

Cochrane Database of Systematic Reviews Hypnotherapy for smoking cessation (Review)

Abbot NC, Stead LF, White AR, Barnes J 1998, Issue 2 Last assessed as up-to-date: 15 February 2005.

Hypnosis for smoking cessation: A randomized trialTimothy P. Carmody, Carol Duncan, Joel A. Simon, Sharon

Solkowitz,Joy Huggins, Sharon Lee, Kevin Delucchi Nicotine & Tobacco

Research Volume 10, Number 5 (May 2008) 811–818

• Total of 286 patients

• 2 grups: Hypnosis and behevioral

counseling.

• HYPNOSIS:Face to face for 60 minutes,

two seance.

• Behavioral counseling: Face to face for

60 minutes, two times and follow up by

telephone on the 3rd, 4th, 6th, weeks.

Hypnosis for smoking cessation: A randomized trialTimothy P. Carmody, Carol Duncan, Joel A. Simon, Sharon

Solkowitz,Joy Huggins, Sharon Lee, Kevin Delucchi Nicotine & Tobacco

Research Volume 10, Number 5 (May 2008) 811–818

Hypnosis for smoking cessation: A randomized trialTimothy P. Carmody, Carol Duncan, Joel A. Simon, Sharon

Solkowitz,Joy Huggins, Sharon Lee, Kevin Delucchi Nicotine & Tobacco

Research Volume 10, Number 5 (May 2008) 811–818

CONCLUSION

• May be more effective if hypnosis

and nicotine bands are

concomittantly used.

• Future studies are necessary for the

investigation of effectivness of such

therapies.

HİPNOZ

CONCLUSION

• There are NO scientific evidence

describing the effect of hypnosisi

for the cessation of smoking!!!

Allen Carr’s method

• Allen Carr’s Easyway removes the

need and desire to smoke.

• No NRT

• No needles

• No LASER

• No drugs! No herbs

• No shock treatment

• NO Scientific Evidence!!

• There are no treatment methods with over

90% success rates in today’s practice.

• The only scientifically evident method of

treatment is the Supportive Therapy with

pharmacological therapy

• The pharmacological therapeutic agents

whose effectivness are approved are:

Nicotine replacement therapies,

Bupropion and Varenicline.

Thanks for your patients