Well thanks to Mr Cameron Gordon of the Department of Health I have now had a chance to study carefully the various reports that he claims are the scientific basis for the famous advertising slogan that smokers are “up to four times more likely to quit” if they use NHS Stop Smoking Services.
In email communications with Belinda Cunnison, of campaign group freedom2choose, Mr Gordon went out of his way to point out – for no reason I can really fathom – that the claim was not “four times more likely”, but “UP TO four times more likely”. Well, okay Cameron! If you say so. But surely, if you are going to use the words “four times more likely” it is going to be assumed that, at some point, the science actually demonstrated that in a way which justifies that wording, and the massive amount of spending that it supposedly validates.
There are three reports which the Department of Health claim to form the basis for the chosen wording in NHS promotional material. The first, generally referred to as the Ferguson report, I already talked about in the last post. This was supposed to demonstrate that the long-term outcomes of the NHS services reached a 15% success rate, which they certainly do not in reality. In fact, 20% of the original sample group had been disqualified before the results were assessed, largely to weed out the smokers least likely to succeed. This is not scientific, it is cherry-picking and makes a nonsense of the final conclusion.
The other reports provided by the Department of Stealth were the Borland report and the Hughes report, the latter also helpfully including summaries of 6 other studies into long-term success-rates of untreated smokers – in other words, people who just quit by themselves without using any services or products..
The largest ever meta-analysis of quit methods, carried out by the University of Iowa in 1992, found that the figure for willpower alone was 6%. The largest of the studies mentioned in the Hughes report was carried out by Cohen et al, and the sample was 5000 smokers. They found 5% not smoking at 6 months, falling to 4% at twelve months – a fairly similar result.
Now, do you remember what I said in the last post, about drug companies using the sneaky tactic in drug trials of running a number of small trials – rather than one big one – because random variations in small numbers makes a big difference to percentages? Well, just look at what happens to that 4% figure when that 5000 sample comes down to just 235 smokers, as it does in the smallest of the studies mentioned in Hughes, carried out by Garvey et al in 1992: 14% still not smoking after 6 months, falling to 13% at twelve months. (These are untreated smokers.)
Now, which trial are you going to have more faith in: one which looked at 5000 smokers, or one which looked at 235? These trials don’t even involve drugs, yet it is obvious that all that baloney about “randomised, controlled trials” spouted by groups like ASH and the drug companies (same thing, really) is marketing posing as science, because you only have to leave out some of the details in your press-releases and you can get the newspapers innocently reporting “success rates” in percentages in “scientific trials” which will bear no relation to the outcomes when the drug is used by hundreds of thousands of people.
An earlier study by Hughes et al, also from 1992 and summarised in the 2003 report provided by the Department of Health used a sample of 630, and straight away the success rate dropped again, this time to 3% at 6 months (no figure given for 12 months). This clearly indicates that all you have to do, if you want to get a figure higher than 13% is take the sample size even lower than 235 people, do a few trials concurrently and then hype the results from the one that happened to produce the best percentage rate.
Take this to its logical conclusion and you end up with a success rate of 100% eventually, from a properly conducted scientific trial involving just one lonely smoker who happened to get lucky.
Back to the actual reports
So we learned from Hughes that the Iowa report had the willpower figure about right, between 4% and 6%. All the big samples showed that. It was only the tiny trials that looked different, so obviously we need to be skeptical about percentage success rates if we are not being told how many people were involved in the trial group showing that percentage.
The Borland report, though, is the most damning of the lot. It set out to show that smokers should be referred to Quitline services by GPs, rather than treated in-practice, because the report does show a slight difference in the long-term results. But this report is a classic example of how scientific studies can end up being used to back up policies that are utterly bonkers simply because they manage to show “a result”! Already we have seen that a study which apparently found “a result” of 7% success for over-the-counter nicotine replacement – 1% more effective than willpower! – led to a “scientific conclusion” that it was therefore “pharmacologically efficacious”, so I guess we shouldn’t be too surprised by the daft conclusions of the Borland report. But first, the all-important results at one-year follow-up:
The Borland report found a marked lack of enthusiasm amongst GPs even to get involved in the trial, and I can’t say I blame them. I feel really sorry for GPs for being obliged to have anything to do with the whole smoking issue, really. And I have yet to meet any experienced GP who has any faith at all in nicotine replacement therapy of any kind. So the proposed sample of 1500 smokers never really materialised, and they ended up with only 1039. Some were treated in-practice, with support only from their GP. The rest were referred to NHS Stop Smoking Services for supposedly “expert” help.
What they found, at 12 month follow up, was that the in-practice treatment scored a mere 2.6% success at one year, whereas the Stop Smoking Services delivered a pathetic 6.5%. [**Update, 2010: Last year, these services cost the UK taxpayer £84,000,000.] And then they actually concluded: “Where suitable services exist, we recommend that referral become the normal strategy for management of smoking cessation in general practice”.
Seriously folks, I ask you: is it possible to believe that anyone – any collective group of people – could be so unutterably stupid as to recommend the continuation of either of those approaches to smoking cessation, at the taxpayer’s expense, based on failure rates of 93.5% and 97.4% respectively? Also, what happened to the supposed 15% success rate claimed by the Ferguson report? Gone – reduced to 6.5% at best. This proves that the report was flawed and misleading and should never again be cited to market NRT products or NHS services. No wonder they buried it.
Finally, if the University of Iowa report found 6% for willpoer over very large sample numbers, as did Cohen (4%), then how is 6.5% “up to four times more likely to succeed”?
The fact is that it is not.
At the start of the Truth Will Out Campaign in March 2008, I reported that smokers were being lied to about the effectiveness of these services and drug company products, and I reproduced in the Evidence section of this site published NHS and DoH documents that claimed up to 90% success rates for short-term results (4 weeks), but did not report at all on long-term outcomes. When they finally did, they claimed 15% success at one year, which I have now proved is also very misleading.
I said, right from the very beginning, that it was 94% failure. Thank you Borland et al, you just officially confirmed it.
Did someone say recently the NHS needed to save some money? Then scrap NRT. Ditch Champix before it kills anyone else – it doesn’t work for 86% of smokers anyway. Zyban has also killed people. Scrap the NHS Stop Smoking Services and divert that precious NHS cash into things that everyone agrees the NHS is actually good at. Smoking cessation clearly isn’t one of them. In fact, the government should STOP wasting public money on trying to encourage smokers to quit. Smokers don’t feel inclined to do what their GOVERNMENT wants them to do! Don’t you guys know ANYTHING about the psychology of smoking? Check the facts: the number of smokers in the UK was declining FASTER before this stupid policy was introduced!
Right now we have Primary Care Trusts cutting back on vital, SUCCESSFUL services, yet proposing to waste even more resources on this humiliating flop! WHY?
For God’s sake, spend the money on much-needed lifesaving equipment like dialysis machines – policy decisions you can defend honestly. Leave smokers to take responsibility for their own lifestyle choices, and the majority of them will – just like they were doing before the Blair government decided to waste hundreds of millions only to end up SLOWING the rate of positive change!
For anyone who simply wants to ditch the tobacco habit – now that no-one can afford the ridiculous tax rate on it, here in the UK – here’s the facts: the best methods are also the safest: hypnotherapy, the Allen Carr method (which is hypnotherapy anyway, really) and acupuncture. All risk-free. No governments involved – hooray!
Central Hypnotherapy (Smoking Cessation Specialist since August 2000)