“You are up to four times more likely to succeed” in stopping smoking if you use NHS Stop Smoking services, that’s what smokers have been told by the Department of Stealth and NHS bosses.
As I have already demonstrated in the Evidence section of this site, for years the NHS published “success rates” with figures ranging from 53% as a national average, right up to 90% in the case of a Kent PCT, which is obviously about as misleading as you can get. These figures were based on “self-report at four weeks”, which bears no relation whatever to real long-term outcomes.
To put this simply, the only figure that genuinely indicates success is the long-term outcome. For years, drug companies have got away with a cynical trick when getting medications approved: if they can get any results at all that look like effectiveness, they halt the trial early – or only do fairly short trials anyway – to hopefully get the medication rubber-stamped on the basis of that short-term effect only. Since this proves nothing about long-term outcomes, it is a bogus basis for approval but drug companies have denied a profit motive, claiming instead that their true motivation is to “get help to patients as fast as possible”. Yeah, I’m welling up, here.
Another trick they frequently use is to do a number of little trials using fairly small numbers of people in each, because by sheer chance the numbers showing a response will vary, so inevitably one group will have more people showing a response than any of the others. They then convert that small number of persons into a percentage – which makes the number seem higher! For example: if there were six trial groups, each with twelve members, and one of those groups happened to hit a success high of six people out of that twelve, this then becomes reported as a “50% success rate in clinical trials” – all the other trial groups are then ignored, and this becomes the only result mentioned in press releases, as if it were the sort of success rate that could be expected of the medication in general use, which of course it is not. This is how Champix first appeared in the newspapers with a ‘success rate’ of 44% attached to it. Less successful trials may not even be reported to approvals bodies at all, which is exactly what happened with the trials that actually showed that Prozac was no more effective than the placebo (dummy pill) – evidence witheld from the FDA at the time, just to cheat the approval system.
These sneaky methods of gaining approval can also fail to pick up dangerous side-effects, sometimes because the numbers being tested are so small, and especially the side-effects caused by long-term use, which is why the horrific side-effects of Champix/Chantix didn’t show up properly in the original trials. With incredible callousness, the manufacturer Pfizer has since claimed that there is ‘no evidence of a causal link’ on the basis that it didn’t show up in the trials!
In my personal opinion, that kind of cynical chicanery is so dishonest that those responsible should be imprisoned for it. Doctors are still prescribing it, people are still dying, Pfizer are making vast fortunes and denying all responsibility. They know perfectly well there’s a serious problem, but their primary objective is to rake in the cash, and fast, before the drug gets withdrawn by the safety regulators.
The Official Claim for Long-Term Success
Incredibly, the Department of Health waited five years before they decided it might be a good idea to have a look at the long-term results of their enormously expensive policy of providing nicotine replacement products and Zyban to any of the 12 million smokers in the U.K. who felt like having a pop at ditching the habit. By this time they had paid the drug companies hundreds of millions of pounds of taxpayers’ money, but without bothering to check if any of this was really making a difference.
The English smoking treatment services: one-year outcomes was published in 2005 in the journal Addiction, which is the journal of the Society for the Study of Addiction. Finding a copy of this has not been easy – I have been searching for it on the internet for years, but without success. It was dead easy to find loud pronouncements about those short-term (useless) figures, but when it came to the real outcomes, the DoH and the NHS were not just hiding their light under a bushel, they were doing their best to bury it beneath the Earth’s crust.
What I did find on the internet, without too much difficulty, were secondary references to the findings of the report into one-year outcomes – now usually referred to as the Ferguson report. These claimed that the outcomes at 52 weeks were 15% still not smoking. Those of us well-acquainted with this field were immediately suspicious of that figure, as it was about double the success rates indicated by various other, independent sources that all seemed to agree that the true figure is between 6% and 8%.
When I wrote about this is Nicotine: The Drug That Never Was, I speculated that the use of the phrase “15% remain quit” might have been a clever twist, suggesting 15% of the total treated but actually referring to only 15% of the 53% (average) that had reported success at four weeks – which works out at about 8% of the total. but that is not what they did.
What they actually did was to start off with a sample of 2564 smokers, which was whittled down to 2069 for various reasons before the results were analysed. In other words, almost 20% of the smokers were disqualified from the study before the outcomes were assessed.
Now, a few of these disqualifications were for what I would call valid reasons. A total of 8 of them were under sixteen, and were therefore illicit smokers at that stage anyway. Obviously it would be unreasonable to expect them to respond well to services designed for adult smokers seeking to quit of their own volition. A further 92 were excluded for reasons that were basically accidental, including some follow-up data being withheld on data-protection grounds, and also simple “clerical error”.
I have no problem with any of that. No, it’s the other 395 people who were excluded that I have a problem with. The reasons for excluding these people were:
“no overall consent to research involvement”
“incomplete postcode”, and
“cases with valid value count less than 21”.
Now, before I explain the ‘valid value count’, let’s just look at those other two reasons. “Incomplete postcode” smacks of IT system incompatibility, so it may have been inevitable in practice, but ask yourself this: What kind of smoker fails to supply a full postcode? Those that cannot be bothered to respond properly to health service standard procedures. Poor motivation, lackadaisical attitude, a bit uncooperative – that would be about right, wouldn’t it? And indeed, the same could be said for “No overall consent to research involvement”, could it not? So aren’t they effectively cherry-picking here, weeding out the probable no-hopers? That’s going to get their success-rate up a bit, for sure!
A smoker’s ‘valid’ value
Now, when it comes to my hypnotherapy practice, one smoker is as valid as another, it’s as simple as that. But when it comes to manufacturing ‘scientific evidence’ that will be used to justify giving hundreds of millions of pounds of taxpayers’ money to big drug companies, it really isn’t simple at all, apparently. In fact it gets pretty complicated, as well as highly questionable. Smokers may be a little surprised – and perhaps a little put out – to learn that their “validity” might be variable when compared to other smokers, but it is clear from the Ferguson report that this is indeed the case.
In assessing this ‘validity’ factor, some of the things taken into account by the points-scoring system may surely raise an eyebrow, as they include: gender, race, whether education finished at sixteen, single parent or not, current household members, time between waking and first cigarette, number of cigarettes smoked per day, age started regular smoking, previous attempts to stop recently, ease/difficulty abstaining for a whole day, whether there is anyone to support client to stop smoking… the list goes on.
So if a smoker has a low points-score on these factors – and I’d love to know what points-differential race and gender variations counts as, wouldn’t you? I mean, is discrimination there even legal? – then they are regarded as having insufficient “valid value”, and disqualified from inclusion in the preferred sample of 2069. This is simply because they are pre-judged as being less likely to succeed, so although they might still be offered help, better to leave them out of the official “success at one year” report, because they’ll probably spoil it… cherry-picking for sure!
************… more soon!************
(Just want to quit smoking? Click here.)