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Wanted: Quitting Smoking 101

According to a new study published in this week's New England Journal of Medicine, doctors are not being trained in medical school to advise patients on quitting smoking, in part because insurance often does not cover such treatment and many in medicine still feel willpower instead of therapy is the answer.

Smoking is the leading cause of preventable death and disability in the us accounting for half a million premature deaths every year, yet few doctors are trained in helping smokers break the habit, reports CBS This Morning Health Correspondent Dr. Emily Senay.

One result is that the rate of cigarette smoking has not declined in the United States in more than five years, with about one in four people still smoking, according to Linda Ferry, a doctor on the faculty of the Loma Linda Schools of Medicine in California.

"A majority of U.S. medical students are not adequately trained to treat nicotine dependence, the most costly and deadly preventable health problem in the United States," she and colleagues said in their report.

"A model core tobacco curricula that meets national recommendations should be developed and implemented in all U.S. medical schools," they added.

The researchers surveyed about 120 medical schools on how they trained doctors on breaking the habit. Seventy percent said they did not require clinical training in smoking cessation techniques.

Doctors are supposed to follow the "five a's" approach to helping patients who smoke:

  1. Anticipate the smoker
  2. Ask about habits
  3. Advise
  4. Assist
  5. Arrange to help the patient quit

Asked why the situation persists despite several decades of publicity about the hazards of smoking, Ferry said, "All of us who are the faculty in medical schools were never trained."

Ferry said there is "no importance to treating tobacco," and few insurance companies will cover the treatment.

"The impression is you stop when you're ready ... with safe, over-the-counter drugs," she added. "And the other issue is that doctors do not do well when it comes to dealing with behavioral problems. They feel they have no control over it and it has chronic relapses. It makes a doctor feel powerless and impotent."

On top of that, she said, doctors have become discouraged at the success rate of nonprescription nicotine-replacement chewing gums, patches and sprays. Despite them, she said, the failure rate among those who try to stop smoking by whatever means is still 85 percent or higher.

Ferry said there are newer prescription drugs that may increase the success rate to 40 percent.

Seven out of 10 smokers wish they could quit, she said, "but doctors don't see it's in their grasp to help them. And this goes back who what we are taught in medical school."

The journal article found that during the first two years of medical school when basic science is taught 54.8 percent of the schoolinclude recommended topics such as the cancer risk of tobacco and the effects of passive smoking.

But during the last two years, when clinical training is taught, nearly 70 percent of the school did not require any work on smoking-cessation techniques, it said. About 24 percent did offer additional training in the subject but as elective rather than required courses.