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Letters to the Editor  |   February 2005
DO Questions Evidence for Including Tobacco Dependence Curricula
Author Affiliations
  • Mark L. Shatsky, DO
    Deaconess Family Medicine Residency Program Evansville, Indiana
    Assistant Director
Article Information
Addiction Medicine / Medical Education / Curriculum
Letters to the Editor   |   February 2005
DO Questions Evidence for Including Tobacco Dependence Curricula
The Journal of the American Osteopathic Association, February 2005, Vol. 105, 52-53. doi:10.7556/jaoa.2005.105.2.52
The Journal of the American Osteopathic Association, February 2005, Vol. 105, 52-53. doi:10.7556/jaoa.2005.105.2.52
Web of Science® Times Cited: 55
To the Editor:  
I read with interest the August 2004 article by Norman J. Montalto, DO; Linda H. Ferry, MD, MPH, and Tiffany Stanhiser, BS, “Tobacco dependence curricula in undergraduate osteopathic medical education” (J Am Osteopath Assoc. 2004;104[8]:317–323 [published correction appears in J Am Osteopath Assoc. 2004;104(9):368]). 
It has been established that tobacco dependence curricula in American medical schools is inadequate.1,2 It has also been shown that medical students can develop skills to counsel nicotine-dependent patients.3 Unfortunately, there are no outcome data that demonstrate whether the inclusion of smoking cessation curricula will translate into a long-term increase in tobacco counseling rates from future osteopathic physicians. 
Smoking remains the number one public health issue in the United States—and effective nicotine dependence interventions are of the utmost importance if we are to accomplish a decrease in the 485,000 annual tobacco-related deaths in the United States. 
But, before we can stand behind the bold editorial statement of Thomas Wesley Allen, DO, who declared of the article by Montalto et al, “I believe the authors have put their finger on the problem” (“Eliminating tobacco use, a continuing challenge” [editorial]. J Am Osteopath Assoc. 2004;104[8]:313), objective evidence is required. 
The Journal must hold its contributing authors to rigorous scientific standards. While the authors may be on to something important (and should be commended for their findings regarding the lack of nicotine dependence training for osteopathic medical students in the United States), drawing conclusions outside the boundary of that which has been measured is not scientific. 
Montalto et al rely upon expert opinion—rather than objective data—to argue for teaching tobacco cessation skills in medical school. Montalto et al also lean too heavily in this original contribution, on now-dated material from a similar article published in 1999 by one of their coauthors, Dr. Ferry.1 For example, both articles cite a 1989 study by Cummings et al4 suggesting that medical school is the optimal time for tobacco cessation training. 
Essential information could result from a pilot study instituting a tobacco cessation program (including smoking prevention counseling for at-risk patients) into osteopathic (or allopathic) medical school curricula. New physicians who have received undergraduate smoking cessation training could be longitudinally followed so that we could measure how their patients fare with this intervention. 
Perhaps a call by The Journal for just such an osteopathic pilot study could help us do more than put our finger on the problem. It could help us get our hands around it. 
 Editor's note: Norman J. Montalto, DO; Linda H. Ferry, MD, MPH, and Tiffany Stanhiser, BS, will respond to Dr Shatsky's letter in the March 2005 issue of The Journal.
 
Ferry LH, Grissino LM, Runfola PS. Tobacco dependence curricula in US undergraduate medical education. JAMA. 1999;282(9):825 –829.
Spangler JG, George G, Foley KL, Crandall SJ. Tobacco Intervention Training Current Efforts and Gaps in US Medical Schools. JAMA. 2002;288:1102 –1109.
Wadland W, Keefe C, Thompson M, Noel M. Tobacco Dependence Curricula in Medical Schools. JAMA. 2000;283:1426 –1427.
Cummings SR, Coates TJ, Richard RJ, Hansen B, Zahnd EG, VanderMartin R, et al. Training physicians in counseling about smoking cessation. A randomized trial of the “Quit for Life” program. Ann Intern Med. 1989;110:640 –647.