laser therapy for smoking cessation

[mellowtigger]

philbutrin points out that a recent review of other studies finds that homosexuals are more likely to smoke cigarettes than heterosexuals. Coincidentally, I had pestered dangerdhotrod at Saturday's Bear Bar Night about his smoking habit. At Wednesday's Bear Coffee, someone mentioned to me a new laser therapy to help people quit smoking. I guess it's time to finally post my review of laser therapy.

Short interruption for important health notice: If you are trying to stop smoking, and you are willing to read a long and semi-technical article, then I heartily recommend this thorough essay to help you along in your difficult process. Education is a valuable part of any smoking cessation strategy. "A review of smoking cessation interventions", 2005, Ashish Maseeh MD and Gagandeep Kwatra MD, http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1681582

Fascinating stuff! Laser therapy is basically high-tech acupuncture that uses lasers instead of needles to stimulate nerve response. Someone told me about this therapy because he is thinking about spending a few hundred dollars to try it because of its advertised success rate. Naturally, I had to learn more about this curious biomedical claim. :)

The short is answer is "No". There is no verifiable evidence that these claims of success are accurate. There is verifiable evidence that the practice does not work better than placebo. While attempting to stop smoking, though, the placebo effect can itself be an effective strategy to employ. So if you think it'll work, then it actually might. Smoking is an addiction that affects both mind and body. There is no quick and easy path to recovery from an addiction.

So... caveat emptor. ("Let the buyer beware.") If you have the disposable income to try it out, then it might be a worthwhile experiment for you. I think that it might be an effective therapy but only for a limited time period like one month. It would be cost effective treatment only if you spend less money on a therapy session than you would on cigarettes for that month.  It does, of course, have the significant "cool factor" working in its favor.  :)

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THEORY: Well, it seems semi-plausible to me anyway.

The idea is that the body naturally works on a circadian cycle that produces an overall ebb and flow of endorphins, serotonin, and dopamine. Each nicotine exposure, however, causes the body to respond with an immediate release of these chemicals. Sustained and frequent exposure (habit) causes the body to acclimate to persistent levels of these substances (addiction).

When you try to quit smoking, the body craves more of these internal chemicals. Laser therapy causes (so the claim states) the body to release these same chemicals without the nicotine exposure, and it continues to have this effect for 30-45 days. During this time, the body does not crave nicotine because it already has the chemicals it wants, and after 21 days the body also begins to reacclimate to daily doses of these chemicals on a natural circadian cycle (rather than on-demand via frequent cigarettes).

That laser stimulation could replace physical needles for nerve stimulation sounds very plausible (and very cool!), but the idea that a single session could suddenly alter your nerve's chemical activity for weeks to come is a claim that strains credulity to the breaking point. I've found no theoretical justification at all for why this process should work.

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TRADITIONAL ACUPUNCTURE: It might work. Not for everyone, but enough to be noticeable.

One Korean study examined the effectiveness when treating high school students. They found that it worked... for only one person after 4 weeks. Doh! One review of that study was pretty harsh about its methods, saying, "In conclusion, Kang et al.'s study seems to not only have failed to answer to its own hypothesis, but has also failed to add anything to our knowledge." Ouch! Similarly, an international review conducted in 2001 found that "acupuncture is no more effective than sham acupuncture" for smoking cessation. Not good news for the alternative therapy business. :(

Positive findings, however, have also been reported. An American study in 2002 concluded, "Acupuncture and education, alone and in combination, significantly reduce smoking; however, combined they show a significantly greater effect, as seen in subjects with a greater pack-year history. A 2001 study done in Norway performed follow-up checks at 8 months and 5 years after acupuncture treatment. Their conclusion is very succinct:

This study confirms that adequate acupuncture treatment may help motivated smokers to reduce their smoking, or even quit smoking completely, and the effect may last for at least 5 years. Acupuncture may affect the subjects' smoking by reducing their taste of tobacco and their desire to smoke. Different acupoints have different effects on smoking cessation.

So it's certainly possible that this therapy works in a limited way. A reasonable person could justify using this therapy as one part of a continuing effort to quit their smoking addiction.

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LASER SUCCESS RATE: Utter, bald-faced lies.

I found several sites that claimed 80% or greater success rates with this laser therapy. I found no data on their websites that supported their claims. A local site attempts to sidestep the issue by relying on a very unscientific review by a local news channel. That channel did indeed state that they received "a list of clients" from the company and that "4 out of 5 people kicked the habit". Well, what was this "list"? Did it include everyone who had received just a single session of treatment? Within the last 4 weeks? Within the last 4 years? Did these people kick their habit for days, weeks, months, or years? Does kicking the habit mean no tobacco use at all and no nicotine replacements at all? The terminology they used is so poorly explained that it's essentially worthless for validating the clinic's claims.

Even scientists who can support the general idea still show an abundance of caution in making claims about efficacy:

AUTHORS' CONCLUSIONS: There is no consistent evidence that acupuncture, acupressure, laser therapy or electrostimulation are effective for smoking cessation, but methodological problems mean that no firm conclusions can be drawn. Further research using frequent or continuous stimulation is justified.

In contraindication, actually, I found more than one PubMed article that mentioned the high dropout rates of subjects in trials meant to measure the efficacy of traditional acupuncture on smoking cessation. Are traditional clinics "cooking" their numbers by excluding people who don't follow up by a particular date? As one of those articles put it (quite politely, I think) in reference to success rates claimed by traditional acupuncture methods:

This is an unusual and inappropriate calculation. A much more suitable approach would have been an intention-to-treat analysis that assumes that those lost to follow-up resumed smoking. Given that approach, the cessation rate drops to 13%. Even this number may be high, depending on the definition and validation of abstinence.

I'll be less polite. I'll plainly state that laser therapy claims are an intentional lie meant to sucker people into paying for their services. Until someone can produce reviewable data (including dropouts due to lost contact, and including definitions of smoking cessation, and including explanations of time periods involved) to justify their claim of 80% success rates, then I stand by my opinion.

If, however, laser therapy is actually useful for eliminating cravings for 3 weeks after each treatment (which is still a possibility I can't totally dismiss), then it might be a useful non-drug therapy for some people. If anyone spends more than $400/month on cigarettes, then a monthly laser therapy session would be a cheaper alternative to continue their chemical addition without having to inhale tar and other noxious substances into their lungs. (At which point, I also want evidence from the clinics on the safety of long-term treatment.)

Comments

[danthered.livejournal.com]

Oy vey. Hawkers of phony and costly smoking "cures" are almost as slimy as tobacco companies themselves.