Laser Quit

From the Rational Enquirer, Vol 3, No. 1, Jul 89.

Anyone thinking of going for laser treatment (to the earlobe!) in order to quit smoking might want to drop by his GP's office first, if only to borrow a copy of that wonderful old standard, How to Lie With Statistics.

Forearmed with the knowledge that no good studies of the effectiveness of laser acupuncture exist, you can try the painless one-shot treatment available at Vancouver's Laser Quit. A heap of delighted testimonials and word-of-mouth referrals attest to the company's popularity since it opened January 16. Whole offices full of smokers are getting lasered--and quitting-- en masse. When B.C. Skeptics asked for details, the company willingly showed us letters and testimonials and allowed us to tour their premises.

Laser Quit, a for-profit "clinic", has an office at 943 West Broadway [as of the time of this article--they have since moved]. That's in the same block as the B.C. Lung Association, a nonprofit organization that devotes much of its time to helping folks quit smoking, where for $7 you can buy two books that give you a do-it-yourself stop-smoking course. (The association no longer offers its $25 "Kick It" course.)

Or, for $90, plus $35 for 3 bottles of vitamins and "red clover cleansing" herbal pills, at Laser Quit you can have a Swiss gallium-arsenide "soft" laser aim a beam of light energy at your lower earlobe. According to traditional acupuncture, treating this point can abolish the desire to smoke.

Laser therapy is considered experimental by the medical profession. Proof that it has more than a placebo effect is lacking; like psi powers, there are true believers, but not much hard evidence. It garners impressive testimonials, but then so did Laetrile. (So did my favorite zone therapy, Perkins' Metallic Tractors, a wild success in the late 1700's that had an eerie resemblance to modern acupuncture/acupressure.) The "80% cure rates" that have been noised about by some stop-smoking operations means customers who quit for even a day; a worthless statistic.

Laser Quit offers a half hour of counselling. You are urged to take seven vitamin and herb pills a day, to "detoxify" and "cleanse the blood". You get a three page handout of quite good advice on managing the smoking habit; it recommends relaxation and meditation, exercise, sensible eating, planning substitute activities and so on.

The clinic does not accept clients who are pregnant or those with a number of chronic diseases, but are vague about why, stating the contraindications are mentioned by the laser manufacturer.

You get one "booster" treatment free. (But if you backslid since the first treatment and smoked again, you have to pay again, albeit at a 40% discount.)

Laser Quit is unusual among such clinics in that it is trying to do decent follow-up, and is actually consulting with the B.C. Lung Association about it. (A Lung Association spokeswoman told me she had never before obtained cooperation from a for-profit laser organization.)

Businessman Norm Kaiser, who with a partner owns five laser treatment offices in the lower mainland and is planning more, gave me a cheerful tour of his attractive office with its three treatment rooms. Kaiser and his assistant Heather Stewart, who graduated in kinesiology at SFU, pointed with pride to a stack of result sheets with their numerous follow up calls. For example, of 21 customers from Pacific Press, 17 quit smoking recently. Letters from satisfied clients mention a pleasant absence of withdrawal symptoms. Some had smoked for decades. Among the files I spotted the name of a surgeon friend of mine.

Unfortunately, none of the 1,116 paid clients since January has been followed longer than 28 weeks, and many of the "successes" have been abstaining only a month or so. Success certificates are handed out after 30 days without smoking, and clients are telephoned at three days and then monthly. The plan is to keep records for at least 12 months, but the company is not computerized, and no records of the attrition rates are being kept. Statisticians, epidemiologists and folks who know how to construct a life-table analysis are thin on the ground in the acupuncture business.

Success for stop-smoking programs is usually calculated by the abstention rate at one year. Good studies measure blood levels of nicotine derivatives, just to be sure-- quitters who fall off the wagon aren't always truthful about it. Just about any treatment gets good to excellent one-month abstention rates, particularly if the smokers have already set a quit date, shown up at the clinic and paid money. The one and two year abstention rates are another matter-- 12 to 25% quit rates are realistic. If Laser Quit clients do better, we'll let you know in a follow up article in six months' time.

Laser Quit provided B.C. Skeptics with a thick stack of literature about laser acupuncture. Much of it was gibberish from a fringe medicine journal, so unreadable that one can only conclude that it has been badly translated from its original German. None of these articles clearly described the methods and materials, but one seemed to indicate that there was no detectable effect on tissues from the radiation. Others dealt, not with lasers, but with needling or laser and needles combined, and only one dealt with smoking. Of 85 smokers (no details about how much they smoked) 71% quit for at least one day, but no follow up at all is mentioned.

One short report compared needle acupuncture with nicotine gum and placebo; both methods produced quit rates of about 20% at one month and about 10% at 13 months. Another paper from a legitimate peer-reviewed journal (the American Journal of Medicine) describes an acupuncture clinic that inserted needles into the ear and left them there. They were replaced weekly, and visits continued till the patient had been abstaining for four weeks. Follow up continued with the family doctor. Counselling was given. (Note that this method has little to do with the Laser Quit method.)

Over six years this clinic saw 514 patients. Of these, 339 came for at least four weeks: 297 quit smoking; 220 were seen at two year follow up, and 152 were still off cigarettes. From these figures, the authors gleefully extract an 88% success rate! (297 of 339 who persisted with treatment). A moment's thought shows the actual success rate to be about 29%, which is about the same as any stop-smoking program that costs money.

This may account for the somewhat sheepish tone of the letter B.C. Skeptics received from Laser Quit, which says "Our initial advertising brochures claim that laser therapy is enjoying a success rate of 85 to 92% may have been somewhat misleading. These figures are reflective of the industry's claims, for which no solid evidence, in the way of a published medical paper, was provided. We regret that the information provided by the marketing consultants, and included in our brochure, was not adequately substantiated."

The revised brochure makes no numerical claims, just "unsurpassed success rate". Norman Kaiser says any analysis would be premature but that so far, 23% of their clients have resumed smoking and 17% are too recent to evaluate. In my opinion, all are way too recent to evaluate. The early abstention rate would be impressive indeed for a GP's office, but then most of my smoking patients are not ready to quit. The freedom from withdrawal cravings would also be impressive if it could be substantiated with a decent interview study.

A recent review in Canadian Family Physician says 4 to 7% of a GP's smoker patients quit all by themselves every year. Intervention by the doctor, in 39 well-designed, controlled studies, increased cessation rates at one year by an average of about 6% over control groups. About one-third to one-half of all smokers try to quit each year, and the successful quitter has quit between 5 and 10 times before he makes it. It seems clear that the most reliable intervention is when the smoker visits the family doctor, obtains counselling, sets a quit date, obtains nicotine gum if he's a heavy smoker and/or has made repeated attempts to quit, comes for follow up, and rewards himself for quitting, perhaps with the money saved. It is also clear, from the medical literature, that there is no proof that acupuncture of any sort helps any illness, except some types of painful conditions. (Incidentally, let's correct a common misconception here: in China, acupuncture anesthesia is used alone in fewer than 2% of operations. It gives poor pain relief and relaxation.)

Being poked with long needles has a powerful placebo effect, as doctors have known for centuries; some studies have shown that needling people completely at random has about the same effect as needling the traditional therapy points. Sensational new kinds of rays are also useful placebos, as we see by the history of magnetic potions in the eighteenth century, electric quackery in the nineteenth, and radiation quackery in the twentieth. Combining such a treatment with a committed paying client, an excellent job of counselling, and a friendly, concerned follow up, and you've got a recipe for success. Of course, the laser might be actually doing something (such as raising the levels of natural endorphins in the body) and doubtless this will be clarified some day.

Acupuncture, including laser acupuncture, is prominently mentioned in the lengthy B.C. Lung Association handout titled "Methods of Quitting". The list mentions 8 or 9 programs, costing anywhere from $25 to $545; 3 doctors who do hypnosis and/or intensive counselling; nicotine gum, which costs $35-$60 for a week's prescription: self-help books and videos; and so on. They also have their own tapes, videos and quit kit for sale. Acupuncture is in good company here, and Laser Quit doesn't omit the all important coping strategies quitters need.

Should you go for laser treatment? Well, if you've made up your mind that this time you really want to quit, you don't mind the complete absence of any proper studies or firm success rates, and you've got $125 to spare, it certainly can't do you any harm.

Of course, if you're ready to quit, you can get pretty good counselling just down the street for a lot less money.

Incidentally, if you're wondering why there seem to be a lot of stop-smoking businesses around, maybe it has something to do with the fact that the B.C. government medical plan explicitly forbids doctors to bill for anti-smoking counselling. This is preventive medicine, and the government regards it as a frill. It's just another service that your family doctor is expected to provide for free, and does. If you'd like that to change, why not mention it to the candidates at the next by-election in your riding?