Neglecting that “red-headed stepchild” has historically proved itself as unwise. Tobacco dependence treatment, often referred to as "cessation," is just such a red-headed stepchild.

Simon Chapman, PhD, from the School of Public Health in Sydney, Australia, is attending the World Conference on Tobacco or Health in Mumbai, India, as are nearly 3,000 others who work in Tobacco Control. Consistent with his history of taking controversial stands, he has done so again.

In a recent letter to The Lancet, a British medical journal, Chapman made the outrageous statement that “...unassisted cessation remains the preferred and most successful method used by most ex-smokers.”  His argument is primarily based on the assertion that treatment drains resources away from “more effective” public health efforts to reduce tobacco use prevalence (i.e., cigarette price increases; excise tax increases; smoke-free indoor air).  Chapman further emphasizes his point stating that the “medicalization” of cessation has consistently undermined smokers’ self-efficacy by giving the message that “you need help and are unlikely to succeed alone.”

Chapman is both right and VERY wrong in different aspects of his assertion.  I have long shared the concern that we must not send a message to smokers that they cannot quit without help.  In fact, most smokers do quit that way.  So in this regard Chapman is correct.  A better message is one that says, “Quitting smoking can be hard -- if you need help just ask.”

But where he is wrong he is VERY wrong.  There are many smokers who are unable to quit without assistance.  I believe it is unethical, in fact egregious, that these smokers be ignored and allowed to suffer, even die, as a result of their tobacco dependence.  In this belief I am in very good company.  Furthermore, these are the same smokers who are spending more for cigarettes through price and tax increases.  To not use some of that money to help those unable to help themselves is plain wrong, certainly unethical, and maybe even criminal.

Another fact that Chapman clearly misses is that treatment services, such as tobacco quit lines (which are enormously cost-effective) and in-person individual or group counseling, are vastly under used.  Many smokers are simply unaware that services are available or do not know how incredibly effective they are.

Furthermore, smoking is the leading cause of preventable death in the US.  Many, many smokers have life-threatening chronic illness directly associated with their smoking.  Many of these smokers have tried many times to quit unsuccessfully. To allow them to suffer and die behind their addiction to smoked tobacco is unconscionable.

So instead of undermining cessation efforts Chapman would better serve the overall objective of reducing tobacco use prevalence by not undermining the undisputable evidence that treatment not only works and is highly cost-effective, but is absolutely necessary for those unable to quit on their own. But once you have stuck your foot in your mouth in a major way, people have a hard time understanding what you are saying...