Despite the over-promotion of nicotine replacement therapies by drug companies and anti-tobacco activists, the most successful method used by ex-smokers is unassisted cessation, according to a new policy forum in PLoS Medicine. In the article, researchers from the School of Public Health at the University of Sydney, Australia take a critical look at most tobacco control campaigns, which emphasize that serious attempts at quitting smoking must be pharmacologically or professionally mediated.

The authors explain that this overemphasis on quit methods like nicotine replacement therapy (NRT) has led to the "medicalisation of smoking cessation," despite good evidence that the most successful method used by most ex-smokers is quitting 'cold turkey' or reducing-then-quitting.

Reviewing 511 studies published in 2007 and 2008 the authors report that studies repeatedly show that two-thirds to three-quarters of ex-smokers stop unaided and most ex-smokers report that cessation was less difficult than expected.

While plenty of evidence indicates that smokers can quit without assistance, the article argues that the medicalisation of smoking cessation is fueled by the extent and influence of pharmaceutical support for cessation intervention studies. 

A recent review of randomized controlled trials of NRT found that 51% of industry-funded trials reported significant cessation effects (surprise!), while only 22% of non-industry trials did. Many assisted cessation studies—but few if any unassisted cessation studies—involve researchers who declare support from a pharmaceutical company manufacturing cessation products.

The authors conclude that "public sector communicators should be encouraged to redress the overwhelming dominance of assisted cessation in public awareness, so that some balance can restored in smokers' minds regarding the contribution that assisted and unassisted smoking cessation approaches can make to helping them quit smoking."

Chapman S, MacKenzie R, 'The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences' PLoS Medicine, February 2010, 7 (2): e1000216; doi: 10.1371/journal.pmed.1000216