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A better way to help people quit smoking?

Rating

3 Star

A better way to help people quit smoking?

Our Review Summary

The story reports that a large smoking cessation study found that some smokers respond better to a prescription pill, sold as Chantix, and other people respond just as well to a less-expensive patch. A new blood test can distinguish whether people fall into one of those groups. By testing people in advance of choosing a therapy, the researchers believe this could improve quit rates and be widely adopted.

While we applaud the instinct to inform readers about this important research, which hasn’t been widely covered by the mainstream media, we think the story had some holes that could have been addressed with minimal effort. Importantly, the story doesn’t adequately describe what kind of study this was, quantify the size of the benefits, or include a perspective from someone not involved in the study. Also, the cost of adding a test to measure each person’s blood before choosing a quitting therapy should have been acknowledged and addressed.

Look, we know this is a blog piece and many blog posts are meant to be (mandated to be?) shorter. But in more than 8 years, our project has tried to drive a stake in the ground proclaiming 10 important issues that consumers need to have addressed in order to make sense of health care claims. We include news blogs among the outlets that we hold to that standard.

 

Why This Matters

Cost and effectiveness comparisons between widely used health therapies are rare and valuable. U.S. smoking rates have fallen, but there are still 42 million Americans who do smoke, including teenagers and young adults. Helping smokers choose a quitting method that’s more likely to be successful, or potentially cost less and have fewer side effects, would have tremendous benefits for individual smokers and the public health.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

Applause for mentioning cost, but we would have liked some actual numbers. A 56-tablet bottle of Chantix, which is discussed in the story, costs around $250 this week according to an easy-to-use online price comparison tool. A direct comparison is not quite fair, since different smokers use these medications at different rates, but a possibly comparable amount of patches that provide medication through the skin is around $50. The story also could have asked the study author to estimate the potential savings in some way. In addition, the story does not acknowledge that adding a blood test to identify slow vs. normal metabolizers will add cost to smoking cessation efforts. How much is unclear.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

Great to see a story addressing the effectiveness of pills vs. patches. Glad also to hear discussion of side effects. Loved this scientist’s comment: “The slower metabolizers, they do very well with the patch. And they get no incremental benefit from varenicline, Why spend the money? Why have the side-effects?”

But again, we were looking for actual numbers. What were the overall success rates, and how did the researchers define “success”? How much better did the normal metabolizers do on the pills compared with the slow metabolizers? How less frequent are side effects with the patch compared with pills? By providing numbers to demonstrate the advantages of each approach for different individuals, the story could have made clearer why this was such an important study.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The story notes that side effects of varenicline include nausea, difficulty sleeping, and abnormal dreams. It also acknowledges that there is harm in pursuing a therapy that does not work if the quitter is discouraged. Excerpt: “Each time somebody fails, it affects their self confidence,” Lerman said. “The trial and error approach is not optimal.”  We’ll rate this borderline satisfactory, but ideally we would have liked to see some quantification of these side effects, especially since frequency of side effects is an important part of the rationale for choosing one approach over the other. Moreover, the story should have explored potential harms from the blood test used to classify nicotine metabolism. How accurate is it? And if the test is wrong, what does that mean for your chances of quitting successfully?

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The study being reported on was a fairly large randomized controlled trial that included over 1,000 patients at different sites across the nation and took four years. It’s an important study. The story doesn’t give us enough detail about the research, and crucially did not explain that this was a randomized trial, which would signal to many readers that this a study capable of proving cause and effect. Another critical missing detail is that all participants received counseling in addition to nicotine replacement. Specifics about the subjects, such as their age, sex, duration and frequency of tobacco use, and socioeconomic status, could also affect how readers interpret the results.

Does the story commit disease-mongering?

Satisfactory

The story did not exaggerate the dangers of smoking.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

We appreciate that this story took the time to interview one of the study authors, who provided useful context. However, one other perspective, at least, would have been great and might have yielded many of the details we wish this story had included. In addition, the story could have mentioned that the medication used in the study was provided by Pfizer — a detail noted in this press release.

Does the story compare the new approach with existing alternatives?

Satisfactory

The study being reported on was a comparison of two popular smoking cessation aids, and the story also mentions nicotine gum. We’ll award a satisfactory, but wish that the story had mentioned counseling as an approach that’s also supported by strong evidence.

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

The therapies in the story are widely available, but the patch is available over the counter and varenicline requires a prescription, which certainly impacts access. The story didn’t mention this. In addition, the story doesn’t describe the availability of the screening test that separates smokers into “fast” and “slow” metabolizers. We could not tell if that is easy for any primary care physician to order.

Does the story establish the true novelty of the approach?

Satisfactory

The story includes a comment from the researcher that this was an obvious question to study, but “no one had done it.” Again, we would have liked for someone other than the author to agree and add credibility. However, the story’s description of the study’s novelty appears accurate.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story clearly includes an interview and went beyond the news release.

See: http://www.uphs.upenn.edu/news/News_Releases/2015/01/lerman/

Total Score: 5 of 10 Satisfactory

Comments (4)

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paula hatfield

January 19, 2015 at 10:11 am

oh please a way to make more money utilizing the addition of nicotine. I smoked for 40 years at a pack a day. I read the book “the easy way to quit smoking” by Allen Carr and quit within a week. It is all in your head people. It was easy quitting and I didn’t have to take other drugs for it. Why doesn’t CVS sell this book if they are so serious about helping people.

Reply

Lenny Bernstein

January 19, 2015 at 4:06 pm

Hey, I love your critiques and have learned something both times. Please keep looking at my posts. Small bits of self-defense: Some of the numbers you call for would confuse most people. We may have to just disagree on that one. I try to get an outsider’s perspective every time, but sometimes it’s just impossible–either when I’m writing on a Sunday for Monday a.m. or when I’m cranking out several posts in a day. Not an excuse, but just so you know. And when a test isn’t even yet available, or is still just in the experimental stage, it’s not worth the space or time to try to find out about cost. All that said, I really like what you’re doing here, please keep it up.
Lenny Bernstein
Washington Post
“To Your Health” blog
Twitter: @LennyMBernstein

Reply

Lenny Bernstein

January 21, 2015 at 1:22 pm

Thanks for the resources, Gary, I will check them out.
Lenny

Reply