Monday, 15 August 2011

Scotland bribes smokers to quit: the efficacy of medication

NHS Tayside is extending its programme that offers money to people who use NHS services in order to attempt to stop smoking, on a postcode lottery basis. It targets its efforts towards those in deprived areas whose postcode indicates that they are probably heavy smokers, in order to try and close the 'health inequality' gap. 

The Courier explains. The scheme (which pays £12.50 a week in supermarket vouchers) has allegedly reached a quit rate of 50 per cent after four weeks. (Only five readers have left comments on this story, and they don't seem very happy about the outlay on the scheme.) This stupendously high quit rate (compared with what is normally achieved – see Michael Siegel's review of a recent study) apparently justifies the roll-out of the scheme, known as quit4u, from Dundee into neighbouring towns. 

Interesting that arch anti-smoker (and plain packaging advocate) Simon Chapman doesn't buy the line that NRT works, or that expenditure on it is justified.
The pharmaceutical industry has a clear commercial interest in eroding public and professional confidence in unassisted smoking cessation, yet easily implemented ideas, such as graphic health warnings, are more effective than nicotine replacement therapy. 
Is Chapman biting the hand that feeds him? It is not hard to find pharmaceutical links with the anti-smoking industry. Indeed health professionals were cautioned about this close relationship only a few weeks ago, by the World Health Organisation. Some of Chapman's anti-smoking colleagues are puzzled by his line of argument. Many have taken issue with him.  Not only does he not believe in smoking cessation treatments, he believes that pharmaceutical interests exaggerate the difficulties of smoking cessation, and that anti-smoking campaigning should not attempt to make out that people can't quit without help. Two years ago he published a major study that made the following points:

  • - Research shows that two-thirds to three-quarters of ex-smokers stop unaided. In contrast, the increasing medicalisation of smoking cessation implies that cessation need be pharmacologically or professionally mediated.
  • - Most published papers of smoking cessation interventions are studies or reviews of assisted cessation; very few describe the cessation impact of policies or campaigns in which cessation is not assisted at the individual level.
  • - Many assisted cessation studies, but few if any unassisted cessation studies, are funded by pharmaceutical companies manufacturing cessation products.
  • - Health authorities should emphasise the positive message that the most successful method used by most ex-smokers is unassisted cessation.
The message still hasn't got through to Tayside. 

I would love to know how Chapman expects the anti-smoking bandwagon to get pharmaceutical industry support if he goes about dissing the effects of nicotine replacement therapy. Does he expect to extort the money from the tobacco industry? Only time will tell.

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