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SMOKING CESSATION METHODS NOT BASED ON
SCIENTIFIC EVIDENCE
Cengiz ÖZGE, Associate Professor.Mersin University Faculty of
Medicine Department of Chest Disease
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Contents
• Introduction
• Electronic Cigarette
• Acupuncture and associated
methods
• Hypnosis
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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.
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• Quit in a single setting
• Success more than 90%
• Refund of money is guarantee
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What is the scientific evidence ?
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WHY ME ?
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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
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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
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Electronic cigarette
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Electronic cigarette
• A Commercial product of
tobacco.
• Certified by the Ministry
of Agriculture.
• Not designed for
smoking cessation
therapy.
• No presented scientific
study.
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Acupuncture
• Have a history of 3000 years.
• Have been in Europe since
1600ths.
• Chen-Chin : Needle-Heat
• Acus: Needle
• Punctura: Prick
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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.
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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.
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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
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Mechanisms of the effects of Acapuncture
• Endorphine
• Met-encephalin
• Serotonine
• Dopamine
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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.
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Acupuncture • Auricular acupuncture
• Moxibustion
• Acupressure
• Electro Acupuncture
• LASER Akapunktur
• Luxopuncture
• Bioresonance
• Moratherapy
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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.
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Luxopuncture
• Developed in France
• Condensed infra red
light application to the
acupuncture points.
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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.
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R.I.S.E
• Reflection Instrument Scanning
Electro-pulse
• I quit smoking (IQS)
• Beta-endorphine
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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.
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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.
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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.
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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.
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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)
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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)
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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
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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.
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• 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
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White AR, Rampes H, Campbell J. Acupuncture and related interventions for smoking
cessation.Cochrane Database of Systematic Reviews 2006, Issue
1. Art. No.: CD000009
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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.
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Alternative therapies for tobacco dependenceL.M. Villano, A.R. White / Med Clin N Am 88 (2004) 1607–1621
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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
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ACUPUNCTURERESULT
• There are no scientific evidence for the effectivess of
• Acupuncture,• Acupressure,• LASER acupuncture and• Electrostimulation to be used for the cessation of
smoking.
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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.
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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.
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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.
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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.
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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
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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.
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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
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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)
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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
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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.
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HİPNOZ
CONCLUSION
• There are NO scientific evidence
describing the effect of hypnosisi
for the cessation of smoking!!!
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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!!
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• 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.
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Thanks for your patients