Saturday, 24 March 2012

Nicotine patches: change of tune from the UK Centre for Tobacco Control Studies

From this:
The prevalence of smoking is higher among Pakistani and Bangladeshi males than among the general population. Smokers who receive behavioural support and medication quadruple their chances of stopping smoking, but evidence suggests that these populations do not use National Health Service run stop smoking clinics as frequently as would be expected given their high prevalence of smoking. [emphasis added] 
To this:
FREE nicotine patches or intensive counselling via an NHS helpline do nothing to help smokers quit, says a Government- funded study.
This latter study is led by Tim Coleman, and the earlier study was co-authored by Rachna A. Begh, both of the UK Centre for Tobacco Control Studies. Three years elapsed between the two pieces.

What are the policy implications? The concluding paragraph of Tim Coleman's study is non-committal:
In England, where support for smoking cessation is available to all smokers either free or at relatively low cost, adding additional proactive telephone counselling or an offer of free nicotine replacement therapy to usual quitline care did not affect smoking cessation rates. On the basis of this study, providing these through a quitline is not recommended.

What is already known on this topic

  • Quitlines can support large numbers of smokers in achieving smoking cessation.

  • The most effective and cost effective methods of support through quitlines need to be determined.

What this study adds

  • Among callers who sought help to stop smoking through the English quitline, offering free nicotine replacement therapy was no more effective than standard support by the quitline.

  • Cessation rates were not improved by offering additional telephone contacts with advisors providing proactive counselling.

  • Offering free nicotine replacement therapy or proactive support were no more effective than standard reactive quitline support
It is tempting to ask what nonsense we have been fed for the last few years about NHS being four times more likely to quit. Freedom2Choose has raised this question more than once in the past (also here).  Three years ago the mantra 'four times more likely to quit with NHS help' was received wisdom.

The Department of Health page making this claim is now archived.  However, new Department of Health guidance, dated 2011/2012, lists Nicotine Replacement Therapy with an A evidence rating ('the recommendation is supported by good (strong) evidence').  Make of this what you will. (The same document gives Champix an A evidence rating, and states there is 'no clear evidence' of a link between taking Champix and increased depression or suicidal thoughts.)

This is an extremely messy picture. The notion that NRT doesn't work is backed by other evidence besides Tim Coleman's study, but it is not supported by the Department of Health guidance linked above. Nor is it reflected in the Scottish 'Give it up for baby' campaigns, which routinely supply free patches, and pay expectant mothers to make use of the quitting service. The  body promoting 'Give it up for baby' is, rather sinisterly, named NMSC (National Social Marketing Centre), with the slogan 'leading behaviour change'. Instead of evidence-based persuasion, we have psychological manipulation of people's behaviour to suit the whims of policy makers and planners. Behaviour change could well take priority over the supporting evidence, with planners claiming that 'the ends justify the means'.  (Incidentally Tim Coleman has also recently 'discovered' that patches don't help pregnant women stop smoking either.)

Prediction: the UK Centre for Tobacco Control Studies will call for 'more research' to solve the problem of quitting; the Department of Health and National Social Marketing Centre will continue to promote the use of nicotine patches.

1 comment:

david said...

More from Coleman

Relapse prevention in UK Stop Smoking Services:
current practice, systematic reviews of effectiveness
and cost-effectiveness analysis