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