The federal Centers for Disease Control and Prevention has once again released a batch of graphic anti-smoking ads, aimed at motivating smokers to quit by showing the horrible health effects of the nasty habit. But, in my opinion, the campaign emphasizes an over-simplified message: that to quit, all smokers need is a little fear.
For the next 12 weeks, the grisly ads will run as public service announcements on TV and in movie theaters, magazines, and newspapers; all contain real people with smoking-related health problems such as throat cancer that destroyed the larynx, diabetes that led to a leg amputation, and a life-threatening asthma attack in a teen who was exposed to second-hand smoke.
There’s “very strong scientific evidence” that such public awareness tactics have led to an increase in the number of smokers who successfully quit, said CDC director Dr. Tom Frieden in a press briefing on Thursday.
“Last year’s [first] campaign exceeded our expectations,” Frieden said. “We saw an increase of more than 200,000 of people who called quit lines.” Research suggests that about 20 percent of people who call a quit line will quit for good.
I don’t doubt the evidence, but I wonder if the ads are a bit over the top, bordering on patronizing. For example, Bill, a 40-year-old with diabetes featured in the ad below, blames smoking for his heart surgery, blindness in one eye, amputation, and kidney failure. (The nicotine in cigarettes makes it much tougher for diabetics to control their blood sugar level and significantly raises the risk of diabetes-related complications.)
Bill provides this tip for helping smokers quit: “Make a list. Put the people you love at the top. Put down your eyes, your legs, your kidneys, and your heart. Now cross off all the things you’re OK with losing because you’d rather smoke.”
Bill makes smoking seem like a simple lifestyle choice rather than an addiction on par with alcoholism or a cocaine habit. For some, quitting requires herculean efforts far beyond a basic fear of what will happen to them if they don’t.
In fact, some people appear to have a genetic susceptibility to becoming heavy smokers. A study published Wednesday in the journal JAMA Psychiatry indicates that certain genetic mutations help predict which teens will be more likely to convert to daily smokers after experimenting with cigarettes and then become heavy smokers as adults. Those teens with the high-risk mutations—who were followed for four decades—were more likely to use smoking to cope with stress and fail in their attempts to quit.
Frieden conceded that it often takes many people several tries to quit. Just ask President Obama. He said in interviews last fall that he finally kicked the habit because his daughters had reached the age when they might feel peer pressure to smoke, and that he didn’t want to look them in the eye and tell them not to smoke if he still was.
Calling a smoking cessation quit line such as 1-800-QUIT-NOW, using nicotine patches or gum to help withdraw gradually from the chemical dependence, or quitting with a friend can all be useful tactics to increase the chances of success.
Certain prescription drugs such as varenicline (Chantix) or bupropion hydrochloride (Zyban) can help those who have failed with other quitting aids, but they’re not without their own risks. Chantix carries a black box warning that it may increase the risk of psychiatric side effects such as suicidal thoughts and suicide attempts, and it may be associated with increased heart risks. Zyban, an antidepressant, can also increase the likelihood of suicidal thoughts, especially in teens and young adults. It carries a small risk of seizures in those with certain medical conditions or people using certain drugs such as the MAO inhibitor class of antidepressants.
Clearly, some smokers need a professional’s help to guide them through these various options or to design a personalized cessation plan.
Unfortunately, doctors aren’t providing enough of this guidance. About 80 percent of specialists who treat lung cancer in smokers reported in a survey that they advised their patients to quit smoking because they knew it would improve their treatment and prognosis. But only 40 percent of them provided assistance such as prescriptions for cessation medications or other cessation tools, according to a recent survey of 1,500 surgeons, oncologists, and other lung cancer specialists that was published last week in the Journal of Thoracic Oncology.
Most of these doctors said they don’t have the ability to help their patients quit, either because patients don’t want to or the physicians aren’t adequately trained to help them.
“As clinicians and researchers, we must work to improve access to tobacco cessation resources and improve effective methods of tobacco cessation for cancer patients,” said study leader Dr. Graham Warren, a radiation oncologist at the Medical University of South Carolina.
These smokers are already scared of cigarettes as a result of their life-threatening illness, and they certainly don’t need more scares from the CDC’s graphic ads to be motivated to quit.