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.

Smoking bans threaten mental health: Opinion, Australia

This writer asks why comprehensive smoking bans are imposed on mentally ill people, when at least at this point in our history nobody would think it right to impose such a comprehensive ban on the rest of the community. Both the circumstances of a person's incarceration in mental health facilities and the fact that they may not get home for a period of days, weeks or months, to say nothing of their existing mental anguish and the effects of any medication, make somebody's stay in a mental health facility possibly one of the least suitable times to deprive them suddenly of nicotine and expect them to get by on patches at best.


There do seem to be people out there in the caring profession who find the opposite and who knows but they may be most sincere in their views. But bringing in a comprehensive ban that will force psychologically disturbed people to withdraw suddenly from nicotine would be controversial even if implemented in a single unit. The current trend is for health departments to encourage if not legislate for the provision of comprehensive smoke-free mental health service, affecting all units everywhere.  People who run these departments are not medics, they are officials, who seem to be motivated by targets and ideologies dressed up as care for patients.


The comments on this story are instructive too, especially the one that points out that 'nicotine replacement is not an alternative to smoking, it's an aid to give up smoking'. In the eyes of tobacco control, nicotine replacement is a form of 'harm reduction': i.e. anything is better than smoking (as long as it's not made in China with cartridges of course) and we'll give you nicotine patches because you really want to give up smoking, don't you – most smokers do, after all! One reader says:

We should not be allowing or encouraging people to utilise pathological coping mechanism when they are facing a crisis. When alcoholics and heroin addicts are admitted we provide healthier alternative and encourage them to reduce their dependence. 

But this is a false parallel. No one is admitted to psychiatric care because he or she is a smoker. Drug and alcohol abuse signify addictions of a completely different order from a nicotine habit. There is no reason that any patient should be compelled to give up smoking. Allowing smoking areas need not undermine the ward experience for everyone else. It's just a matter of will.


To finish let's have another story about Champix (comments disabled). Sorry it's from the Daily Mail. The MHRA (medicines regulators) are convinced that people who react to Champix have underlying problems (even though most reports I have read concerned people without any history of psychological problems I can't pretend to have read enough to be certain of this). This will account for ASH Scotland's keenness to recommend Champix to those in mental health facilities.

ASH declared interest in GlaxoSmithKline, 2001

In 2001, then head of Action on Smoking and Health Clive Bates wrote to the Chief Executive Officer of GlaxoSmithKline, protesting at the appointment of a tobacco industry representative Derek Bonham on its board of directors. Bates felt that a conflict of interest was involved: the public already in 2001 had identified collusion between pharmaceutical and tobacco interests:

There are already campaign groups that claim the tobacco industry and pharmaceutical industry have a symbiotic relationship that is parasitic on the smoker. I believe it would be highly damaging to the category, to the company and the industry as a whole would be highly damaging to feed that cynical perception.

News to me if the public had any such 'cynical' perception ten years ago.

The letter says:

1. that Action on Smoking and Health had a 'small holding' in GSK
2. that Action on Smoking and Health was instrumental in getting smoking cessation treatments accepted by the Department of Health in London

It identifies policy measures, such as raising prices and increasing regulation of tobacco, that benefit 'the smoking cessation market' at the expense of the tobacco market.  'Every time a smoker switches to "lights" as
an alternative to quitting the market for smoking cessation is diminished.' Clive's letter lists measures that he believes promote the smoking cessation market at the expense of tobacco:

• Restrictions on smoking in public places and workplaces
• Marketing restrictions on tobacco companies
• Higher tobacco taxation
• Greater NHS involvement in smoking cessation
• Regulatory measures to be applied to tobacco products.

Tobacco companies and pharmaceutical companies carrying nicotine replacement treatments are competing for the same market: that of smokers. To that extent, there is a logical conflict of interest.

Nicotine replacement therapies became available on the NHS in April 2001. The Guardian was excited about this move soberly  reporting John Britton's then-cautious estimate that NRT doubled a smoker's chance of quitting (the claim escalated to a quadrupling of the cold-turkey quit rate). In those days one could say:
'this doubled success rate only applies if you are ready to stop. Taking NRT cannot make you more committed to giving up smoking or transform you into a non-smoker, although it can help end the psychological habit of reaching for a cigarette.'

Even giving nicotine treatments to kids as young as 12 didn't raise any scepticism among Guardian writers on health.

The early days saw campaigners fighting for greater availability of NRT, using the same harm reduction arguments now used by campaigners for e-cigarettes. Said Anne McNeill (now at the UK Centre for Tobacco Control Studies): 'It's simple really - the more the regulators place stringent regulations on the use of NRT, the more likely it is that people will continue to smoke, and then die as a result.'

My question is – the smoking cessation market is important to Clive Bates. No doubt he believed it would help smokers to give up smoking. But what is it worth (as an investment) to the NHS, when it's clear that much of it will go out free on prescription?

Just asking.

Biting the hand that feeds them?

Partick Thistle urges its supporters to 'quit smoking' by promoting Smokeline.

We find the usual assurances from smoking cessation experts:

Fiona Dunlop, Health Improvement Lead for Tobacco with NHS Greater Glasgow and Clyde, said: “Even if you’ve tried to stop smoking in the past, there are many ways to help you quit in a way to suit every lifestyle. So whether you’ve tried quitting before, or are giving it a go for the first time, Smokeline and Stop Smoking Services in Glasgow and Clyde are here to help.  The Stop Smoking services are very easy to access and sessions are informal and supportive.  Advisors will discuss using products such as Nicotine Replacement Therapy (patches or gum), Champix or Zyban and help you get the product of your choice. In this way your quit attempt can start as soon as you are motivated.” 

We don't find this: "Currently stop smoking services are evaluated on the percentage of 4-week quitters, but around three-quarters relapse after this date." Is Partick Thistle being used as a front for pushing drugs that fail to work far more often than not? No therapy that doesn't involve smoking cessation drugs finds space here.

Partick Thistle is less likely to take up this issue with its sponsors Ignis, whose corporate bond managers' report reveals that Imperial Tobacco is included in its top ten holdings. However, the current sponsorship arrangement is due to expire this year, so perhaps Partick Thistle will take this opportunity to rid itself of such an unhealthy investment.

Imperial Tobacco, like other tobacco companies, cannot directly invest in sports or any other endeavour, but investment via bonds is less easy to ban (and perhaps such investment is still feeding MSPs' and other official pension funds).

UK National Smoking Cessation Conference 2011

The dates and venue have been announced for this year's major annual trade conference in the calendar of the anti-smoking industry. It'll be held in London on Monday 13 and Tuesday 14 June, at the Novotel London West Hotel.

Further details will be released closer to the date, but expect a line-up of seasoned tobacco control advocates from throughout the UK, sponsorship from major pharmaceutical companies and the manufacturers of breath-testing equipment, and hundreds of publicly funded delegates assembled to learn how to push medicinal nicotine (they'll all walk out of the conference with folders and hessian bags emblazoned with the UKNSCC logo).

These are guesses based on last year's conference. A few of us waved banners outside the Radisson Hotel, Glasgow last June, and it did have an impact: one or two delegates seemed genuinely astonished that anyone would want to protest against their conference.

Our placards: the slogan on the right has also been used on demos in the US

Eddie poses with Sheila Duffy: Radisson Hotel, Glasgow

You'll get an idea about the likely agenda of the conference here. The home page of the UKNSCC site gives a brief preview of the 2011 conference (we can look forward to a nicotine vaccine, for example), mentioning  treatments that are 'known to be effective such as nicotine replacement therapy'. See this paper to discover how untrue this is: 'Currently stop smoking services are evaluated on the percentage of 4-week quitters, but around three-quarters relapse after this date,' says Tim Coleman of the UK Centre for Tobacco Control Studies, in a bid to keep smokers on nicotine cessation medication for the longer term.

For the smoking cessation industry, smoking restrictions represent marketing opportunities. Smoking bans already exist in workplaces, but last year's conference reported local projects that discourage parents from smoking at home: this slide presentation features a Glasgow project. Using potential damage to children as a pretext, 'intervention' to make smoking difficult at home will become more popular among enforcing authorities (discussed today at Dick Puddlecote's place).

Pressuring people to use nicotine substitutes rather than expose their children to smoke will become more common: this seems to be what the smoking cessation industry means by 'harm reduction'. Given the lack of any significant evidence linking passive smoking to specific cases of ill health or mortality, I find it hard to believe that exposing children to smoke is usually harmful (and the idea that it can be described as child abuse is absurd). The idea that pharmaceutical companies are helping to create pressure to 'denormalise' smoking in the home is far more likely than the idea that secondary smoke harms kids, in homes where fresh air is reasonably abundant.

So I will be looking out for the agenda of this conference. It won't be the only smoking cessation conference this year, but it involves significant players in the UK anti-smoking industry.

Free patches for a smoke-free New Year

Chris Holmes, a hypnotherapist and campaigner against NHS expenditure on nicotine replacement therapies urges us to join the campaign to consign these ineffective treatments to history. He starts with a government plan to provide one week's supply of nicotine patches free of charge to assist people with their new year's resolutions.

Read what he has to say, share the story with your friends, and then write to your MP, MSP, assembly member, local and national press, health board, or if you have any further ideas let us know. We picketed the 2010 UK National Smoking Cessation Conference in Glasgow last June, which was all about pushing medication.

Drug companies benefit far more from smoking bans than tobacco companies suffer from them.

THE ANTI

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