What is Allen Carr’s ‘Easy Way’ to quit smoking? — WHYY
“He, in the media, would say .. .everybody else didn’t know what they’re talking about,” said Founds.
Allen Carr famously didn’t pay for much in the way of advertising, but Foulds says he was good at getting it for free — basically by picking fights.
“That was kind of a bit of a style. He called out everybody else, you know — nicotine gum and nicotine patches, ‘They’re bad, they’re useless,’” Foulds said. “The Action on Smoking and Health, which is the big, anti-smoking charity in the UK — ‘They’re no good.’ The British Medical Association — ‘They don’t know what they’re talking about.’”
He got into one particular beef with a charity called QUIT that ran England’s national quit-smoking resource hotline.
“They had a policy that they would only refer people to services that, you know, had evidence-based treatment, but also that didn’t make excessive claims about their success rates,” Foulds said. “And they started to butt heads with Allen Carr, because Allen Carr at the time claimed he had a 90% success rate.”
QUIT commissioned the St. George’s study that Foulds worked on essentially to call Carr’s bluff. Nobody believed 90% was even possible — some figured Carr was just making it all up.
“I don’t think he was a mean guy,” Foulds said. “To be honest, I thought he was maybe a bit of a charlatan.”
But when the two men met, Carr agreed to the study on the spot. He also, Foulds noticed, seemed to believe every word he said. To Carr, the Easy Way really was gospel.
“I didn’t come away with the sense that this is a con man. I came away with, this is a guy who had been a very heavy smoker himself and he had failed to quit many times. And then he kind of saw the light,” Foulds said. “He became a born-again smoking cessation expert.”
As for the efficacy rate, Carr had apparently been basing that on the fact that only 10% of customers ever came back for a refund. He assumed that meant that the rest had quit for good.
“I asked [Carr], ‘How do you get your money? What do you have to do to get your money back?’,” Foulds said. “And he said, ‘Well, you have to come once and try and quit. And if you fail, you have to come back again. You can get your second treatment for free, but you have to try to come back and try again. And if you fail that time, then you get your money back.’”
The problem is: it’s a lot of hoops to jump through; some people might have felt ashamed about failing to quit, and would just rather forget the whole thing. But Carr, remember, wasn’t a scientist — he hadn’t really considered any of this. He saw that 90%didn’t ask for a refund, and, to him, that was evidence — really strong evidence.
Testing the 90% success claim
Carr was sure Foulds would come away converted, and sat in on the hours-long trial sessions.
“It was kind of like — somebody does describe it a little bit like brainwashing you to stop smoking,” Foulds said. The sheer length of sessions was strange, considering that most doctors only see patients for 10 or 15 minutes, and therapists sit with clients for maybe an hour. The Easy Way sessions lasted all day.
“I do believe that there’s a little bit of a point where it stops and there’s a sort of a hypnosis suggestion-type thing, but I don’t think they call it hypnosis and they don’t pretend to be hypnotists,” said Foulds. “But it’s a very similar kind of thing.”
Foulds says there definitely is something to Allen Carr’s method, though he’d really only be guessing what it is. He thinks maybe it’s something like confidence
“In the corners of the room, in each of the four corners, there was a great big pile of cigarette packs,” Foulds said. “And so at the start of the treatment, the therapist would tell the people that these were cigarette packs that had been thrown away by the thousands of prior people who’d succeeded.”
The therapist tells you it works; the pile of abandoned cigarette cartons shows you it works. It could work in part because people believe it does. Like maybe the sales pitch is part of the treatment.
The problem was: it didn’t seem to work as well as Carr was claiming.
Something like a quarter of the smokers remained smoke-free by the three-month check-in. That’s about on par with the patch, medications, and traditional counseling — but it was no miracle.
Something that stuck out to me that I hadn’t realized before researching is that Allen Carr also wrote a book called “The Only Way To Stop Smoking.”
“Yes, yes — that was a modest title,” said Foulds.
If you have a method that actually works 90%of the time, maybe you can get away with that. But if you tell people your way is the only way — that everything else is a scam or poison, and your method doesn’t actually help everyone — that’s where public health had real reason to look sideways at the Easy Way.
The organization has backed away from the 90% success rate claim, but they do think it’s much higher than the QUIT study suggested.
But it’s hard and expensive to prove.
“Randomized controlled trials are no small feat,” said Jamie Hartmann-Boyce, a UK researcher at the Centre for Evidence-Based Medicine in the Cochrane Tobacco Addiction Group.
Randomized control trials involve tracking two randomly chosen groups of participants, one of which gets a placebo, and the other of which gets the real thing.
“They take a lot of resources,” Hartmann-Boyce said. “That’s time, that’s effort, and that is money.”
Dicey, the Easy Way executive, says it always felt like science had sided against them, instead cozying up to big pharma and nicotine — and, at least in a structural sense, he’s kind of right.
The Easy Way in-person seminars are considered a behavioral intervention, as opposed to pills or patches, which are pharmacological. Logistically speaking, it’s trickier to test behavioral interventions than just giving one group a sugar pill and the other a nicotine replacement. What would be the proper placebo version of an ex-smoker talking at you for five hours while you smoke half a pack?
“When you have behavioral interventions, obviously you don’t typically have a big pharmaceutical company who has any imperative to fund those,” Hartmann-Boyce said.
Cost is the second big problem, as trials can run in the millions. To test the books as opposed to the seminars, Hartmann-Boyce says, you need thousands of participants. It’s considered self-help, one of the toughest kinds of interventions to prove.
Another issue is trust. The most convincing trials are those that are funded by third parties instead of the company selling the treatment, which could have an obvious bias.
“A lot of the research that gets done, for example, in different behavioral ways to help people stop smoking gets funded either through government research grants or through grants from charities,” Hartmann-Boyce said.
Government and charities — the two groups Carr had gone out of his way to belittle and alienate.
There’s a case to be made that Carr got in his own way.
The Easy Way basically needed someone in the big leagues — professional public health — to take a chance on them: to take the financial hit, and do the work of a trial. For years no one would.
The Easy’s Way’s chance at legitimacy
But in 2018, in Ireland, one such scientist stepped up. Luke Clancy is a respiratory physician and has worked in tobacco control research for the last 10 or 20 years.
Clancy treated lung cancer patients for decades. He personally witnessed hundreds of smoking-related deaths every single year.
He also met patients who used Allen Carr and quit. How exactly did the method work? He had no idea, and he didn’t really care.
“You get to the stage of saying, ‘well, I don’t care what’s going on if they stop,’” Clancy said.
If patients stop smoking, that’s good enough. Clancy wanted to do that gold standard randomized control trial — Allen Carr’s Easy Way seminar vs the Irish government’s national quit smoking program. At the time it was online, featuring in-person counseling with nicotine replacement and other drugs.
“I thought that if it was ever going to be introduced into the national service that the evidence would be needed and somebody would have to try and fund such a trial,” Clancy said. “So we approached the Department of Health and submitted the normal application.”
And the Department of Health — said no. Allen Carr’s method was stuck in a strange catch-22.
“We were dealing with an intervention that was 30 years old, and yet hadn’t got the scientific backing,” Clancy said.
Just the fact that no one had taken it seriously in the decades it had already been around meant no one would take it seriously now.
But as it turns out, Clancy is kind of a big deal in Irish medicine. He went to his old pal, the minister of health — the guy in charge of the guy in charge of whoever initially rejected Clancy’s application.
“And he obviously doesn’t interfere with those kinds of decisions, but he had within his power to give money from the national lottery, which he did to help support this trial,” Clancy said. “So that’s how it came about it.”
So the real deal randomized control trial finally went forward thanks to scratch-offs essentially.
“We found that the people who had received Allen Carr had twice the success rate of those that had done the national quitting service,” Clancy said. “And this was true at all times.”
It wasn’t 90% — but at one month, three and six, almost twice as many people were still smoke-free with Allen Carr than with the government service.
So surely Allen Carr became a part of the government service?
“Not a lot has happened since,” Clancy said.
There’s still the big problem of how you formalize something as downright strange as the Easy Way.
“The scientific method demands that we know how it happens, how you’re trained to do it. For instance, all of the practitioners of Allen Carr are ex-smokers who have used the method themselves. Now, that’s not the way we behave with other diseases,” Clancy said. “You know, I treat asthma — I don’t have asthma. I treat chronic bronchitis. But here’s [a treatment in which] a requirement is practically that you have the condition yourself and that you’ve overcome it through their method.”
But Clancy says it’s a start. No one can legitimately say there are no studies or evidence anymore.
And the why and how of Allen Car and the Easy Way — it’s actually not as important as you might think.
“If you were looking at a drug for cancer or something, it’s almost unthinkable that we’d be like, yeah, we’re going to treat you with this, and we have no idea why it works, right?” said Hartmann-Boyce, the researcher from the Centre for Evidence-Based Medicine. “That’s not the way we think of most medications. The thing with smoking and cigarette addiction is that it is incredibly complex, right?”
Take, for example, antidepressants, which are often prescribed for smoking cessation.
“And no one knows for sure what the exact mechanism of action is,” she said.
Not unlike the Easy Way, the one thing we know for certain is that it works, not really how. Hartmann-Boyce’s group periodically reviews new interventions, to decide whether or not to include them among recommended, evidence-based treatments. She thinks the Easy Way is going to get a pass soon, earning its way onto lists alongside nicotine patches and other drugs.
“My change of tack as soon as I sort of became responsible for the organization was to not [call for ] Allen Carr’s Easy Way to be the only method of stopping smoking available, but as, as an option, like, why shouldn’t smokers be offered the Easy Way a well,” Dicey said.
He thinks what happened to Carr, the way he was treated by the establishment, was wrong. And he still thinks the Easy Way is the best way.
“But I’m not going to win a fight against Pfizer or Johnson and Johnson, or Glaxo,” Dicey said. “There’s no way I’m going to win that battle.”
He realized he had to get diplomatic — the Easy couldn’t be the only way. And it’s been paying off — not just with Clancy’s study in Ireland or with the Centre For Evidence-Based Medicine; the Easy Way is working with the World Health Organization, which started including the method in global campaigns.
It’s a reality Allen Carr could’ve only dream of when he passed.
“He was frustrated,” Dicey said. “He described himself as a man in a hurry, particularly when he realized that his days were numbered.”
The man behind the world’s best selling stop smoking book had been diagnosed with terminal lung cancer.
I wondered if, there at the end, he was ever bitter.
“No, not at all. I think he was frustrated about the method not being adopted by the authorities. That’s that’s for sure,” Dicey said. “He wasn’t bitter at all about lung cancer.”
He says Carr was sure he had bought himself decades of life by quitting — thought he might’ve lost a few years hanging around smoke-filled Easy Way seminars for years after, helping others get free.
“I think it was 20 million smokers — he had helped 20 million smokers around the world. And he said, ‘Well, if that’s true, of course it’s been worth it,’” Dicey said. “He was the happiest man in the world.”