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Smoking raises health inequalities

I refer to your news report 'Smoking cessation scripts double but no rise in quitters' (May 26). The real story here is that there is no rise in the four-week quitter rate with the national scheme, despite the Chief Medical Officer's bulletin reporting 'more success for the smoking cessation scheme'.

This is a disaster for the Goverment. It pinned its colours to the mast, saying it would reduce health inequalities that had increased under the Tories. Unfortunately when Labour got to power it was told the reason inequalities had increased was because social classes 1+2 had stopped smoking, and social classes 4+5 had not, and this was behind the majority of increase in inequalities in health.

It gets worse: 200,000 smokers may have tried quitting, and this may sound a lot, but it isn't ­ only 20,000 will become long-term quitters out of 12 million in 600 each year, barely a drop in the ocean, nowhere near the numbers to have an effect on the nation's health or reduce inequalities.

And worse, the numbers going through the national scheme have actually gone down slightly year on year for the past two quarters.

And worse still, if you have 600 smokers you would expect seven or eight to stop each year anyway. Are we really adding to this with the scheme, or are those who get through it and set a quit date going to be a quitter anyway?

And even worse, it doesn't appear to be due to lack of resources ­ the scheme copes OK with the New Year resolution bulge.

Fortunately GPs are starting to realise they can help people to help themselves by prescribing nicotine replacement therapy, hence the rise in prescriptions, but these quitters are not routinely counted. Much of what we do in primary care isn't, but it doesn't mean it doesn't happen, isn't of high quality, or isn't evidence based.

People have forgotten that the largest NRT study in this country was actually based on prescribing of NRT in routine surgeries,with brief intervention. It was shown to work and be highly cost-effective ­ 10 times more so than prescribing statins to patients with CHD, for instance.

Research from the USA has shown the best way of helping people quit isn't just to prescribe NRT, but to supply it free. People then use more of it, are more likely quit, and when you factor in the cost of the medical care, this actually works out cheaper per quitter!

Even better is to provide combination NRT, ie a patch, with a shorter-acting preparation for use as required ­ gum, lozenge, etc. Combinations are safe and nearly double quit rates.

But remember, NRT will not make your patient quit smoking, they have to do that themselves. And they must stop totally, not even one puff ­ NRT just helps to stay quit.

Dr John Ashcroft



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