People are quitting smoking — even though many doctors aren’t telling them to

MORE THAN a half-century of efforts in the United States to get people to stop smoking tobacco has had a remarkably good effect. From 1965 to 2017, the prevalence of current smoking has tumbled from 52 percent to 15.8 percent among men and from 34.1 percent to 12.2 percent among women. At the same time, there are still 34.2 million adult smokers in the United States, many of whom want to quit but still suffer the addictive power of nicotine. The surgeon general’s latest report is about how to help them, and it raises two very important issues that require more attention and research.

The 700-page report, released Thursday, is the first major effort since 1990 by the surgeon general to examine the scientific evidence behind smoking cessation. A lot has happened in those years. All kinds of programs and policies helped people to quit smoking. More and more Americans came to realize that tobacco smoking is the leading cause of preventable disease, disability and death in the United States, and to act on that by quitting — which can lead to better health, longer life span and money saved. A host of useful, effective tactics have and should continue to help advance this realization, including nicotine replacement therapies and non-nicotine oral medications approved by the Food and Drug Administration. There is also counseling, public education and smoke-free rules and laws.

But Surgeon General Dr. Jerome Adams points out that one method to persuade people to quit that is not being used as much as it should be is the health-care system itself. The report notes that “four of every nine adult cigarette smokers who saw a health professional during the past year did not receive advice to quit.” Dr. Adams said that “was a shocking statistic to me,” and more could be done by clinicians and other health professionals to tell people that smoking is bad for them.

The other important issue raised by the report is the use of e-cigarettes to help those who want to quit. The industry has argued that a basic justification for e-cigarettes is that they can ease the transition for those seeking to quit combustible tobacco. Overall, the study found that “the evidence is inadequate to infer that e-cigarettes, in general, increase smoking cessation.” The uncertainty stems from the ever-changing nature of the e-cigarette products and a lack of scientific research data.

The study warns that simply replacing cigarette nicotine addiction with e-cigarette nicotine is not a good answer. However, e-cigarettes could help adult smokers “if they completely switch from conventional cigarettes to e-cigarettes and do not partake in an extended period of dual-use that delays quitting.” Among those who make the leap, “the ultimate goal should be to also quit the use of e-cigarettes completely.”

The study points out that while nicotine replacement therapy has been proved safe and effective, “the same has not been proven for any e-cigarette. There is no safe tobacco product.” That means the persistent challenge is to help the remaining 34 million smokers quit.