The Smokers We Treat vs. Those We Study

The profile of the smoking population in the developing world has changed dramatically in recent decades. The era when smoking was normative among adults is gone, to be replaced by one in which those people still smoking tend to be low income and/or have mental health and alcohol/drug problems.

You might think that this new world of smoking would lead smoking cessation researchers to focus intensely on how to help smokers who have comorbid problems. But as my colleague Anna Lembke and I describe in the current issue of Tobacco Control, just the opposite is true:

One review of the smoking cessation trial literature found that 40% excluded depressed smokers, 55% excluded smokers with alcohol use disorders and 59% excluded those taking psychiatric medications. One critic described the practice of excluding smokers with mental health issues as a ‘scandal’, which is reasonable given the stunning 62% rate of smoking among people with schizophrenia, the 42.6% rate of binge drinking among all smokers, and the enormous tobacco-related health damage in the seriously mentally ill population.

Smoking cessation research is one of too many cases where the science that is supposed to guide medical practice for all patients is generated primarily by studying relatively healthy, wealthy, happy and young research subjects. A scandal indeed.

Author: Keith Humphreys

Keith Humphreys is a Professor of Psychiatry at Stanford University. His research, teaching and writing have focused on addictive disorders, self-help organizations (e.g., breast cancer support groups, Alcoholics Anonymous), evaluation research methods, and public policy related to health care, mental illness, veterans and drugs. He is the author or co-author of numerous books and scholarly articles, and has written for the New York Times, Wall Street Journal, Washington Post, The Guardian (UK), the San Francisco Chronicle and other media outlets. When he is not in the San Francisco Bay Area, he is usually in London, where he is an ad hoc policy adviser to the national and city government, an honorary professor of psychiatry at Kings College, a senior editorial adviser to the journal Addiction, and a member of The Athenaeum. When he is not in the San Francisco Bay Area or London, he is usually in Washington D.C., where he serves as a frequent science and policy advisor to federal agencies, and where he has served previously as an appointee to a White House commission and several Secretarial task forces. From July 2009-2010, he served as Senior Policy Advisor at the White House Office of National Drug Control Policy. When he is not in the San Francisco Bay Area or London or Washington D.C., he is usually in the Middle East, where since 2004 he has volunteered in the international humanitarian effort to rebuild Iraq’s mental health care system. This work has taken him to Turkey, Egypt, Iraq, Jordan and Lebanon to teach and consult with Iraqi health professionals and policy makers.