This story managed to address nearly all of our criteria in this clearly written piece. We always wish stories had a little more detail about costs, and this one, like the other two reviewed, also missed information about harms. The main drawback to this story, though, was that it relied too heavily on people connected to GlaxoSmithKline, which makes some of the most popular nicotine replacement products.
As this story points out, the research on nicotine therapy has been evolving. Because of the strength of so many clinical trials, people assume that patches, gum and other nicotine products work, but this study indicates that under real world conditions, these medicines might actually not show much benefit. The story says, “In the past five years, the declines in adult smoking seen in previous years have stalled”. Jump starting those efforts is crucial giving the impact smoking has on population health.
A Cochrane Report in 2008 reported on trials involving more than 40,000 subjects and concluded that nicotine replacement therapy improves the likelihood of smoking cessation in the short term. Although many people stop smoking, the return to smoking within a year is common. This study looks at the long term benefits over a 5 year period in the real world. Although there are limitations to the study, the conclusions bring the relative value of the hundreds of millions of dollars spent annually into question.
This story discussed costs in the context of overall sales figures. “Deciding how best to get smokers to quit for good is a public health challenge. Sales of the nicotine replacement products have risen, Connolly says. Sales totaled $45 million in 1984, when nicotine gum was introduced. Since 1997, sales have totaled more than $800 million annually.” We wish the story had included some examples of the costs of the individual products compared to cigarettes.
The cost of 8 weeks of the nicotine patch is approximately $160-200.
The story, like the others, provides no hard numbers for quantifying the benefits, but we thought it did an adequate job explaining what the study found. Unlike the NY Times and LA Times stories, this one provided accurate information about the number of subjects who started and completed the study.
All three of the stories have the same problem of not explaining whether ultimately two-thirds of the study participants relapsed or the same one-third relapsed at two different intervals.
Nonetheless, we’ll give the story the benefit of the doubt with a satisfactory score on this.
None of the stories mentioned the potential harms from taking nicotine, as opposed to quitting cold turkey. Nor did they mention the additional risks associated with continuing to smoke instead of making use of a more successful smoking cessation program that would actually help a smoker quit. As the leading risk factor for early death, smoking should be stopped as quickly and effectively as possible.
The story, like the others, did a fair job explaining the study design. This one excelled by explaining a key fact about the study. “Most did not use the products. For instance, at the first interview, 77% did not use them. Those who did use them did so for various time periods. At the first interview, the 33% of those who used the products did so for more than six weeks.” This gets to both a potential problem with how comprehensive the study might be and whether it is a good measure of the products’ effectiveness. This isn’t just a question of whether people were compliant. It’s a question of whether the study could adequately judge the products’ effectiveness given the size of the cohort and varying lengths of time people took the drugs. The New York Times story indicates that the lengths of time did not matter, but none of the stories fully addressed this point.
No disease mongering.
We give the story a pass here because it includes one independent source with good perspective on both the study’s strengths and drawbacks. Half of the people quoted in the story, though, either work for Glaxo or receive funding from Glaxo.
The story gave a good, independent perspective about the fact that the preponderance of evidence is leaning toward a combination therapy of drugs and counseling.
We like that this story was very specific on what types of nicotine products were studied. “The participants told whether they had used a patch, gum, inhaler, or spray. They told how long they used the product continuously.”
The story says that the new study gives a more “real world” picture of nicotine replacement therapies.
The story did not rely on any press release.