The Department of Stealth 4

So we finally got a response from the Department of Health that was supposed to give us access to the ‘scientific’ reports that they claim underpin the suggestion that smokers are “up to four times more likely to be successful” in quitting if they use NHS services to help them.

This came in the form of an email, sent to Belinda Cunnison of the freedom2choose organisation, who are opposing some of the recent petty smoking regulations.

Anti-Smoking Legislation
Ok, while we’re on the subject, here’s my take on that. In my view, the law that banned smoking in enclosed public spaces was bound to happen, and there are convincing public health arguments for that. Banning tobacco promotion was also long overdue.

All the other measures – raising the legal age for purchase to eighteen, forcing shops to put tobacco under the counter, further restrictions on smoking anywhere on the grounds of hospitals, prisons etc. – this is all counter-productive. This just brings out the rebel in smokers, many of whom will have started smoking in the first place because they were told not to. Smokers just feel got-at now, and that doesn’t motivate anyone to quit, does it? Who knows, maybe that is actually deliberate. I wouldn’t be at all surprised, because the government don’t really want to have to look somewhere else for all that tax revenue, do they?

The Information Provided
Mr Cameron Gordon of the Department of Health included in his email to Belinda four links to relevant information, and two attached reports, which he hoped (or so he said) would help us. I shall take these one at a time.

Link 1 took us to the Tobacco Control page of the British Medical Journal, but to actually read the article concerned you have to be a subscriber to the BMJ or be able to log in through your medical institution. Perhaps Cameron didn’t realise it, but Belinda doesn’t subscribe to the BMJ and is not a medic, so she couldn’t gain access to that article and neither could I. Cheers Cameron, Link 1 was a really big help.

Link 2 was to Wiley InterScience (I love that name!) the American publisher of the Journal Addiction which is where the ‘missing’ report into NHS long-term outcomes was originally published. Obviously, this meant that almost nobody ever saw it or heard of it, whereas in contrast the short-term (4 week) outcomes were trumpeted all over the web.

Three sections of this report particularly interested us, and I managed to print off a copy of the first one: The English smoking treatment services: one-year outcomes.
The other two failed to print off, instead all I got in each case was a completely black page, which emptied my black printer-cartridge. Thanks.

The third link took us to the BMJ again, so of course we couldn’t read the whole article, but we did get a summary. The report was “A meta-analysis of the efficacy of over-the-counter nicotine replacement”. It begins:

Objective: To determine whether over-the-counter (OTC) nicotine replacement therapy (NRT) is pharmacologically efficacious, whether it produces abstinence rates similar to those in prescription settings, and to estimate the long term (that is, greater than six month) abstinence rate with OTC NRT.
Method: Systematic literature review.

This report found as follows:

“The long term (that is, greater than six months) quit rates for over-the-counter NRT was 1% and 6% in two studies and 8–11% in five other studies. These results were not homogenous; however, when combined the estimated odds ratio was 7%”.

They then concluded thus:

“Conclusions: Over-the-counter NRT is pharmacologically efficacious and produces modest quit rates similar to that seen in real world prescription practice.”

Now, from the evidence reproduced in the Evidence section of this site (and in the book) we know that the largest ever meta-analysis of quit methods that was carried out at the University of Iowa in 1992 put the quit-rate for willpower alone at 6%. Here we have scientific evidence that the quit rate for over-the-counter nicotine replacement is 7%. That 1% difference officially qualifies the product as “pharmacologically efficacious”.

What a staggeringly blatant con that is. What extraordinary barefaced cheek, to pass that off as a bona fide success rate. Do you think for one moment that the public would bother with that method if they had been told the truth about it?

But wait! Didn’t they just say “modest quit rates similar to that seen in real world prescription practice”? Does that mean the failure-rate is pretty much the same if smokers get NRT via the NHS? And if so, what would that suggest about the claim in NHS advertising about smokers being “up to four times more likely” etc? I have three more reports to wade through before I can comment more precisely on that.

Meanwhile, the fourth link took us to the Cochrane Library, which was very exciting because just about every sweeping dismissal of complementary therapies I have ever seen refers to one Cochrane Review or other, so obviously the Cochrane Library plays an important role in steering the public away from methods that aren’t approved of by the Pill Factories. I clicked on the Search facility and tapped in the words “Nicotine Replacement Therapy”.

What came up was: MeerKat User Guide Version 1.4!

This is a software user guide of course, it has nothing to do with

So anyway, well done, the Cochrane Library. And thanks Cameron, these links have indeed been very helpful. Well, one of them was. A bit. But nowhere near as useful as

(Just want to quit smoking? This is the easiest, most successful method.)